Evidence of meeting #115 for Veterans Affairs in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was symptoms.
A recording is available from Parliament.
4:15 p.m.
NDP
Rachel Blaney NDP North Island—Powell River, BC
Okay.
For the awareness piece, how do we build awareness so that people know to ask that question?
4:15 p.m.
Psychologist, Central Ontario Psychology, As an Individual
I think you're doing it right now. I think paying attention to the issue is an important thing. We need to get the information out to veterans. We need to get the information out to those clinicians who work with Veterans Affairs and communicate that way.
If you look at veterans affairs in the United States, the VA, they do a pretty good job of communicating constantly with the clinicians who work with Veterans Health Administration.
In the case of Veterans Affairs Canada, I don't see a lot of communication going out from VAC to the clinicians on the street, and that can be a bit of a challenge. We're sort of training ourselves in a sense, and of course, that leaves a lot of gaps. Having even some form of newsletter coming from Veterans Affairs to the providers would be a very effective strategy for communicating to those who are on the front lines.
4:15 p.m.
NDP
Rachel Blaney NDP North Island—Powell River, BC
Thank you. I think that's really important.
I have one last question, and I don't even know if it's a question as much as a statement, but I would like to hear your response. What I understand from all of this is that we don't even know how many veterans have taken mefloquine. We don't even have the numbers.
4:15 p.m.
Psychologist, Central Ontario Psychology, As an Individual
To the best of my knowledge, we don't. No.
4:15 p.m.
NDP
Rachel Blaney NDP North Island—Powell River, BC
Okay. How do we even start? As was said earlier, it's this cohort—and over a period of time it has lessened—that we need to care for in a respectful way, but we don't even know who they are.
4:15 p.m.
Psychologist, Central Ontario Psychology, As an Individual
Yes.
Dr. Nevin suggests that Somalia forward is the era he's looking at, at least with respect to American veterans. I'm not sure if that would apply directly to Canada or not, but it sounds about right. If we started from 1990 forward...? Honestly, I don't know when the drug was released. I don't know when it started getting used by veterans, or soldiers at the time. There are a lot of question marks in my own mind certainly.
4:15 p.m.
Liberal
Bob Bratina Liberal Hamilton East—Stoney Creek, ON
Thank you both for joining us.
Dr. Suter, your discussion on the optic nerve hit a nerve with me, especially with the remarkable numbers—with around 70% of all sensory input fibres to the brain beginning in the eye.
Is that correct?
4:15 p.m.
Liberal
Bob Bratina Liberal Hamilton East—Stoney Creek, ON
That's as opposed to every other source in the brain.
In your connection with veterans and so on, is there anything in a normal examination that ever leads you to suspect there are issues beyond the ones that you are treating for?
4:15 p.m.
Optometrist, As an Individual
I kind of owe an apology to Dr. Douglas and his colleagues in that I made it sound as if psych is not a huge part of treatment for the veterans or anybody with a brain injury. I think it's because psych is a place where people immediately turn. I wanted to emphasize what I think is being missed more so.
I really feel strongly that Dr. Douglas's mention about needing strong case management in these cases is part of the solution. It would be a “down the road“ step in terms of getting the information we need to find out about mefloquine toxicity—how it is intertwined and how much of it is intertwined with PTSD or other psych diagnoses that go along with mefloquine toxicity versus straight neurologic or neuro-optometric symptoms that aren't being masked. When I'm working with patients with brain injuries, veterans or not—most of mine are not veterans—it's really important to have a multidisciplinary approach. In fact, our book is titled Vision Rehabilitation: Multidisciplinary Care of the Patient Following Brain Injury.
4:20 p.m.
Liberal
Bob Bratina Liberal Hamilton East—Stoney Creek, ON
I see.
Unlike my colleague, I'm not a doctor. When I hear you talk about micro-lesions that don't show up in brain scans, let me ask you this: How do they show up? How do you know that there are micro-lesions there that you can't see?
Sorry for sounding simple on that, but it's not my field.
4:20 p.m.
Optometrist, As an Individual
No, not at all.
