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Volume 21, No. 14

February 2014

“Serving with Pride and Professionalism since 1993”

THE EXAMINER An Award Winning Publication

Robert E. Bush Naval Hospital

Did you know?...

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ou have the right to express your concerns about patient safety and quality of care. There are several avenues open to you: * Through the ICE website. * The Hospital Customer Relations Officer at 760-8302475, or any of the Customer Relations representatives in the Hospital clinics, or directly to the Joint Commission via: E-mail at complaint@jointcomission.org Fax: 630-792-5636 The Joint Commission Oak Renaissance Boulevard Oakbrook Terrace, IL 60181

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o report Fraud, Waste and Abuse contact one of the below offices by calling:

Naval Hospital: 760-830-2344 Combat Center: 760-830-7749 NavMedWest: 1-877-479-3832 Medical IG: 1-800-637-6175 DoD IG: 1-800-424-9098

http://www.med.navy.mil/sites/nhtp/pages/default.aspx

Veterans Affairs Reps are Here to Help Dave Marks NHTP PAO If you're facing a medical board or are about to retire from the military, or maybe you’re a military retiree and have questions about your benefits, there’s an office at NHTP with the answers. Gerald D. Syas, U.S. Department of Veterans Affairs, advises active-duty service members and retires about their benefits in the Patient Administration Section at NHTP. Syas retired from the Army in 1997 after 23 years of activeduty service and knows the score. “I know so much about how these guys feel,” Syas said. “When I got out of the service, we didn’t have services like this. You basically had to fend for yourself. You got a book and maybe someone taught you how to write a resume or something.” Syas noted that in the Vietnam era many veterans didn’t take advantage of the benefits they

had because they didn’t know about them. “Now they’re actually catering to the service members coming back,” Syas said. “That’s a good thing, because it doesn’t do you any good to have all of these benefits and not be aware of them. It’s nice when you’re sitting down and you can tell them, you can do this, this and this. And giving some options, especially to those that are hurt, which are the ones I deal with mostly. And these guys, they’re already upset because most of them thought they were coming into the military and they were going to make a career out of it. And now they’re finding out they’re going to be med boarded out and they have to think about, okay, where does life take me from here?” Syas helps service members find the training they will need to function in the civilian work force. He works with transitioning service members enrolled in the Transition Readiness Seminar (TRS) and the Transitional Assistance

Commanding Officer Naval Hospital Public Affairs Office Box 788250 MAGTFTC Twentynine Palms, CA 92278-8250

Patients seen in December -- 11,203 Appointment No Shows in December -- 874 In December we had a 7.2 percent no show rate. We need to keep trending downward by keeping the appointments we make, or by canceling in enough time for someone else to use the slot... To help patients obtain appointments, the Naval Hospital now shows the number of open appointment slots each day on the hospital Facebook site, check it out. On Facebook, search: Naval Hospital Twentynine Palms.

To make an appointment call -- 760-830-2752 To cancel an appointment call -- 760-830-2369

Sandy Leblanc, Department of Veterans Affairs Vocational Rehabilitation Counselor, offers advice to transitioning service members in the Integrated Disability Evaluation System (IDES) class, held at NHTP on the second and fourth Thursday of every month. bers who are not going through Program (TAP). Working closea medical board, who however, ly with Dawn Schadegg, NHTP may want to file a claim for Physical Evaluation Board their disability benefits prior to Liaison Officer and Integrated leaving the military, which they Disability Evaluation System can do up to 6 months prior to (IDES) coordinator, Syas countheir EAS date. sels active-duty service members who are facing medical Syas is also the Veterans Affairs boards. Usually they’ve susrepresentative for the local area tained an injury or illness that and counsels veterans from the makes military service problemMorongo Basin. “They come in atic. He is the Base-wide point because they’ve been out of the of contact for the initial stages service for many years but of the IDES process. He also they’ve never filed any claims offers advice concerning the for their disabilities; so I’m here Benefits Delivery and Discharge as their point of contact,” Syas (BDD) and Quickstart programs. Syas helps with pre-disContinued on page 2, see VA charge claims for service mem-


