Meet Maj. Ben Richards and Bronco, his Service Dog

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I had a delightful lunch yesterday with Maj. Ben Richards and Bronco, his service dog.  Also joining us for lunch were Eilhys England, Chairperson of Stand for the Troops (“SFTT”) and Dr. Yuval Neria, Director of the PTSD Research Program at Columbia Presbyterian.

Maj Ben Richards and Service Dog Bronco

I hadn’t seen Bronco (a labradoodle) before and was interested in learning how service dogs are trained.

After the dogs reach maturity – normally 6 months – they begin an intensive 5 month training program designed to familiarize the service dog with elements of supporting a human being. For instance, the dog has to learn to navigate elevators and escalators and to respond to potential danger signals which could cause panic in the dog’s human companion.

A well-trained service dog is not distracted by peripheral events like the presence of other dogs or animals and will avoid eating food that has been dropped on the floor.

After the service dog has successfully completed his training, the certified service dog is then introduced to his/her human companion.  Ben spent seven weeks in intensive training with Bronco.  According to Ben, it was about 4 hours of training a day (generally in the morning) and a few weekend sessions.

Ben and Bronco have been constant companions for almost a year.  Ben mentioned that it is the first time in 9 years he has been able to sleep without facing the door of his bedroom.  Bronco will also wake him up if he has nightmares or if thunder is approaching which might threaten sleep and trigger an anxiety attack.

Bronco has allowed Ben to feel comfortable enough to attend movies and, in fact, he went to a museum in D.C. by himself for the first time in several years.   The museum visit brought a small to Ben’s face as he recalled that it was the first time he didn’t feel like he had to process potential threats without the attendant anxiety of not being able to do so fast enough.

Ben looked great and it was wonderful to re-establish personal contact with him again.  Ben is a brave warrior who has suffered his own particular demons and is intent on helping others recover their lives from the silent wounds of wars.

Ben’s service dog has brought much needed comfort, safety and stability to his life.

Sadly, the VA is “studying” the efficacy of service dogs in helping other Veterans with PTSD.  This study will not be available until 2019.

What the VA should actually be studying are its own failed programs of Prolonged Exposure (PE), and Cognitive Processing Therapy (CPT) which the VA continues to tout as being so successful in helping Veterans with PTSD.

While VA administrators and consultants like Dr. David Cifu can continue to hoodwink Congressional committees with their disingenuous sales pitch, most Veterans have given up on the VA with their substandard and largely ineffectual services.

Many Veterans like Ben are gradually taking matters into their own hands despite threats by the VA to withdraw benefits.  Fortunately, many States, private hospitals and charitable institutions are rushing in to fill the void left by the VA.

Is it too much to expect that the VA step up to the plate and truly support Veterans rather than hand grants to people and institutions who are prepared to parrot a pollyanna party-line based on half-truths and downright lies?

Our brave men and women in uniform deserve better.

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Did the VA Hook Veterans on Opioids?

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Recent information suggests that 68,000 Veterans are addicted to some form of opioid (hydrocodone, oxycodone, methadone and morphine).  The VA argues that “more than 50 percent of all veterans enrolled and receiving care at the Veterans Health Administration are affected by chronic pain, which is a much higher rate than in the general population.”

Oxycontin and PTSD

According to the Center for Investigative Reporting obtained under the Freedom of Information Act,

. . . prescriptions for opioids surged by 270 percent between 2000 and 2012, leading to addictions and a fatal overdose rate that was twice the national average.

Citing a VA Office of Inspector General’s report, the Center for Ethics and the Rule of Law (CERL) said: “Between 2010 and 2015, the number of veterans addicted to opioids rose 55 percent to a total of roughly 68,000. This figure represents about 13 percent of all veterans currently prescribed opioids.”

The American Society for Addiction Medicine reports these startling facts on the opioid epidemic currently sweeping the U.S.

– 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.

– From 1999 to 2008, overdose death rates, sales and substance use disorder treatment admissions related to prescription pain relievers increased in parallel. 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.

