Vol. 25 No. 2 www.cnic.navy.mil/bethesda/ January 17, 2013

By SharonRenee Taylor

WRNMMC Journalstaff writer

Surgeons and robots work-ing together in the operat-ing room at Walter ReedNational Military MedicalCenter (WRNMMC), the na-tion’s largest military medi-cal treatment facility, ensuremany patients experienceless pain, less blood loss,and shorter recovery times,according to the physiciansand patients.

More than nine experts atWalter Reed Bethesda in the

areas of gynecology, urogyne-cology, gynecology oncology,urology, prostate oncology,pediatric urology, and car-diothoracic surgery, as wellas reproductive endocrinol-ogy and infertility (REI)perform robotic surgery. Thetechnology allows more pa-tients than ever before tobenefit from minimally-in-vasive surgery, the surgeonsexplained.

“With greater acceptanceand use, robotic surgery isgoing to become increasinglyimportant in the future aswe try to continue to mini-mize the invasive nature of

surgery and disruption inpeople’s lives, whether it’stime away from work or timespent recovering,” explainedArmy Col. (Dr.) Joseph M.Gobern, chief, Departmentof Obstetrics and Gynecol-ogy at WRNMMC, who hasperformed robotic surgerysince 2008.

Keisha Turner, a behav-ioral health case managerat Fort Meade, Md., said lessdown time is the reason whyshe opted for robotic surgery.Severe back pain and othersymptoms she endured formore than a year as a resultof uterine fibroids affected

her lifestyle so much that thewife of a retired Soldier wasunable to make it throughher 16-year-old son’s highschool football game.

The myomectomy Gobernperformed on Turner from arobotic console in September toremove the fibroids went with-out complication. She returnedhome after an overnight stayat WRNMMC, and returnedto work two weeks later. “I feelgreat,” Turner said.

Recovery time is the big-gest difference for cardiotho-racic patients who undergorobotic surgery to removeanterior mediastinal tu-

mors, in front of the chest,explained Navy Capt. (Dr.)John Thurber, chief of Car-diothoracic Surgery. “Weused to have to split thebreast bone,” said Thurber,who performs about five tho-racic procedures a month atWRNMMC. He uses a robotto treat lung cancer, esopha-geal disorders and meticu-lous tumor resection aroundvital structures of the chest.“Instead of dividing the bone,we go through the side,” hesaid. “The patient can gohome in one or two days.”

Robots in the Operating Room:Technology supports rapid return to duty, improved quality of life for WRNMMC patients

Photo by John R. Chew, Medical Photography

Nurses bedside in a Walter Reed Bethesda operating room watch monitors as surgeons seated several feet away at a computerized consolecontrol perform an operation. The “arms” of the robot can cut, dissect, grasp and suture. “It’s just a way for me to move my hands,” explainedArmy Col. (Dr.) George Stackhouse, a Walter Reed National Military Medical Center urologist who has used robots in surgery since 2004.

See ROBOTS page 9

10 Thursday, January 17, 2013 The Journal

had many great mentors and peers who I haveworked with that inspired me to be successful.But the two people who inspired me the most aremy great grandmother and great grandfather whoalways believed in my ability to be successful nomatter what I choose.”

Cooper attributed her selection to her hardwork and self discipline.

“If you know how to do your job, nobody shouldhave to come and tell you how to do it the right

way,” said Cooper. “You need to have that self dis-cipline to go forth and do what you need to do plusa little more just to stand out above the rest.”

She added, “My mom and my dad have mostlybeen my inspiration because of everything thatthey have been through throughout situations intheir life that still never had their self drive downor their self discipline, which they taught me, di-minish.”

Leitzinger’s inspiration comes from his son andhis need to become a good role model that his soncan look up to. He said staying calm, maintainingmilitary bearing and speaking confidently aboutwhat he knew is what helped him during the com-petition.

McQuagge said the winners were selected froma number of factors including: primary duties, col-lateral duties, off duty volunteer service, off dutyeducation, at work education and their ability tocommunicate. But overall it was their characterand how they lived the Navy core values and howthey articulated that to the board. He added thatthe title of Sailor of the Year is up for grabs toanyone who wants it.

“Any Sailor in the command, any rate and anypay grade can be Sailor of the Year,” said McQuag-ge. “In order to do that, they should align them-selves with a good mentor. A good mentor wouldbe someone that has already been selected as Sail-or of the Year, and work to emulate that person.”

NSABContinued from 3

technology in 2007 at WRAMC aftera congressional grant establisheda Telerobotics and Advanced Mini-mally Invasive Surgery Program in2006. A next-generation robot waspurchased the same year, expand-ing robotic surgery to other surgicalspecialties. With both telesurgeryand telementoring capabilities, themilitary’s first Minimally InvasiveGynecologic Surgery (MIGS) Fellow-ship was established in 2010. Theprogram graduated its first fellowsat WRNMMC in November 2011.

Walter Reed Bethesda added themedical center’s newest surgical ro-bot in October 2012.

“We currently have two of thelatest generation of surgical robotsand have expanded robotic surgeryfurther,” Lockrow said. The MIGSfellowship program director atWRNMMC and associate professorat Uniformed Services University ofthe Health Sciences, explained plansto expand the use of robotic tech-nology to other surgical specialtiesthroughout the medical center.

“We’re doing everything that wecan to offer our patients the mostmodern, the safest and best care - ev-ery modern option for our patients,”Stackhouse said.