2 -- The Examiner -- February 2014 VA, continued from page 1 make the transfer prior to your retirement day, it’s good to go,” said. “It keeps them from havSyas said. “So I always recoming to travel to Los Angeles to mend they transfer just a small Wilshire and Westwood.” amount because you never know what you’re going to do At NHTP, he’s been helping in the long run. If you transfer transitioning service members 10 percent of your benefits, you and retirees for the past two can always modify it. But if you years and sees an average of 50 don’t transfer anything, after beneficiaries a month. Syas you retire, it’s too late. He lives in Indio and travels in noted that a transfer of benefits excess of 70 miles, one-way, to can also be revoked or modiwork. I’m the outreach coordified, at the service member’s nator for this area so whenever request. there are any outreach events, I’m usually there representing the Veterans Benefits Administration (VBA). Syas explained that the Department of Veterans Affairs is an umbrella organization for three separate entities: the National Cemetery Administration, the Veterans Health Administration, and the Veterans Benefits Administration. Syas represents the Veterans Benefits Administration. He advises service members facing separation to do their homework. “Get as much knowledge as you can about your benefits and utilize them. Don’t leave benefits on the table,” Syas said. Syas noted he’s frequently asked: “How can I utilize my VA home loan? What can I do with my post 9-11 Bill; what if I don’t want to go to school and I want to transfer the benefit to my wife, or can I transfer it to my kids? These are things that guys are learning ahead of time so that they don’t leave those benefits on the table.” He explained that a service member can transfer education benefits to his/her spouse in some cases. “If you’re coming up on retirement, as long as you

Syas provides service members with a federal benefits book which lists all of the benefits that the VA offers. He noted that some benefits are time sensitive. “You only have a short amount of time to switch from your Servicemembers Group Live Insurance (SGLI) to your Veterans Group Live Insurance (VGLI),” he said. Other benefits service members should be aware of include, the Post 9/11 GI Bill, the Montgomery GI Bill, and VA Home Loans. Sandy Leblanc, Dept. of Veterans Affairs Vocational Rehabilitation Counselor, is another MCAGCC resource for service members transitioning out of the military. Her office is located in Bldg. 1427 (across from the Base Theater). She provides guidance that takes into account the service member's skills, goals, finances, and family. “Let’s say a service member wants to go to school in New York. I don’t know that much about New York schools and what they have to offer; so I’ll get the vocational rehab counselor at the New York Regional VA office to develop a plan for him or her. Because they know what’s available and can advise him or her better than I can,” Leblanc said.

“Sometimes a service member comes in and all they ask for is help with their resume. I’m happy to do that,’ she said. Leblanc’s services are available for all active-duty service members, but since she arrived on the Combat Center in April, only one sailor has sought her advice. She can be reached at (760) 830-6817. Her email is: sandra.leblanc@va.gov. Additionally, the Lifelong Learning Center, Bldg. 1530 (the new education building near the Base Library) offers a GI Bill workshop every Wednesday at 1 p.m. This is a walk-in service where they explain the differences between the various GI Bills and assist with filling out the forms for benefits. For further information, please call the Lifelong Learning Center at (760) 8306881. To contact Gerald Syas: Phone: (310) 235-6064 Email: gerald.syas@va.gov To contact Sandy Leblanc: Phone: (760) 830-6867 Email: sandra.leblanc@va.gov Published by Hi-Desert Publishing, a private firm in no way connected with the Department of Defense, the United States Marine Corps, United States Navy or Naval Hospital, Twentynine Palms under exclusive written contract with the Marine Air Ground Task Force Training Command. The appearance of advertising in this publication, including inserts or supplements, does not constitute endorsement by the Department of Defense, the United States Marine Corps, the United States Navy or Hi-Desert Publishing of the products or services advertised. Everything advertised in this publication shall be made available for purchase, use, or patronage without regard to race, color, religion, sex, national origin, age, marital status, physical handicap, political affiliation, or any other non-merit factor of the purchaser, user or patron. If a violation or rejection of this equal opportunity policy by an advertiser is confirmed, the publisher shall refuse to print advertising from that source until the violation is corrected. Editorial content is prepared by the Public Affairs Office, Naval Hospital, Twentynine Palms, Calif. Commanding Officer Capt. Jay C. Sourbeer, MC, USN Executive Officer Capt. Angela S. Nimmo, NC, USN Command Master Chief HMCM (FMF/SW) Carol Merricks, USN Public Affairs Officer/Editor Dave Marks Command Ombudsman Bright Opoku (760) 910-2050 email: nhtpombudsman@yahoo.com The Examiner welcomes your comments and suggestions concerning the publication. Deadline for submission of articles is the 15th of each month for the following month’s edition. Any format is welcome, however, the preferred method of submission is by e-mail or by computer disk.

