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San Antonio Express News wrote:AF wants to boot recruit with leukemia
By Sig Christenson - Express-News
Web Posted: 11/23/2008 10:47 CST
The Air Force has moved to deny health benefits to a recruit who learned he had acute leukemia only weeks into basic training at Lackland AFB.
An evaluation board ruled that Airman Basic Joseph Weston had fallen ill before coming to boot camp. It ordered him dismissed from duty with an administrative discharge — making him ineligible for medical and retirement benefits.
The ruling came despite the opinion of an Air Force cancer specialist who said there was “absolutely no way” to prove that Weston came to Lackland sick. The case is being appealed, with Weston fighting to win a discharge that grants him continued medical care and possibly even a pension.
“I feel I’m entitled to that,” he said. “I definitely feel that the Air Force owes me a medical discharge, if not retirement.”
As he fights to survive, Weston, 21, of Cadillac, Mich., is waging what he sees as a battle for honor. He joined the Air Force during a time of war, wanting to serve and defend his country and better himself.
But after telling him he had a rare form of cancer that could either kill him or leave him an invalid, an Air Force Physical Evaluation Board denied Weston a medical/honorable discharge, which would allow him to receive government-covered chemotherapy treatment for the next three years. It also could help him receive a 100 percent disability rating, which would allow him to qualify for medical retirement benefits.
In the absence of either one, he could qualify for Medicaid, but no one knows much about that possibility at the moment.
“I don’t know what’s in my future at this point,” Weston said. “I thought I had a good idea at one point, but it’s kind of been taken away from me, so I don’t really know at this point what I’m going to do, what I want to do anymore. It’s all just kind of been thrown up into the air, like a deck of cards.”
Living in isolation
As he marked his 21st birthday, Weston was living in isolation in a medical holding squadron where airmen who flunk their drug tests, the walking wounded and seriously ill are warehoused. He avoids others because of an immune system weakened by treatments. He wears a surgical mask when he walks in the cramped squadron building or elsewhere on base — if he has the strength to walk.
The windowless room Weston has lived in since his diagnosis June 10 isn’t much bigger than a prison cell. For a while he was denied the right to read books other than the Bible. Once, he was chastised by a noncommissioned officer for resting his eyes after grueling chemotherapy treatments.
The Air Force says strict discipline is normal for those in the medical holding squadron, where the rules are similar to those in other training units. He has since been allowed to read and sleep during the day, in accordance with doctors’ orders.
An angry Weston said some NCOs in the 319th Training Squadron, as it’s called, have treated him as if he were a recruit who flunked a drug test.
But worst of all is the Air Force’s decision to give him an administrative discharge.
Weston said some recruits he knows are getting medical discharges for stress fractures and anxiety attacks. He finds that ironic and insulting.
It makes matters worse that he can’t go home to his parents, who have watched from afar as their son fights a two-front war from his sickbed.
“What became his initial battle of life with the cancer is almost secondary with this battle he’s got with this discharge decision,” Jim Weston, his father, said in a telephone interview. “It just causes more stress for him, more stress for the family, and obviously it’s not pleasant.”
A long march
Wearing a surgical mask and blue armband, Weston stands at attention in a formation outside the 319th dorm as he and other recruits await orders on a chilly Monday.
This is a relatively short walk to a Lackland dining hall, but for him it is part of a long march with no clear destination.
“Why is my body doing it?” he said. “I know it is happening, but why me? Why now?”
This was supposed to be his year. After taking a hard look at his life, Weston had decided the time had come to join the Air Force. He qualified to be a jet engine mechanic and would have come to training months sooner if it had been his call.
The Air Force delayed his arrival to Lackland for five months. Weston, who had lived with a girlfriend and worked in a restaurant, moved home with his parents and anticipated the day he could get to boot camp. This was his chance to pick up a family tradition. Both of Weston’s grandfathers had been in uniform, and now it was his turn.
But the plane flight to Lackland at the end of Memorial Day weekend was also an escape from a nowhere job and Michigan’s moribund economy. It offered a chance for him to acquire discipline and direction in a life that had gone in circles.
Soon after starting boot camp, Weston showed signs of lagging in physical training, but it wasn’t cause for alarm. At first it was thought he wasn’t drinking enough water to compensate for the hot San Antonio summer. He also wasn’t used to exercising.
Tall and thin, Weston, like many boot camp recruits, had been a couch potato at home. His military doctor, pediatric oncologist Della Howell, also reported that he had taken Chantix, a drug to help him quit smoking. The drug’s many side effects include insomnia, which can cause fatigue and anemia.
Weston said he drank more water, but the problems persisted. He had swelling in his legs, and a medical check revealed an abnormally high heart rate long after exercising — 110 beats per minute.
Doctors at Wilford Hall Medical Center figured out what was wrong after blood tests: He had acute lymphoblastic leukemia. Called ALL, it’s typically seen in 3- to 4-year-old children, not young adults.
Weston called home. The gravity of the situation didn’t dawn on him until his mother, JoAnn Weston, broke down on the phone and said they were coming to be at his side.
“When he told me that they thought he had leukemia, to be very, very honest with you, I don’t remember what I said. I was in such a state of shock,” she said.
For Weston, the setback came just as things “had started to come together.”
“My dad, in fact, said quite a few times he felt jealous of me,” he continued. “It was like, ‘If I could go back right now 20 years, I’d switch places, I would, because you’ll be able to retire.’ He was just going through the benefits to it.
