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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Dr. David Cifu: Do Veterans with PTSD Want Him in Their Corner?

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Stand for the Troops (“SFTT”) has written extensively about treating Veterans with PTSD and TBI.  Sadly, much of the publically available literature for brain-related injuries deals with identifying the symptoms and helping Veterans – and their loved ones – cope with terrible consequences of living with PTSD and TBI.

The issue(s) – at least in my mind – are these:

– Is treating the behavioral symptoms of PTSD and TBI enough for Veterans?  

– Have we given up hope in helping Veterans permanently reclaim their lives?

Sadly, treating the symptoms of PTSD/TBI is generally confused with actually providing Veterans with a meaningful long term solution to overcome the debilitating impact of a war-related brain injury.  

Now we learn that the VA is again studying the medicinal benefits of marijuana in treating Veterans with PTSD.   As many Veterans have been experimenting with marijuana for quite some time, I believe that the study will conclude that “medicinal marijuana, if used wisely, can mitigate anxiety, wild mood swings and suicidal thoughts among Veterans suffering from the effects of brain-related injury.”

The phrase in quotes are my words, but I suspect that conclusions of the multi-million dollar clinical study will not differ significantly.

The use of mind-altering drugs – whether medicinal marijuana or opioids – will most certainly help Veterans cope with the debilitating pain and anxiety of PTSD and TBI, but will prescription drugs meaningfully contribute to curing brain injury among Veterans?  

While the Department of Defense (“DoD”) and the Department of Veterans Affairs (“the VA”) have largely agreed that prescription drugs is not the answer, there is little evidence that the DoD or VA are clearly committed to provide Veterans with a clear path to full recovery.

Dr. David Cifu

Dr. David Cifu

In fact, the VA, represented by its spokesperson, Dr. David Cifu, continues to push a 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.

As the SFTT and others have pointed out, the VA has little – if anything – positive to show in having treating tens of thousand of Veterans with PTSD and TBI with these therapy programs.  You don’t have to be a brain surgeon (sorry for the very poor pun) or even Dr. David Cifu to recognize that currently recommended VA therapy programs have failed Veterans miserably.

Nevertheless, Veterans, the public and countless Congressional committees continue to listen to the same irresponsible dribble year-after-year and buy the same stale argument that Veterans are getting the best treatment possible.  To use a popular phrase, a little “fact-checking” would go a long to way to dispelling this insipid myth.

Dr. David Cifu represents what is wrong with the VA:   A lack of willingness to consider other alternatives.   As Judge and Jury on what constitutes “authorized therapy programs,” the VA has effectively precluded thousands of Veterans from seeking “out of network” solutions that appear to provide a far better long-term outcome.

The VA claims otherwise as we have seen in a long battle over the efficacy of Hyperbaric Oxygen Therapy (“HBOT”) in treating Veterans with PTSD and TBI.  Dr. David Cifu stands behind questionable studies that suggest that there is insufficient clinical evidence to support the thesis that HBOT can improve brain function.   In fact, Dr. Paul Harch, cites plenty of evidence in an academic study for the National Library of Medicine (Medical Gas Research) that conclusively demonstrates the lack of substance to Dr. Cifu’s bland and misleading opinions.

It is difficult to know whether new leadership within the VA will lead to more openness in providing Veterans with PTSD/TBI the support they require in finding therapy programs that work, but unless gatekeepers like Dr. David Cifu can be shown a quick exit, it is unlikely that much will change.

Our brave Veterans deserve far better than the sad and tragic delusional claims of Dr. Cifu.

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Partner Support Resources for Veterans with PTSD

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While Stand For The Troops (“SFTT”) primarily focuses on making sure Veterans with PTSD receive the therapy and support they deserve, we would be remiss in not acknowledging that Veteran families also suffer grievously from the “silent wounds of war.”

Caregiver for Veteran with PTSD

Indeed,  social media is inundated with heart-wrenching stories of partners of Veterans seeking advice and support of other Veteran partners on coping with the day-to-day problems of Veterans with PTSD and TBI.   In many cases, these partners (primarily wives) have benefitted from support groups in which they exchange advice and provide comfort to others as their husbands combat the demons of PTSD.