How to reach us... Commanding Officer Naval Hospital Public Affairs Office Box 788250 MAGTFTC Twentynine Palms, CA 92278-8250 Com: (760) 830-2362 DSN: 230-2362 E-mail: david.marks@med.navy.mil Hi-Desert Publishing Company 56445 Twentynine Palms Highway Yucca Valley, CA 92284 Com: (760) 365-3315 FAX: (760) 365-8686


The Examiner --February 2014 -- 3

Bath Salts and Spice Jeopardize Careers and Ruin Lives Bath Salts Intoxication

Continuing Education Credit!

New England Journal of Medicine

The Criminal Investigative Division Commander, Navy Region Hawaii, displays an example of seized synthetic drugs commonly known as “spice” as part of an awareness campaign and training against its usage. The Navy is now checking for these substances through routine urinalysis.

Random Drug Testing for “Spice” Navy Personnel Command Public Affairs MILLINGTON, Tenn. (NNS) -As part of a new Department of Defense (DoD) policy, the Navy began testing for synthetic marijuana compounds during random urinalysis, officials announced Dec. 31. According to NAVADMIN 334/13, testing for synthetic marijuana compounds will be randomly conducted on samples submitted to all drug screening laboratories, and positive results will subject members to disciplinary action under the Uniform Code of Military Justice. The Navy expects to test more than 1.1 million samples this year, and a portion of them will be screened for synthetic marijuana. Those that test potentially positive will be forwarded to the Air Force Drug Testing Laboratory at Lackland, Texas for confirmation. "We are testing synthetic cannabinoids - also known as Spice, K2, Herbal Essence and other names - within the standard testing panel conducted for urinalysis samples," said Lanorfeia Parker, deputy director, Navy Alcohol and Drug Abuse Prevention Office (NADAP). The change will be largely transparent to the command, requiring no changes to the way

they currently collect and ship urine samples for drug testing. In contrast to the Navy's previous synthetic drug testing program, no action is required by the command to have random synthetic drug testing performed on the samples that are submitted. The DoD estimates that nearly 1 percent of military personnel may be using synthetic marijuana. In fiscal year (FY) 2012, illicit marijuana use among active duty military personnel was 0.43 percent and for the entire DoD the prevalence rate was 0.64 percent. FY 2013 testing for Navy personnel indicated that .09 percent of all samples were positive for marijuana. If a member uses, possesses, promotes, manufactures, or distributes synthetic drugs, they face disciplinary action that could result in unfavorable separation from the Navy. According to Parker, the Navy's policy on substance abuse is zero tolerance. "Substance abuse puts lives and missions at risk, undercuts unit readiness and morale, and is inconsistent with our Navy ethos and core values of honor, courage, and commitment," said Parker. For more information about Navy Alcohol and Drug Abuse Prevention, visit www.npc.navy.mil/support/nada p.

The abuse of psychoactive “bath salts” (PABS) has become commonplace, and patients with PABS overdoses are presenting to emergency departments with increasing frequency. The primary ingredient of the synthetic designer drugs in these bath salts, which are not related to any hygiene product, is methylenedioxypyrovalerone (MDPV). MDPV is structurally related to pyrovalerone and pyrrolidinophenone compounds that inhibit norepinephrinedopamine reuptake and thus act as central nervous system stimulants. Despite growing efforts to ban these products through legislation, PABS often skirt substance-control laws and are readily available at low cost. These products are easily obtained over the Internet under such names as Ivory Wave or Vanilla Sky and are marketed as producing a high similar to that obtained with illegal stimulants such as methamphetamine. They are sometimes referred to as “legal cocaine” (but without causing the pronounced euphoria), as alertness enhancers, or as aphrodisiacs. The long-term use of PABS leads to tolerance, and abstinence is characterized by withdrawal and intense craving. When PABS are taken orally, intranasally, intravenously, or rectally, their effects occur with doses as low as 3 to 5 mg, and the average dose ranges from 5 to 20 mg. The risk of overdose is high, since packages contain as much as 500 mg, and some labels suggest escalating the dose to more than 50 mg. PABS are rapidly absorbed when ingested orally, with a rush reaching its peak at 1.5 hours. Their effects last for 3 to 4 hours before the user has a potentially harsh crash. The total experience occurs over 6 to 8 hours. Note: To read the full text, please go to : http://www.nejm.org/doi/full/10 .1056/NEJMc1107097

