Journal 070413

Vol. 25 No. 25 www.cnic.navy.mil/bethesda/ July 4, 2013

By Bernard S. LittleWRNMMC Journal

staff writer

As the sun reflected off ablack marble wall with thegold etching, “Walter ReedNational Military MedicalCenter (WRNMMC), Thecoming together of the bestof Army Medicine and thebest of Navy Medicine tocreate the best of MilitaryMedicine,” leaders at theNation’s Medical Centerand Naval Support ActivityBethesda (NSAB), spoke ofthe success of this integra-tion Friday before a crowdgathered for the dedicationof the healing plaza in frontof the America Building.

Army Col. John Gaal,WRNMMC deputy com-mander for administra-tion, called the ceremony“a celebration of a specialplace of healing and peace,[and] a testament to thecommitment and fortitudeof the staff of Walter ReedBethesda who worked dili-

gently to remain focused onpatients while moving intothe future and honoring theheritage which shaped” thenation’s largest militarymedical center.

“Erecting buildings iseasy,” said Capt. Frederick“Fritz” Kass, NSAB com-mander. “Building a cultureis hard, and it takes time.In a way, this garden repre-sents the building of a newculture from two terrificoriginal pieces. In a fittingway, we’re taking a momentto not only look backwards,but also together lookingforward, and this ceremonyis a way to mark our prog-ress on that journey.”

Rear Adm. Alton L.Stocks, WRNMMC com-mander, agreed the plazais “a tribute to the histo-ries and legacies of the twogreat military medical in-stitutions that came beforeus.” Those institutions, theformer Walter Reed ArmyMedical Center (WRAMC)and National Naval Medical

Center (NNMC), integratedto form WRNMMC in Sep-tember 2011. “This healinggarden is really a visiblesymbol of this successfulintegration and our culture.We’re new and we’re movingforward as one team heretogether.”

Stocks and Kass werejoined by retired Lt. Gen.Eric B. Schoomaker, for-mer surgeon general of theU.S. Army and commandinggeneral of WRAMC, to cutthe ribbon dedicating theplaza. The three, joined byWRNMMC Command Mas-ter Chief Terry Prince repre-senting all enlisted servicemembers at Walter ReedBethesda, then unveiled theshiny, bronze bust of Maj.Walter Reed, which rest ona pedestal with the words,“Walter Reed ... 1851-1902… Bacteriologist, ResearchScientist … In Honor of HisGreat Work in the Fightfor the Eradication of Yel-

Healing Plaza Dedication Trumpets Integration Success

Photo by Bernard S. Little

Leaders unite to unveil a bust of Walter Reed at thenewly opened Healing Plaza in front of the Americabuilding at Walter Reed National Military MedicalCenter Friday. See HEALING page 10

By Bernard S. LittleWRNMMC Journal

staff writer

As Wallace Pyles reflectsback on a career of morethan 30 years at the formerNational Naval Medical Cen-ter (NNMC) and Walter ReedNational Military MedicalCenter (WRNMMC), he saysone of his proudest momentswas on July 3, 2008, whenthen President George W.Bush helped break groundfor construction of the Na-tion’s Medical Center —WRNMMC.

“The scope of the event,setting up for it, the presi-

dent being here and the co-ordination with the SecretService, called for quiteof bit of effort,” Pyles ex-plained. “It all just fell intoplace, but hundreds of hourswere put into coordinatingfor the event.”

The Maryland native saidhe’s also proud while work-ing at WRNMMC, to havehad the opportunity to meetevery U.S. president since1992. “Not many people cansay that,” he adds.

A senior program analystat Walter Reed Bethesda, Py-les is responsible for trouble-shooting the various mainte-nance systems on base. He

coordinates and often leadsefforts to resolve any prob-lems without impacting pa-tient care.

The reward in doing thiscomes from simply beingable to help people, he added.

“I enjoy helping people,”Pyles says. “If I see someonestruggling to put groceriesin the car, I’m going to stopand help that person. Mydad was my inspiration. Hewould say, ‘You always takecare of your elders and peo-ple who need help.’”

Born and raised in CampSprings near Andrews AirForce Base, Pyles added hisfather also instilled in him a

strong work ethic. “My dadalways worked multiple jobs.He was from the viewpointthe man is the breadwinner.It was a treat sometimes tosee him at home because heworked three or four jobs.”

Even as Pyles moves to-ward retirement soon, hisplans aren’t to take it easyand go fishing, but continueto work much like his father.“I’ve run a heating and airconditioning company on theside, and I plan to do thatmore than just on nights andweekends.”

Pyles began working atthe former NNMC in 1980as an air conditioning tech-

nician, working his way tohis current position.

“I met Wallace in 1981where we both worked forPublic Works in the Preven-tive Maintenance Shop,” saidAlbert Loften, engineeringtechnician at WRNMMC.“We maintained varioustypes of heating, ventilationand air conditioning equip-ment in many of the build-ings on the Base. A few yearslater he was promoted to aplanner estimator.

“Wallace treated the placelike home,” Loften added.“He learned about all the

‘Helping People’ Inspires 30-Plus Year Career at Walter Reed Bethesda

See PYLES page 6

2 Thursday, July 4, 2013 The Journal

The season of Ra-madan will begin atsundown on July 8th.During the 30 days ofRamadan, Muslims fastas a sacred ritual prac-ticed to bring cleansingand spiritual wholeness.It is common for manyfaith traditions to fastas a means of devotion,cleansing, and worship.Fasting is an ancient

and universal practice.The Romans, the Babylonians, theCynic, Stoic, Pythagorean and Neo-Platonist philosophers commendedfasting. Followers of Hinduism, Jain-ism, Confucianism, and Zoroastrian-ism practice it. Jews observe an an-nual fasting on the Day of Atonementin commemoration of the descentof Moses from Sinai after spendingforty days of fasting in order to beable to receive revelation and Jesusobserved fasting for forty days in thedesert and commanded his followersto fast. In brief, the practice of fast-ing has been common in one form orthe other in all human societies.The thing that all of these reli-

gions have in common is that theyuse fasting to connect the spiritualheart with the physical heart. Manybelieve the body is a manifestationof the heart, and that the pains andillnesses of the body are a manifesta-tion of the pains and illnesses in theheart. It stands to reason that untilthe heart is healed, the body will notchange its complaints. And that theheart governs the body, so when it isin sound health, then the whole bodyis in sound health. The soul also hasa heart, in Arabic it is called “Sadr,”the heart of the spirit. Its wellnessand perfection is attained by prayerand worship.