While evidence provided by the Center for Controlled Disease and Prevention (CDC) suggests that the use prescription opioid painkillers has fallen some 41% since its peak in 2010, some 33,000 Americans died last year from addiction to opioids.  The addiction to prescription painkillers like Vicodin (hydrocodone) and Percocet (oxycodone) are rampant in the U.S.

The VA and Prescription Drugs for PTSD

For well over 5 years, Stand for the Troops (“SFTT”) has been reporting on the Department of Veterans Affairs (“the VA”) fascination with potent prescription drugs to treat Veterans with PTSD.

Despite the VA’s dismal record in effecting any meaningful change in patient outcomes, a cocktail of prescription drugs (generally opioids) are often the last resort since the VA’s Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT) treatment programs have proved largely unsuccessful.

In what continues to be standard SOP, the VA perseveres in treating the symptoms of PTSD without offering any compelling life-changing treatment alternatives.  In effect, the VA is tacitly admitting “we don’t have a clue,” while arguing that they are providing the best therapy available and to seek funding for new “clinical” studies that address symptoms and not causes (i.e. cannabis, for instance) of PTSD and TBI.

In our research (mostly anecdotal but with those “in the know”), SFTT discovered that many Veterans treated with prescription opioids for PTSD would become violent and often suicidal.  In fact, they would often either discard these potent drugs (“flush them down the toilet”) or sell them on the black market to civilians.

One former Veteran explained that his colleagues would often grind up oxycontin pills into a powder and sell it on the black market for approximately $500 a month.  So prevalent was this behavior, that the government forced a large pharmaceutical company to produce oxycontin only in gel.  The result:  sales at the pharmaceutical company dropped 60% once the black market disappeared.

Personally, I think the FDA and the pharmaceutical industry effectively colluded into turning many Veterans and a large percentage of our population into junkies.

The Rationale?:  The level of addiction in the U.S. and easy access by the public to potent prescription drugs is simply unprecedented if compared to other countries.

How to Fix the VA’s Opioid Credibility Problem

It is sad to read the daily stories of spouses and loved ones deal with ravages of PTSD.  A few days of reading the Facebook page of “Wives of PTSD Vets and Military” will give you some idea of the ravages of the silent wounds of war.

Sure, we can continue to medicate these Veterans and military personnel with prescription drugs to deal with the symptoms, but I would far rather see an attempt to reverse the causes of debilitating brain injury rather than mask the symptoms.

There are several noninvasive solutions used by other countries.  First and foremost is hyperbaric oxygen therapy or HBOT that is widely used by the IDF.  For reasons that seem incomprehensible, the DoD claims that there is no scientific evidence to suggest that HBOT is effective.

Gosh, there doesn’t seem to be much evidence that suggests that prescription opioids, Prolonged Exposure (PE), and Cognitive Processing Therapy (CPT) are effective either.  Yet, the VA continues to push it’s stale and misleading agenda that it is providing our Veterans with the best available treatment programs.

Surely, we can do better than “talk the talk.”  Let’s look for real solutions.  If it can’t be found in the VA, let’s give the private sector an opportunity to help our brave Veterans.

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Veterans Affairs On The Fence for Service Dogs

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Almost every day one hears a moving story of how Veterans with PTSD and other debilitating injuries are provided comfort and support by service dogs.

Service Dogs for PTSD

Photo via Pixabay by Skeeze

Nevertheless, the Department of Veterans Affairs (“the VA”) continues to argue that there is little  scientific or clinical evidence to confirm that service dogs benefit Veterans in a meaningful way.

“I would say there are a lot of heartwarming stories that service dogs help, but scientific basis for that claim is lacking,” said Michael Fallon, the VA’s chief veterinary medical officer. “The VA is based on evidence based medicine. We want people to use therapy that has proven value.”

The argument is a brief synopsis of Dr. Fallon’s testimony to the House Subcommittee and Government Reform provided in April, 2016.