Lt. Phyllis Dykes discusses the dangers of “Spice,” a psychoactive substance with long-term health hazards during the Clinical Nurse Specialist Advisory Board Ground Rounds Jan 17. More of these sessions will be offered quarterly, conveying 1-hour of continuing education credit. By Lt. Cmdr. Bridget Wise-San Health CNS), Lt. Cmdr. Valerie Antonio Littlefield (Mental Health Nurse Practitioner), and Registered The Clinical Nurse Specialist Nurse Kirsten Imhoff (CNS) Advisory Board hosted (Behavioral Health Case the first Nursing Grand Rounds Manager) were comprised as a on Jan. 17. Nursing grand panel of experts presenting to rounds (NGR) use a mixed the multidisciplinary care of case-study and/or lecture format patients from the acute setting to to enable nurses to systematicalpost-discharge requiring outly examine a specific patient’s reach resources. Plans are curepisode of care, review the rently underway to continue to pathophysiology, evaluate the conduct quarterly NGRs. These nursing care provided, and activities will be approved for 1 relate the art of nursing to evihour of continued education by dence and science. This first the American Nurses NGR for NHTP examined the Credentialing Center’s care of patients with Bath Salts Commission of Accreditation or Spice substance-abuse issues. and are open to all staff. Lt. Phyllis Dykes (Mental

2X3 Smith’s Family Properties


4 -- The Examiner -- February 2014

Super Stars...

HM1 David A. Whittington

Welcome Aboard!

HM2 Diana G. Camacho is congratulated by Capt. Jay Sourbeer, MC, upon her honorable discharge from the U.S. Navy. The discharge was a formality. Within minutes, Camacho re-enlisted for another 2 years. Camacho has been in the Navy 8 years, mostly at Naval Medical Center San Diego, with a stint at Camp Pendleton.

CS2 Kris Masicampo is sworn in for a 6-year re-enlistment under the direction of Lt. j.g. Rachel Smith and NHTP Commanding Officer, Capt. Jay Sourbeer, MC. Masicampo, 26, originally from Oxnard, Calif., has been in the Navy 7 years.

CS3 Dominique Demeritte (right) is congratulated by NHTP Commanding Officer Capt. Jay Sourbeer, MC, during a welcomehome ceremony Jan. 24. Demeritte deployed Dec. 7, 2012, onto the USS Champion, a minesweeper out of San Diego. “We did workups,” he said in describing his work with the Board of Inspection and Survey (INSURV) and the Supply Management Certification (SMC). His efforts were recognized with a Navy Achievement Medal. In June of 2013, Demeritte was assigned to the USS Century, another minesweeper, this time in Bahrain. As a junior sailor he was assigned to a 1st-class billet as records keeper. He received another Navy Achievement Medal and passed his Supply Management Certification (SMC) inspections, twice, with high scores. His ship earned its Battle Effectiveness (Battle “E”) award; and Demeritte was again recognized with his selection as Junior Sailor of the Year for his command. “I got to meet Secretary of Defense Chuck Hagel,” Demeritte said, showing intense pride for the challenge coin the Secretary gave him. “I also did stretcherbearer training with the Iraqi Navy.” And he trained with the British Navy. In addition to his other awards and accomplishments, he earned his Surface Warfare pin while on the USS Century. He encourages those interested to view his former crew’s Facebook page (Search MCMCrewSpartan on Facebook). “You’ll see everything the crew accomplished,” Demeritte said. “You’ll see everyone’s award ceremonies, pictures of what we did. You’ll see everything that could be posted on the internet.” Demeritte joined the Navy at age 23. His father was career Army so he’s traveled the world, but went to high school in Killeen, Texas. He’s been in 6 years. He lives unaccompanied in town and is currently pursuing a physical-therapy degree. Of the many adventures he’s had in the past year he said, “I’m just glad to be home.” CS3 Demeritte is currently assigned to the NHTP Galley.

Welcome Aboard! Lt. Jericho Ramirez arrived at NHTP in December from Naval Hospital Guam, where he worked in the Surgery Dept., the MultiService Unit, and Labor & Delivery. Ramirez earned his Registered Nurse Degree from Cal State San Bernardino. Originally, from Riverside, Ramirez has been Lt. Jericho Ramirez

in the Navy 5 years. He was initially assigned to Naval Hospital San Diego before shipping out to Guam. His wife, Theresa, and 19-monthold son still live in San Diego so he travels back and forth as often as possible. Ramirez enjoys playing sports and generally keeping fit.