Therefore, fastingseeks to purify the soul,self, heart and mind ofall impurities that tendto pollute them. The hu-man body is composedof matter, which needsfood, water and air forits survival, while thesoul is a delicate entitywhose growth and de-velopment is dependenton the renunciation ofworldly and material

things. The respective demands ofbody and soul are contradictory witheach other.Fasting reins in the material

forces, thereby strengthening soul.Fasting is self-denial for a purpose;it brings focus to the mind and souland uses physical discomfort to re-mind us of our spiritual dependence.Some of the religious verses that

mention fasting appear below:“Oh you who believe! Fasting is

prescribed to you as it was prescribedto those before you, that you many at-tain piety and righteousness” (HolyQur’an, 2:183)Peter 4:1-2 “Therefore, since Christ

suffered in his body, arm yourselvesalso with the same attitude, becausewhoever suffers in the body is donewith sin. As a result, they do not livethe rest of their earthly lives for evilhuman desires, but rather for the willof God.”John 5:14-15 “This is the confi-

dence we have in approaching God:that if we ask anything according tohis will, he hears us. And if we knowthat he hears us -whatever we ask -we know that we have what we askedof him.”

Mohammed A. Khan, ImaamWalter Reed NationalMilitary Medical Center

Chaplain’s Corner Pharmacy HoursThe Walter Reed National Military Medical

Center (WRNMMC) pharmacies are no longeropen on Saturdays. The Arrowhead Pharmacy’shours are Monday through Friday, 8 a.m. to 7p.m., and the America Pharmacy’s hours areMonday through Friday, 7 a.m. to 6 p.m. TheDrive-thru Refill Pickup Point is open Mondaythrough Friday, 8 a.m. to 6 p.m. The pharmacywill continue to provide 24/7 support for theEmergency Room and for all hospitalized pa-tients. All pharmacies will be closed on theFourth of July. On Friday, July 5, the AmericaPharmacy will be closed, but the ArrowheadPharmacy in Building 9 and the Drive-thruRefill Pick-up location will be open from 8 a.m.to 4 p.m. For questions about pharmacy services,call the Pharmacy Call Center at 301-295-2123.

Prostate Cancer Support GroupThe Prostate Cancer Support Group meets at

Walter Reed National Military Medical Centerthe third Thursday of every month for discus-sions about prostate cancer. The next meetingwill be July 18 from 1 to 2 p.m. and 6:30 to 7:30p.m. in the America Building, River ConferenceRoom (next to the Prostate Center), 3rd floor.Spouses and partners are invited. Military IDis required for base access. For men without amilitary ID, call Prostate Center at 301-319-2900, 48 hours prior to event for base access.For more information, contact retired Col.Jane Hudak at 301-319-2918 or [email protected], or Vin McDonald at 703-643-2658 or [email protected].

Free Financial CounselingFree financial coaching for all service mem-

bers, federal employees, contractors and fam-ily members is available at the Fleet andFamily Support Center (FFSC) in Building 11.Assistance is available to analyze your cred-it report or credit scores, discuss retirement(Thrift Savings Plan) options, and create abudget. To schedule an appointment, or formore information, call 301-319-4087, or [email protected].

Bethesda Notebook

Published by offset every Thurs-day by Comprint Military Publi-cations, 9030 Comprint Court,Gaithersburg, Md. 20877, a pri-vate firm in no way connectedwith the U.S. Navy, under ex-clusive written contract with theWalter Reed National MilitaryMedical Center, Bethesda, Md.This commercial enterprise news-paper is an authorized publication formembers of the military services. Contentsof The Journal are not necessarily the of-ficial views of, nor endorsed by, the U.S.Government, the Department of Defense,or the Department of Navy. The appearanceof advertising in this publication, includinginserts or supplements, does not constituteendorsement by the Department of De-fense or Comprint, Inc., of the products orservices advertised. Everything advertisedin this publication shall be made availablefor purchase, use or patronage without re-

gard to race, color, religion, sex,national origin, age, maritalstatus, physical handicap,political affiliation, or anyother non-merit factor of thepurchaser, user, or patron.Editorial content is edited,prepared and provided bythe Public Affairs Office, Naval

Support Activity Bethesda, Md.News copy should be submitted to

the Public Affairs Office, Building 11, lowerlevel, Room 41, by noon one week pre-ceding the desired publication date. Newsitems are welcomed from all installationsources. Inquiries about news copy will beanswered by calling 301-295-1803. Com-mercial advertising should be placed withthe publisher by telephoning 301-921-2800.Publisher’s advertising offices are locatedat 9030 Comprint Court, Gaithersburg, Md.20877. Classified ads can be placed by call-ing 301-670-1700.

Naval Support Activity (NSA) BethesdaCommanding Officer: Capt. Frederick (Fritz) Kass

Public Affairs Officer NSAB: Joseph MacriPublic Affairs Office NSAB: 301-295-1803

Journal StaffStaff Writers MC2 John Hamilton

MC3BrandonWilliams-ChurchSarah MarshallSharon Renee TaylorCat DeBinderDavid A. DickinsonJeremy Johnson

Managing Editor MC2 Nathan Parde

WRNMMC Editor Bernard Little

Walter Reed National Military Medical CenterOffice of Media Relations 301-295-5727Fleet And Family Support Center 301-319-4087

WRNMMC OmbudsmanJulie Bondar 443-854-5167NSAB OmbudsmanJojo Lim Hector 703-901-6730Michelle Herrera 240-370-5421

SARC Hotline 301-442-2053

Visit us on Facebook:Naval Support Activity Bethesda page:https://www.facebook.com/NSABethesda

Walter Reed National Medical Center page:http://www.facebook.com/pages/Walter-Reed-National-Military-Medical-Center/295857217111107

Uniformed Services University of the Health Sci-ences page:http://www.facebook.com/pages/Uni-formed-Services-University-of-the-Health-Sciences/96338890888?fref=ts

The Journal Thursday, July 4, 2013 3

By David Vergun

Last month, the militarymedical community wasnotified that a new antibi-otic drug is now available totreat Soldiers who have life-threatening, multidrug re-sistant bacterial infections.

