Table Of ContentAPPROVAL SHEET
Title of Dissertation: “Risk of Peripheral Nerve Disease in Military Working
Dogs Deployed in Operations Desert Shield/Storm”
Name of Candidate: LTC Kelly G. Vest
Doctor of Public Health
May 2003
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1. REPORT DATE 3. DATES COVERED
2003 2. REPORT TYPE -
4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER
Risk of Peripheral Nerve Disease in Military Working Dogs Deployed in
5b. GRANT NUMBER
Operations Desert Shield/Storm
5c. PROGRAM ELEMENT NUMBER
6. AUTHOR(S) 5d. PROJECT NUMBER
5e. TASK NUMBER
5f. WORK UNIT NUMBER
7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) 8. PERFORMING ORGANIZATION
Uniformed Servicces universsity of the Health Sciences,F. Edward REPORT NUMBER
Herbert School of Medicine,4301 Jones Bridge
Road,Bethesda,MD,20814-4799
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Approved for public release; distribution unlimited
13. SUPPLEMENTARY NOTES
14. ABSTRACT
A population-based, cohort study was conducted to determine the importance of Gulf War deployment to
Southwest Asia, from 1 August 1990 to 31 December 1991, in explaining neurologic mortality and
peripheral nerve disease among United States military working dogs. The study cohort consisted of 2,123
military working dogs that were eligible to deploy to the Gulf War and died between 4 September 1990 and
30 June 2001 with complete medical records maintained at the Department of Defense Military Working
Dog Training Center and Veterinary Services, Lackland AFB, San Antonio, TX. Within this Gulf War
cohort was a prospectively followed cohort of 651 dogs; 347 of these dogs had complete peripheral nerve
histopathologic diagnostic records. Descriptive analysis of the study variables defined neurologic mortality
incidence for the Gulf War cohort at 1.90 cases per 1,000 dog-months. Rates among dogs assigned to the
United States, overseas, and Southwest Asia were 1.83, 1.91, and 2.44 cases per 1,000 dog-months,
respectively. Analysis of other exposures showed highest neurologic mortality among dogs assigned to
Southwest Asia countries other than Saudi Arabia, dogs arriving before or departing after the war, dogs
that arrived before and departed after the war, and dogs that spent more than 176 days in Southwest Asia.
Peripheral nerve disease incidence was 3.69 cases per 1,000 dog-months for the prospective cohort. The
rate for dogs assigned to the United States was higher than for those overseas or in Southwest Asia (3.86,
3.53, and 3.21 cases per 1,000 dog-months, respectively). Using survival analysis, adjusted neurologic
mortality and peripheral nerve disease rates were similar between the United States, overseas, and
Southwest Asia assignment locations. An increasing trend of neurologic mortality was evident with
increased time spent in Southwest Asia. Results from this study suggest that there was not a relationship
between Southwest Asia deployment during the Gulf War and neurologic mortality or peripheral nerve
disease. This study is consistent with previous human Gulf War neurologic studies. The military working
dog remains a viable sentinel model for measuring outcomes of unique military exposures. This study and
available data sets can form the basis for future studies.
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a. REPORT b. ABSTRACT c. THIS PAGE 135
unclassified unclassified unclassified
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COPYRIGHT STATEMENT
The author hereby certifies that the use of any copyrighted material in the thesis
manuscript entitled:
“Risk of Peripheral Nerve Disease in Military Working Dogs Deployed in
Operations Desert Shield/Storm”
is appropriately acknowledged and, beyond brief excerpts, is with the permission
of the copyright owner.
LTC Kelly G. Vest
Department of Preventive Medicine and Biometrics
Uniformed Services University of the Health
Sciences
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ABSTRACT
Title of Thesis: Risk of Peripheral Nerve Disease in Military Working
Dogs Deployed in Operations Desert Shield/Storm
Name, degree, year: LTC Kelly G. Vest, Doctor of Public Health, 2003
Thesis directed by: CAPT David Trump, MD, MPH, Associate Professor,
Department of Preventive Medicine and Biometrics
A population-based, cohort study was conducted to determine the importance of
Gulf War deployment to Southwest Asia, from 1 August 1990 to 31 December 1991, in
explaining neurologic mortality and peripheral nerve disease among United States
military working dogs. The study cohort consisted of 2,123 military working dogs that
were eligible to deploy to the Gulf War and died between 4 September 1990 and 30 June
2001 with complete medical records maintained at the Department of Defense Military
Working Dog Training Center and Veterinary Services, Lackland AFB, San Antonio,
TX. Within this Gulf War cohort was a prospectively followed cohort of 651 dogs; 347
of these dogs had complete peripheral nerve histopathologic diagnostic records.