In his written testimony, Dr. Fallon goes on to state the following:

The VA/Department of Defense Clinical Practice Guideline recommends trauma-focused cognitive behavioral therapy [such as Prolonged Exposure (PE), and Cognitive Processing Therapy (CPT)], Eye Movement Desensitization and Reprocessing, stress inoculation, selective serotonin reuptake inhibitors, and venlafaxine, a serotonin norepinephrine reuptake inhibitor, as primary treatments for PTSD. PE and CPT are among the most widely studied types of trauma-focused cognitive behavioral therapy. Evidence demonstrating their effectiveness is particularly strong.

As SFTT has reported on numerous occasions, Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT) have been largely ineffective in reversing brain damage to Veterans suffering from PTSD and TBI.

Specifically, the VA has very little evidence to show that PE and CPT therapy programs have done much to reduce the incidence of PTSD symptoms among Veterans against the “gold-standard” standardized PCL-M tests currently used by the VA.   The chart below illustrates the point (50 is considered base level):

Veterans Affairs Fails at PTSD

Aside from being very expensive to administer, the “evidence based medicine” supporting the effectiveness of PE and CPT programs currently administered by the VA is SADLY LACKING.

It is not unusual in the scientific community that promotes the effectiveness of the VA to apply fuzzy logic to alternative treatment programs.   In fact, there is a propensity among advocates to search for pharmacological solutions rather than embrace alternative therapy programs.

As one who has watched this charade play itself out on the big stage of public opinion, it is difficult for me to accept the argument that new pharmacology alternatives outcomes will be any different than the VA’s embrace of OxyContin to deal with the symptoms of PTSD.

Whether it is dog or equine therapy or hyperbaric oxygen therapy (“HBOT”), Veterans are seeking out alternatives that are largely discredited by the VA.   In fact, one NIH researcher suggests argues that

Research also suggests further opportunities for the VA and other health care systems to develop new and innovative ways to overcome barriers to treating veterans with PTSD. With veterans and their families increasingly seeking care outside of the VA system, community providers play a key role in helping to address these challenges. It is critical they receive the education, training, and tools to improve their understanding of and skills for addressing the needs of this unique population.

It is difficult to understand that it should take 10 years to test the efficacy of using service dogs to help Veterans with PTSD.  Similarly, I recently learned that suspect test conditions used by the DoD to evaluate HBOT several years ago have prevented the VA from offering Veterans this life-changing service.

The VA continues to be its own worst enemy in helping provide Veterans with a lasting solution to their brain injuries.

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What do NFL and Military Helmets Have In Common?: Not Much!

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Like many, I am moved by the tributes paid to military Veterans and active service members at NFL games.  Nevertheless, both the NFL and the military have come under sharp criticism regarding the number brain injuries suffered on both the playing field and battlefield.

chronic_traumatic_encephalopathy

Both the NFL and military have stonewalled the problem for many years, but it now appears that the NFL is taking action to introduce a “safer” helmet in the hope that they can reduce concussions and permanent brain injuries for professional athletes. Hopefully, better protective gear will work its way through college and high school football programs.

The Vicis Zero1 helmet has now been purchased by 25 NFL teams and will be introduced during the 2017 season. According to initial press releases:

In testing against 33 other helmets to measure which best reduces the severity of impact to the head, the Vicis ZERO1 finished first. Included in the study were helmets from Schutt and Riddell, which currently account for approximately 90 percent of helmet sales.

Vicis was founded by neurosurgeon Sam Browd and Dave Marver, former CEO of the Cardiac Science Corporation, with the goal of reducing the high rate of concussions in football. While it would take years of play and further studies to conclusively prove that they’ve been successful, the studies show that they’re on their way to making an impact.

Found below is a video explaining how this helmet helps provide additional protection to football professionals:

While the safety requirements for battlefield and football helmets differ significantly, it does appear that the NFL has acted a lot quicker than the military to protect its professionals.

Reducing brain injuries at their point of origin is far preferable to treating neurological damage to sensitive brain cells in the aftermath.

The US Army – and other DoD components – have long been aware that current helmets offer battlefield personnel little protection against IED devices typically found in Afghanistan and in the Middle East.  Indeed, SFTT has been reporting on various studies by the military embedding sensors into military helmets.