Arbekacin is a new antibi-otic treatment for multidrugresistant, or MDR, infec-tions. Those types of infec-tions may complicate woundssustained by Soldiers in the-ater, said Col. Michael Zapor,an infectious diseases physi-cian at Walter Reed NationalMilitary Medical Center, inBethesda, Md.

Stopping a killer“Of all the bacterial spe-

cies found on the planet, rel-atively few are intrinsicallymulti-drug resistant patho-gens,” Zapor said. “In Iraqand Afghanistan, the bacte-rium known as Acinetobacteris one such MDR bacteriumthat has caused problems inour patient population.”

Acinetobacter is common-ly found in the water andsoil of regions such as Iraqand Afghanistan, he said.Although it’s intrinsically re-sistant to many antibiotics,

it’s not especially virulentand generally not problem-atic in humans unless theirimmune system has beenseverely compromised or

the bacterium is inoculateddeep into macerated tissue,as would occur with massiveopen wounds resulting frombattle injuries.

Infections caused by thebacterium were prevalentduring the Vietnam War, hesaid. But at the time, Aci-netobacter remained mostly

susceptible to antibiotics.However, over time, re-

sistance emerged and anti-biotics became less effectiveagainst many pathogenicbacteria, including Acineto-bacter.

“We’re losing antibioticsmuch faster than new onesare coming through the pipe-line and made commerciallyavailable,” he explained. “Inthe 1950s, penicillin cureda lot of bacterial infections.Not so now.”

Humans reproduce ataround 20 years, he said, butbacteria reproduce maybeevery 20 minutes. With pro-longed exposure to antibiot-ics, they evolve over time tobecome drug resistant, heexplained. They’re survivors.

“Now, our Acinetobacterisolates are resistant tomost antibiotics,” he contin-ued. “It’s only a matter oftime before pan-resistanceemerges,” thus, the urgencyfor a new antibiotic.

Slow processIn 2004, when Zapor was

a battalion surgeon withthe 10th Mountain Divisionin Iraq, he and colleagues

Army Medicine Continues its Wartime Advances

Source Army.mil

Dr. (Col.) Michael Zapor, a staff infectious diseases physician at Walter ReedNational Military Medical Center, treats Afghans during his 2010 tour there as abattalion surgeon with the 82nd Airborne Division. Six years earlier he did similarwork in Iraq with the 10th Mountain Division.

See ADVANCES page 8

By Sarah MarshallWRNMMC Journal

staff writer

A series of town hall meet-ings on June 25 updated Wal-ter Reed Bethesda staff onthe command’s Strategic Planand its many successes overthe last year. The meetingsalso introduced staff mem-bers to new senior leaders, asothers prepare to embark onretirement or new duty sta-tions.

On Aug. 28, 2012, Wal-ter Reed National MilitaryMedical Center (WRNMMC)kicked off its Strategic Plan,outlining the command’s mis-sion and vision, and set forthseveral command-wide initia-tives. The plan encompassessix pillars - service excellence,quality of care, research, read-iness, education and businessof health care - and each hasits own objectives and initia-tives. The pillars are basedon foundations - people andresources. For each pillar and

foundation, senior leadersand staff formed groups toensure all initiatives are met.

“Throughout the last year,quite a lot of work has beendone,” said WRNMMC Chiefof Staff Col. Ramona Fiorey,attributing the many achieve-ments throughout the com-mand, to the Strategic Planand its initiatives. “We want-ed to bring this news to you.”

Capt. David Breier ex-plained the resources foun-dation’s goals, such as pro-viding greater transparencyof the command’s resources,and building internal and ex-ternal partnerships. Severaltown hall briefings, leader-ship forums and board brief-ings have taken place, mak-ing the command’s resourcesmore visible, he said. Addi-tionally, an online share pointwas created, allowing greateraccess to the command’s bud-get.

“Our goal is to continue togive you updates as we moveforward into FY13 and FY14,so you know at any given

time how our funding statuslooks,” Breier said. To con-tinue building internal andexternal partnerships, thepillar champion continued,“We’ve been working withthe Department of Researchto develop a plan so we canstart getting reimbursementsfor some of our research proj-ects.”

Over the last year, thepeople foundation collectedhundreds of comments fromstaff during a Gallery Walk,to hear their concerns onvarious command matters,said Col. John Gaal, peoplefoundation champion. As aresult of these suggestions,the postmaster system hasbeen revamped. Postmastersare now released only once aday, with command priorityinformation separated fromgeneral staff information.

“We [also] developed the‘Ask Your Leadership’ site, soeveryone can have an oppor-tunity to submit questions,”Gaal said. Through this siteon the intranet, staff ques-

tions can go directly to leader-ship, and/or may be addressedat future town hall meetings.

Capt. David Larson, ser-vice excellence pillar cham-pion, gave staff an update onthe service excellence initia-tives, geared toward meetingand exceeding the needs ofpatients, their families andstaff. Since the Strategic Plankicked off, his group has im-plemented “What I Do Mat-ters” customer service train-ing, reinforcing that each staffmember’s role is important inproviding service to patients.

“You’ll [also] notice thereare now street signs in thehallways to help direct ourpatients and staff,” Larsonsaid.

Additionally, the groupworked with the InformationTechnology (IT) Departmentand Strategic Communica-tions to improve the medicalcenter’s intranet site. Theyalso conducted an internalcommunications question-naire to gain feedback fromstaff, to ultimately improve

how information is dissemi-nated within the command.

“We’re always looking forways to improve the way wetake care of patients, and theway we communicate,” Lar-son said.

Maj. Dalmar Jackson toldstaff the business of health-care pillar group aimed to im-prove access to care, includingphone access. Making callsand appointing more efficient,the Integrated Referral Man-agement and Appointing Cen-ter (IRMAC) has developed aspecialty-care based routing,where staff are assigned tohandle specific specialty careclinics, he explained.