Again, I'm not a mefloquine toxicity expert. The research that I saw was actually with rat studies. They just sectioned the brain stem so that they could see them under the microscope. I don't know if there is a way to tell in a human being if that is occurring. However, the symptoms are the signs. Not the symptoms...well, it's both. Vestibular neurotoxicity and the visual deficits that we are very familiar with from other brain stem injury in humans all point to brain stem lesions.
4:20 p.m.
Liberal
Bob Bratina Liberal Hamilton East—Stoney Creek, ON
I get it. Thank you.
Dr. Douglas, on your point of knowing how many did or didn't, whenever I now meet with veterans, the first thing I ask them is where they served. For instance, I just came back from Africa and I had to take a malarial drug. If they say Somalia or some African location—others say India, Afghanistan and so on—I ask if they took the drug.
I would assume there is a way of accumulating how many of our soldiers were in malarial postings.
4:20 p.m.
Psychologist, Central Ontario Psychology, As an Individual
Yes, do it by asking them. Absolutely.
4:20 p.m.
Liberal
Bob Bratina Liberal Hamilton East—Stoney Creek, ON
Do you think it would be sufficient for Veterans Affairs to acknowledge the relationship between the mental health problem that the veteran is having and the military service?
We're dealing with veterans now, not active members.
4:20 p.m.
Liberal
Bob Bratina Liberal Hamilton East—Stoney Creek, ON
We want to do the best for them, so we want to accumulate our knowledge of the issues they are dealing with.
Is it necessary to bring the mefloquine into that discussion at the veteran's level, in terms of the benefits they might potentially receive?
4:20 p.m.
Psychologist, Central Ontario Psychology, As an Individual
My understanding is that Veterans Affairs takes an approach that basically says, “Is there a diagnosable condition? Is it attributable to military service? To what degree is their impairment arising from that?”
I think what I gather, reading between the lines of Dr. Nevin's research, is that the issue may be somewhat different in the United States, where they might put more emphasis on it having to be PTSD. If it's a generalized anxiety disorder, they're not going to cover that. I don't think Veterans Affairs is so fine-tuned about it. They just want to know that there's a link to military service. In that regard, I think you're correct. With respect to treatment, it's quite a different matter. From there, I think we really have to train the practitioners and ensure there is some kind of a knowledge of how to diagnose this.
There may also be the issue of people who have never served in a traumatic situation, and they are very harshly judged by their peers: “Nothing ever happened to that guy. How come he's seeking out a disability pension?” Such people may be shamed into silence and may not be seeking disability pensions.
I think it's very important that we be able to acknowledge that it's not just a general disability. We also have to be reaching out to these people and letting them know about the benefits. They may be suffering from something that is service related even in the absence of having been exposed to a specific trauma.
4:25 p.m.
Liberal
Bob Bratina Liberal Hamilton East—Stoney Creek, ON
They may be in a theatre but not in combat but still expressing....
4:25 p.m.
Psychologist, Central Ontario Psychology, As an Individual
Right, exactly.
April 29th, 2019 / 4:25 p.m.
Liberal
Darrell Samson Liberal Sackville—Preston—Chezzetcook, NS
Thank you.
Thank you for both for your presentations today. It's very helpful as we move forward in this study.
I'll start with Dr. Suter.
You made reference at the beginning of your presentation to there being no experts out there for mefloquine. Can you expand on that a little? I believe it's important as we move forward.
4:25 p.m.
Optometrist, As an Individual
I believe what I said was that there are no experts out there on mefloquine toxicity in vision.
With regard to the visual consequences, the brain stem is an area where the vestibular system coordinates with the visual system in terms of keeping us balanced and helping us understand what's around us, keeping us oriented. I do not believe we have anybody who has had enough cases that they have put out the information in terms of the visual consequences.
I think that Dr. Nevin has done an amazing job of getting the vestibular consequences published and out there. He has also mentioned.... Really, he has been pushing to get people to neuro-optometry because he recognizes that it's vestibular and visual.
That was what I meant. The people who are working with these patients in vision have not, I think, looked at enough cases nor published those cases.
