Hyperbaric Oxygen Therapy (HBOT) to Treat Veterans with PTSD

Veterans and casual observers continue to be mystified why the Department of Veterans Affairs (the “VA”) continues to insist on failed therapy programs to treat Veterans with PTSD.

Dr. David Cifu, the senior TBI specialist in the Department of Veterans Affairs’ Veterans Health Administration, argues that Veterans treated with Cognitive Behavioral Therapy and Prolonged Exposure Therapy are receiving the best therapy possible to treat PTSD.   There is no reliable third-party verification to support Dr. Cifu’s bold assertion.

More to the point, Dr. Cifu dismisses  other treatment alternatives arguing that there is no scientific basis to support them.  In particular, Hyperbaric Oxygen Therapy (HBOT) has been singled out for particular disdain by Dr. Cifu.

Specifically, the VA concluded their trial “study” with the following observations:

“To date, there have been nine peer-reviewed publications describing this research,” Dr. David Cifu, VA’s national director for physical medicine and rehabilitation recently told the Oklahoman. “All the research consistently supports that there is no evidence that hyperbaric oxygen has any therapeutic benefit for symptoms resulting from either mild TBI or PTSD.”

Frankly,  there is voluminous scientific evidence that HBOT is both a viable and recommended treatment alternative for Veterans suffering from PTSD and TBI.

Hyperbaric Oxygen Therapy (HBOT)

Hyperbaric Oxygen Therapy or HBOT is available at many privately-owned hospitals in the United States and around the world.  There is compelling scientific evidence that HBOT reverses brain damage.

In fact, HBOT is the preferred therapy of  the Israeli Defense Forces (“IDF”) for service members with head injuries.  Frankly, this assertion alone trumps any argument to the contrary by Dr. Cifu.

In its most simple form, HBOT is a series of “dives” in a decompression chamber (normally 40) where concentrated oxygen is administered under controlled conditions by trained physicians.  There is clear and conclusive evidence that brain function improves through the controlled application of oxygen.  In effect, it stimulates and may, in fact, regenerate brain cells at the molecular level.

HBOT Brain Functionality Over Time

In addition, HBOT is far cheaper to administer than currently approved programs at the VA.   Maj. Ben Richards argues that all Veterans with PTSD and TBI could be treated with HBOT for less than 10% of the VA budget allocated for pharmaceuticals.

More to the point, the annual VA treatment costs for Veterans with PTSD and TBI are roughly $15,000. For this annual expense, many Veterans could receive HBOT.

Dr. Figueroa asks, What are we Waiting For?

Almost 3 years ago, Dr. Xavier A. Figueroa, Ph.D., in an article entitled “What the <#$*&!> Is Wrong with the DoD/VA HBOT Studies?!!” clearly sets forth a compelling scientific argument why Veterans with TBI and PTSD should be treated with HBOT.

Found below is a summary of Dr. Figueroa’s conclusions (footnotes removed):

A large fraction of the current epidemic of military suicides (22+ service members a day take their lives) are more than likely due to misdiagnosed TBI and PTSD. Although the DoD and VA have spent billions (actually, $ 9.2 billion since 2010) trying to diagnose and treat the problem, the epidemic of suicide and mental illness are larger than ever. Drug interventions are woefully inadequate, as more and more studies continue to find that pharmacological interventions are not effective in treating the varied symptoms of TBI or PTSD. In many cases suicide of veterans have been linked through prescribed overmedication.

HBOT is a safe and effective treatment with low-to-no side effects (after all, even the DOD accepted the safety of HBOT back in 2008). Access to HBOT is available within most major metropolitan centers, but the major sticking point is money. Who pays for the treatment?  Those that are willing to pay for it out-of-pocket and state taxpayers picking up the tab for brain-injured service members forced back into society without sufficient care (or forced out on a Chapter 10, when it should have been treated as a medical condition).

The continued reports of studies like the DoD/VA sponsored trials allow denial of coverage and provide adequate cover for public officials to claim that more study needs to be done. As we have seen, the conclusions of the authors of the DoD/VA sponsored studies downplay the results of effectiveness. There are sufficient studies (and growing) showing a strong positive effect of HBOT in TBI. More will be forthcoming.

The cardinal rule of medicine is “First, Do No Harm”. With HBOT, this rule is satisfied. Now, by denying or blocking a treatment that has proven restorative and healing effects, countless physicians and organizations, from the VA to DoD, Congress and the White House, could be accused of causing harm. Never mind how many experiments “fail” to show results (even when they actually show success). Failure to replicate a result is just that…a failure to replicate, not a negation of a treatment or other positive results. You can’t prove a negative and there are many clinical trials that do show the efficacy of HBOT.

The practice of medicine and the use of HBOT should not be dependent on the collective unease of a medical profession and the dilatory nature of risk adverse politicians, but on the evidence-based results that we are seeing. Within the VA, there are hard working physicians that are trying to change the culture of inertia and implement effective treatments for TBI and PTSD, using evidence based medicine. Unfortunately, evidence-based medicine only works when we accept the evidence presented to us and not on mischaracterized conclusions of a single study (or any other study). Our veterans, our citizens and our communities deserve better than what we are currently giving them: bad conclusions, institutions too scared to act in the interests of the people it serves and too many physicians unwilling to look at the accumulated evidence.

Indeed, it is time to for Dr. Shulkin to rid the VA of Dr. Cifu and embrace cost-effective treatment therapies which provide some hope for Veterans with PTSD and TBI.

SFTT Military News: Week Ending Apr 21, 2017

Found below are a few military news items that caught my attention this past week. I am hopeful that the titles and short commentary will encourage SFTT readers to click on the embedded links to read more on subjects that may be of interest to them.

If you have subjects of topical interest, please do not hesitate to reach out. Contact SFTT.

Kim - North Korea

Grim Military Options Available in Confrontation with North Korea
Three weeks before becoming president, Donald Trump weighed in on the threat of North Korea developing a nuclear warhead capable of reaching the U.S.: “It won’t happen,” he vowed on Twitter. Now planners are contemplating what a U.S. strike to prevent that development might look like, and the options are grim.Analysts estimate North Korea may now possess between 10 and 25 nuclear weapons, with launch vehicles, air force jets, troops and artillery scattered across the country, hidden in caves and massed along the border with South Korea. That’s on top of what the U.S. estimates to be one of the world’s largest chemical weapons stockpiles, a biological weapons research program and an active cyberwarfare capability.  Read more . . .

New Russian Military Base in the Arctic
Visitors to the Russian defense ministry website can now take a “virtual tour” of a new military base in a remote region of the Arctic. The Arctic Trefoil permanent base is in Franz Josef Land, a huge ice-covered, desolate archipelago. The Russian military sees the resource-rich Arctic as a key strategic region. President Vladimir Putin visited the new base, on Alexandra Land, last month. It is built on stilts – to help withstand the extreme cold – and will house 150 personnel on 18-month tours of duty. Winter temperatures typically plunge to minus 40C.  Read more . . .

Head Injuries Can Alter Hundreds of Genes
Head injuries can adversely affect hundreds of genes in the brain that put people at high risk for diseases including Alzheimer’s, Parkinson’s, post-traumatic stress disorder, stroke, ADHD, autism, depression and schizophrenia, life scientists report. The researchers have identified for the first time potential master genes which they believe control hundreds of other genes that are linked to many neurological and psychiatric disorders.  Read more . . .

Veterans with PTSD

New Study Suggests “Post-Traumatic Growth” after PTSD
A new study of military veterans who went through trauma finds that those veterans who have related post-traumatic stress disorder (PTSD) are also more likely to experience ‘post-traumatic growth’ — such as an increased appreciation of life, awareness of new possibilities and enhanced inner strength.   Read more . . .