Descriptive analysis of the study variables defined neurologic mortality incidence
for the Gulf War cohort at 1.90 cases per 1,000 dog-months. Rates among dogs assigned
to the United States, overseas, and Southwest Asia were 1.83, 1.91, and 2.44 cases per
1,000 dog-months, respectively. Analysis of other exposures showed highest neurologic
mortality among dogs assigned to Southwest Asia countries other than Saudi Arabia,
dogs arriving before or departing after the war, dogs that arrived before and departed
after the war, and dogs that spent more than 176 days in Southwest Asia. Peripheral
nerve disease incidence was 3.69 cases per 1,000 dog-months for the prospective cohort.
The rate for dogs assigned to the United States was higher than for those overseas or in
Southwest Asia (3.86, 3.53, and 3.21 cases per 1,000 dog-months, respectively). Using
survival analysis, adjusted neurologic mortality and peripheral nerve disease rates were
similar between the United States, overseas, and Southwest Asia assignment locations.
An increasing trend of neurologic mortality was evident with increased time spent in
Southwest Asia.
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Results from this study suggest that there was not a relationship between
Southwest Asia deployment during the Gulf War and neurologic mortality or peripheral
nerve disease. This study is consistent with previous human Gulf War neurologic
studies. The military working dog remains a viable sentinel model for measuring
outcomes of unique military exposures. This study and available data sets can form the
basis for future studies.
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RISK OF PERIPHERAL NERVE DISEASE IN MILITARY WORKING
DOGS DEPLOYED IN OPERATIONS DESERT SHIELD/STORM
By
Kelly G. Vest, DVM, MPH
Dissertation submitted to the Faculty of the
Department of Preventive Medicine and Biometrics of the
Uniformed Services University of the Health Sciences
in partial fulfillment of the requirements for the degree of
Doctor of Public Health 2003
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ACKNOWLEDGEMENTS
I thank my advisor Dr. David Trump and the other members of my dissertation
committee--Drs. Leonelo Bautista, Pat Carney, David Cruess, William Inskeep,
and Ajay Verma for all their advice and assistance in development and
completion of this project; my veterinary colleagues LTC Kay D. Burkman and
MAJ Linda D. Harris for their diligence and efforts in data abstraction and
management; Mrs. Isabel Castro-Perrez for her assistance in data file
management; and professional mentors COL Larry Carpenter, COL George
Moore, and COL Dale Dunn for their advice, helpful comments, and belief in me.
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DEDICATION
To my children that bring joy into my life:
Michael for his light heartedness to see the things that are good in times that are bad;
Amy for her determination to overcome physical obstacles is an inspiration; David for his
gift of kindness and longsuffering and always do what is right; he is an example to me;
Aaron for his sense of adventure and excitement to do anything he sets out to do; To
Leah for her sweet smile that brightens my every day; And to Matthew for his wonderful
hugs that brings happiness to my soul; To my wonderful wife, Jeanine, who has given me
her love, support, and understanding, enduring with me through these many years of
work and school adventures.
I love you all.
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TABLE OF CONTENTS
APPROVAL SHEET...............................................................................................................i
COPYRIGHT STATEMENT................................................................................................ii
ABSTRACT............................................................................................................................iii
ACKNOWLEDGEMENTS..................................................................................................vi
DEDICATION.......................................................................................................................vii
LIST OF TABLES..................................................................................................................x
LIST OF FIGURES..............................................................................................................xii
Chapter 1: Introduction.........................................................................................................1
Background and Significance.......................................................................................1
Pilot Study.........................................................................................................4
Literature Review..........................................................................................................4
Government and Policy Document Review......................................................4
Disease and Injury among Gulf War Veterans.................................................9
Peripheral Nerve Disease Epidemiology in Humans......................................14
Sentinel Animal Studies..................................................................................15
Canine Breed Characteristics..........................................................................18
Military Working Dog Studies........................................................................20
Neurologic Disease Testing............................................................................23
Neurologic Studies in Dogs............................................................................25
Neurologic Toxicants in Environment............................................................26
Preliminary Studies.....................................................................................................29
Chapter 2: Materials and Methods.....................................................................................31
Research Design..........................................................................................................31
Research Question and Study Aims............................................................................31
Study Population.........................................................................................................32
Exposure.....................................................................................................................33
Sample Size and Power Estimates..............................................................................34
Data Sources...............................................................................................................35
Data Quality and Management.......................................................................35
Data Analysis..............................................................................................................41
Ethical Considerations................................................................................................43
Study Investigators......................................................................................................44
Chapter 3: Results.................................................................................................................45
Gulf War Military Working Dog Cohort....................................................................45
1997 Prospective Gulf War Military Working Dog Cohort.......................................48
Military Working Dogs Deployed to the Gulf War....................................................52
Chapter 4: Discussion...........................................................................................................55
Study Strengths...........................................................................................................56
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