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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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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