Please Pick Up the Phone at the Suicide Crisis Center

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It is fashionable these days to pick on people or institutions that promote a “political” agenda.  Mind you, there are plenty of targets worthy of scorn and outrage, but righteous indignation and self-promotion discourages meaningful dialogue.

As a 501 (c)3 non-political educational foundation, Stand For The Troops (“SFTT”) often focuses on the shortcomings of military and political institutions that fail to meet their obligations to support military personnel and Veterans.

In particular, SFTT has been most critical of the level of care provided by the Department of Veterans Affairs (“the VA”) to Veterans.  We get no pleasure in citing the many shortcomings of the VA, but it seems like every day one scandal or another emerges which captures national attention.

A few days ago, we learned that the VA’s “Crisis Line” to prevent Veteran suicides appeared to be woefully unresponsive:

An insider memo newly uncovered by the Associated Press indicates that more than one-third of calls to the national suicide hotline for troubled veterans are not being answered by front-line staffers because of poor work habits and other problems at the VA.

This follows an Inspector General Report in February which cited numerous problems in the Crisis Line now managed by the VA.

It is interesting to note that a little over a year ago the DoD suspended funding for a Veteran Suicide Hotline run by Vets4Warriors, to centralize the function within the VA.

Priggee Cartoon from Denver Post

Reading the IG’s report and recent disclosures that Veterans in crisis are underserved by the VA, this decision to close down an effective and privately-run Veteran Suicide Hotline now doesn’t seem to be a great idea.

Frankly, I am tired of listening to President Obama (or any other President for that matter) state that “I don’t want to in any way pretend that we are where we need to be,”  after having increased the VA budget by 85% during his presidency.

Any sane citizen would simply conclude that we are simply wasting valuable resources within the VA that could be more efficiently deployed to provide Veterans with support and treatment that might make some difference in their lives.  Let’s face it:  If VA employees at Crisis Centers don’t pick up the phone or respond to text messages, then no amount of money is going to solve the problem.

The VA appears to be a broken institution that has simply lost its way. It is hard to conceive of a more responsive and efficient VA, with the likes of J. David Cox, the President of the American Federation of Government Employees, seemingly more interested in defending the status quo of his constituency rather than encourage radical reform in a bloated bureaucracy.

The battle lines have been drawn and it is difficult to see how Veterans – who don’t seem to have much of a voice in the final outcome – will receive better treatment and care from an institution that is reeling out of control.

The VA has strayed far from its mission to fulfill President Lincoln’s promise “’To care for him who shall have borne the battle, and for his widow, and his orphan’ by serving and honoring the men and women who are America’s Veterans.”

va_payroll

More to the point, the Department of Veterans Affairs has effectively disavowed its five core values that “underscore” the VA’s mission: Integrity, Commitment, Advocacy, Respect, and Excellence.

Integrity: Act with high moral principle. Adhere to the highest professional standards. Maintain the trust and confidence of all with whom I engage.

Commitment: Work diligently to serve Veterans and other beneficiaries. Be driven by an earnest belief in VA’s mission. Fulfill my individual responsibilities and organizational responsibilities.

Advocacy: Be truly Veteran-centric by identifying, fully considering, and appropriately advancing the interests of Veterans and other beneficiaries.

Respect: Treat all those I serve and with whom I work with dignity and respect. Show respect to earn it.

Excellence: Strive for the highest quality and continuous improvement. Be thoughtful and decisive in leadership, accountable for my actions, willing to admit mistakes, and rigorous in correcting them.

The VA’s “core values” are simply words that appear to have little in common with the “dignity and respect” we should show our Veterans.   How sad!  More importantly, how tragic it is that little will be done to restore today’s VA to an institution that we can all admire and respect.

President Lincoln’s “promise” is little more than a soundbite at a political rally.