HM1 David Whittington arrived at NHTP after spending 4 years with the 1st Bn, 7th Marines on MCAGCC. He arrived in that unit as Petty Officer, 2nd Class, picked up his first-class rank in May 2010 and just recently completed Preventive Medicine Technician school. At NHTP, he’s assigned to Preventive Medicine. Of his career so far he says, “Everything’s been operational--staying late and taking care of sailors.” Whittington is originally from California’s Central Valley. His wife, Stephanie and 5-year-old son live in Hanford, Calif., where Stephanie teaches grade school. Whittington has been in the Navy 12 years. During his down time, he enjoys competitive shooting.


The Examiner -- February 2014 -- 5

Bad Habits Marshal Brain Chemistry National Institutes of Health News Service If you know something is bad for you, why can’t you just stop? About 70% of smokers say they would like to quit. Drug and alcohol abusers struggle to give up addictions that hurt their bodies and tear apart families and friendships. And many of us have unhealthy excess weight that we could lose if only we would eat right and exercise more. So why don’t we do it? National Institutes of Health (NIH) funded scientists have been searching for answers. They’ve studied what happens in our brains as habits form. They’ve found clues to why bad habits, once established, are so difficult to kick. And they are developing strategies to help us make the changes we would like to make. “Habits play an important role in our health,” says Dr. Nora Volkow, director of NIH’s National Institute on Drug Abuse. “Understanding the biology of how we develop routines that may be harmful to us, and how to break those routines and embrace new ones, could help us change our lifestyles and adopt healthier behaviors.” Habits can arise through repetition. They are a normal part of life, and are often helpful. “We wake up every morning, shower, comb our hair or brush our teeth without being aware of it,” Volkow says. We can drive along familiar routes on mental auto-pilot without really thinking about the directions. “When behaviors become automatic, it gives us an advantage, because the brain does not have to use conscious thought to perform the activity,” Volkow says. This frees up our brains to focus on different things. Habits can also develop when good or enjoyable events trigger the brain’s “reward” centers. This can set up potentially harmful routines, such as overeating, smoking, drug or alcohol abuse, gambling and even compulsive use of computers and social media.

“The general machinery by which we build both kinds of habits are the same, whether it’s a habit for overeating or a habit for getting to work without really thinking about the details,” says Dr. Russell Poldrack, a neurobiologist at the University of Texas at Austin. Both types of habits are based on the same types of brain mechanisms. “But there’s one important difference,” Poldrack says. And this difference makes the pleasure-based habits so much harder to break. Enjoyable behaviors can prompt your brain to release a chemical called dopamine. “If you do something over and over, and dopamine is there when you’re doing it, that strengthens the habit even more. When you’re not doing those things, dopamine creates the craving to do it again,” Poldrack says. “This explains why some people crave drugs, even if the drug no longer makes them feel particularly good once they take it.” In a sense, then, parts of our brains are working against us when we try to overcome bad habits. “These routines can become hardwired in our brains,” Volkow says. And the brain’s reward centers keep us craving the things we’re trying so hard to resist.

studies on decision-making and willpower have led him to conclude that “self-control is like a muscle. Once you’ve exerted some self-control, like a muscle it gets tired.”

The good news is, humans are not simply creatures of habit. We have many more brain regions to help us do what’s best for our health. “Humans are much better than any other animal at changing and orienting our behavior toward long-term goals, or longterm benefits,” says Dr. Roy Baumeister, a psychologist at Florida State University. His

One approach is to focus on becoming more aware of your unhealthy habits. Then develop strategies to counteract them. For example, habits can be linked in our minds to certain places and activities. You could develop a plan, say, to avoid walking down the hall where there’s a candy machine. Resolve to avoid going places where you’ve usually smoked.

After successfully resisting a temptation, Baumeister’s research shows, willpower can be temporarily drained, which can make it harder to stand firm the next time around. In recent years, though, he’s found evidence that regularly practicing different

types of self-control, such as sitting up straight or keeping a food diary, can strengthen your resolve. “We’ve found that you can improve your self-control by doing exercises over time,” Baumeister says. “Any regular act of self-control will gradually exercise your “muscle” and make you stronger.” Volkow notes that there’s no single effective way to break bad habits. “It’s not one size fits all,” she says.