New Bill May Provide Veterans with Greater Private Care Health Options
President Donald Trump signed a bill Wednesday to temporarily extend a program that lets some veterans seek medical care in the private sector, part of an effort by the president to deliver on a campaign promise. The extension will give Veterans Affairs Secretary David Shulkin time to develop a more comprehensive plan to allow veterans to more easily go outside the VA health system for care. Under the bill Trump signed into law, the VA will be allowed to continue operating its Choice Program until the funding runs out, which is expected early next year. The program was scheduled to expire on Aug. 7 with nearly $1 billion left over.  Read more . . .

New VA Facility in Waco, Texas Targets Brain Injuries
Waco’s Doris Miller Department of Veterans Affairs Medical Center now can provide the gold standard in research and treatment for brain injuries suffered on the battlefield with Thursday’s opening of a 53,000-square-foot facility for the VISN 17 Center of Excellence for Research on Returning War Veterans that sprawls across three floors of Building 93. More than 150 people attended a grand-opening ceremony to mark the occasion, and U.S. Rep. Bill Flores said the Waco VA will become a hub for dealing with the invisible wounds of post traumatic stress disorder and traumatic brain injury that have become part of this country’s global war on terror.  Read more . . .

Drop me an email at info@sftt.org if you believe that there are other subjects that are newsworthy.

Feel you should do more to help our brave men and women who wear the uniform or our Veterans? Consider donating to Stand For The Troops

Opioid Abuse: Department of Veterans Affairs Culpability?

While many families will be celebrating Easter today, I am quite sure that their thoughts will turn to a family member or friend who were among the 52,000 that died of a drug overdose last year.

By comparison, there were only 33,000 traffic fatalities over the same period.  These statistics suggest that substance abuse plays a far greater threat to our society than careless driving.

In an excellent 5-part series by FOX News entitled “Drugged, Inside the Opioid Crisis,” the network explores the devastating impact of opioid abuse in towns across the United States.

In fact, the FOX network claims that 4 out of 5 overdose fatalities can be traced to the initial use of prescription drugs for pain medication.   It is clear that prescription painkillers have caused many innocent victims to become dependent on more lethal drugs like heroin.

Temazepam_10mg_tablets-1

As Stand for The Troops (“SFTT”) has been reporting for several years, Veterans suffering from PTSD have been regularly over-served with a concoction of drugs – primarily opioids – to allow them to cope with pain and other issues.

If there was any doubt about the culpability of the Department of Veterans Affairs (“the VA”) in addicting our Veterans to painkillers rather than treat them, I suggest that you watch the video below:

With 20-20 hindsight most everyone can be on the “right side of history,”  but our Veterans, the VA and Congressional oversight committees have known that opioids was not the proper way to treat Veterans suffering from PTSD and TBI.

Dr. David Cifu:  A State of Denial at the VA

Unfortunately, VA protocols to treat PTSD as articulated by Dr. David Cifu, the senior TBI specialist in the Department of Veterans Affairs’ Veterans Health Administration, have resulted in few lasting benefits for Veterans with PTSD.  Paraphrasing Dr. David Cifu,  “the worse thing you can do for someone with PTSD is not to press them back into action as quickly as possible.  At the VA, we prescribe drugs for those in pain or suffering trauma.”

Indeed, there is no compelling evidence that the VA has improved the lives of Veterans suffering from PTSD or TBI.  

The VA continues to push its stale and failed agenda that states that the only two effective treatment therapies offered by the VA are:

- Cognitive Behavioral Therapy and,

- Prolonged Exposure Therapy.

To see how badly the VA has failed our Veterans, one only needs to listen to a detailed explanation by Maj. Ben Richards citing his experience with the VA and a summary of failed patient outcomes at the VA. Watch the first two minutes to see Maj. Richards refute all VA claims that they are dealing with the problem effectively.

Conversation with a Veteran Drug Abuse Specialist

Several years ago, I had the opportunity to visit a Community Center in northern New York that was working with high-risk Veterans suffering from PTSD and TBI.  During this visit, I encountered a Drug Abuse Specialist, who had been rescued from addiction through the Veteran Court System.

