Bobbie Bee can no longer contain her outrage after her husband was prescribed a drug that if taken in conjunction with his current cocktail of medications potentially could have raised his serotonin levels to dangerous heights, a risk that she says — and the FDA warns — “could’ve been deadly.”

“I can’t carry them all at once,” Bobbie J. Bee says over the unmistakable sound of pills individually bouncing off the sides of plastic bottling tubes as she walks in from her home’s kitchen and into the dining room.

She lays the containers out one-by-one.

“These are for nerves, anger and anxiety,” Bee says as she reads each bottle description carefully. “Those are so he can go to sleep; and these ones are so he can stay asleep.”

One pill for pain, another for vomiting. This one is for coping with the memories of lost friends. In total, the magic number is 16 pills a day, “And that’s not counting the injections…every month,” Bee says. “They’re for low testosterone…the meds cause it.”

“This is my life,” she adds, looking down at the pill bottles.

For Bee’s husband, former Marine Staff Sgt. William “Billy” Bee, this is his new standard operating procedure, and it has been for quite sometime. On most days, the pills help him get through the day; however, since May, his “episodes” as Bobbie Bee characterizes them, have been getting worse.

“I will wake up in the middle of the night and he will be in the bathroom vomiting,” she says, “Then there are some days when he becomes very distant and disoriented, where he doesn’t know what he’s doing and he will apologize to me and I will tell him, ‘It’s OK, it’s fine.’ But the episodes…when they come on, they last all day.”

The “episodes” have been occurring more frequently — the vomiting and migraines happen two and three times a week on average, according to Bobbie Bee, his caretaker.

“He doesn’t go to work (when the episodes occur). His boss knows about it and there’s been a few times where he has had to come home after vomiting on himself,” she says.

For Billy Bee, a Department of Veterans Affairs transition counselor and former infantry unit leader with Camp Lejeune’s 1st Battalion, 6th Marine Regiment, the pain does not stem from the iconic Thomas Reuter’s photograph taken of him and seen around the world during a firefight in the Garmsir district of Afghanistan 2008. Instead, it was just nine days before Billy was supposed to start his rotation back to the United States in 2010.

‘I don’t even remember doing it’

Billy walks out into the carport to tell the story, lighting a cigarette as the garage door opens to their street in Carolina Forest.

“There are still things I don’t want her to hear,” Billy says as he leans up against his garage bar table.

The fighting in Afghanistan 2010 was often an uphill battle to win over the populace and drive out the Taliban forces, especially after the Marine Corps’ invasion of Marjah in the southern Helmand province back in February. But now, Billy is just nine days from home and he’s not taking any chances.

“So (2nd Battalion, 6th Marine Regiment out of Camp Lejeune), our sister battalion comes in to relieve us and I was going to take them down south. I was like, ‘We’re not getting into any fights’ because we are ripping out on the 17th,” Billy says.

Billy is leading a squad of infantry Marines, along with squad leaders from 2/6, who are there to learn about the area. “The way it works” in his region, Billy explains, is the Taliban would see the Marines, which subsequently would launch a van that would drop off Taliban fighters.

“You would have like 10 minutes before (a firefight is) going down, so I wanted to show these new guys what happens.”

One of the Marines from 2/6 was Sgt. Derek L. Shanfield, 22, of Hastings, Pa; Billy had recruited Shanfield into the Marines years prior.

“I knew him since he had been a junior in high school, and he shows up on my patrol and I was like ‘I put this kid in,’” Billy said.

Billy took a squad of eight Marines into a building to wait for the Taliban to show up in order to teach the new Marines the Taliban’s tactics, the other members of his squad were on a building rooftop 100 meters north providing overwatch.

Shanfield and another 2/6 Marine, Sgt. Zachary J. Walters, were standing in the back right corner of the building when the Taliban van arrived, just as Billy said it would.

“So I’m like ‘OK, here we go’ and my (Designated Marksman) tells me his rifle is jammed and he can’t fix it,” Billy said. “So I walk over to him and rack the charging handle and then boom.”

Unbeknownst to the Marines and one Navy Corpsman in the room, sitting in the corner was an improvised explosive device (IED) that strung together approximately two or three other rocket propelled grenade rounds, a common tactic the Taliban uses in order to achieve a higher degree of destruction and death. The IED is victim operated, meaning one of the Marines stepped on the pressure plate — usually made of wood or even plastic drinking bottles — completing the fatal circuit.

“The shockwave knocked down the walls, the only two people still standing were my corpsman and my radio man. I was told that I was screaming into the radio my (medical evacuation) procedures, but I don’t even remember doing it,” Billy said, “All I remember is clearing a jammed round and then looking up at a CAT scan in the hospital.”

Shanfield and Walters, who had each been in Afghanistan for only two weeks were instantly killed. Billy told The Daily News that a Marine informed him later that “what was left of the Marines, only filled one trash bag.”