Stay away from friends and situations linked to problem drinking or drug use. Another helpful technique is to visualize yourself in a tempting situation. “Mentally practice the good behavior over the bad,” Poldrack says. “If you’ll be at a party and want to eat vegetables instead of fattening foods, then mentally visualize yourself doing that. It’s not guaranteed to work, but it certainly can help.” One way to kick bad habits is to actively replace unhealthy routines with new, healthy ones. Some people find they can replace a bad habit, even drug addiction, with another behavior, like exercising. “It doesn’t work for everyone,” Volkow says. “But certain groups of patients who have a history of serious addictions can engage in certain behaviors that are ritualistic and in a way compulsive, such as marathon running, and it helps them stay away from drugs. These alternative behaviors can counteract the urges to repeat a behavior to take a drug.” Another thing that makes habits especially hard to break is that replacing a first-learned habit with a new one doesn’t erase the original behavior. Rather, both remain in your brain. But you can take steps to strengthen the new one and suppress the original one. In ongoing research, Poldrack and his colleagues are using brain imaging to study the differences between first-learned and later-learned behaviors. “We would like to find a way to train people to improve their ability to maintain these behavioral changes,” Poldrack says. Some NIH-funded research is exploring whether certain medications can help to disrupt hard-wired automatic behaviors in the brain and make it easier to form new memories and behaviors. Other scientific teams are searching for genes that might allow some people to easily form and others to readily suppress habits.

Who Needs Knee Surgery? If you or someone you know is considering knee replacement, a new resource can help you understand how it works, how to prepare for surgery, and what to expect in recovery. Knee replacement involves removing parts of your natural knee joint and replacing them with artificial parts. Knee replacement is the most common type of joint replacement surgery. Several forms of arthritis can damage knees and cause so much pain and disability that knees need to be replaced. Certain knee deformities such as bowed legs or knock knees can wear down cartilage and create difficulties. Knee damage can also result from a problem called avascular necrosis, or osteonecrosis, in which the bones lose their blood supply, die, and eventually collapse. If other treatments haven't helped, your doctor may suggest knee replacement when pain and stiffness begin to interfere with your everyday activities. If you'd like to consider knee replacement, ask your doctor to refer you to an orthopedic surgeon, a doctor specially trained to treat problems of the bones and joints. For more information, visit the NIHSeniorHealth Knee Replacement page. Note: For further information, please visit: http://newsinhealth.nih.gov/issue/jan2014/ca psule2


6 -- The Examiner -- February 2014

Introducing New Staff -- Welcome Aboard!

LS2 James R. Griminger LS2 James Griminger is entering his 13th year as a Navy logistics specialist. He arrived at NHTP from Helicopter Sea Combat Squadron 15, San Diego. Before that he was on the USS John C. Stennis. And before that he was in Japan for 9 nine years in three different commands. Originally from Dunnigan, Calif., Grimminger joined the Navy following a family tradition. “My dad retired out of the Air Force. My uncle was active-duty Navy. And my grandfather served in the Navy in WWII,” Griminger said. He arrived to the command with wife, Stephanie, and his three children, Lucas, 9, Charles, 6, and Alex, 1. The family loves the high desert. “My wife decided, after being here a week, she wants to buy a house and stay permanently.” They are buying a house in Twentynine Palms. He enjoys writing and playing video games with his boys.

Lt. Tasha N. Gallegos Lt. Tasha Gallegos arrived at NHTP from Naval Medical Center, San Diego, where she’s been for the past 3 years. She joined the Navy shortly after earning her Registered Nursing Degree from Wichita State University, Kansas. “I wanted to get out of Kansas,” Gallegos said. “My recruiter basically sold me. She told me the pros and cons and was totally honest.” She said. She’s had no complaints with her decision to join. “I’ve had an opportunity to deploy (7 1/2 months in Helmand Province). I’ve been in a big command, Balboa. I’ve loved my career so far,” she said. Originally from Liberal, Kansas, Gallegos has always been a sports enthusiast. “I love to coach all ages (volley ball, track & field).” Being from a small town, Twentynine Palms reminds her of home, but she says the isolation and inky night blackness takes some adjustment.

CS3 Falanne S. White CS3 Falanne White arrives at NHTP from Strike Fighter Squadron 143, nicknamed the “Pukin Dogs,” Naval Air Station Oceana, Va. When she graduated from high school in Elaine, Ark., she wanted something different and to see the world. She’s served just over 5 years, enjoys the culinary arts field, and when ask what she likes most, replies, “the people.” Hobbies include writing, reading, and photography.