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NFL Reluctantly Opts to Research Concussions

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In yet another token concession to those concerned with repeated trauma of concussions on NFL players, Commissioner Roger Goodell announced a new initiative “intended to increase the safety of the game, specifically by preventing, diagnosing and treating head injuries.”

As reported by CNN, Goodell said:

. . . the league and its 32 club owners will provide $100 million in support of engineering advancements and medical research — in addition to the $100 million previously pledged by the league to medical and neuroscience research.

The Play Smart Play Safe initiative also requires hiring a physician to serve as the league’s chief medical officer.  The physician will work with each team’s medical staff and establish an independent scientific advisory board to consider head injury research proposals.

Concussions and, more importantly, chronic traumatic encephalopathy ( or”CTE’) continues to be a subject that is only whispered about behind closed doors at the NFL.  Nevertheless, it is a problem that will not soon disappear and SFTT remains hopeful that researchers will be able to improve the safety of the game and provide insights into how this horrific “sport” injury can be prevented and,  hopefully, treated more effectively.

chronic_traumatic_encephalopathy

While the NFL has been slow to address this problem, the Department of Defense and the Department of Veterans Affairs (the “VA”) have been even slower.  Consider what SFTT stated in March, 2016 in its article entitled “NFL Preempts Veterans with Brain Injuries“:

With hundreds of thousand of Veterans suffering from brain trauma, isn’t it about time our political and military leadership quit burying their heads in the sands and deflect public scrutiny by investigating the NFL, which has Congressional immunity from antitrust regulation?  What a strange but convenient retreat for our feckless political leadership.

If the NFL owners had any sense, they would embrace the battle against brain trauma and work with the military to help both its gladiators and the brave men and women suffering from PTSD. Indeed, this public relations initiative could help deflect “public” outrage and provide the medical profession and others with the resources and impetus to deal with the silent wounds of war.

While the causes of brain trauma are different, shared research could go a long way in helping both Veterans and NFL players deal with the problems of repeated concussions.  No one expects easy answers, but the military has collected a wealth of data on concussions over the last six years from sensors implanted in helmets of soldiers serving in combat.

The first step in solving a problem is to admit you have a problem.  Sadly, both the NFL, the VA and the DoD have been slow to address this most serious problem and one wonders how committed either organization is to do so.

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Virtual Reality Better Than Opioids for Veterans

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Although the technology is not new, video games may be more effective than opioids in treating PTSD.

According to Nicholas Kardaras, Ph.D and Clinical Assistant Professor at Stony Brook University, playing virtual games may be more effective than narcotic drugs in treating pain.

In an article published in Psychology Today, the author interviewed researchers and made the following observations:

In my interview with the Navy’s head of Addiction Research Commander Dr. Andrew Doan, a Johns Hopkins MD and Ph.D. in neuroscience, he stated that he believes that there is indeed an endorphin-increasing mechanism that’s not entirely understood; he embraces the notion of screens acting as “digital pharmakeia” (Greek for pharmaceuticals), a term that he coined to explain the neurobiological effects produced by video technologies.

Brain imaging would eventually confirm that the burn patients treated with Snow World Virtual Reality (VR) were indeed experiencing less pain in the parts of their brain associated with processing pain. (See Figure Below) All of these stunning findings have led the military to further pursue the use of Virtual Reality and video games as a quasi-digital drug in order to help treat pain.

Indeed, the game used to help soldiers cope with burn pain was called Snow World and first used in 2008.

Recent studies indicate that brain scans of patients who used virtual reality programs showed significant improvement in cognitive functions.

With further study, this form of treatment could help curb opioid addiction.

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Service Dogs for Veterans with PTSD

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It is not exactly known how many military dogs have died in Afghanistan and Iraq in the service of their country, but most anyone in combat can attest to their valor.  While the number of military dog fatalities dwarfs the estimated 8 million horses that died in WW1, their protective role in combat cannot be underestimated.