‘I am afraid he’s not going to wake up one day’

Life has not been easy for Billy and his family since that day five years ago, but it only gets worse as wait times, more unneeded prescription drugs and little Congressional action in reforming the crisis at the Department of Veterans Affairs continues to plague the government agency down to its local affiliates.

Specifically, Bobbie could no longer contain her outrage after her husband was prescribed a drug that if taken in conjunction with his current cocktail of medications potentially could have raised his serotonin levels to dangerous heights, a risk that Bobbie says, “Could’ve been deadly.”

“I was afraid that he was going to take this pill and wouldn’t wake up one day,” Bobbie said.

In July, Bobbie took to her Facebook page to express her frustration with the VA after a doctor there who specializes in internal medicine, prescribed Sumatriptan Succinate, a medication used for treating migraine headaches by narrowing the blood vessels in the brain for pain relief. Bobbie had called to ask for help regarding Billy’s Traumatic Brain Injury headaches.

Bobbie’s Facebook page read in part, “Thank goodness I pay very CLOSE attention to Billy’s medications (seeing as the VA obviously doesn’t check the interactions)…I URGE everyone to PLEASE check the medication interactions BEFORE taking that medication! Not today VA, NOT TODAY.”

Billy would be prescribed 100mg of Sumatriptan Succinate or what is commonly referred to as Imitrex to be taken twice a day along with the 16 other pills he already took daily for everything ranging from treating nerve pain and seizures to high blood pressure and vomiting.

One prescription, Paroxetine or what is known as Paxil, is an antidepressant medication used to treat chemicals in the brain that contribute to an individual’s depression, anxiety or post traumatic stress.

The FDA has warned that mixing common migraine drugs with antidepressants can cause serotonin syndrome, which increases the chemical levels of serotonin in the central nervous system. The human body naturally produces serotonin in order to regulate nerve cells, body functions and brain activity; however, having too much serotonin can cause mild symptoms, such as shivering and diarrhea to severe reactions that include fever, seizures and death, if left untreated, according to The American Journal of Psychiatry.

Dr. Harry Croft, a former Army Psychiatrist and member of the American Psychiatric Association who’s been practicing psychiatry for the past 41 years, told The Daily News that a patient developing serotonin syndrome from mixing medications is rare, but something that should be taken and monitored very closely.

“The warning that comes with drugs like Paxil and Zoloft, when mixed with drugs like Imitrex is a general warning that in theory, someone could develop serotonin syndrome…But in my 41 years of practicing psychiatry, I have never seen a case of serotonin syndrome being developed after mixing antidepressant medication with migraine medication,” Croft said.

Croft says that despite the rarity of a negative reaction, it is something that needs to be consistently monitored.

Croft also said that the multitude of different medications that veterans are prescribed needs to be reexamined.

“I have treated over 7,000 veterans for post traumatic stress and traumatic brain injuries and still see three to four veterans a day. And it’s just unbelievable the combination of medications they are on,” he said. “But it’s tragically not uncommon as we see the same thing in the civilian sector and I am not really sure those are needed.

“Part of the problem is we have lost ‘the captain of the ship’ you know, the old doctor that oversees everything a patient is getting prescribed,” Croft added. “People are going to three or four different specialists and before you know it, you’re on 15 or 16 different medications…I mean, if (Billy Bee) were my patient I would probably reevaluate the number of pills he’s on.”

The Department of Veterans Affairs in Fayetteville told The Daily News that it could not comment on a specific veteran’s case nor address hypothetical situations.

“However, many medications interact,” an email response from Fayetteville press officer Jeffrey Melvin read. “The VA system database informs clinical staff of potential drug interactions during the medication process. Ultimately, clinical staff must decide what is in the best clinical interests of the patient, evaluating the potential medication benefits against potential drug interactions and possible side effects. Clinicians then monitor patients as clinically appropriate for both treatment benefits and adverse reactions. Adjustments in treatments, if needed, are made as clinically appropriate.”

According to the email, the VA is a proponent of the “just culture” concept, recognizing human error and faulty systems can cause mishaps and supports investigations into causality versus assigning blame to a specific person. Additionally, the email says while the VA discourages assigning blame, the recognition of a “no-fault” system is in effect and seeks to mitigate mistakes through coaching and training — recommending disciplinary action only for “malicious or purposefully harmful behavior.”

Billy sees a bigger problem.

“The problem is not the people in Jacksonville, they are working as hard as they can,” he said. “It’s what’s happening (at the VA) on the national level that is screwing everyone over. …Until reform happens there, the wait times between appointments, the multiple pills veterans are pushed will continue for guys who are really suffering. … I’m lucky compared to them.”

Retrieved from: http://www.jdnews.com/article/20160103/NEWS/160109873