ROBOTSContinued from 9

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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 Sarah Marshall

Sharon Renee TaylorCat DeBinderDavid A. DickinsonJeremy Johnson

Managing Editor MC2 Nathan Parde

NSAB Editor MC2 John Hamilton

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- 854-5167

NSAB OmbudsmanJojo Lim Hector 703-901-6730

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

Martin Luther King Jr. CelebrationWalter Reed Bethesda will observe the

birthday of Rev. Dr. Martin Luther KingJr. with a celebration today at 11:30 a.m.in the atrium of the America Building. Thecelebration will include a musical perfor-mance and free food. For information, callSgt. 1st Class Jason Zielske at 301-555-0356, or Chief Hospital Corpsman OluyinkaAdefisan at 301-295-6482.

Simulation Center Ribbon-CuttingA ribbon-cutting for the Walter Reed

National Military Medical Center(WRNMMC) Simulation Center will be heldtomorrow in Building 3/5 (Heros), room4008 at 11 a.m. The center will includeeight exam rooms, three conference rooms,a skills laboratory, a fully-outfitted operat-ing room, and an emergency room/intensivecare unit space capable of providing a num-ber of simulation trainings to enhance pa-tient-centered care throughout WRNMMC,the National Capital Area, the Departmentof Defense and the Department of VeteransAffairs. For more information, call Maj.(Dr.) Chad Cryer at 301-400-0747.

Tax Assistance Volunteers NeededWRNMMC needs volunteers for the Tax

Center to assist military members and theirspouses with free tax assistance. Incometax assistance volunteers work 12 or morehours a week during tax season, from earlyFebruary to late April. For more informa-tion, call Debra Clark-Burnside at 301-319-7828.

Army EO Office MovesThe Army Equal Opportunity Office

is now located in Building 2, third floor,Room 3268C (across from the MemorialAuditorium). The new phone number forthe office is 301-555-0356.

Bethesda Notebook

Those of you in themilitary have an annu-al Sexual Assault Pre-vention and Response(SAPR) training require-ment. Specifically in theNavy we have begun anadditional training tractcalled SAPR - Fleet orSAPR - F. In additionto the legal informa-tion you’ll need shouldyou personally becomeinvolved in a sexual as-sault case, there is another even moreimportant take away from this train-ing. That’s the critical role you canhave in preventing sexual assault tobegin with. In the Army and MarineCorps they’re called Battle Buddies. Inthe Air Force they’re called Wingmen.And in the Navy, we call them ship-mates or liberty buddies.

Your role in sexual assault pre-vention is to be a good shipmate. It’sthat simple. Statistics show that mostsexual assaults are committed by anacquaintance and approximately onein three will involve alcohol or drugsmaking the target all the more vulner-able. This is important because whilerecognizing someone who would com-mit such an act is difficult to do, rec-ognizing a situation that might leadto it is often far easier. At one time oranother, we’ve probably all been in asituation where we’ve seen somethingthat just didn’t seem right. Maybe it’ssomeone who pushes another personto keep drinking even though they areobviously past their limit. Or you’reout in a group and someone is insist-ing a little too adamantly that theytake the intoxicated person back tothe barracks. Or you witness repeatedunwanted advances. Many times thewarning signs are there. People knowthey are there but choose to ignore

them and hope every-thing will work out. Thisis the reason the Navyspends so much of theclass emphasizing peerintervention. Becausepeople who are going tocommit a sexual assaulthave evil intentions,they aren’t typically in-fluenced by classes likethis. What can make itharder still to interveneis when the bad actor is

a friend or co-worker. I understandthat.

I believe that there are many moregood people than bad who wear ournation’s uniforms and they can makea big difference just by trusting theirgut instincts. It is similar to drunkdriving, people who know better al-low it to happen because the driverwill probably make it home but whatif they don’t? So if I were to choose themost important thing from the SAPRtraining, it’s this - Being a good ship-mate comes down to trusting yourinstincts. If you KNOW something isnot right, intervene. Don’t hope thatsomeone else will. Don’t trust the sit-uation to work itself out. Don’t allowsomething to happen that you’ll knowyou could have prevented. When youare faced with such a situation, do forothers what you would want done foryou or your family.

When we call someone a “hero” inthe military, typically we think of ac-tions in combat or similar acts of cour-age in the face of danger. Standing upto your enemies is hard, but standingup to your friends can be even harder.Let’s tackle this problem together.

All Ahead Full,Capt. Frederick (Fritz) KassNaval Support Activity BethesdaCommanding Officer

Commander’s Column

The Journal Thursday, January 17, 2013 3

By Mass CommunicationSpecialist 2nd Class

Nathan PardeNSAB Public Affairs

staff writer

Service members, veter-ans and their families inMontgomery County nowhave access to the first web-site dedicated to coordinat-ing local resources, care andsupport for county residents.

“The official name for theprogram is Serving Together:Troops, Veterans and Fam-ily Care Project, a project ofthe Mental Health Associa-tion (MHA) of MontgomeryCounty,” said Jessica Fuchs,project director for ServingTogether. “We want the mili-tary and veteran communityto know what MontgomeryCounty can do for them. Wewant to let them know thatthere are community-basedorganizations that can helpthem that they may havenever considered.”

Studies with the Depart-ment of Veterans Affairs andthe U.S. Census Bureau haveestimated there are 50,000veterans in MontgomeryCounty, in addition to theirfamily members, said Fuchs.The website, www.servingto-

getherproject.org, launchedlate last year and providesmembers of the military andother county residents withdirect access to informationregarding local organizations.

“It is a great resource forfamilies and service provid-ers on the installation (Na-val Support Activity Bethes-da), to know how the com-munity can be a safety netand provide these additionalresources to them. This canhelp to supplement what theDOD (Department of De-fense) already has in placefor that family,” said Fuchs.