According to my calculation, the US Army has over 10 years of sensor data to draw on.  Surely, this is sufficient to draw some conclusions and develop a better-designed helmet capable of providing additional protection against concussive brain injury.

While the military continues to “study” the issue, it is encouraging to see the NFL to take action.  Frankly, I don’t buy the NFL sales pitch that the league rushed in to protect the health and safety of its players.  If true, they would have done so long ago when the NFL first started studying brain injuries.

As the New York Times reported earlier, the NFL leadership buried extensive “concussion” evidence collected between 1996 and 2001 to deflect potential claims by former NFL players who had suffered brain damage.

As we have seen in the case of body armor,  DoD leadership and the NFL have much in common:  a strong propensity to hide the facts from their employees and the public at large.

While one can find many faults in the way the NFL leadership has acted “to protect the safety of its players” and the integrity of their franchise, NFL teams are now treating brain injuries far more seriously than the DoD.

In addition to helmets, several NFL teams are now treating players with suspected brain injury with hyperbaric oxygen therapy (HBOT).    Sadly, the Department of Veterans Affairs continues to block the use of HBOT in treating Veterans with PTSD and TBI.

Could it be that DoD personnel charged with evaluating HBOT therapy failed to employ the proper protocols in 2010 clinical testing procedures?  If so, why?

SFTT remains hopeful that both the VA and the DoD will act quickly to introduce helmets that afford more protection to battlefield personnel and approve HBOT as an acceptable treatment procedure for PTSD and TBI.

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Hyperbaric Oxygen Therapy (HBOT) by Grady Birdsong

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Hyperbaric Oxygen Therapy HBOT Grady BirdsongGrady Birdsong, a USMC Veteran from Vietnam, has co-authored a book with Col. Robert Fisher (USMC – Ret) that deals with hyperbaric oxygen therapy (“HBOT”) entitled “The Miracle Workers of South Boulder Road:  Healing the Signature Wounds of War.”

The book is a 2016 Best Book Awards finalist and details how HBOT helps reverse the damage of traumatic brain injury.   In a must-hear interview, Grady Birdsong explains his experience with HBOT (and now his advocacy)  to Jerry Fabyanic on his “Rabbithole” program at KYGT in the Idaho Springs/Denver area.

Grady Birdsong spikes up interest in hyperbaric oxygen therapy with a down-to-earth radio interview with KYGT Radio with the following introduction:

In our advocacy campaign to make this clinic and treatment known, I had the good fortune of being interviewed on KYGT Radio over the weekend by Jerry Fabyanic on his “Rabbithole” program in a mountain town close to Denver. He has so graciously provided me with a link to that interview about our book. We most gratefully appreciate his voice and his audience at KYGT in the Idaho Springs/Denver area. Likewise my close friend and veteran Marine, David T. “Red Dog” Roberts, 1st Bn, 4th Marines, Delta Company in Vietnam and his Doc, Corpsman, Kenneth R. Walker produced two songs that are complementary to this advocacy of healing the signature wounds of war. You will hear them in the interview.

CLICK HERE for the entire and very educational 50+ minute podcast.

SFTT has long recommended the use of hyperbaric oxygen therapy or HBOT to treat Veterans with the symptoms of PTSD and TBI.  There are many studies that prove conclusively that the supervised application of HBOT helps improve brain function and restores cognitive abilities.

While Mr. Birdsong points out the many restorative benefits of HBOT, follow-up supervision is recommended to help deal with some of the symptoms of PTSD.

Sadly, in many online forums dealing with the ravages of PTSD, most military families are unaware of the benefits of regular supervised “dives” in HBOT chambers.  I would argue that the Department of Veterans Affairs has purposely discredited the use of HBOT in treating PTSD and TBI to promote their own failed agenda and the prevalent use of addictive prescription drugs.

One only needs to listen to the likes of Dr. David Cifu, Senior TBI Advisor to the Department of Veterans Affairs, to see the cynicism and blatant disregard for clinical evidence adopted by the VA against HBOT.   One can only speculate why, but HBOT seems to offer Veterans a far better solution than the cocktail of drugs served up by the VA.