The quality of care pillarhelped quantify evidence-based practices by imple-menting an extensive JointCommission Mock Survey,explained Lt. Col. Scott Pe-tersen, pillar champion. Indoing so, the group has con-centrated on Healthcare Ef-

Town Hall Briefs Staff on Strategic Plan

See PLAN page 6


By Mass CommunicationSpecialist 3rd Class Brandon

Williams-ChurchNSAB Public Affairs

staff writer

The effect that an injury resultingin amputation, posttraumatic stressdisorder (PTSD) or a mild traumaticbrain injury (mTBI) has on familyrelationships is an aspect of medi-cine that does not get the attentionit deserves.Thanks to the Uniformed Services

University of the Health Sciences’(USU) Center for the Study of Trau-matic Stress Science Team (CSTS),the impact of physical and “invisibleinjuries” are getting a closer look.Implemented at Walter Reed

Bethesda in January, the FamiliesOverComingUnder Stress: Combat In-jured (FOCUS-CI) group aims to shedlight on the effects of combat injurieson all members of the family.The groupfocuses on the recovery of the injuredveterans to see how they and theirfamilies can be helped over time.

“When somebody is injured, wewant to look at how it affects theirchildren and loved ones in theirlives,” said FOCUS-CI Coordina-tor Mona Mendelson. “It’s what wewould call psycho-educational. It’snot therapy, its resiliency train-ing. We perform skill teaching, skillbuilding, emotional regulation, prob-lem solving, family communication,family goal setting and communicat-ing the injury with children. Some-times, families aren’t clear on howto talk to their children about theinjury, so we help give some age anddevelopmentally appropriate guide-lines.”To qualify for the study, the ser-

vice member or veteran must haveexperienced a combat injury (e.g.,amputation, burn, paralysis, mTBI,etc.) within the past 5 years and ei-ther the veteran or the partner musthave or take care of at least one childyounger than 18 years of age.According to CSTS, the capacity to

resume and establish relationshipsthat provide emotional closeness and

sexual togetherness can enhance orundermine individual health, rela-tionship health and even the healthof one’s family. “Intimacy studies areongoing in relation to PTSD,” saidFOCUS-CI Principal InvestigatorDr. Stephen J. Cozza. “PTSD can im-pact the sense of intimacy becauseof avoidance or intensity of experi-ence. What some survivors might dois try to bring the level of intensityfrom the battlefield into the relation-ship and this can be complicating tothe partner to match that certainlevel. The challenge that mTBI’spresent is that they don’t get identi-fied or treated. The family might notunderstand the changes in the sur-vivor and make false assumptionsthat it ‘must have something to dowith them.’ This disorder powerfullyimpacts because of the cognitive andpersonality changes.”CSTS’ main focus is to create an

environment where families can con-fidentially share the successes andchallenges they have experiencedwhile adjusting to a combat injury,

learn more about the recovery pro-cess in relations to the injury, andprovide families with skills to live abetter life with the injury.“Communicating with people

within the family and outside thefamily can help the warriors in tre-mendous ways,” said Cozza. “Whenwe talk with people about our issues,we then become better problem solv-ers.”“What’s helpful for these families

is telling their story,” said Mendel-son. “I see families trying to showstrength and resourcefulness thatI can’t imagine with some being asyoung as they are. A lot of thesepeople are amazingly resilient. Itimpresses me these families are soyoung and have these serious inju-ries, and yet a lot of them are land-ing on their feet. I am just blownaway by it.”To see if you qualify for the FO-

CUS-CI group or for more informa-tion, contact Mendelson at [email protected] or visitwww.cifamilies.org.

Warriors and Families Show Resilience with Help from Focus Group

By Sharon Renee TaylorWRNMMC Journal staff writer

The American College of Surgeons’(ACS) Commission on Cancer (CoC)presentedWalter Reed National Mil-itary Medical Center (WRNMMC)with the 2012 Outstanding Achieve-ment Award.In a select group of only 79 U.S.

health care facilities with accreditedcancer programs to receive this na-tional honor, Walter Reed Bethesdaearned the national honor for sur-veys performed last year. The awardacknowledges cancer programs thatachieve excellence in providing qual-ity care to cancer patients.“This level of recognition of our

Cancer Program by the national ac-crediting body again demonstratesour commitment to provide the finestcare for all Warriors-past, present,and future; their beneficiaries andour veterans,” explained WRNMMCCommander Rear Adm. Alton L.Stocks.Walter Reed Bethesda boasts the

only Department of Defense-desig-nated Center of Excellence for Can-cer Care, the John P. Murtha Can-cer Center, dedicated with a formalceremony in December 2012. “OurCancer Program and Tumor Regis-try is once again validated as a top

program in the country, civilian ormilitary,” Stocks said.The main elements of the John P.

Murtha Cancer Center include Med-ical Oncology, Center for ProstateDisease Research, Gynecological(GYN) Cancer Center of Excellence,Breast Care and Imaging Center,Surgical Oncology, along with Pedi-atrics Hematology and Oncology. Atits dedication, Army Col. (Dr.) CraigShriver, director of the Murtha Can-cer Center, described the facility asa “unique” interdisciplinary programencompassing WRNMMC’s vast re-sources, as well as off-site researchlocations.Evaluated on 29 program stan-

dards categorized within one offour cancer program activity areasinvolving leadership, data manage-ment, clinical services and qualityimprovement, CoC further reviewedthe WRNMMC cancer program oneight commendation standards.Established in 1922 by the ACS,

the CoC is a consortium of profes-sional organizations dedicated toimproving patient outcomes andquality of life for cancer patientsthrough standard-setting, preven-tion, research, education and themonitoring of comprehensive qual-ity care.

Walter Reed Bethesda ReceivesNational Award for CancerProgram Excellence

The Daily Grind Opens

Photo by Mass Communication Specialist 2nd Class Nathan Parde

The Daily Grind, a bakery and coffee shop in the Warrior Café atNaval Support Activity Bethesda, opened for business Monday.