A military spouse herself,Fuchs is married to a Marinewho has served four overseasdeployments throughout his10 year military career.

“I was there to experiencethree of the four deploy-ments, so it gives me a pas-sion for this line of work andan understanding of whatveterans and family mem-bers experience,” said Fuchs.“What we do every day here,pushing the awareness andeducation for the communi-ty, means a lot to us becausewe’ve experienced it fromthe other side and we knowwhat value it can bring tothe community.”

Many Montgomery Coun-ty residents have experi-enced unique challenges asservice members, veteransor family members.

“When my son was killed inIraq nearly eight years ago, Ihad nowhere local to turnfor help,” said Lee Ann Doer-flinger, mother of Army Spc.Thomas Doerflinger, who waskilled in action on Nov. 11,2004, in Mosul, Iraq. “Com-munity support was lacking.This new website will providevaluable resources and infor-mation to the community,military members and their

families, including families ofthe fallen.”

Fuchs said there is awealth of resources avail-able in Montgomery County,if you know where to look.

“The website is a resourcehub, so it is divided into dif-ferent service categoriessuch as employment, mentalhealth services, transition,benefits assistance, etc.,” shesaid. “It offers many guidesthat are tailored for activeduty, service providers, vet-erans or family membersand act like a how-to guidefor that topic.”

In the future, the ServingTogether website will postcontinuing education eventsfor healthcare providers andmental health profession-als, such as those who workat Naval Support ActivityBethesda, said Fuchs.

“We have an educationcomponent, including acourse called Mental HealthFirst Aid,” said Fuchs. “It’sa $120 course, but (MHA is)offering it for free for mili-tary families, veterans, andthose who work with them.We talk about early signsand symptoms of mentalhealth and what to do in thecase of a crisis and how tointervene.”

The Serving Togetherproject currently operatesas a four-year pilot programin Montgomery County, withhopes to take it nationalover the next few years, saidFuchs.

In addition to the Serv-ing Together project, MHAoffers 10 direct service pro-grams for people with awide range of experiences.For more information, visitwww.mhamc.org.

Website Offers Resources for Montgomery County’s Veterans, Families

Photo by Pablo Benavente

The landmark Veteran’s Park fountain in Bethesda,Md., pays tribute to the service members of Mont-gomery County who gave their lives in defense of ourcountry.

By Mass CommunicationSpecialist 2nd Class

John K. HamiltonNSAB Public Affairs

staff writer

Naval Support ActivityBethesda (NSAB) recentlyselected the top Sailors fromtheir command to claim theirposition of Sailor, JuniorSailor and Blue Jacket of theYear during the command’sfirst Sailor of the Year com-petition.

“This is the first time thecommand has run the Sailorof the Year program,” saidChief Master-at-Arms MartyMcQuagge, NSAB senior en-listed leader. “We just got theinstruction approved in Oc-tober of 2012 so we couldn’teven have a Sailor of theYear program until we hadan established instruction.

The command is new. It’snot that it wasn’t a priorityit’s just that there were oth-er standard things such ascommand duty officer thatwere more mission oriented

that had to be taken care offirst.”

After taking part in a com-petitive selection processthat pitted 12 candidatesagainst one another, the win-ners shared their account ofwhat it means to be the bestof the best.

Sailor of the Year Master-at-Arms 1st Class Christo-pher Varga said, “My initialreaction to the news wasshock. I work with some

hard working peers who areworthy of the title as well, soto be selected as Sailor of theYear is a great honor and Iam humbled. Being Sailor ofthe Year gives me a sense ofaccomplishment and worthi-ness to the command. I amfortunate to work with someincredible people and lead agreat team to be successful.”

Junior Sailor of the YearCulinary Specialist 2ndClass Stephanie Cooper,

building manager for Tran-quility Hall, said she wasshocked and didn’t believe itat first until she started re-ceiving emails and was con-gratulated by the command-ing officer.

“It makes me feel as ifthe hard work that I did hasnot gone unrecognized,” saidCooper. “To me it’s kind ofa cherry on top for doing astellar job.”

Blue Jacket of the Year

Religious Program Specialist3rd Class John Leitzinger ofNSAB’s pastoral support de-partment said his reactionwas disbelief because of thefierce competition he was upagainst. “I thought I did real-ly well but I think everyonedoes well going into it,” saidLeitzinger.

The winners shared whatinspired them to go aboveand beyond throughout theirNavy career and what theythought they did right to beselected for the competition.

“I was able to achieve thisaward because of the supportof my wife (Stephanie Varga)[and her] giving me the pushI need to accomplish mygoals,” said Varga. “I am alsofortunate to have some greatmentors and also my ATFP(Anti-Terrorism Force Pro-tection) team who supportthe command mission timeand time again with nothingbut excellence.

Varga added, “In thepast twelve years I have

NSAB Sailors Earn Top Honors During Sailor of the Year Competition

Junior Sailor of the YearCulinary Specialist 2ndClass Stephanie Cooper

Blue Jacket of the YearReligious ProgramSpecialist 3rd Class

John Leitzinger

Courtesy Photos

Sailor of the YearMaster-at-Arms 1st Class

Christopher Varga

See NSAB page 10

4 Thursday, January 17, 2013 The Journal

By Bernard S. LittleWRNMMC Journal

staff writer

Recognizing the contri-bution certified registerednurse anesthetists (CRNAs)make to world-class patientcare behind the scenes, Wal-ter Reed Bethesda joinsthe rest of the nation Jan.20-26 in saluting the nursespecialists during NationalCRNA Week.