Sub Offer 5X3

Lt. j.g. Derek Witkowski

Ensign Claudia Briano

Lt. j.g. Derek Witkowski checked into the Command at the end of October, but he’s been so busy working information technology, we’ve only just caught up to welcome him aboard. Witkowski arrived from Tampa, Fla., where he completed work on his Bachelor’s (Biology) and Master’s (Health Administration) degrees. Born in St. Petersburg, Fla., Witkowski grew up in northeast Pennsylvania. He and his wife, Kristyn, live in Twentynine Palms with their siberian husky puppy. Witkowski enjoys working on cars, tinkering with computers and playing computer games. “I came into the Navy looking for adventure and here I am,” Witkowski said of his first assignment here at NHTP.

Ensign Claudia Briano is a mustang officer. She arrived at NHTP from Officer Development School but had been a Navy Corpsman for 10 years at Naval Medical Center, San Diego. At Balboa, Briano worked in the OB/GYN, Otolaryngology (ENT), and Surgery. “I got picked up for the MECP Program (Medical Enlisted Commissioning Program) and they sent me to school. I was still active-duty while they sent me to school. I went to University of Texas and graduated in 2013, in April and then came here,” Briano said. Briano, originally from Houston, Texas, lives with her two children, 6 and 8, in Twentynine Palms. She enjoys reading mystery novels and spending time with her children. She is currently an RN on the Multi-Service Ward.


The Examiner -- February 2014 -- 7

Nine Corpsmen perform the coursework to certify as occupational hearing conservation technicians at Branch Health Clinic China Lake. The Department of Veterans Affairs spent an estimated $1.39 billion in fiscal year 2010 in calculated compensation for auditory disabilities.

Hearing Conservation Technicians Combat Hearing Loss NHTP Preventive Medicine Branch Health Clinic China Lake hosted a 3-day training course in early January to certify nine corpsman as occupational Hearing Conservation Technicians. One of the corpsman traveled all the way from Branch Medical Clinic Bridgeport to participate. The other eight corpsman were local staff at Branch Health Clinic China Lake. All nine participants successfully completed the course and were praised by the training-course instructor, Lt. Cmdr. Richard Blair, NHTP's Hearing Conservation Program Manager. "They were an exceptional group, very attentive, and thoughtful, it was a pleasure to work with all of them,” Blair remarked. Lt. Cmdr. Blair noted the Hearing Conservation Technicians play an important role in the Navy and Marine Corps’ hearing-conservation efforts. "The Technicians are on the front line in our efforts to

combat noise-induced hearing loss in the military. All of our Marines and Sailors who are routinely exposed to occupational hazardous noise will have to interact with a technician at least annually to perform a surveillance hearing test. The role of the technician is critical for ensuring that testing is done accurately, and that any patients in need of follow-up testing are appropriately triaged," Blair said. Hearing loss in the military is a major problem. The DoD Hearing Center of Excellence website reports that The Department of Veterans Affairs spent an estimated $1.39 billion in calculated compensation for major auditory disabilities in fiscal year 2010. Auditory disabilities also account for the two most prevalent service-connected disabilities among veterans, tinnitus (971,990 veterans) and hearing loss (774,384 veterans). Noise-induced hearing loss is also among the top disabilities associated with our most recent conflicts (Operations Enduring

Freedom and Iraqi Freedom). Lt. Cmdr. Blair further explained: "A large number of jobs in the military involve periodic exposure to hazardous noise. There's no shortage of loud and dangerous jobs in the Navy and Marine Corps. That's one of the reasons we see so much hearing loss. Another reason is there is a long-standing culture in the military to not use hearing protection, or to use it incorrectly. This is why we need great technicians who are motivated and competent. In addition to running earing tests, the technicians provide counseling on the results, and training on proper use of hearing protection. Here again, the role of the technician is critical because many Sailors and Marines have a mistrust of hearing protection. For a myriad of reasons they mistrust hearing protection, misuse it, or disregard it altogether. A sharp technician can help change attitudes, and provide training that will save hearing."

MBTA 2X8

The Base Library is a valuable resource for MCAGCC personnel (including NHTP). There are over 5,000 videos, 38,000 books, and over 1000 music CDs. All are free for checkout. There are even televisions and quiet spots for getting away from it all. The Library is located in Bldg. 1524 (just up from Domino’s Pizza). Open week days from 8 a.m. to 9 p.m.; weekends, 10 a.m. to 6 p.m. (same hours for holidays, except Thanksgiving, Christmas, and New Year’s day.) Phone number is, (760) 830-6875.