By Sharon Renee TaylorWRNMMC Journal

staff writer

Family, staff and instruc-tors filled the StrathmoreMusic Center in Bethesda,Md., to watch more than200 interns, residents andfellows graduate from 67medical, dental and health-related training programs inthe National Capital Consor-tium (NCC), June 21.The group completed in-

ternships, residencies andfellowships at Army, NavyAir Force, and Departmentof Defense medical treat-ment facilities throughoutthe National Capital Region.More than 12 select gradu-ates, faculty and staff mem-bers from Walter Reed Na-tional Military Medical Cen-ter (WRNMMC), UniformedServices University of theHealth Sciences, Fort BelvoirCommunity Hospital andMalcolm Grow Medical Clin-

ic received special awardsfor excellence in teaching,practice and outstandingperformance in GraduateMedical Examination (GME)programs.“We are truly proud of

you,” WRNMMC Command-er, Rear Adm. (Dr.) Alton L.Stocks, told graduates at theStrathmore ceremony.Army Surgeon General

and Commanding General

of the United States ArmyMedical Command, Lt. Gen.Patricia Horoho, served askeynote speaker.Looking out into the sea

of uniforms before her, shetold the graduates any ofthem could work in the civil-ian world but they chose, “towear the cloth of our nationand join a team of healthcare professionals that havethe privilege to be able to fo-

cus on caring for those whoare willing to put their liveson the line to defend ourfreedoms.”

“Don’t let this momentpass you by-enjoy every mo-ment of it,” Horoho said. “It’sa day you should rememberfor the rest of your medicalcareers.”She congratulated the

leadership of Stocks andJoint Task Force NationalCapital Region MedicalCommander, Maj. Gen. SteveJones. “Under their leader-ship, along with the facultyand the staff of Walter Reed,of Belvoir, of the UniformedServices University, GMEprograms were reaccreditedin all fields of GME study,”Horoho said. “That’s a tre-mendous accomplishment,”said Stocks.“We are the largest aca-

demic medical education inthe Department of Defensewith over 700 trainees at anyone time. We have 67 gradu-

ate medical education pro-grams and 20 allied healthcare programs, all being sup-ported by a faculty of over1,200. Significant is that ourfirst time board pass rate isover 95 percent, which is farbetter than the national av-erage for any program.”He explained graduates of

NCC programs will embarkto all corners of the globe:from the South Pacific to Eu-rope, from Asia to the MiddleEast, and to military bases,ships and areas of conflictaround the world. Accord-ing to the commander, moreWRNMMC trainees are in-volved in active researchprotocols than at any othermedical center in the De-partment of Defense.Stocks said many go on

to present their research atnational and internationalforums as well as publish insome of the most prestigiousjournals in the medical pro-fession.

Outstanding physicians, faculty and students recognized

National Capital Consortium Graduates More Than 200

Photo by Sharon Renee Taylor

More than 200 interns, residents and fellows graduatefrom 67 medical, dental and health-related trainingprograms in the National Capital Consortium dur-ing a ceremony at the Strathmore Music Center inBethesda, Md., June 21.

01040270


utilities-water, steam andelectrical feeds where theyall go and what they ser-viced. All the engineerswould go to him for draw-ings and building layouts.There was not one construc-tion project that he was notinvolved with.”

Loften recalled when acold water line broke at themedical center one evening.“Wallace picked me up andwithin 45 minutes we ar-rived at the hospital to gal-lons of water flowing downthe hallway. We crawled inthe ceiling to try to locatethe valve to turn off the wa-ter. After about an hour, wewere able to secure the wa-ter and stop the flooding. We

both returned home aroundmidnight.”

The engineering techni-cian recalled another inci-dent with Pyles. “One timewe had to go to the roof ofBuilding 1, the Tower, andif anyone knows Wallace, hewalks fast and he does not

like waiting on the eleva-tor, so he said, ‘Let’s takethe stairs.’ The Tower is 21floors, and Wallace was tak-ing three stairs at a time,and I was running up thestairs trying to keep up withhim. By the time I got to thetop - out of breath, Wallacewas standing there laugh-ing at me. I told him neveragain.”

Loften explained Pyles ishands on in tackling issuesas well. “One summer daysome severe thunderstormscame through Bethesda,and we were informed a treehad fallen near the Uni-formed Services Universityof the Health Sciences gateand onto Jones Bridge Roadblocking traffic. Wallace andI went to assist the groundscontractor with the removalof the tree. Wallace jumpedin there and asked the con-tractor for a chain saw and

started cutting up the tree,which wasn’t a small tree.If you needed a third hand,you could depend on Wal-lace. He would never say noto anything.

“What I will miss [becauseof Pyles’ retirement] is I willnot be able to walk over tohis office when I have a prob-lem and ask his advice as tohow I should handle a prob-lem,” Loften said about hisfriend of more than 30 years.“Working in Facilities eachday, we are faced with vari-ous types of maintenanceproblems and not havinghim around it will be a littlebit more difficult. It neverfails every Friday afternoon,an emergency comes up thatneeds to be addressed beforegoing home, and you couldcount on Wallace to stay un-til it had been resolved.”

Pyles said although he’sfound all the positions he’s

had at Walter Reed Bethes-da enjoyable, the one hesaid he found most reward-ing was as a managementanalyst, tracking all mainte-nance system work from thetime of their request to theircompletion. “I liked knowingwhere everything was andwhere everything was go-ing,” he said.

Also part of the MTEUteam since 1992, Pyles hascoordinated all of the fa-cilities requirements, frompainting, ceiling and floorrepair, for VIP visits to themedical center. “He wouldarrive early the day of [thevisit], and be readily avail-able until the visit was over,”Loften said.

“There are so many peopleI’ve worked with over thedecades here, and they arewho I will miss most after Iretire,” Pyles said.

PYLESContinued from 1

Photo by Bernard S. Little

By Joseph MacriNSAB Public

Affairs Officer

Naval Support ActivityBethesda (NSAB) will honorthe sacrifices of Gold Starfamilies with three new des-ignated parking spots on theinstallation.

Gold Star families are thesurviving parents, siblingsand spouses of service mem-bers who have died in combat.

“Although a parking spaceseems like a trivial thing,

when compared to whatthese family members havegone through, it’s one way ofsaying that they will alwaysbe a part of our militaryfamily,” said Capt. Frederick“Fritz” Kass, NSAB’s com-manding officer.

The parking spaces arejust one part of the Navy’sGold Star program, whichwill allow unescorted accessto Gold Star family memberswho may not have it other-wise. This provides them ac-cess to certain services and

enables them to attend onbase ceremonies and events,memorials, museums, andvisit with other Gold Starprogram members.

According to Ryan Emery,NSAB’s transportation pro-gram manager, the installa-tion will have three reservedspaces that will be availableshortly.