“CRNAs work in manyenvironments, includinghospital operating rooms,remote procedure areas,such as the gastrointesti-nal, pulmonary and otherclinics, ambulatory surgerycenters, field hospitals, com-bat support hospitals, hospi-tal ships, and with forwardsurgical teams,” explainedArmy Maj. Lori Lawhorn,staff CRNA at Walter ReedBethesda.

Lawhorn further ex-plained CRNAs are ad-vanced practice nurses whospecialize in providing an-esthesia, but are not anes-

thesiologists — physicianswho specialize in anesthe-sia. “CRNAs provide periop-erative and anesthesia carefor surgical procedures andobstetric care. This includespreoperative assessment ofpatients, patient educationregarding the anesthesia,the anesthesia itself, suchas peripheral nerve blocks,

sedation, general anesthe-sia, epidural and spinal an-esthesia, and postoperativecare, such as pain controland follow-up assessments.At some facilities, CRNAsalso provide emergency air-way management and medi-cal evacuation transportcare,” she added.

To become a CRNA re-

quires a bachelor of sciencein nursing, followed by anadditional three years ofgraduate education result-ing in a doctor of nursingpractice, Lawhorn said.“We are often referred to asphysician augmenters, phy-sician extenders, or simi-lar terms,” she added. “Allmilitary branches and thePublic Health Service, ex-cluding the Marines, use theUniformed Services Univer-sity of the Health Sciences(USU) to train CRNAs,”Lawhorn continued. “In ad-dition, the Army has the U.S.Army Graduate Program inAnesthesia Nursing at FortSam Houston, Texas, in con-junction with NortheasternUniversity.”

“I trained through theNavy Nurse Crops Anes-thesia Program, which wasaffiliated with GeorgetownUniversity [until trainingbegan at USU],” explainedCmdr. David Markell, cur-rently a staff CRNA at Wal-ter Reed Bethesda prepar-ing for deployment on theUSS Eisenhower (CVN 69).

“I decided to become aCRNA because I had a num-ber of friends with an inter-est in the field who encour-aged me to look into it,” saidMarkell. “From the firstobservation day in the OR(operating room), when theCRNA handed me a laryn-goscope and let me intubatesomeone, I knew this wasthe job I wanted to do.

“I enjoy almost every as-pect of the job,” Markell add-ed. “I love the patient care,the autonomy, and the criti-cal thinking involved withbeing a CRNA. Coming froman emergency room andintensive care unit back-ground, nurse anesthesiatakes all of the best aspectsof those jobs, ranging fromtriage to invasive monitor-ing. There is nothing aboutthis job I don’t like. You willfind yourself hard pressedto find a CRNA who doesn’tlove what they do.”

There are typically 25 to30 CRNAs, both militaryand civilian, on staff at

CRNA Week Salutes The Behind-the-Scene Work of Nurse Specialists

Photo by Bernard S. Little

Army Maj. John Y. Yauger (right), a certified regis-tered nurse anesthetist (CRNA), helps with a patientprocedure Friday in the operating room at WalterReed National Military Medical Center. Army Maj. LoriLawhorn.

See NURSE page 5

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WRNMMC, Lawhorn said.Markell added, “No two days are alike. You

could have five or six short cases in your room,or you could have a single eight-hour case. Youcould have a few healthy people, or one sick per-son with lots of medical problems, or a healthypatient having a serious surgery, or a sick pa-tient having a minor procedure. You just reallynever know what the day is going to hold andyou certainly never know when the unexpectedis going to happen. In this line of work, we al-ways must maintain vigilance and be prepared.”Markell continued, “Providing anesthesia can bechallenging even on the best of days. It is really aconstant exercise in human physiology and phar-macology. I heard it said once, ‘If you love whatyou do, you never truly work a day in your life.’ Ifthat is the case, then I haven’t really worked oneday since becoming a CRNA.”

Lawhorn, who decided to become a CRNA dur-ing her OR rotation in college, said she enjoysthe autonomy the specialty offers in the military.

She said the most rewarding aspect of her job istaking care of military beneficiaries.

“I know very well what a sacrifice it can be toserve, and I want to do my part to make surgerybetter for the patient, especially service men andwomen,” Lawhorn said.

The American Association of Nurse Anesthe-tists started National Nurse Anesthetist Weekin 1999 to inform and educate the public aboutthe nurse specialists’ contribution to health care.According to the association, nurses have beenproviding anesthesia for 150 years, nurse anes-thesia became a certification in 1956, and CRNAsprovide more than 33 million anesthetics in theU.S. each year.

To celebrate National Nurse Anesthetist WeekJan. 20-26, CRNAs at WRNMMC plan to set up atable with displays and information about theirprofession, on Main Street.

For more information about CRNAs, emaillori.a.lawhorn@health.mil.

NURSEContinued from 4

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By Jeremy K. JohnsonNSAB Public Affairs

staff writer

“BATH SALTS: It’s not afad...It’s a NIGHTMARE.”That’s the title of a videoproduced by the Bureau ofNavy Medicine and Sur-gery’s (BUMED) Visual In-formation Directorate (VID)that has gone “viral” since itwas first uploaded to the in-ternet on Dec. 20 of last year.

The video, depicting aSailor using bath salts toget high, experiencing hal-lucinations and ultimatelybeing hospitalized, has re-ceived attention from ma-jor news outlets across thecountry, including CNN andFox News.

It has reached more thanhalf a million views on thepopular video sharing siteYouTube. Compare that toa video about the syntheticdrug Spice that was also pro-duced by VID and uploadedby BUMED in October of2011; it’s received approxi-mately 18,000 views.

The project began whenthe directorate, located hereat Naval Support ActivityBethesda in Building 5, wastasked by BUMED to createa video detailing the dan-gers of illegal bath salts toeducate Sailors. The video’screator, VID producer ChuckAllen, said at the time itwas just one of many assign-ments. “We stay fairly busy,”said Chuck. “We’ve got about80 projects going on at anygiven time, from simple ‘se-nior leadership message’ todocumentary-type stuff.”

He said the steps for pro-ducing any video are routine.They first consulted with the‘client’ and talked about thedesired outcome. An outlineand script were producedand reviewed based on thatvision. Tweaks were madealong the way.

Despite this particularproject being “just anotherproduct,” Chuck admits hefelt it had to be perfect. “Pre-viously, we’d done a ‘Spice’video and we had a ‘gim-mick’ of doing all the actionin reverse. For this one, wewanted it to be cool and havea similar ‘gimmick’ so we de-cided it would be filmed inthe first person point of view.”

At this stage, the productwas still being formulated.The level of collaborationcan vary from client to cli-ent, he said. “Some are more

involved than others. Theymay say, ‘Here’s some musicchoices that we’re lookingat…’ – it just depends onhow involved in the creationthey want to get.”

“Bath Salts” may look likeit was expensive to put to-gether, but according to MikeAllen, the media productiondeputy, costs for productionsare accounted for in the ex-isting budget and resources.

“If you walk in today andsay you need a video, I maysay, ‘No, it already exists,’”he said. “We’re not spend-ing taxpayer money; it’s al-ready been done. If you comein and say, ‘We have a newear procedure we need videofor,’ then we’ll look, see thatnothing exists and say, ‘OK,we can do that because ithasn’t been done.’ There’s achain of things that happento make sure that we’re ascost effective as we can be.”

“Bath Salts” did requirehiring several actors toportray the user, his room-mate and his girlfriend, butChuck says that’s normal aswell. “We use actors becauseyou never want to show ac-tual military members usingdrugs, or in a way that caststhem in a negative light,” heexplained.

BUMED paid for Lt.George Loeffler, the Navyexpert featured in the latter

half of the video, to travelto Washington, D.C. to befilmed as part of the con-tent gathering process. “Wegot Lt. Loeffler in the studiofor one day,” said Chuck. “Ihad him on camera for anhour and a half. I had to findwhich four minutes I wantedto use from all of the goodcontent he gave us.”

Loeffler said working withVID was enjoyable. “Havingzero training in televisioninterviewing, I was look-ing to Mr. Allen and his col-leagues for guidance. Theyput me at ease, asked mequestions to get me talking,and soon I forgot about thecamera a few feet from me.”

They also worked togetherto accurately represent howa ‘high’ from using bath saltscould turn out.

“This video specificallycalled for hallucinations,”said Chuck. “I made sure wetalked to Lt. Loeffler beforeI made any final decisionson the production. I had inmind, ‘OK, [the user] has gotto get it. He’s got to do it.He’s gotta enjoy it. He’s gotto suffer from it. He’s got toREALLY suffer from it.’

Are you really euphoric,or does it just speed thingsup?What kind of hallucina-tions do they have? Are theyreally ‘crazy’ hallucinationsor are they just ‘colory’ [sic]

hallucinations? I actuallyran some of the things I hadby him: ‘Is this possible?’”

One example of this wasthe depiction of violence bythe user toward his girl-friend.

“He specifically men-tioned domestic abuse – thatis definitely a plausible situ-ation,” said Chuck.

Another aspect of the vid-eo, one that has been shownover and over in a video stillsince it went viral, is thezombie effect Chuck usedto turn the user’s roommateinto a demonic-looking char-acter.

“I really wanted to do thewhole zombie thing. I kindof pushed that forward fromthe beginning, and I gotsome pushback for it beingtoo cliché. I really thoughtwith the whole zombie pop-culture kind of thing wouldreally resonate. The zombieface morph had to happen.”

Mike said adding spe-cial effects may have takena little more time, but thatdidn’t add to the cost of pro-duction.

“The costs are minimal,”he said, “With special effects,they’re not new. Chuck has alot of software and the other[editing] suites do too. Some-times that’s used for part ofa medical procedure – en-hancing the view – but that

same software can be usedfor something like this.”

Once the product was fin-ished, they handed it over toBUMED, where it was up-loaded to their website andYouTube for disseminationworldwide. Though the vid-eo has received a substantialamount of attention, Chuckinsists it’s not up to him todetermine whether it’s asuccess.

“I thought it was reallypositive that it was gettingthat kind of attention, butto have the mainstream me-dia pick it up and promoteit was huge. I do think itadds an air of credibility tothe whole thing,” he said.“My name isn’t anywhere onit, and I think that’s whatmakes the difference. I takepride in the fact that it’s be-ing seen and knowing I didmy best to get it right.”

Lt. Loeffler gives the teamhigh praise for their efforts,“As the ‘talking head’ I knowI became the face for theBath Salts public service an-nouncement, but I recognizeMr. [Chuck] Allen and hiscolleagues for doing the realheavy lifting. Bravo Zulu tothem all.”

To see the video, visithttp://www.youtube.com/USNavyMedicine and se-lect “BATH SALTS: It’s nota fad… It’s a NIGHTMARE.”

BUMED’s Visual Information Directorate Zombie Video Goes Viral

Photo by Jeremy K. Johnson

Bureau of Navy Medicine and Surgery (BUMED) Visual Information Directorate Producer Chuck Allen looksover the project files for “Bath Salts: It’s not a fad … It’s a Nightmare.” The public service announcement cre-ated for BUMED has gone viral, receiving more than half a million views on YouTube, and has been featured onCNN, Fox News and multiple websites.

