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.”
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.
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.
“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 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.
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.
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.
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.
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.
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.
– 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.
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!
“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.
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.
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
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.
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.
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.
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!
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
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.
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.”
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:
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.
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.
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.
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.
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.
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: