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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The VA Semantics of Treating Veterans with PTSD

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While watching the “Talking Heads” address the Russian hacking scandal through the prism of partisan politics, it struck me that much the same language is used by the VA when discussing the treatment of Veterans with PTSD.

PTSD Support Veterans

While I have always thought that the proper use of language should be celebrated rather than used as a divisive instrument, I am very much bothered by the implications of blurring the meaning of words to suit one’s political ends.

Specifically, hacking DNC or private servers is very much different than “intervening” in the election process.  Most, if not all, governments (including our own) hack foreign and often their own domestic communication’s networks.

While one can endlessly debate the ethics of hacking, it has been going on for centuries.  It is simply a derivative of spying.

Using that purloined information to disrupt or interfere in our own or any other election process can most certainly be construed as an aggressive act.

The point here is that the act of “hacking” and “weaponizing the information” from that hack are two very different subjects.    Blurring the meaning and intent of these two very separate activities is cause for alarm. Specifically, it introduces a number of conflicting and non-related elements into the equation that cannot be properly analyzed.  Formulating an “appropriate response” will even be more difficult.

The intent here is not to discussing Russian hacking, but to show how the use of language can be used to create a distorted view of the efficacy of various VA programs to treat Veterans with PTSD and TBI.

Specifically, there is huge difference between the following statements:

The VA is treating Veterans with PTSD;

The VA is treating Veterans for the symptoms of PTSD.

As Maj. Ben Richards eloquently points out, there is no evidence that VA-prescribed therapies have  “healed” or resulted in any significant improvement to Veterans suffering from PTSD and TBI.

 

Clearly, treating the symptoms of PTSD and TBI is quite a bit different than restoring brain function and permanently improving the physical and mental condition of military Veterans suffering from PTSD.

In effect, current VA programs seem to be designed to help Veterans cope with the side-effects of PTSD and TBI (i.e. depression, suicidal thoughts, alienation, etc.) rather than cure the underlying problem.    In many cases, we have seen that lethal combinations of prescription drugs have had the opposite effect.

The semantics of VA administrators stating that they are “treating PTSD” rather than “coping with the symptoms of PTSD” is not a trivial distinction.  In fact, there seems to be little evidence that the VA has provided Veterans with a clear path to restore some level of normalcy in their everyday life.

Clearly, with VA consultants like Dr. David Cifu suggesting unorthodox practices to deal with “concussive events” that no one in the medical profession seems to support, it is not surprising that the Veteran treatment outcomes have been so poor.

While there is clearly a need to help Veterans cope with the myriad of frightening symptoms that emanate from PTSD and TBI, we urgently need benchmarks to help provide Veterans with a path to recovery.

As long as a disproportionate amount of money is spent by the VA on drugs and ineffective therapy programs to deal with the behavioral symptoms of PTSD and TBI, then Veterans will be shortchanged by the organization responsible for their care.

With new leadership on the horizon at the VA, SFTT remains hopeful that Veteran trust in the VA will be restored and that the organization will be purged of the toxic leadership of Dr. David Cifu and others who defend the status quo.  Our Veterans and those in the military are not well served by these corrosive and divisive administrators.

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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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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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