Found below is a very moving and instructional video by Grady Birdsong of a young woman who “recovered her life” from the “signature wounds of war” with the use of HBOT:

Thanks to the effort of Grady and many other dedicated Veterans, we can all join together and help Veterans reclaim their lives. It is simply the right thing to do!

Nevertheless, the benefits of HBOT will not be widespread until the restrictive and self-serving barriers to this treatment are adopted and encouraged by the VA. Secretary Shulkin of the VA wants change to occur at the VA.  What better way to demonstrate his commitment to reducing Veteran suicides than by embracing HBOT to treat PTSD?

If you want to learn more about how HBOT can be used in treating PTSD and TBI, I suggest that you purchase The Miracle Workers of South Boulder Road:  Healing the Signature Wounds of War.  Share it with family and friends to encourage them not to give up hope on our brave Veterans.

For those tired of watching the lives of loved one end in pain, depression and hopelessness; write Dr. Shulkin and members of Congress and ask for action.  Don’t allow naysayers and self-serving bureaucrats like Dr. Cifu block Veteran access to HBOT.

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Veterans with PTSD Knew that VA Opioid Prescriptions Were Wrong

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After many lives of many brave Veterans with PTSD have been lost, the State of Ohio has finally taken action against pharmaceutical drug companies for hyping opioids.

Opioids

According to the New York Times reporter,  

The State of Ohio filed a lawsuit on Wednesday against the pharmaceutical industry over the opioid epidemic, accusing several drug companies of conducting marketing campaigns that misled doctors and patients about the danger of addiction and overdose.

Defendants in the case include Purdue Pharma, Teva Pharmaceutical Industries, Johnson & Johnson, Endo Pharmaceuticals, Allergan and others.

Purdue, the maker of OxyContin, a time-release opioid, released a statement saying, “We share the attorney general’s concerns about the opioid crisis and we are committed to working collaboratively to find solutions,” and calling the company “an industry leader in the development of abuse-deterrent technology.”

As most Veterans treated by the Department of Veterans Affairs (“the VA”) are aware, opioids were the prescription of choice for Veterans suffering from PTSD.

Despite overwhelming evidence available to the VA and the Department of Defense (the DOD) that this was probably not a wise course of action, the VA persisted in treating the symptoms of PTSD with dangerous prescription drugs.

It is only now with opioid and drug addiction ravishing communities across the United States that some local and State governments are beginning to take action.  In the interim, thousands of Veterans with PTSD have suffered through over-medication with opioids by doctors at the VA.

More to the point, the VA continues to insist on dated and ineffective treatment programs for Veterans with PTSD and TBI.   Under the inept counsel of Dr. David Cifu, these same treatment therapies continue at the VA today.

It is difficult to predict when this tragic saga will end, but clearly there are no indications that the VA plans to make any substantial changes to current programs.  As such our brave Veterans will continue to receive the same flawed therapy and, most likely, a healthy supply of prescription drugs to mask the symptoms.

Where are our leaders in Congress and leaders within the VA to put an end to this tragedy?  Cynical though I am, I have a difficult time believing that Big Pharma political campaign donations would be the reason.

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Hyperbaric Oxygen Therapy (HBOT) to Treat Veterans with PTSD

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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.

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Opioid Abuse: Department of Veterans Affairs Culpability?

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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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Will the VA Provide Better Service to Veterans?

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With much fanfare, Dr. David Shulkin, the new Secretary for the Department of Veterans Affairs (“the VA”), has moved quickly to address some of the recurring problems at the VA.

Dr. David Shulkin, VA Secretary

As the first VA Secretary without a military background, Dr. Shulkin appears committed to resolve several pressing concerns:

– Speedier processing of Veteran benefit claims and,

– Eliminate unnecessary bureaucracy and artificial constraints on “out-of-network” support for Veterans (Choice Program).