The Journal Thursday, January 17, 2013 7

By Sharon Renee TaylorWRNMMC Journal

staff writer

On Monday, the flu mobi-lization unit, also known asthe “Blue Tent”, began offer-ing flu vaccinations to pa-tients, military beneficiariesand staff members at Wal-ter Reed National MilitaryMedical Center (WRNMMC).Now, through Jan. 25, thevaccination will be offeredMonday through Friday, from8:00 a.m. until 4 p.m., in the“Blue Tent” located in Build-ing 9 on the first floor, nearthe Radiology Department.

As concerns about the earlyarrival of this year’s flu sea-son rise, Navy Cmdr. ShawnClausen, Chief of InfectiousDisease at WRNMMC, en-sures the medical center isready for the early arrivingflu season. There is no short-age of vaccine, she said.

“The flu peak is comingearly, and the rate of rise hasbeen attention catching, butthere’s no reason to panicnow,” Clausen said. “Whatit does do is reminds us of

general precautions againstthe flu: hand-washing, vac-cination [and] staying homewhen you’re sick.” The in-fectious disease chief saidmaintaining general hygienehabits will also help preventthe flu.

Clausen indicated themedical center is ahead of thecurve in terms of treatmentand response. Launching theannual “It’s not too late tovaccinate” campaign a monthearlier than it typically doesis one of the aggressive mea-sures instituted. She saidproviders received informa-tion on how to interpret andtreat positive influenza caseslast week, “so we’re all on thesame page.”

Early estimates from theCenters for Disease Controland Prevention (CDC) indi-cate there is a good matchbetween the circulating in-fluenza virus strains and thecurrent 2012-2013 seasonalinfluenza vaccine. Seasonalinfluenza vaccination is man-datory for all Department ofDefense uniformed personnelwho are not medically or ad-

ministratively exempt. In ad-dition, the Joint Commissionrequires influenza vaccina-tion for all staffers employedat the medical center threedays or longer, according toClausen.

The flu shot is recom-mended for children ages 6months and older. The intra-nasal vaccine is available forindividuals ages 2 through40 without medical contrain-dications.

Seasonal influenza vac-cinations are also availablein the immunization cliniclocated in Building 19 on thefourth floor, from 7:30 a.m. to4 p.m.

Additionally, medical cen-ter members can receivevaccinations in occupationalhealth, located in the preven-tive medicine department inBuilding 7 on the 2nd floor,from 7:30 a.m. to 4 p.m.

“Rest, drink fluids, stayhome, use over-the-counterpain medications as needed,and wash your hands fre-quently if you have the fluor influenza-like symptoms,”Clausen said. “Seek medi-

cal attention if you experi-ence severe symptoms suchas prolonged fever, a deepproductive cough, if you’repregnant, or have underly-ing medical conditions,” sheadded.

If you have additional

questions about influenzavaccination, call the Infec-tion Prevention and ControlService (IPaC), weekdaysfrom 6 a.m. to 4 p.m., at 301-319-8559, or Immunizationat 301-295-5798, and pressoption #1.

Medical Center Ready for Early Flu Season

By Patrick GordonNaval District

WashingtonWaterline writer

This past summer,Commander, Navy In-stallations Commandreleased a FacilitiesServices NAVSHOREmessage that outlinedservice level reductionsthat Navy shore in-stallations will need toadopt in order to com-ply with the fiscal year2013 budget. Whilesome personnel will no-tice minor changes asa result, Naval DistrictWashington (NDW)maintains its missionreadiness regardless.

“The changes thatare going to be the mostnoticeable to people onthis base or on any ofour bases are going tobe the ones that involvefacility services,” saidNDW Executive Direc-tor Thomas McGuire.“So, reduced frequencyof such custodial ser-vices as carpet cleaning,recycling, trash pickup,

these are going to be themost visible. Less vis-ible, but equally impor-tant, there are going to

be changes in things asseemingly mundane ashow often the grass getscut and to what height,

and other landscapingmeasures. All of this isdone in the interest ofreducing expendituresin the coming years inorder to stay withinbudget and to protectservice levels in otherprograms which moredirectly impact Fleet,Fighter and Family.”

Mcguire added thattenant commands canalso expect to see somechanges as a result ofthe service reductionsdue to shared services.

“Tennant commandswill be affected becausea lot of their base-oper-ating support servicesrest on common con-tracts,” said McGuire.“For example, each ten-ant doesn’t do its ownrecycling because wehave a recycling con-tract for the base andwe pick up from everytenant; similarly for alot of cleaning services.”

While certain ser-vices will be affected bythese changes, missionreadiness remains theprimary concern of theregion, said Mcguire.

“We are trying toprotect mission readi-ness as much as pos-sible,” said McGuire.“So where you’ll seemost of the reductionsare in things which af-fect convenience. I don’tsee mission readinessbeing significantly de-graded, because that’sprecisely what we’retrying to protect. Forexample, one of our mis-sions is to protect theinstallation, and thereare many ways to ac-complish that mission.So to the degree thatwe might invest moneyin perimeter monitor-ing systems and remotecameras and sensors,we may be able to con-tinue to achieve ourmission but with loweroverall costs.”

Though all personnelare expected to do theirpart in promoting effi-ciency and maximizingeffective and responsi-ble use of resources, thereduction in custodialcontract work will notresult in a wholesaletransfer of these duties

to Sailors and civilianpersonnel. Personnelmay be responsible forsmall things, such asdesk-side trash remov-al, due to the service re-ductions, but McGuiresaid the savings in thelong run will benefit re-gion, Navy and country.