“The spaces will be locatedat the NEX, in the Patient Ga-rage Building 55 and behindBuilding 11 with close accessto the Fleet and Family Ser-

vice Center. We received thedirective for these spaces andimmediately went into actionto bring them to fruition. NSABethesda is dedicated to pro-viding support wherever wecan and hold this cause in theutmost regard,” he said.

Historically, mothers offallen service members begancalling themselves “Gold StarMothers” during the WorldWar I. Since 1936, the UnitedStates has been observingGold Star Mothers Day on thelast Sunday of September to

honor these mothers.In 1967, Congress stan-

dardized the service bannersand established the GoldStar lapel pins to issue toimmediate family membersof service members killed incombat, including those whohave committed suicide intheater. The Next of Kin pinsignifies a service-relateddeath or suicide during ac-tive duty other than combat.In 2010, Congress desig-nated Dec. 18 as Gold StarWives Day.

NSAB Implements Gold Star Family Program

fectiveness Data InformationSet (HEDIS) indicators andtheir accuracy. These stan-dards are used to determinehealth care effectiveness, andallow staff to ensure they aremeeting patient care goals,he said.

To help make educationaltraining opportunities moreaccessible to staff, the edu-cation pillar created a “one-stop” portal and training cal-endar for local courses, setup now on the intranet, ex-plained Col. Michael Nelson,education pillar champion.

“We’re very excited aboutthat, and want you to accessit,” Nelson said.

With the number of edu-cational opportunities avail-

able within the command,the group seeks to continueexpanding those opportuni-ties. The group has done soby hosting a trauma sympo-sium, and bringing AmericanCollege of Physicians train-ing opportunities to staff.

“We have a lot to offerhere,” Nelson said.

The research pillar groupset out to enhance and sus-tain research support ser-vices, and in doing so, con-ducted an external review ofthe command’s research pro-cesses, explained Navy Capt.Brooks Cash, research pillarchampion. This resulted ina re-organization in the De-partment of Research, withnew forms and templates,and a new principal investi-gator guide, he said.

The research group alsoworked to promote the valueof research at the command.

“Col. Nelson and his team,

along with Lt. Col. [Mary]Klote, conducted a very suc-cessful Research Week. Thatculminated in a number ofprestigious awards and re-ally highlighted a lot of thegreat research that contin-ues to be done atWalter ReedBethesda,” Cash said.

The group also completedmore than 100 cooperativeresearch and developmentagreements (CREDA), Cashadded, each documenting themedical center collaboratingon a research project with aprivate company. “That pro-cess has significantly stream-lined, as has the process ofpublication clearance,” hesaid. “We’ll continue to workon facilitating research.”

The readiness pillar aimedto maintain and continuepromoting a healthy work-force, Cmdr. Shawn Clauseninformed staff. The readi-ness pillar champion ex-

plained the group assessedthe command’s DeploymentHealth Readiness processes,and combined seven sepa-rate requirements into a 2.5-hour appointment. As a re-sult, she said the command’sMedical Indeterminate Rateimproved to less than twopercent - well below the fivepercent maximum standard,Clausen said.

Thanking staff for attend-ing the town halls, Rear Adm.Stocks went on to announceand welcome new leadershipwithin the command.

Navy Capt. Phillip Per-due will be the new DeputyCommander for Surgery,while Air Force Col. MichaelAdames will take on the roleof Deputy Commander forAdministration. Cmdr. JohnRotruck will be the newPresident of Medical Staff,Cmdr. Darby will be the newDeputy Commander for Spe-

cial Assistants, and ArmyCol. Taylor Casmere will bethe new Deputy Commanderfor Public Health.

Later this summer,WRNMMC Chief of Staff,Col. Fiorey, will go on to takecommand of Madigan ArmyMedical Center in Washing-ton State. WRNMMC Com-mander Rear Adm. Stocksexpressed his gratitude forher tremendous support andleadership over the last year,and in doing so, the two-starAdmiral presented her withhis set of one-star pins.

Col. Fiorey will be pre-ceded in leadership by NavyCapt. Sarah Martin, whohas previously served atthe former National NavalMedical Center and most re-cently served at Navy Medi-cine Headquarters, the Bu-reau of Medicine & Surgery(BUMED).

PLANContinued from 3


By Bob ReinertUSAG-Natick Public Affairs

Fans of the long-running comicstrip “Beetle Bailey” got a bit of asurprise June 16, when its creator,Mort Walker, chose to set aside hisusual military-inspired humor totackle a more serious subject.That day’s three-panel strip

showed Beetle Bailey experiencingthe signs and symptoms of post-traumatic stress disorder, known asPTSD — including nightmares andtrouble sleeping. The third panel re-minds readers that “Post-traumaticstress can affect any Soldier.” Thatmessage fromWalker helped kick offa public service campaign by the RedSox Foundation and MassachusettsGeneral Hospital Home Base Pro-gram to bring attention to the invis-ible wounds of war — post-traumaticstress and traumatic brain injury —during June, National PTSD Aware-ness Month.The Home Base program, founded

in 2009, has provided clinical treat-ment for more than 600 veterans

and family members, and has edu-cated more than 7,500 clinicians na-tionwide about PTSD and traumaticbrain injury, known as TBI.In a video he recorded, Walker, an

89-year-old Army veteran of WorldWar II, discussed why he used BeetleBailey to help shed light on this is-sue.“I feel so sorry for the veter-

ans that have that post-traumaticstress,”Walker said. “I would do any-thing to help them — even one, evenone, if I could.”In the three-minute video, Walker

talks about growing up in the Mid-west, becoming a cartoonist, anddeveloping the Beetle Bailey charac-ters based on his Army experience.“If you can make somebody happy,

boy, I’ll tell you, that cures all kindsof problems that people have,” Walk-er said. “It’s my business, in a way,and I enjoy that part of it.”Beetle Bailey is one element of

the Home Base campaign’s seriesof messages about helping Iraq andAfghanistan veterans and theirfamilies recover from those invis-

ible wounds. Developed pro bono byadvertising firm Hill Holliday, it fea-tures print, radio, online, and elec-tronic billboards.See the ads here http://bit.