Indeed, Secretary Shulkin recently unveiled a 10 Point Plan to modernize the VA:

1. Firing bad employees

2. Extending the Choice program

3. Choice 2.0

4. Improving VA infrastructure

5. ‘World-class’ services

6. Better VA-DoD partnerships

7. Better electronic records

8. Stopping suicide

9. Appeals modernization

10. Internal improvements 

While there is little in these Powerpoint presentation bullet points that anyone would quibble with, implementing these broad goals tends to be far more complicated than listing the goals.   Unless there are rigorous benchmarks to assess progress toward achieving these goals, then this “goal-setting” exercise is rather fruitless.

In fact, it is difficult to reconcile the need for increased hiring within the VA unless one sees clear and conclusive evidence that “bad employees” are being fired.  In fact, the VA is recommending a hiring surge to deal with a backlog of benefit claims, a situation that has persisted for 4 years.

Are more employees needed or does the VA lack the “right” mix of employees to implement Shulkin’s 10 point plan?

For instance, State and Local VA coverage varies radically across the US.  For example, NPR reported in 2015 “that spending is nearly $30,000 per patient in San Francisco, and less than $7,000 per patient in Lubbock, Texas. Nationally, the average is just under $10,000. In places where more veterans are enrolled in VA health benefit plans, spending per veteran did tend to be higher.”   Why?  This is a huge variance that is not well explained.

Aligning the VA to Achieve Measurable Goals

As one looks at Shulkin’s proposed goals, it would be useful to determine their priority and the level of commitment (personnel and capital expenditure) that is required to attain them.  Furthermore, what are the benchmarks to chart progress toward achieving those goals.

For instance, “stopping Veteran suicides” is a goal that would find few naysayers.  Nevertheless, it is difficult to reconcile that goal with the sad fact that 30% of suicide watch calls are not currently attended by the Veteran Crisis Center.  Indeed, I find it disturbing that the Suicide Crisis Line has been centralized under the VA in the name of “efficiency.”

Perhaps, Dr. Shulkin and his staff have some measurable goals.  If so, they should be made public and both the Executive Body and Congressional Oversight Committees should receive regular updates from the VA on progress to date in achieving mutually agreeable goals.

Is this likely to happen?  Most certainly not!  This is an anathema to Big Government.

Is Firing Bad Employees Really Going to Occur?

With 365,000 employees, there are certainly going to be a few “bad eggs.”  While Dr. Shulkin praised the vast majority of VA employees, he told a cheering crowd  that “We’re going to make sure that the secretary has the authority to make sure that those (sic “bad”) employees … are leaving the VA system.”

J. David Cox

J. David Cox

Really?  It seems to anyone who has taken more than a cursory look at staffing within the VA, that David Cox, the President of the American Federation of Government Employees, will be calling the shots rather than Dr. Shulkin.

In most cases, distinguishing between a “bad” employee and an inefficient one is largely subjective.  Given the protection afforded by employees at the VA, it is highly unlikely that both the bad and inefficient employees will be “leaving the VA system” anytime soon.

In effect, this places a greater burden on both ” the good” and the many efficient and competent employees within the VA.  With little say or control on managing the workforce, I find it highly unlikely that Dr. Shulkin will be able to fulfill his promise to fire “bad” employees.

More importantly, it is unlikely that he will be able to realign staffing levels to implement his 10-point plan.

And Speaking of Bad Apples:  How About Dr. David Cifu?

If Secretary Shulkin is really serious about dealing with “Veteran suicides” and providing Veterans with alternative treatment for Veterans with PTSD, he would do well to question the credentials of Dr. David Cifu and others within the VA who continue to block Veteran access to better treatment alternatives.

When one looks at Secretary Shulkin’s complex agenda, one should focus on the signs that change is actually occurring.  Personally, I don’t expect to see much change over the next couple of years, unless there are clear bookmarks to measure that change.  Sadly, it seems likely that we will be looking at the same litany of complaints a couple years down the road.

Dr. Shulkin, I admire your bravado and enthusiasm, but question whether you have the right tools and authority at your disposal to bring about a much needed reform within the VA.