“It’s incumbent uponall of us to find ways tocut costs and save mon-ey,” said McGuire. “Wehave direction from theDepartment of Defenseand the President tocut over $400 billionworth of costs from se-curity spending overthe next 10 years, andour own reductions areone small piece of that.Every one of us-everyNavy employee, everyAmerican citizen-hasto do some part of thisand shoulder part of theburden. This is the De-fense Department’s con-tribution to solving ournational debt problem.”McGuire explained thatthrough these servicereductions, NDW’s mis-sion remains on task,and within budget.

Service Reductions Geared to Cut Costs, Maintain Readiness in NDW

U.S. Navy photo by Patrick Gordon

Lt. Cmdr. Randall Harmeyer, deputy as-sistant regional engineer for Naval DistrictWashington, empties his recycling into a col-lection container at the Washington NavyYard. Personnel will be responsible for desk-side recycling collection as a result of servicereductions in an effort to cut costs through-out the Department of Defense.

Photo by Sharon Renee Taylor

Hospital Corpsman 3rd Class Kristofer Gonzalez ad-ministers a flu shot to Lorraine S. Berlin, 93, a mili-tary beneficiary, on Jan. 14, opening day for the “BlueTent” vaccination center, located in Building 9, firstfloor, near the Radiology Department.

8 Thursday, January 17, 2013 The Journal

By Jeremy K. JohnsonNSAB Public Affairs

staff writer

If you’ve considered usingsupplements as part of yourNew Year’s resolution, “Op-eration Supplement Safety”(OPSS) is an online tool free-ly available to check whetherthe ones you’ve chosen arepotentially harmful.

According to their website:“OPSS is a joint initiativebetween the Human Perfor-mance Resource Center andthe Department of Defense(DOD) to educate servicemembers and retirees, theirfamily members, leaders,healthcare providers andDOD civilians about dietarysupplements and how tochoose supplements wisely.”The program was launchedonline last fall and began itsfirst major push on militaryinstallations in December.OPSS also maintains a pageon Facebook.

Dr. Patricia Deuster, a Uni-formed Services Universityprofessor and chair of theDOD Dietary SupplementSubcommittee, says the pur-pose of OPSS is to preventwhat the U.S. Food and DrugAdministration (FDA) labels“adverse events” from theuse of supplements. “Thereare really three categoriesof concern to the FDA,” sheexplains, “including perfor-mance enhancement, sexual

enhancement and weightloss supplements. Any ofthese could be used by mili-tary members or their fami-lies.” The website includes afeed from the FDA with thelatest releases on harmfulsupplements.

She strongly encourageseveryone to use the site, re-gardless of their militarystatus, including active duty,reserve, veteran, dependentor retiree. “It isn’t just mili-tary members using thesesupplements,” she says.“Kids are using these drugs,performance enhancers, andsome of them contain ingre-dients that have been pro-hibited by major sports or-ganizations like the NCAA,NFL, NBA, MBL and NHL.”She adds that there is alsoa danger of family membersshipping dangerous perfor-mance enhancing supple-ments to members stationedoverseas.

The danger, she notes,comes from not knowingwhat ingredients are in asupplement, or whetheradverse effects have beenreported from using a spe-cific product. “Some of thesesupplements contain illegalingredients, including am-phetamines,” Deuster says.“There’s a risk of overheat-ing, heart strain or even con-traindication of ingredientswithin the supplements. Youmay be fine if you take them

and don’t move or go out inthe heat, but once you exertyourself, there’s no tellingwhat could happen.”

“Many of these supple-ments aren’t regulated orapproved by the FDA. The[OPSS] web site provides allof the necessary informationto become an informed con-sumer,” she adds. “It’s also aforum for questions and an-swers. We get 40 to 50 ques-tions a month from militarymembers.”

She hopes that by mak-ing people aware of this tool,more informed decisions canbe made and harmful deci-sions can be prevented. “Atthe moment, there’s no wayto track adverse incidentswith military members; anyincident with a supplementmay get reported to the FDA,but we don’t know if they’remilitary. You hear about in-cidents, but we don’t havenumbers right now and wehope to change that,” saysDeuster. “In the meantime,the website and Facebookpage are there for membersand their families to informthemselves - and they can al-ways ask questions throughthose.”

For more informationabout OPSS and to accessthe website, search for “Op-eration Supplement Safe-ty” through your preferredsearch provider.

Using Supplements? Check OPSS Online First

Courtesy graphic

A sample poster from the Operation Supplement Safe-ty (OPSS) program calls attention to energy drinks.OPSS is designed to provide military members andtheir families with tools to access information on avariety of dietary and fitness supplements, includingwhich ingredients and products may be dangerous oreven illegal. (Poster courtesy of Human PerformanceResource Center)

By Bernard S. LittleWRNMMC Journal

staff writer

The 1st Annual TraumaSymposium at Walter ReedNational Military MedicalCenter (WRNMMC) beginsTuesday and runs throughFeb. 1, with courses and lec-tures each day.

“The purpose for thesymposium is to provideessential skills and profes-sional trauma training forfederal medical employ-ees at WRNMMC. We arealso coordinating with theNavy Reserve component ofthe National Capital Area(NCA) to provide trainingfor those personnel,” ex-plained Cmdr. Rhonda O.

Hinds, service chief, Staffand Faculty Developmentat WRNMMC.

Courses and lectures areopen to all Department ofDefense (DOD) and federalhealth-care workers. Con-

tractors are not eligibleto attend trauma courses,but can attend lectures, al-though they are not eligibleto receive credit.