ly/14lAndk and listen to the radiospots here http://bit.ly/11OiVfwand here http://bit.ly/12hXV46.“There’s no greater honor than

being of service to our veterans andmilitary families,” said Mike Shee-han, Hill Holliday chairman. “Weare honored to offer our resources,creativity and support to HomeBase, and to raise awareness aboutpost traumatic stress and traumaticbrain injury. Returning veterans andtheir families deserve every resourceavailable to help them adjust to lifeback home.”Numerous media outlets contrib-

uted advertising space and time tothe Home Base campaign.“These messages are timely and

urgent,” said retired Brig. Gen. JackHammond, Home Base executive di-rector. “Although the war in Iraq hasended and more troops are returningfrom Afghanistan, it is critical that

we remember that for many veter-ans and their families, these warshave not ended and the return homehas meant nightmares and difficultysleeping, no longer feeling safe in ev-eryday places, trouble concentrating,severe headaches and family stress.”“The clinicians and staff of Home

Base and all of our veterans andfamily members are so grateful forthe talent and generosity of HillHolliday in creating this unique andvery powerful campaign.We are alsograteful for the generous contribu-tion of Mr. Mort Walker, and espe-cially to our media partners, whohave recognized the importance ofthis issue and made the decision tostep up in support of our returningveterans and families.”For more information about the

Home Base program and its pub-lic service campaign, visit www.helpathomebase.org. To view MortWalker’s video, go to http://bit.ly/19vbCBo.

‘Beetle Bailey’ Draws Attention to Post-Traumatic Stress

Fans of the long-running comic strip “Beetle Bailey” got a bit of a surprise, June 16, 2013, when its creator, Mort Walker, chose to setaside his usual military-inspired humor to draw attention to a more serious subject, as part of a public service campaign by the Red SoxFoundation and Massachusetts General Hospital Home Base Program.


started seeing cases of Acinetobacterand knew that a new antibiotic wasneeded, and soon.

At the time, he said, Arbeka-cin was being used in Japan forthe treatment of pneumonia andsepticemia caused by methicillin-resistant Staphylococcus aureus,or MRSA. Zapor thought the drugmight have promise for treating in-fections caused by other MDR bacte-ria, to include Acinetobacter.

Lab trials were initiated at Wal-ter Reed, and Arbekacin was foundto be effective against many isolatesof Acinetobacter, as well as otherpotentially harmful bacteria likeE. coli, Klebsiella pneumoniae, En-terobacter and Pseudomonas aeru-ginosa, as well as MRSA. The nextstep was to get it approved for usein humans.

Zapor drafted a human-use proto-col with the U.S. Army Medical Ma-teriel Development Activity, or US-AMMDA, as a sponsor. As the drug’sprinciple investigator, Zapor wasresponsible for shepherding Arbeka-cin through the federal regulatoryprocess for approving new drugs. Itwas harder than he ever imagined,he said.

Surprisingly, the Food and Drug

Administration was very receptiveto a human-use protocol and encour-aged his team to proceed, he said.But progress got mired down in sci-entific and institutional reviews andmany painstaking revisions to theprotocol were required.

The process dragged on for years,but he finally got the green light toproceed with the human-use proto-col this month. Meanwhile, Soldierswounded in Afghanistan continuedto develop MDR infections.

“Isn’t it ironic that approval wasfinally given at a time when the waris winding down and our populationof wounded warriors is shrinking?”he said.

But Zapor said he knows regula-tors need to ensure drugs are safefor use, adding that the Departmentof Health and Human Services andCongress are very aware that theprocess should and could be betterstreamlined.

Moreover, pathogens will invari-ably become more drug resistantand Arbekacin remains available forfuture use.

Waiting to pop the corkZapor said he and the protocol’s

sponsors at USAMMDA intend tocelebrate as soon as the first patientwith an MDR bacterial infection issuccessfully treated with Arbekacin.

As of yet, however, no one hasreceived treatment with Arbekacin.This is due to the protocol’s intention-

ally strict eligibility requirements,designed to delay the emergence ofArbekacin resistance, he said.

Eligible patients include thosewith MDR infections of the lungs,urinary tract, soft tissues, skin,bones and blood, for whom otherantibiotics are either ineffective orcontraindicated. That means otherantibiotics either won’t work or pro-duce undesirable side effects like al-lergic reactions, he said.

Also, the treatment will only beavailable at Walter Reed. This way,use of the antibiotic will be tightlyregulated, minimizing the risk of theemergence of drug resistance.

Fortunately, there are far fewerwar wounded these days so “we an-ticipate an infrequent need for Ar-bekacin at this time,” he said.

Moreover, fewer Soldiers who getwounded are being infected withAcinetobacter, he said. The causes ofthis are probably multifactorial. Forexample, during the early part of thewar, it was common practice to placewounded Iraqi and U.S. Soldiersside-by-side in intensive care units.

“However, we learned that thewounded Iraqi soldiers tended tobe colonized with Acinetobacter” ata much higher rate than were theAmericans, he said.

“One possible scenario is that asdoctors and nurses moved from bedto bed, they might have unintention-ally transmitted the bacterium be-tween patients.

“Over time, the indigenouswounded were separated from theAmerican wounded and the preva-lence of Acinetobacter colonizationamong the latter declined,” he con-tinued.

Importance of army medicineWithout the support of Army

medicine, it’s doubtful Arbekacinwould have ever been tested for useagainst MDR bacteria, he said. TheJapanese, who licensed Arbekacin inthe early 1990s, approved it for useagainst MRSA.

Although there were scattered re-ports of efficacy against other organ-isms, no role was envisioned for itsuse against MDR bacteria.

The Japanese were, however, veryhelpful in translating documentsrelating to their early studies intoEnglish for us, Zapor said.

“I truly think they were motivat-ed by humanitarian reasons and anappreciation for our problem withMDR infections in our war wound-ed,” Zapor said.

Moreover, the drug’s manufactur-er, Meiji Seika Pharma Corporation,has agreed to supply Arbekacin forthe protocol at no cost.