What he told me shocked me.

- Well over 90% of Veterans returning from Iraq and Afghanistan suffer from substance abuse issues;

- Veterans are well aware that opioids don’t work and have major side-effects (i.e. suicidal thoughts) when combined with other prescription drugs provided by the VA;

- Rather than flush prescription drugs down the toilet, the drug of choice, OxyContin, was pulverized into powder and sold on the black market to civilian drug users;

- A leading supplier of OxyContin to the VA had its sales of the drug fall by more than 60% when Congress forced them to repackage the pills in a gel composite so it couldn’t be sold as a powder on the black market;

- This same pharmaceutical company petitioned Congress to reinstate OxyContin in pill form citing that “it is more effective than gel;”

- VA prescribed drugs don’t provide Veterans with a meaningful road to full recovery.

Sadly, I don’t believe the situation has changed significantly in recent years.

Opioid Abuse in the United States

The magnitude of the addiction problem in the United States can’t be underestimated.  Consider these staggering statistics from the American Society for Addiction Medicine (ASAM):

- Drug overdose is the leading cause of accidental death in the US, with 52,404 lethal drug overdoses in 2015. Opioid addiction is driving this epidemic, with 20,101 overdose deaths related to prescription pain relievers, and 12,990 overdose deaths related to heroin in 2015.

–  The overdose death rate in 2008 was nearly four times the 1999 rate; sales of prescription pain relievers in 2010 were four times those in 1999; and the substance use disorder treatment admission rate in 2009 was six times the 1999 rate.

– In 2012, 259 million prescriptions were written for opioids, which is more than enough to give every American adult their own bottle of pills.

– Four in five new heroin users started out misusing prescription painkillers.

– 94% of respondents in a 2014 survey of people in treatment for opioid addiction said they chose to use heroin because prescription opioids were “far more expensive and harder to obtain.

Opioids for Veterans: Deja Vu All Over Again

It’s often said that the definition of insanity is doing the same thing over and over again and expecting a different outcome.  As previous articles from SFTT have argued, the VA is in a rut and will continue to pursue well-meaning but demonstrably ineffective procedures to help Veterans with PTSD.  Most tragic.

While one would think that there is compelling evidence for the VA to follow in a different tack, I read a few days ago that OxyContin is again being tested to treat PTSD and substance abuse.

How much longer to our Veterans need to suffer from the VA bureaucracy and autocratic controls that remains largely unresponsive to their very real needs?   Based on the evidence, it seems that the VA management philosophy of benign neglect will continue to persist.  How sad!

Easter Advice from Veteran Wives Who Care

On Facebook, I recently came across this wonderful advice from Wives of PTSD Vets and Military.  I quote this useful advice below:

“If there is anything you have learned from your experience that you would tell those who are new to PTSD and the VA, what would it be?

Just A FEW of mine would be:

1. Staying on top of the VA and the veteran’s care is a full time job by itself. It is important to stay on top of it or they will fall through the cracks. Don’t wait for the VA to call. You call the VA.
2. Always research the severe side effects, and interactions of ALL medications including over the counter.
3. Always be aware of their moods, anniversaries (if possible), and seek help if you see them slipping downward.
4. Have a safety plan.
5. Find ways to communicate with your spouse. Use of code words, safety words etc are extremely helpful for us. Our new one is trust tree, which means either one of has something important to say, and the other one can’t judge, flip out, or start an argument. So far, it’s working. I’ll make a post later for it.

These are only a few off the top of my head. I have a lot more in depth ones that I will write about after while. What things have you learned or did you wish you knew when starting this roller coaster ride called PTSD?”

While one can only hope that this pragmatic spouse finds a sympathetic ear at the VA, “effective treatment” still seems out of reach.

In summary, may our brave Veterans and their families and friends get the HONEST SUPPORT THEY DESERVE.

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