“I could tell he was really proud of me.”
Facing long odds
Weston had a better chance of being struck by lightning than coming down with ALL.
The government estimates your odds of being struck by lightning at 1 in 400,000. Just 90 people age 20 were diagnosed with all types of leukemia in the United States in 2000, the most recent statistics available to Howell. Of those 20-year-olds, she said, perhaps a third to a little more than half suffered from ALL.
ALL’s young victims, a subset of that group, have a better chance of survival than Weston.
“Anyone over the age of 10 is considered high risk, and that puts his survival rate at 60 or 65 percent,” Howell said.
Leukemia cells divide quickly and crowd the bone marrow. As they fill up the marrow, it becomes more difficult for the body to produce normal red blood cells that create platelets. When that happens, you bruise and bleed more easily and have increased difficulty in fighting off infections.
Adults with chronic leukemia can live for years. That is far more problematic with ALL.
“I’ve seen some children come in with an infection at the time of diagnosis and die that day. I’ve seen others have leukemia smolder in their bodies for months, and for some reason their bodies are just able to handle it better,” said Howell, 35, of Helotes. “In this case, had Airman Basic Weston not come in for treatment, if he had never had received any chemotherapy, I’d say that it could have easily taken his life in a matter of weeks.”
The question before the Physical Evaluation Board headed by Air Force Lt. Col. James Waggle was whether Weston was sick even before arriving at Lackland. He ruled the recruit was unfit to serve due to a physical disability but that it wasn’t incurred while on duty.
Waggle also said he wasn’t sure Weston’s impairment was permanent. After consulting with Wilford Hall’s adult hematology/oncology department, he wrote that “the board feels that there is compelling evidence to warrant a finding that the ALL existed before your entrance on active duty.”
Kenny Pruitt, a spokesman at the Air Force Personnel Center where the board is based, said the board could not comment on details of the case.
But Howell said Weston’s treatment could cause permanent, life-altering injuries. Howell also said that she thinks the board saw a letter she wrote insisting that Weston’s cancer was not a pre-existing condition.
The letter, obtained by the Express-News, said tests and past studies indicate that he would have had a normal amount of “blasts,” or leukemia cells, in his bone marrow on the day he entered training.
“Following this reasoning, Airman Weston had 2 percent blasts (a normal number) when he arrived in San Antonio, and he did not technically have ‘leukemia’ until 5 June 2008,” she wrote.
“Based on Airman Weston’s clinical history and laboratory findings, there is absolutely no way to prove that he did in fact have leukemia as a ‘pre-existing condition,’” Howell added. “The cell life cycle of acute leukemia cells seems to support that he did not have leukemia on arrival to San Antonio on 27 May 2008 for basic training. Therefore, there is no way that I can support the classification of this illness as a pre-existing condition.”
Weston is doing well despite intensive chemotherapy. He takes pills each day, gets shots in his legs and has a catheter in his chest, and undergoes a monthly spinal tap. He had three spinal taps in his first month of care.
The drugs he’s taking attack cancer cells during their life cycles. Chemo tends to kill rapidly dividing cells, among them ones that cause cancer and others linked to hair growth.
Since cancer cells can quickly develop a resistance to a single chemotherapy agent, different types of drugs are used to combat the cancer. The side effects of the drugs include hair loss, tumbling blood counts, mouth sores and loss of appetite.
As the week began, Weston sat alone at a table for five in one of Lackland’s dining halls eating a spaghetti sandwich. He hadn’t touched the baked potato on a smaller dish, but his appetite has been good thanks to the steroids doctors have given him.
Still, nothing can be done to stop Weston from feeling as if he’s been stranded. Airmen sit three to four at a table in front of him, some holding conversations under their breaths — a violation of the rule against talking but one tolerated by boot camp trainers through the years.
Though Weston’s dream of serving out his six-year contract is over, as is his hope to earn a college degree while in the Air Force, he still lives under military discipline — a 4:45 a.m. daily wakeup call, marching to the dining hall in formation and ending his sentences with “sir” or “ma’am.”
Weston’s blue armband tells trainers he is a recruit in need of continued medical care. He resents some of the trainees who wear orange armbands because they’re being banished from the Air Force for failing to meet the service’s standards. It may be that he envies the ones with green armbands because they’re working to improve their strength as part of Lackland’s “Get Fit” program.
They have hope of staying in the Air Force.
He’s on his way out, as soon as his case is resolved — which could be in as little as six weeks or as long as six months, he’s been told.
“We are all treated equally. There’s no difference in the way we are treated. Now, I didn’t choose to have cancer. I didn’t choose to get kicked out because of that, but I get treated the same as if somebody — I don’t think it’s right, I don’t think it’s fair,” Weston said.
He is seated at a table in a briefing room. Behind him to his left, a helmet rests atop a rifle beside a pair of desert combat boots — the traditional trappings used to honor a fallen soldier.
Finding himself in the same circumstance as recruits who flunked their drug test makes no sense to him.
“It really makes me mad,” Weston said, and then he began to cry.
“It’s like I get stereotyped in with them, and I didn’t do it,” he said. “I would give anything to switch, and I can’t. But all they worry about is, ‘Oh my God, I have three weeks left!’ And I’m sitting here, and I hope I can go home in three months, and I have a serious problem.”
source: http://www.mysanantonio.com/news/local_ ... kemia.html