Zapor said in the U.S. there wasnot much commercial incentivefor the kind of research he and histeam did with Arbekacin. But Army

ADVANCESContinued from 3

See ADVANCES page 10

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medicine, he said, sees an incentivewhen battlefield injuries and illnessdictate the need for a new drug orproduct.Examples of that include the

anthrax and hepatitis A vaccines,treatments for malaria, clottingbandages and recent improvementsto devices like prosthetics and theCombat Application Tourniquet.Zapor predicted that drugs for

hard-to-treat fungal infections ofwounds which are also problematicin wounded warriors will be the nextcandidates for new drug studies.More potent and resistant patho-

gens are emerging all the time, hesaid, explaining there won’t be anyshortage of new work to do.Just this April, for instance, a new

virus, the MERS-CoV, was reportedin Saudi Arabia. The fatality rate isaround 65 percent, according to re-searchers at Johns Hopkins.Someday, he said, Arbekacin re-

sistance will emerge and the use-fulness of that drug will be limited.“We’re just hoping to stave off theinevitable.”

MalariaWhen Zapor was serving in Iraq,

he said he didn’t see a single case

of malaria except in those who hadcontracted it elsewhere.That was not the case when he

was deployed to Afghanistan in2010, as a battalion surgeon withthe 82nd Airborne Division.“There is a lot of malaria there,”

he said.There are five species of clinically

relevant malaria in the world, hesaid, and Plasmodium vivax is theone most commonly found in Afghan-istan. Although not as dangerous asthe deadly Plasmodium falciparum,P. vivax can cause serious illness.Moreover, if inadequately treated, P.vivax infections can relapse.Drug resistant malaria isn’t wide-

spread in Afghanistan. In most cas-es in which Soldiers are diagnosed,they did not comply with directivesto take anti-malarial medication, hesaid. Also, some were not applyinginsect repellent or it became ineffec-tive due to heavy sweating.

Q FeverThe illness “Q fever” is caused by

inhalation of the Coxiella burnetiibacteria, found in the feces of birdsand other animals as well as theplacenta and amniotic fluids frombirthing animals. The bacteria be-come airborne, usually by latchingon to dust particles.Acute infection is characterized by

pneumonia and liver inflammation.Chronic infection may result in

damage to the heart valves, Zaporsaid.“Q fever is probably one of the

more vexing infections we’ve had todeal with among troops returningfrom Iraq and Afghanistan,” he said.The reason, he explained, is that

it is difficult to diagnose. Patientsappear to have pneumonia, he said,and physicians may not suspect Qfever unless they also are able to de-tect damage to the liver and put thetwo together.Once suspected, it is very difficult

to definitively diagnose, he said, not-ing that there are only a few special-ized labs that test for it and theremay be discordance in results.“You can get two different results

from two labs,” he said, adding thatseveral years ago colleagues in theArmed Forces Infectious DiseasesSociety came up with guidelines inan effort to provide guidance for mil-itary physicians on diagnosing andtreating patients with Q fever.Unlike most other bacteria, C.

burnetii is fastidious and cannot begrown in hospital laboratories. In-stead, diagnosis involves looking forthe presence of surrogate markers ofinfection, Coxiella burnetii antibod-ies in the blood, he said. However,there are several types of C. bur-netii antibodies corresponding todifferent phases of the bacterium’sgrowth and their levels rise and fallover time, confounding the interpre-tation of test results.Patients who have suffered from

Q fever can also suffer additionalcomplications that come a result ofthe infection. One such example isdamage to the heart valves, Zaporsaid.Because of this, “there has been a

lot of discussion in the military in-fectious diseases community aboutwhether or not to test every Soldiercoming back from theater or onlythose with respiratory infections,”Zapor said.Zapor said C. burnetii is found

in the U.S., but Q fever is probablyunder-reported here. When it is di-

agnosed, it is usually in someonewith an occupation that puts themat increased risk, such as veterinar-ians and farm workers.

Baghdad boilsA curious thing started happen-

ing when troops began arriving inIraq and Afghanistan early in thewar. Tiny sand flies were biting Sol-diers who would then develop ulcer-ated skin sores, Zapor said.As one can imagine, Soldiers who

got these sores were alarmed, aswere their commanders, who medi-cally evacuated them, he said. Hun-dreds of Soldiers had their tours cutshort by what they called the “Bagh-dad boil.”Actually, the disease is Old World

leishmaniasis, caused by the Leish-mania parasite and transmitted bysand flies, Zapor said.Leishmaniasis was common

among Soldiers serving in the Medi-terranean and North Africa duringWorld War II, but “over time, it wasforgotten by the collective conscious-ness,” he said.The good news, he said, is that

the disease is usually painless andclears up on its own without treat-ment.As commanders came to realize

that the threat was less ominousthan originally supposed, he said,they opted to monitor those affectedin theater instead of sending themstateside.Over time, the incidence of the

disease diminished. That was a re-sult of improved living conditions forSoldiers, including sleeping quarterswith air conditioning. With fewerSoldiers sleeping on the ground atnight, fewer were exposed to thesand fly that carries the parasite.As Soldiers deploy worldwide in

regionally aligned units, Zapor saidnew pathogens will be discovered,and old pathogens will again reartheir heads.Army medicine, he said, will be

there to protect them.

ADVANCESContinued from 8

low Fever … In Recognition Of TheHigh Public Service of Major Wal-ter Reed U.S.A.”The bust was created by Felix W.

de Weldon, who also sculpted theMarine Corps War Memorial basedon the photograph of five U.S. Ma-rines and one Sailor raising theU.S. flag on Iwo Jima during WarWorld II. The memorial is locatedjust outside Arlington NationalCemetery. The bust of Maj. Wal-ter Reed was originally part of thememorial dedicated in 1966 on thegrounds of WRAMC.When WRAMCintegrated with the NNMC to formWRNMMC, the bust was moved toits new home, but not unveiled un-til the plaza was completed.

While the Maj. Walter Reed bustand a bronze healing fountain cre-ated by Vietnam Era Veteran Ger-hard Ehlerding are located in theplaza’s center, a U.S. Navy FouledAnchor bas relief welcomes pa-tients, staff and visitors to thehealing plaza’s northern edge, sym-bolizing the leadership role of “TheChief ” in the Navy and Navy Medi-cine. The bas relief was securedfrom a façade of the former SeniorEnlisted Barracks, Building 12 atNNMC. The building was replacedin 2009 by the National IntrepidCenter of Excellence.The black marble wall between

the U.S. Navy Fouled Anchor andMaj. Walter Reed bust, also in-cludes names of Medical Medal ofHonor recipients, and paved al-coves around the plaza perimetercontain the emblems of the U.S.military branches.

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