Veterans should be hopeful, but not too optimistic.

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Techniques to Help Veterans Minimize Chronic Pain

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Dealing with chronic pain can be quite a . . . pain.  Chronic pain is defined as any pain that lasts longer than 6 months, chronic pain can be moderate or unbearable; episodic or continuous. Of course, whether due to past injuries, strain from overuse, or just general wear and tear, chronic pain is common amongst military Veterans.

Caregiver for Veteran with PTSD

On days when the pain is debilitating, you may not want to get out of bed. It may seem as though you are fighting a losing battle against the pain, but your quality of life can be restored. More importantly, it can be done without having to rely on opioids for relief. Here are a few tips on what you can do to minimize chronic pain.

Biofeedback Therapy for Chronic Pain

Biofeedback is a relaxation technique in which patients use their mind to control body functions that normally occur without fail. Participating in a biofeedback therapy session can give you the skills to lessen your pain at home. In a session, sensors will be attached to your body, then connected to a monitoring device. The device will measure your body functions such as breathing, perspiration, skin temperature, blood pressure and heart rate. As you relax during therapy, your breathing slows and your heart rate will dip. As the numbers on the monitor begin to reflect your relaxed state, you will start to learn how to consciously control your body functions. Through biofeedback therapy, you will learn how to use your mind to overcome bouts of pain.

How to Reduce Inflammation for Chronic Pain

It’s no secret that chronic pain and inflammation go hand-in-hand. Inflammation is a normal immune response in  your body that usually alerts you when something is wrong. Pain, swelling and redness are all forms of inflammation that is needed to help with the healing process. Inflammation becomes an issue when it becomes chronic, and the initial healing process fails, which causes pain. Fortunately you can reduce chronic pain and inflammation by consuming a healthy diet. Certain foods can cause flare ups, therefore they need to be reduced or eliminated. Those foods include dairy products, fried food, refined flour, sugar, high-fat red meat and all processed foods. The proper diet should be rich in leafy-green vegetables, low-sugar fruits and foods high in omega-3 fatty acids.

Exercise Regularly to Reduce Chronic Pain

Exercise is actually one of the best ways to reduce chronic pain. The less you move, the more pain you are likely to feel. The endorphins that are released during exercise are natural painkillers that increase your tolerance by changing how your body responds to pain. Routine exercise can help you reduce your medicine intake, increase your happiness and return your zest for life. If you find it difficult to move fluidly during exercise, start by walking a few times a week, then gradually increase your efforts.

Don’t Hesitate to Ask for Help

Naturally, you’ll want to do everything you can to maintain your independence, but know that it is more than ok to need help. Overdoing it in areas where you shouldn’t will only worsen your pain, causing you more stress and unhappiness. Figure out areas of your life where you could use some help and then see who might be able to provide it.

For example, keeping your house clean may be especially difficult when your pain is at its worst. Consider asking a family member to help you with cleaning once a week or if you have the resources, hire a housekeeper. Yard work can be another troublesome area for people with chronic pain. Chances are you can find a tween or teen in your neighborhood who would be more than happy to pick up leaves in your yard or mow it once every couple of weeks for a few extra bucks. Just having this little bit of extra help can make a world of difference.

Find Support

Chronic pain can be very isolating and it may seem as though no one in your immediate circle understands your frustration. Participating in a support group, such as those provided by the ACPA and its sister organization Veterans in Pain, will provide a safe haven for you and allow you the opportunity to vent. Those that suffer with chronic pain tend to see themselves in a negative light. Thinking negatively of yourself can lead to depression and more painful flare-ups. If you find that the group setting is not helping you solve your issues, consider reaching out to a therapist. Never be ashamed or prideful to ask for help –it just may save your life.

When you are in pain, it can be hard to find the motivation to do anything. Feelings of anger and resentment toward your body are to be expected, but it is important that you push forward. Chronic pain is a condition that can be successfully managed as long as you treat it with self-love and patience. Use these tips as a blueprint to help you combat chronic pain and start living your best life!

Guest Contributor, Constance Ray
Recovery Well

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