In fact, the Department of Veteran’s Affairs (“the VA”) has a “caregiver support line for partners of Veterans with PTSD.    That caregiver support line is 1-855-260-3274.

Indeed, the VA provides some useful advice on the advantages of joining a “peer support group” and how to locate them:

Joining a peer support group can help you to feel better in any number of ways, such as:

– Knowing that others are going through something similar

– Learning tips on how to handle day-to-day challenges

– Meeting new friends or connecting to others who understand you

– Learning how to talk about things that bother you or how to ask for help

– Learning to trust other people

– Hearing about helpful new perspectives from others

Peer support groups can be an important part of dealing with PTSD, but they are not a substitute for effective treatment for PTSD. If you have problems after a trauma that last more than a short time, you should get professional help.

Aside from the VA recommendations, many other independent organizations have sprung up to support partners who feel the need to exchange ideas and support one another during a particularly difficult period in their relationship.

Found below in no particular order are online support resources that may help provide a peer support forum to exchange ideas and advice:

Wives of PTSD Vets (Facebook Page)

A useful Facebook Page of engaged partners who seek to provide useful resources to others on helping wives of military Veterans with PTSD

Hidden Heroes

Established by Senator Elizabeth Dole, Hidden Heroes has as its mission to:

– Raise awareness of the issues military caregivers confront every day

– Inspire individuals, businesses, communities, and civic, faith and government leaders to take action in supporting military caregivers in their communities

– Establish a national registry, encouraging military caregivers to register at HiddenHeroes.org to better connect them to helpful resources and support

Family of a Vet

A practical guide, gleaned from contributions by its many members, on how to cope with PTSD and TBI.  More practical and common sense advice than clinical evidence, but certainly a recommended resource for those who require guidance and a helping hand.

PTSD Support Group

Essentially, a forum to exchange ideas and vent.  Clearinghouse for frustrations that emanate from being a caregiver for a Veteran coping with PTSD

Army Reservist Wife (Blog)

Authentic – pulls no punches – blog featuring genuine stories of how caregivers cope with the difficulties of sustaining a relationship with Veterans suffering from PTSD and TBI.

While there are many other notable online resources, local support groups that meet in person are probably far more effective than online advice.  Most base facilities provide programs for spouses of active duty personnel.

Veterans discharged from the military or reservists may find active support groups at religious centers or outreach programs supported by local community activists or charitable organizations.

Veterans suffering from PTSD and/or TBI value companionship.  While it may seem difficult to provide them the support they are seeking, it is a battle worth fighting valiantly.  Support groups may well provide the necessary resources one needs to persevere.

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Will Much Change at the VA with David Shulkin as Secretary?

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Much was made during the election campaign over the failings of the Department of Veterans Affairs (“the VA”) to serve our Veterans effectively.  While President-elect Trump had vowed to overhaul the VA, his selection of Dr. David Shulkin, an Obama administration holdover, as his nominee raises questions over what may change within the VA.

Dr. David Shulkin, VA Secretary

Indeed, the initial Senate confirmation hearings suggest a “love fest” according to Quil Lawrence of NPR.  Found below is the complete Senate confirmation hearing of the VA secretary-nominee’s testimony to the Senate committee:

Personally, I would like to think that Dr. Shulkin is the right person for the job – and he may well be – but I find it curious that not one of the questions at the confirmation hearing directly addressed the implementation of the Commission on Care recommendations. While some of these issues were addressed obliquely at the hearing, it seems to me that there should be a regular status report to the respective Congressional committees on how (or whether) these programs are currently being implemented.

While a good deal of the confirmation hearing was an opportunity for Senators to showcase their “genuine” concern for Veterans and pontificate on the silly rumors of “privatizing the VA,”  the hearing covered many of the same issues that continue to plague the VA.

Nevertheless, I am encouraged by some of the remarks by Dr. Shulkin at his confirmation hearing which are summarized below:

– Commitment to moving care into the community were it makes sense for the Veteran.  Currently, some 31% of health services are provided by local communities compared to 21% when Dr. Shulkin joined the VA.

– Expand Choice Program to ensure that Veterans are able to seek care in their community.

– Work to eliminate disability claims backlog (already significantly reduced) and seek legislation to reform the “outdated appeals process.”

– Need to address “infrastructure issues” . . . and explore expansion of public/private partnerships rather that build medical centers that have “large cost overruns and take too long to build.”

The Veteran’s Choice Program (“the VCP”) is the result of the Veteran’s Choice Act that was enacted to address chronic wait times for Veterans seeking care at VA facilities.  To a large extent, “the VCP” is the brainchild of Dr. Shulkin.

During the confirmation hearings, Dr. Shulkin agreed that the “mileage” requirement to access private medical services (currently 40 miles from a VA facility) shouldn’t be a deciding factor.  In Dr. Shulkin’s opinion, wait times should be the determining criteria.  Couldn’t agree more.

Furthermore, Dr. Shulkin acknowledged that there was far “too much bureaucratic” red tape involved when a Veteran received the green light to seek private care and the required VA approvals to actually receive it.

While praising the work ethic and dedication of nearly all VA employees, he admitted that he was frustrated by current legal constraints to shed the VA of a few bad apples.  Perhaps, he should enlist the support of government labor leader, David Fox, to join him in helping streamline the VA for the benefit of Veterans.

With 314,000 employees and a VA budget of $180 billion (of which only $76 billion is discretionary), SFTT has long believed that the VA is “too big” to succeed in its mission to provide adequate and responsive care to Veterans in need.

The issue is not the “quality of care” provided by the VA, which according to a recent Rand Corporation study compares favorably with private institutions.   The question remains, who gets access to these quality VA services and when?

During his confirmation hearing, Dr. Shulkin stated that only 61% of interviewed Veterans “trust” the VA (up from 41%).   I am quite sure that as the new VA Secretary, Dr. Shulkin, will seek to improve trust levels among Veterans, but ease of access to urgent medical services – whether at the VA or private facilities – is critical.

Furthermore, Veterans should be provided with a wider range of choices in determining the type of treatment they feel is appropriate for their medical condition.  Specifically, it is simply not acceptable that “gatekeepers” at the VA should determine ALL “eligible” treatment procedures.

Certainly, Dr. Shulkin appears to have the “right” temperament for the job, but in my opinion, far more is needed to turn around this largely non-responsive ship that is currently adrift and aloof from meeting the needs of Veterans.

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Drs. Paul Harch and David Cifu Spar over Hyperbaric Oxygen Therapy

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Well over a year ago, Dr. Paul Harch, one of the leading experts in Hyperbaric Oxygen Therapy (“HBOT”) published an authoritative report entitled “Hyperbaric oxygen in chronic traumatic brain injury:  oxygen, pressure and gene therapy” for the U.S. National Library of Medicine (Medical Gas Research).

In this report (a lengthy extract is printed below), Dr. Harch argues persuasively over the many benefits of using HBOT in treating brain injury:

Hyperbaric oxygen therapy is a treatment for wounds in any location and of any duration that has been misunderstood for 353 years. Since 2008 it has been applied to the persistent post-concussion syndrome of mild traumatic brain injury by civilian and later military researchers with apparent conflicting results. The civilian studies are positive and the military-funded studies are a mixture of misinterpreted positive data, indeterminate data, and negative data. This has confused the medical, academic, and lay communities. The source of the confusion is a fundamental misunderstanding of the definition, principles, and mechanisms of action of hyperbaric oxygen therapy. This article argues that the traditional definition of hyperbaric oxygen therapy is arbitrary. The article establishes a scientific definition of hyperbaric oxygen therapy as a wound-healing therapy of combined increased atmospheric pressure and pressure of oxygen over ambient atmospheric pressure and pressure of oxygen whose main mechanisms of action are gene-mediated. Hyperbaric oxygen therapy exerts its wound-healing effects by expression and suppression of thousands of genes. The dominant gene actions are upregulation of trophic and anti-inflammatory genes and down-regulation of pro-inflammatory and apoptotic genes. The combination of genes affected depends on the different combinations of total pressure and pressure of oxygen. Understanding that hyperbaric oxygen therapy is a pressure and oxygen dose-dependent gene therapy allows for reconciliation of the conflicting TBI study results as outcomes of different doses of pressure and oxygen.

Not surprisingly, Dr. David Cifu, Senior TBI Specialist in the Department of Veterans Affairs’ Veterans Health Administration, gave the standard stock answer from the spin doctors at the VA that:

There is no reason to believe that an intervention like HBOT that purports to decrease inflammation would have any meaningful effect on the persistence of symptoms after concussion. Three well-controlled, independent studies (funded by the Department of Defense and published in a range of peer reviewed journals) involving more than 200 active duty servicemen subjects have demonstrated no durable or clinically meaningful effects of HBOT on the persistent (>3 months) symptoms of individuals who have sustained one or more concussions. Despite these scientifically rigorous studies, the clinicians and lobbyists who make their livings using HBOT for a wide range of neurologic disorders (without scientific support) have continued to advocate the use of HBOT for concussion.

To Dr. David Cifu’s stock VA response, Dr. Harch responded as follows:

The charge is inconsistent with nearly three decades of basic science and clinical research and more consistent with the conflict of interest of VA researchers.  A final point: in no publication has the claim regarding effectiveness of HBOT in mTBI PPCS been predicated on an exclusive or even dominant anti-inflammatory effect of HBOT. Rather, the argument is based on the known micro-wounding of brain white matter in mTBI, and the known gene-modulatory, trophic wound-healing effects of HBOT in chronic wounding.  The preponderance of literature in HBOT-treated chronic wound conditions, is contrary to Dr. Cifu’s statement of HBOT as a “useless technology.”

As a layman, Dr. Harch’s detailed rebuttal (see FULL RESPONSE HERE) completely destroys Dr. Cifu’s “non-responsive” comment to the scientific points raised in Dr. Harch’s report.  In my view, it goes beyond the traditional “professional respect” shown by peers:  Dr. Harch was pissed off and, in my opinion, had every right to be.

Not surprisingly, Dr. Cifu has not responded to the irrefutable arguments presented by Dr. Harch.

The discussion of HBOT is not a subject of mild academic interest.  Specifically,  Veterans are being deprived of hyperbaric oxygen therapy because Dr. David Cifu and his cronies at the VA are misrepresenting the overwhelming evidence that suggests that HBOT restores brain function.

Why?  Indeed, that is the $64 question.

It is difficult to forecast how this academic drama will play out.  Nevertheless, I suspect that David Ciful will eventually be viewed by Veterans as performing a similar role within the VA as Alvin Young, aka “Dr. Orange.”

I hope and pray this is not the case.  On behalf of tens of thousands of Veterans who are denied HBOT treatment for PTSD and TBI by the clumsy and sloppy claims of Dr. Cifu and others within the VA, please “do the right thing” and lend your support to HBOT as a recommended VA therapy for treating brain injury.

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Service Dogs: Helping Some Veterans Cope with PTSD

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Service Dogs for PTSD

Photo via Pixabay by Skeeze

Soldiers returning from deployment sometimes bring the trauma of war home with them. Being injured themselves or witnessing others injured or dying, can have lasting physical and emotional effects on our military men and women. Symptoms of Post Traumatic Stress Disorder, or PTSD, can surface immediately or take years to appear. These symptoms can include sleeplessness, recurring nightmares or memories, anger, fear, feeling numb, and suicidal thoughts. These symptoms can be alleviated with medications and/or by the use of service dogs.

Service Dogs for Veterans and What They Do

A service dog is one that is trained to specifically perform tasks for the benefit of an individual with a physical, mental, sensory, psychiatric, or intellectual disability. Service dogs meant specifically for PTSD therapy, provide many benefits to their veteran companions. These dogs provide emotional support, unconditional love, and a partner that has the veteran’s back. Panic attacks, flashbacks, depression, and stress subside. Many vets get better sleep knowing their dog is standing watch through the night for them.

Taking an active role in training and giving the dog positive feedback can help the veteran have purpose and goals. They see that they are having a positive impact and receiving unconditional love from the dog in return. The dog can also be the veteran’s reason to move around, get some exercise, or leave the house.

Bonding with the dogs has been found to have biological effects elevating levels of oxytocin, which helps overcome paranoia, improves trust, and other important social abilities to alleviate some PTSD symptoms. When the dogs help vets feel safe and protected, anxiety levels, feelings of depression, drug use, violence, and suicidal thoughts decrease.

Service dogs can also reduce medical and psychiatric costs when used as an alternative to drug therapy. Reducing bills will reduce stress on the veteran and their family.

Impact of Service Dogs on Veterans with PTSD

These dogs offer non-stop unconditional love. When military personnel return to civilian life adjustment can be difficult, and sometimes the skills that they have acquired in the field are not the skills they can put toward a career back home. A dog will show them the same respect no matter what job they do, and that can be extremely comforting.

Service dogs can also foster a feeling of safety and trust in veterans. After going through particular experiences overseas, it may be difficult for veterans to trust their environment and feel completely safe. Dogs can offer a stable routine, be vigilant through the night (so the vet doesn’t have to), and be ever faithful and trustworthy.

Veterans sometimes have difficulty with relationships after departing the military because they are accustomed to giving and receiving orders. Dogs respond well to authority and don’t mind taking orders. The flip side is that by taking care of the dog’s needs, the veteran can also get used to recognizing and responding to the needs of others.

Service Dogs are also protective. They will be by the veteran’s side whenever needed and have their back like their buddies did on the battlefield. They will provide security and calm without judgment. The dog will not mind if you’ve had a bad day and be there to help heal emotional wounds. For this reason, PTSD service dogs are also a great help to veterans suffering from substance abuse disorders.

In an article by Mark Thompson called “What a Dog Can Do for PTSD”, an Army vet named Luis Carlos Montalvan was quoted as saying, “But for all veterans, I think, the companionship and unwavering support mean the most. So many veterans are isolated and withdrawn when they return. A dog is a way to reconnect, without fear of judgment or misunderstanding.

Check out the Department of Veteran’s Affairs for information on the VA’s service dog program by CLICKING HERE.

Here are a few of the dozens of programs to help if you are a vet or know one who could benefit from a service dog:

PawsandStripes.org

OperationWeAreHere.com

PawsForVeterans.com

SoldiersBestFriend.org

TenderLovingCanines.org

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Drs. Paul Harch and David Cifu Spar over Hyperbaric Oxygen Therapy

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Well over a year ago, Dr. Paul Harch, one of the leading experts in Hyperbaric Oxygen Therapy (“HBOT”) published an authoritative report entitled “Hyperbaric oxygen in chronic traumatic brain injury:  oxygen, pressure and gene therapy” for the U.S. National Library of Medicine (Medical Gas Research).

Brain Function after HBOT

In this report (a lengthy extract is printed below), Dr. Harch argues persuasively over the many benefits of using HBOT in treating brain injury:

Hyperbaric oxygen therapy is a treatment for wounds in any location and of any duration that has been misunderstood for 353 years. Since 2008 it has been applied to the persistent post-concussion syndrome of mild traumatic brain injury by civilian and later military researchers with apparent conflicting results. The civilian studies are positive and the military-funded studies are a mixture of misinterpreted positive data, indeterminate data, and negative data. This has confused the medical, academic, and lay communities. The source of the confusion is a fundamental misunderstanding of the definition, principles, and mechanisms of action of hyperbaric oxygen therapy. This article argues that the traditional definition of hyperbaric oxygen therapy is arbitrary. The article establishes a scientific definition of hyperbaric oxygen therapy as a wound-healing therapy of combined increased atmospheric pressure and pressure of oxygen over ambient atmospheric pressure and pressure of oxygen whose main mechanisms of action are gene-mediated. Hyperbaric oxygen therapy exerts its wound-healing effects by expression and suppression of thousands of genes. The dominant gene actions are upregulation of trophic and anti-inflammatory genes and down-regulation of pro-inflammatory and apoptotic genes. The combination of genes affected depends on the different combinations of total pressure and pressure of oxygen. Understanding that hyperbaric oxygen therapy is a pressure and oxygen dose-dependent gene therapy allows for reconciliation of the conflicting TBI study results as outcomes of different doses of pressure and oxygen.