Videos

Computers

Books on Tape


8 -- The Examiner -- February 2014

Bath Salts Present Formidable Risk for Users The term “bath salts” refers to an emerging family of drugs containing one or more synthetic chemicals related to cathinone, an amphetaminelike stimulant found naturally in the Khat plant. Reports of severe intoxication and dangerous health effects associated with use of bath salts have made these drugs a serious and growing public health and safety issue. The synthetic cathinones in bath salts can produce euphoria and increased sociability and sex drive, but some users experience paranoia, agitation, and hallucinatory delirium; some even display psychotic and violent behavior, and deaths have been reported in several instances. The synthetic cathinone products marketed as “bath salts” to evade detection by authorities should not be confused with products such as Epsom salts that are sold to improve the experience of bathing. The latter have no psychoactive (druglike) properties. Bath salts are typically taken orally, inhaled, or injected, with the worst outcomes being associated with snorting or needle injection. Chemically, the substances in “bath salts” bare similarities to amphetamines (such as methamphetamine) as well as to MDMA (ecstasy). The energizing and often agitating effects reported in people who have taken bath salts are con-

sistent with other fatal in severdrugs like amphetaal mines and cocaine instances. that raise the level of Early indicathe neurotransmitter tions are that dopamine in brain synthetic circuits regulating cathinones reward and movehave a high ment. A surge in abuse and dopamine in these addiction circuits causes feelpotential. ings of euphoria and Bath salts increased activity. A users have similar surge of the reported that transmitter norepithe drugs nephrine can raise trigger intense heart rate and blood cravings (or a pressure. Bath salts compulsive have been marketed urge to use as cheap, and until the drug recently, legal. A again) and Bath salts typically take the form of a white or brown crystalline recent study found that they are powder and are sold in small plastic or foil packages labeled “not that MDPV-- the highly addicfor human consumption.” Sometimes also marketed as “plant most common syntive. food”--or, more recently, as “jewelry cleaner” or “phone-screen thetic cathinone cleaner”--they are sold online and in drug paraphernalia stores Frequent confound in the blood under a variety of names, such as “Ivory Wave,” “Bloom,” “Cloud and urine of patients sumption may Nine,” Lunar Wave,” “Vanilla Sky,” “White Lightening” and admitted to emerinduce toler“Scarface.” ance, dependgency departments the country. Common reactions ence, and strong withdrawal after bath salts ingestion--raises reported for people who have brain dopamine in the same symptoms. The dangers of bath needed medical attention manner as cocaine but is at least salts are compounded by the after using bath salts include 10 times more potent. fact that these products may cardiac symptoms (such as racThe hallucinatory effects often contain other, unknown ingrediing heart, high blood pressure, reported in users of bath salts ents that may have their own and chest pains) and psychiatric are consistent with other drugs harmful effects. Also, drug users symptoms including paranoia, such as MDMA or LSD that who believe they are purchasing hallucinations, and panic raise levels of another neuroother drugs such as ecstasy may attacks. transmitter, serotonin. A recent be in danger of receiving synanalysis of the effects in thetic cathinones instead. For Patients with the syndrome rats of mephedrone and methyexample, mephedrone has been known as “excited delirium” lone showed that these drugs found commonly substituted for from taking bath salts also may raised levels of serotonin in a MDMA in pills sold as ecstasy have dehydration, breakdown of manner similar to MDMA. in the Netherlands. skeletal muscle tissue, and kidney failure. Bath salts have been linked to When bath salts emerged at the an alarming surge in visits to end of the last decade, they rapIntoxication from several synemergency departments and idly gained popularity in the thetic cathinones has proved poison control centers across U.S. and Europe as “legal

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highs.” In October 2011, the U.S. Drug Enforcement Administration placed three common synthetic cathinones under an emergency ban pending further investigation, and in July 2012, President Obama signed legislation permanently making two of them, mephedrone and MDPV, illegal along with several other synthetic drugs often sold as marijuana substitutes (“Spice”). Although the new law also prohibits chemically similar analogues of the named drugs, manufacturers are expected to respond by creating new drugs different enough from the banned substances to evade legal restriction. After mephedrone was banned in the United Kingdom in 2010, for example, a chemical called naphyrone quickly replaced it, and is now being sold as “jewelry cleaner” under the brand name “Cosmic Blast.” Editor’s note: This article and picture are reprinted from the National Institutes of Health website: www.drugabuse.gov/publications/drugfacts/synthetic-cathinones-bath-salts


Examiner february 2014