Advanced burn life sup-port, emergency nurse pe-diatric, pre-hospital traumalife support, tactical combatcasualty, trauma nursingcore, suturing, and hospital-man skills basic are some ofthe courses offered at thesymposium. Lectures willinclude history of the trau-ma service, welcome to Af-ghanistan-lessons learned,joint theater trauma sys-tem, from civilian to mili-tary trauma, war woundinfections, mild and moder-ate brain injury (TBI), as-sessment and treatment of

mild TBI, lower and upperextremity prosthetic, alongwith advances in combat ca-sualty care.

“All courses are traumarelated,” Hinds explained.“We will be using a blend-ing-learning environmentthat will consist of class-room, hands-on skills sta-tions, expert panels, andvideo teleconference presen-tations,” she added.

The WRNMMC staff sub-ject matter experts, whowill instruct and lead thecourses, include nurses,physicians, corpsmen, med-ics and emergency medicaltechnicians, Hinds said.

“We are also using re-sources from the DefenseMedical Readiness Training

Institute,” she added.“This is a first for our

facility,” Hinds continued.“We are collaborating withother federal entities to pro-duce high quality trainingto add to the already incred-ible skill set of our medicaland nursing staff. We arebringing the best of the besttogether to continue to pro-vide the required resourcesin order to provide the bestcare for our patient popula-tion.”

For more informationabout the symposium, call301-319-5209, or registerat classregistration@health.mil. Reservists can registerby emailing reserve.liaison@med.navy.mil.

WRNMMC to Host Its First Trauma Symposium

Courtesy Graphic

The Journal Thursday, January 17, 2013 9

Using the side-approachwith the robot, Thurber saidthe usual two-month re-covery period is reduced toabout a week.

Robotic technology also of-fers three-dimensional (3-D)visualization, which enablessurgeons to see depth whenoperating, he explained.“Better than even high-defi-nition scopes,” Thurber said.“Patients are asking for it.”

The cardiothoracic sur-geon said he plans to beginperforming robotic-assistedcardiac mitral valve repairsand bypass surgery laterthis year.

Navy Cmdr. (Dr.) LisaCartwright, a pediatric urol-ogist, uses the 3-D viewing toperform delicate pyeloplasty- a surgical repair of the tubethat connects the kidney andbladder - on babies throughseveral tiny incisions, thelargest measuring 1.2 centi-meters long.

Seated at a console sever-al feet away from her smallpatient draped on a table,Cartwright grips hand-con-

trols to operate a computer-ized “endowrist” that mimicsher motions with intuitive,seven-degree movement and90-degree articulation. “Therobot doesn’t do anythingthat I don’t do,” she said.

After the surgical area isprepped and filled with car-bon dioxide to change thepressure around the organsfor surgery, up to five inci-sions are made - the largestin the belly button to insert asmall scope the surgeon will

use to look through. A surgi-cal assistant at the bedsidechanges out the surgical in-struments connected to upto three computerized “arms”that cut, dissect, grasp andsuture.

“It’s just a way for me tomove my hands,” explainedArmy Col. (Dr.) GeorgeStackhouse, a WRNMMCurologist who has used ro-bots in surgery since 2004.“Anybody who needs a surgi-cal procedure that requires a

lot of sewing and knot-tyinginside of the body, we can dothat with the robot,” he said.

Surgeons at WRNMMCalso use robots to removeovarian cysts and pelvic ad-hesions, as well as performreconstructive pelvic surgeryand prostate removals - alsoknown as prostatectomy.“Blood loss can be significantwith an open prostatectomy,”explained Army Lt. Col. (Dr.)Inger Rosner, the director ofurologic oncology and associ-ate director of the Center ofProstate Disease Research atWalter Reed Bethesda. Shesaid robotic surgery reduc-es the amount of bleeding,which lessens the patient’sneed for blood transfusionand improves the surgeon’sview.

Cmdr. Sarah Dachos, a for-eign policy advisor assignedto the Pentagon, said she hadno doubt or concern about asurgeon using a robot to per-form her May 2012 surgery.“I actually thought it wouldbe better,” she said. TheNavy officer watched videosbefore her surgery. She saidshe noted how the physicianremains seated during thesurgery, which could takeseveral hours.

Dachos and Turner said

they did their own researchon robotic surgery beforethey elected the option. Thetwo agree they each madethe right choice. Four monthsafter her robotic-assistedlaparoscopic myomectomy atWalter Reed Bethesda, Turn-er said she would absolutelyrecommend robotic surgeryto other patients, and pre-ferred to have the operationat WRNMMC. “I knew I’dhave it here,” she explained.

Since 2007, the number ofrobotic procedures that areperformed in the U.S. hasnearly tripled, from 80,000to more than 250,000 in2010, according to the NewEngland Journal of Medi-cine. As early as 2001, ro-botic surgery has been anoption for service membersat military treatment facili-ties, initially to urology andgynecology patients at theformer Walter Reed ArmyMedical Center (WRAMC),according to Army Col. (Dr.)Ernest G. Lockrow, who hasbeen cited as a pioneer ofmilitary laparscopic roboticsurgery.

Lockrow was the firstmilitary surgeon to use 3-Dminimally invasive surgical

ROBOTSContinued from 1

Photo by Sharon Renee Taylor

Army Lt. Col. (Dr.) Chad Hamilton, chief, GynecologicOncology Service at WRNMMC, sits at a computer-ized console in an operating room where he controlsa robot to perform surgeries like the hysterectomy heperformed on Navy Cmdr. Sarah Dachos May 2012.

See ROBOTS page 10