Not surprisingly, Dr. David Cifu, Senior TBI Specialist in the Department of Veterans Affairs’ Veterans Health Administration, gave the standard stock answer from the spin doctors at the VA that:

There is no reason to believe that an intervention like HBOT that purports to decrease inflammation would have any meaningful effect on the persistence of symptoms after concussion. Three well-controlled, independent studies (funded by the Department of Defense and published in a range of peer reviewed journals) involving more than 200 active duty servicemen subjects have demonstrated no durable or clinically meaningful effects of HBOT on the persistent (>3 months) symptoms of individuals who have sustained one or more concussions. Despite these scientifically rigorous studies, the clinicians and lobbyists who make their livings using HBOT for a wide range of neurologic disorders (without scientific support) have continued to advocate the use of HBOT for concussion.

To Dr. David Cifu’s stock VA response, Dr. Harch responded as follows:

The charge is inconsistent with nearly three decades of basic science and clinical research and more consistent with the conflict of interest of VA researchers.  A final point: in no publication has the claim regarding effectiveness of HBOT in mTBI PPCS been predicated on an exclusive or even dominant anti-inflammatory effect of HBOT. Rather, the argument is based on the known micro-wounding of brain white matter in mTBI, and the known gene-modulatory, trophic wound-healing effects of HBOT in chronic wounding.  The preponderance of literature in HBOT-treated chronic wound conditions, is contrary to Dr. Cifu’s statement of HBOT as a “useless technology.”

As a layman, Dr. Harch’s detailed rebuttal (see FULL RESPONSE HERE) completely destroys Dr. Cifu’s “non-responsive” comment to the scientific points raised in Dr. Harch’s report.  In my view, it goes beyond the traditional “professional respect” shown by peers:  Dr. Harch was pissed off and, in my opinion, had every right to be.

Not surprisingly, Dr. Cifu has not responded to the irrefutable arguments presented by Dr. Harch.

The discussion of HBOT is not a subject of mild academic interest.  Specifically,  Veterans are being deprived of hyperbaric oxygen therapy because Dr. David Cifu and his cronies at the VA are misrepresenting the overwhelming evidence that suggests that HBOT restores brain function.

Why?  Indeed, that is the $64 question.  

It is difficult to forecast how this academic drama will play out.  Nevertheless, I suspect that David Ciful will eventually be viewed by Veterans as performing a similar role within the VA as Alvin Young, aka “Dr. Orange.”

I hope and pray this is not the case.  On behalf of tens of thousands of Veterans who are denied HBOT treatment for PTSD and TBI by the clumsy and sloppy claims of Dr. Cifu and others within the VA, please “do the right thing” and lend your support to HBOT as a recommended VA therapy for treating brain injury.

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What Does the VA have Against HBOT for Treating PTSD?

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HBOT or Hyperbaric Oxygen TherapyStand For The Troops (“SFTT”) asks frequently what the Department of Veterans Affairs (“the VA”) has against HBOT or Hyperbaric Oxygen Therapy in helping to treat Veterans with PTSD.   The VA hides behind of veil of half-truths arguing that there is not enough “clinical evidence” to support HBOT.

Clearly there is and many hospitals across the United States have been treating brain trauma patients using HBOT for years.  In fact, HBOT is the “go-to” procedure for the Israel Defense Forces or “IDF” in treating PTSD and TBI.

Recently, Xavier A. Figueroa, Ph.D. has written extensively in a well-researched article entitled “What the <#$*&!> Is Wrong with the DoD/VA HBOT Studies?!!” which refutes many of the “convenient” studies by the VA.  Found below is an edited summary of a recent article by Dr. Figueroa:

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.

On top of the military epidemic there is a large existing civilian population of TBI survivors (now ~10 million in the US alone). How many in the civilian population take their lives because the pain is just too much?  How many can’t work because their brain injury won’t allow them to work?  We don’t know because we, as a society, are just starting to realize how prevalent brain injuries have become. And how many caregivers are equally and negatively affected by caring for their brain injured relatives? And what is the COST of continuing to deny a safe and effective treatment that is constantly mischaracterized?