Service Dogs and Veterans

While dogs have long served alongside men and women in combat, it is surprising (at least to me) that the Department of Veterans Affairs (the “VA”) continues to insist that there is no “clinical evidence” to conclude that service dogs offer any material benefit to Veterans with PTSD:

Owning a dog can lift your mood or help you feel less stressed. Dogs can help people feel better by providing companionship. All dog owners, including those who have posttraumatic stress disorder (PTSD) can experience these benefits.

Clinically, there is not enough research yet to know if dogs actually help treat PTSD and its symptoms. Evidence-based therapies and medications for PTSD are supported by research. We encourage you to learn more about these treatments because it is difficult to draw strong conclusions from the few studies on dogs and PTSD that have been done.

Fortunately, many States and private foundations feel differently than the VA about the emotional benefits Veterans may receive with a service dog.  As such, many charitable organizations have popped up around the country to provide Veterans with access to service dogs.   Veterans who receive these wonderful companions are most grateful.

Train a Dog – Save a Warrior (“TADSAW”)

It costs money to identify and train service dogs.  One organization that does a commendable job in doing so is Train a Dog – Save a Warrior or “TADSAW”.

Sadly, there are far too many Veterans with PTSD seeking “battle buddies” than TADSAW or other similar organizations can provide. While many Veterans find it difficult to make the time to train with their new “buddy,” there are many wonderful stories that suggest these dogs do have a positive impact on the lives of Veterans.

Some 3.9 million dogs enter animal shelters each year in the United States. If only 1% of these dogs could be properly trained and given to Veterans, we would make a serious dent on reducing the number of abandoned dogs and help 39,000 Veterans reclaim their lives.

This sounds like a win-win proposition.  Shouldn’t we give it a go or wait until further research is available at the VA?

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Why Veterans with PTSD are Seeking Alternative Therapy

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It is becoming increasingly clear that the Department of Veterans Affairs (the VA) is no longer able to provide the care or therapy that Veterans with PTSD demand.  Increasingly, Veterans are seeking alternative therapy outside the VA.

Department of Veterans Affairs

According to New England Public Radio, a large percentage of Veterans seek alternative therapies for PTSD despite explicit warnings by the VA that many of these therapies are “untested.”

The Department of Veterans Affairs estimates up to 30 percent of former service members — from the Vietnam war to Iraq and Afghanistan — have Post Traumatic Stress Disorder. They don’t all seek treatment, but among those who do, the VA says 20 to 40 percent don’t get better with the standard regimen of therapy, medication, or both. Increasingly veterans are seeking out alternative mental health care — and much of it untested.

Implicitly, the VA is telling Veterans that seek alternative therapies to treat PTSD that they they do so at their own risk.  

In fact, the VA is arguing that treatments not endorsed by the VA are probably a hoax.    This is the same FEAR SYNDROME used by the Roman Catholic Church during the Medieval ages to maintain discipline among parishioners.

As I have suggested earlier, the VA is broken and its $180 billion annual budget is clearly not addressing the needs of its constituents.

Ask yourself these simple questions:

  1. If prescribed VA therapies were effective, why would Veterans need to seek alternative forms of treatment?
  2. If prescribed VA therapies are “tested,” why don’t these therapies seem to be effective?
  3. Is treating the symptoms of PTSD (for instance, pain and depression) with “tested” prescription drugs the same as treating the core problem?

Sadly, the VA has become more of a gate-keeper of self-serving in-house solutions than a caregiver to the many brave men and women who have served our country so valiantly.

Spokespersons for the VA like Dr. Xavier Cifu ridicule other forms of therapy while vigorously defending their own “tested” but seriously flawed version of the truth.

As an outside observer, one can only shake one’s head when therapies such as Hyperbaric Oxygen and acupuncture are summarily dismissed by the VA despite decades of use in many parts of the world, including our own.

I guess those in Congress will argue that the VA is simply too big to fail.   Nevertheless, the VA fails many of its constituents on a daily basis.   For instance, Brandon Ketchum, a former Marine and Army National Guardsman who served 3 tours of duty in Iraq and Afghanistan, committed suicide recently after he was turned away by the VA in Iowa City.

How much longer do we need to see promised reforms within the VA?   Sadly, many Veterans are expressing their despair by turning away from “tested” VA prescriptions to embrace other forms of therapy.  Their message seems loud and clear to anyone listening.

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Congress Passes Drug Abuse Bill

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With broad bipartisan support, the Senate passed a compromise legislative bill aimed at curbing prescription drug abuse.

While this comes as relief to many, one must simply scratch their head and wonder why it has taken so long to curb prescription drug abuse.  This horrible addiction problem didn’t emerge yesterday.

Could it have anything to do with lobbyists?

Drug Abuse

Not surprisingly, one political party blamed the other for a lack of action on a bill to curb prescription drug abuse:

White House press secretary Josh Earnest said in a statement Wednesday night that President Obama will sign the bill even though it “falls far short.”

“Every day that Republicans stand in the way of action to fund opioid treatment means more missed opportunities to save lives: 78 Americans die every day from opioid overdose,” Earnest said.

The spokesman said Mr. Obama “won’t stop fighting to secure the resources this public health crisis demands. Congressional Republicans have not done their jobs until they provide the funding for treatment that communities need to combat this epidemic.”

Taking money from pharmaceutical lobbyists continues to enjoy wide bipartisan support, so to blame one party or the other for Congressional inaction is simply outrageous hypocrisy.

You need to look no further than the Department of Veteran Affairs, (the “VA”) to see the widespread abuse of using prescription drugs in treating PTSD and other ailments.   Masking pain has been Standard Operation Procedure (“SOP”) at the VA for many years rather than providing curative treatments.

Will more government funding in addition to their $180 billion a year budget help the VA do the right thing?  I think not. 

Veterans have long been aware of the dangerous side-effects of the drugs commonly prescribed by the VA.  One military Drug Abuse specialist informed me that some Veterans would often sell Purdue Pharma’s wildly successful OxyContin on the black market to supplement their income or – in many cases – to simply make ends meet.

Purdue Pharma:  A Description of Hell?

In a recent investigation into Purdue Pharma,  Los Angeles Times authors Harriet Ryan, Lisa Girion and Scott Glover suggest that the company’s shameless promotion of “OxyContin’s 12 Hour Problem” is little more than a “description of hell.”

After reviewing thousands of confidential internal documents, the LA Times reporters concluded that:

√ Purdue has known about the problem for decades. Even before OxyContin went on the market, clinical trials showed many patients weren’t getting 12 hours of relief. Since the drug’s debut in 1996, the company has been confronted with additional evidence, including complaints from doctors, reports from its own sales reps and independent research.

√ The company has held fast to the claim of 12-hour relief, in part to protect its revenue. OxyContin’s  market dominance and its high price — up to hundreds of dollars per bottle — hinge on its 12-hour duration. Without that, it offers little advantage over less expensive painkillers.

√ When many doctors began prescribing OxyContin at shorter intervals in the late 1990s, Purdue executives mobilized hundreds of sales reps to “refocus” physicians on 12-hour dosing. Anything shorter “needs to be nipped in the bud. NOW!!” one manager wrote to her staff.

√ Purdue tells doctors to prescribe stronger doses, not more frequent ones, when patients complain that OxyContin doesn’t last 12 hours. That approach creates risks of its own. Research shows that the more potent the dose of an opioid such as OxyContin, the greater the possibility of overdose and death.

More than half of long-term OxyContin users are on doses that public health officials consider dangerously high, according to an analysis of nationwide prescription data conducted for The Times.

Needless to say, a spokesperson for Purdue Pharma vigorously disputes the allegations in the LA Times investigation, but others suggest that  . . .

. . . more Americans die from opioid overdose than from car accidents. And this (sic LA Times) article gives only a partial tally of Purdue Pharma’s predatory conduct. The drugmaker targeted overly-busy, not very well trained general practitioners in communities which were likely to have high incidence of pain (think communities with a lot of jobs that involved manual labor). In other words, it’s no accident that OxyContin has become a plague in rural America.

Sadly, this bipartisan Congressional bill comes far too late for many Veterans and others who have been deceived by the predatory practices of Big Pharma and their enablers in the FDA and VA.  Is it asking too much for those in a position “to know” the effects of potentially lethal drugs to take action far sooner to protect the safety of our brave warriors and our citizens?

While some Senators are urging an investigation into Purdue Pharma’s predatory practices, it is unlikely that much will come of it.   Big money trumps ethics and common sense.

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PTSD: More Drugs on the Way?

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In yet another example of how the Department of Veteran Affairs (“VA”) and DoD try to reinvent the wheel in search of a miracle drug to treat PTSD, Fox News reports that “TNX-102 SL, which contains the same chemical property as Flexeril” may soon be used in treating Veterans with PTSD:

An already-approved muscle relaxant may offer relief for U.S. military veterans and first responders suffering from combat-related post-traumatic stress disorder (PTSD). The Phase 2 trials of the drug, TNX-102 SL, which contains the same chemical property as Flexeril, identified a dose and administration method that statistically improved participants’ PTSD symptoms among several mental health indices.

The findings were announced this month at the American Society of Clinical Psychopharmacology Annual Meeting (ASCP), and could eventually lead doctors to unroll the first PTSD drug in more than a decade, said Dr. Harry Croft, Chief of CNS Studies at Clinical Trials of Texas. Croft, who has also headed the investigation of 60 similar clinical trials over the last 25 years, said current PTSD treatments either don’t address every individual’s range of PTSD symptoms, pose unwanted side effects, or have poor adherence rates. Thus, scientists have continued searching for new PTSD treatments.

According to the article, “no new PTSD drug has been approved by the Food and Drug Administration (FDA) since Paxil in 2001, and before that, Zoloft in 1999.”

the VA and drugs

While the VA has been dismissive of other proven old-fashioned therapy programs such as Hyperbaric Oxygen (“HBOT”), it appears that the VA has an unlimited research budget for new experimental drugs.  The pharmaceutical companies must be thrilled.

For many, especially Veterans seeking to reclaim their lives, it is difficult to fathom the “logic” of the folks at the VA, but it is hard to argue with a program administrator who places his or her interest ahead of the Veterans they should be serving.  It is difficult – read impossible – to have a discussion with someone who has all the answers.  Particularly so, if they are the wrong answers.

At a time when Congress is trying to determine whether the monolithic VA is the best way to provide help to Veterans,  it would appear that VA bureaucrats will continue to determine what drugs or therapy works best for Veterans.

In effect, Veterans – particularly those suffering from PTSD and/or TBI – will be denied access to alternative therapies in the private sector because the VA gatekeepers “know best.”

How many more Veteran suicides and disrupted lives do we need to say that this may not be the right approach?

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Meet Dr. David Cifu: VA Gatekeeper for PTSD & TBI

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A reader of the SFTT Blog suggested that we “take a look” at Dr. David Cifu, Senior TBI Specialist in the Department of Veterans Affairs’ (“VA”) Veterans Health Administration. Found below is a short video clip of Dr. Cifu testifying at a U.S. Congressional Hearing on concussions in March, 2016.

For Veterans living with the effects of PTSD and/or TBI, I would find his testimony quite disturbing.

While it is unwise to draw conclusions from an edited video clip without the benefit of a full transcript of the proceedings, it is evident that Dr. Cifu has clear and strong convictions on how to deal with concussions. Furthermore, it was clear from the proceedings, that not every expert at the Hearing shared Dr. Cifu’s opinion on how to treat concussions.

A biographic extract from Virginia Commonwealth University states the following about Dr. Cifu:

In his 20 years as an academic physiatrist, he has been funded on more than 30 research grants and is the principal or co-principal investigator on eight current grants. He has delivered more than 425 regional, national and international lectures, published more than 165 articles and 65 abstracts and co-authored 20 books and book chapters. He has recently co-authored the patient and family focused self-help book, “Overcoming Post-Deployment Syndrome: A Six-Step Mission to Health.”

Now, I do not claim to be anything close to being an “expert” in analyzing  brain injury, but it strikes me that Dr. Cifu’s strong convictions on how to treat PTSD and TBI do not reflect the latest findings in brain-related trauma that SFTT reported last week based on new research by Dr. Perl.

In fact, with Dr. Cifu admitting to experiencing 6 concussions might – in itself – be considered a disqualifying event to hold such an important role within the VA.

While I have no reason to doubt Dr. Cifu’s integrity or sincerity, I have seen little evidence that Dr. David Cifu’s opinions on treating traumatic brain injury and PTSD have provided significant long-term benefits to Veterans to help them reclaim their lives.   In fact, many of the substance abuse problems affecting Veterans can be directly attributed to the VA for prescribing opioids and other pain-killers.

While it is all good and well to hold strong opinions, if those beliefs are wrong or even incomplete, many Veterans living daily with PTSD and TBI are at risk.  Does this make sense?

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Hyperbaric Oxygen: What the VA Doesn’t Want You To Know

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The gatekeepers at the Department of Veteran Affairs (the “VA”) remain intransigent in providing urgently need care to Veterans suffering from PTSD and/or TBI. Standard Operating Procedure (“SOP”) at the VA is to argue that FDA-approved clinical studies are needed to sanction treatment methods – regardless if these treatment alternatives have been used with success in many other countries for decades and, in some cases, hundreds of years.  

hyperbaric oxygen and the VA

Instead, the VA serves our Veterans a cocktail of potentially lethal prescription drugs that do carry the FDA’s “Good Housekeeping Seal of Approval.”   How is this possible when the Centers for Disease Control and Prevention (“CDC”) reports  an epidemic in addiction to prescription drugs?

Unfortunately, the VA’s SOP in prescribing these opioids to Veterans with PTSD and TBI hasn’t changed in many years.   Why?  Could it be that the benefits to Big Pharma outweigh the benefits of providing our Veterans with the treatment they merit?   I am most hesitant to ask this question, but I can think of no other explanation.

For instance, treating head injuries with Hyperbaric Oxygen Therapy (“HBOT”) has been around for decades.  It is the standard procedure provided to wounded soldiers and civilians with head injuries by the Israeli medical profession for decades.

This short video below is in Hebrew with English subtitles, but it provides a very compelling argument why our Veterans should have access NOW to HBOT while the bureaucrats and FDA twiddle their thumbs and continue to ingratiate themselves with Big Pharma lobbyists.

Gordon Brown  of Team Veteran argues that  “We need this type treatment in our VA and military hospitals instead of the DRUG therapy they are now using. Most TBI cases have been misdiagnosed as PTSD and drug treatment cause further complications for our veterans.”   Gordon’s views reflect my own and those of hundreds if not thousands of Veterans.

In fact, some hospitals in the private sector are taking radical steps to curtail the use of opioids in treating pain.  In an recent New York Times article, St. Joe’s hospital is implementing wide-ranging changes to comply with CDC recommendations:

“St. Joe’s is on the leading edge,” said Dr. Lewis S. Nelson, a professor of emergency medicine at New York University School of Medicine, who sat on a panel that recommended recent opioid guidelines for the Centers for Disease Control and Prevention. “But that involved a commitment to changing their entire culture.”

In doing so, St. Joe’s is taking on a challenge that is even more daunting than teaching new protocols to 79 doctors and 150 nurses. It must shake loose a longstanding conviction that opioids are the fastest, most surefire response to pain, an attitude held tightly not only by emergency department personnel, but by patients, too.

Is it too much for that lumbering behemoth VA to show the same sense of urgency?

I suppose we can continue to get distracted with the many other “big” issues facing our country, but providing our Veterans with proper therapy is one issue where Americans can easily unite.  Let’s not let the bottom line of Big Pharma distract us from that mission.  The brave men and women who have served our country deserve no less.

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Latest Developments on Treating PTSD

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Much has been written about the terrible long-term consequences of Post Traumatic Stress or “PTSD,” but there appears to be no clear way of treating PTSD.  Some argue that PTSD is best treated using “psychological” methods to treat the trauma while others argue that certain war-related events (i.e. IEDs) cause physiological changes in the brain.

treating ptsd

This dilemma makes diagnosing and treating PTSD so difficult.  Based on SFTT’s experiences, we have found that Veterans with symptoms of PTSD respond differently to various forms of therapy.   In short, there seems to be no definitive solution to a very serious problem which is now reaching epidemic proportions.

In a recent article published in the New York Times, medical scientists now believe that traumatic war-related events may actually cause physiological changes in the brain.

Quoting Dr. Daniel P. Perl, a neuropathologist who led a study for Lancent Neurology, evidence now exists that changes brain patterns:

Less understood is how the blast wave — the pulse of compressed air that shoots in all directions faster than the speed of sound and arrives before the wind — affects brain tissue after crashing through the helmet and skull. Blasts are also believed to compress the sternum and send shock waves through the body’s blood vessels and up into the brain. . .

The researchers examined the brains of the five veterans who had been exposed to blasts, and compared samples with those of 16 other veterans and civilians with and without brain injuries from military service or other activities. Scar tissue in specific locations of the cerebral cortex, which regulates emotional and cognitive functioning, was found only in the blast-injury cases.

Dr Perl and fellow researchers discovered the following changes in the brain following concussion like events:

Perl and his lab colleagues recognized that the injury that they were looking at was nothing like concussion. The hallmark of C.T.E. is an abnormal protein called tau, which builds up, usually over years, throughout the cerebral cortex but especially in the temporal lobes, visible across the stained tissue like brown mold. What they found in these traumatic-brain-injury cases was totally different: a dust-like scarring, often at the border between gray matter (where synapses reside) and the white matter that interconnects it. Over the following months, Perl and his team examined several more brains of service members who died well after their blast exposure, including a highly decorated Special Operations Forces soldier who committed suicide. All of them had the same pattern of scarring in the same places, which appeared to correspond to the brain’s centers for sleep, cognition and other classic brain-injury trouble spots.

Then came an even more surprising discovery. They examined the brains of two veterans who died just days after their blast exposure and found embryonic versions of the same injury, in the same areas, and the development of the injuries seemed to match the time elapsed since the blast event. Perl and his team then compared the damaged brains with those of people who suffered ordinary concussions and others who had drug addictions (which can also cause visible brain changes) and a final group with no injuries at all. No one in these post-mortem control groups had the brown-dust pattern.

Dr. Perl on Treating PTSD

While it will takes years of analysis and research to determine whether these neurological changes can be reversed, many Veterans will continue to suffer the “invisible wounds of war.”  Dr. Perl is justifiably worried:

 After five years of working with the military, he (Dr. Perl) feels sure, he told me (author Robert Worth), that many blast injuries have not been identified. “We could be talking many thousands,” he (Perl) said. “And what scares me is that what we’re seeing now might just be the first round. If they survive the initial injuries, many of them may develop C.T.E. years or decades later.”

This is not hopeful news, but at least we as a society are beginning to take PTSD seriously.  Hopefully, we will not try and bury the research in the way the NFL has sought to hide the effects of CTE on NFL players and downplay its significance to football fans who seem addicted to the violence of the spectacle.

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