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 averse 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.

HBOT works for the treatment of mild-to-moderate TBI and PCS.

Treat now.

For those inclined to follow Dr. Figueroa’s detailed analysis, please CLICK HERE for the hard details.  Even the spin doctors and the VA would have a difficult time refuting his analysis.

Dr. Figueroa exposes many of the lies and myths perpetrated by Dr. David Cifu and others in the VA who prefer a cocktail of toxic pharmaceutical to HBOT which is a lot cheaper and has proven far more successful than VA programs.

 

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Suggestions for Veterans to Maintain a Stress- and Relapse-Free New Year

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The holiday season and New Year’s bring many stressful situations that can be difficult to handle, especially for veterans who are recovering addicts or those suffering from another mental health disorder.

stress free holiday for VeteransOld triggers, family encounters, large parties, or loneliness can be enough to push a veteran with an addiction toward a relapse. With a healthy game plan, you can get through the holiday season with your sobriety intact and make it a positive experience. The first step is to avoid situations which may increase stress to insure that you can enjoy the holidays with friends and family. But of course, this time of year that can be easier said than done. Whether you are trying to avoid family conflict or struggling with substance abuse, veterans may benefit from these simple suggestions:

One Day at a Time for A Stress Free Holiday 

Focus on today when you wake up each morning and how you want to stay sober. Think about what types of environments you need to navigate and make plans to handle those specific situations. Tell yourself that you can resist any temptations and will stay sober.

Start by taking care of your body, eating regular healthy meals, and getting in exercise whenever possible. This will keep your body’s blood sugar regulated, boost mood and confidence, help you avoid irritability, and resist impulses.

Have realistic expectations for the holidays. Expecting everything to run perfectly can set you up for an emotional let down. You can only control yourself, so focus on maintaining your sobriety when confronted with hostile or emotional situations.

Family Events and Parties

Attending family get-togethers and holiday parties can be stressful. Know which situations or people might set off your triggers and avoid them. Arrive early so that you can leave earlier, if needed. Drive yourself if you might need an easy way to leave when you want to. Time spent with people that do not respect your boundaries or elicit temptation should be limited or avoided altogether depending on your level of recovery.

Holiday food and drinks may have unwanted alcohol in their recipes. If you’re a recovering alcoholic, being handed drinks or desserts with alcohol in them could trigger relapse. Make your own snacks and drinks to bring with you to parties. Having your own preferred drink or snack in hand will help avoid the possibility of being handed things you will need to decline.

Have a few simple responses ready for awkward questions from relatives regarding your recovery. Do not feel the need to go into long explanations, or to answer every single question. Change the subject or let them know that you have some other things to do.

Help plan activities instead of just sitting around and drinking. Suggest some board games, sporting events, holiday movies, or building a snowman. Keeping yourself busy will nix cravings, alleviate stress, and help you steal some joy from the holidays.

Handling Stress or Cravings

When stress and cravings start to creep up on you, take a minute to remind yourself why sobriety is better and healthier for you. Recognize possible triggers and move to a different spot or find someone you trust to strike up a conversation with. You can also find someone to help with tasks that they need done, or find a game or activity to do.

Support systems are especially helpful and important during this time of year. Call a trusted friend, family member, or sponsor to talk with when feeling stressed. Attending extra AA or NA meetings during the holidays can give you extra confidence to get through the holiday season. Plan ahead to find meetings even if you will be in another city for the holidays.

Give Back to Others

Many just like you are battling temptations of relapse during this time of year. Make an effort to reach out and help other recovering addicts by attending parties with them to further their sobriety. Reaching out to others during the holidays can have a healing effect on you just as much as them. It can make you more confident in your own sobriety.

Selfless acts remind you of the things for which you can be grateful. Positive interactions will bring love and joy back into your life, and remind you that you can successfully avoid relapse and have a joyful holiday season.

Constance enjoys sharing stories of hope with those feeling lost, and encourages them to believe that there is a healthy, fulfilling life on the other side of whatever path they’re currently traveling.

Photo by BookBabe

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