Meet Maj. Ben Richards and Bronco, his Service Dog

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I had a delightful lunch yesterday with Maj. Ben Richards and Bronco, his service dog.  Also joining us for lunch were Eilhys England, Chairperson of Stand for the Troops (“SFTT”) and Dr. Yuval Neria, Director of the PTSD Research Program at Columbia Presbyterian.

Maj Ben Richards and Service Dog Bronco

I hadn’t seen Bronco (a labradoodle) before and was interested in learning how service dogs are trained.

After the dogs reach maturity – normally 6 months – they begin an intensive 5 month training program designed to familiarize the service dog with elements of supporting a human being. For instance, the dog has to learn to navigate elevators and escalators and to respond to potential danger signals which could cause panic in the dog’s human companion.

A well-trained service dog is not distracted by peripheral events like the presence of other dogs or animals and will avoid eating food that has been dropped on the floor.

After the service dog has successfully completed his training, the certified service dog is then introduced to his/her human companion.  Ben spent seven weeks in intensive training with Bronco.  According to Ben, it was about 4 hours of training a day (generally in the morning) and a few weekend sessions.

Ben and Bronco have been constant companions for almost a year.  Ben mentioned that it is the first time in 9 years he has been able to sleep without facing the door of his bedroom.  Bronco will also wake him up if he has nightmares or if thunder is approaching which might threaten sleep and trigger an anxiety attack.

Bronco has allowed Ben to feel comfortable enough to attend movies and, in fact, he went to a museum in D.C. by himself for the first time in several years.   The museum visit brought a small to Ben’s face as he recalled that it was the first time he didn’t feel like he had to process potential threats without the attendant anxiety of not being able to do so fast enough.

Ben looked great and it was wonderful to re-establish personal contact with him again.  Ben is a brave warrior who has suffered his own particular demons and is intent on helping others recover their lives from the silent wounds of wars.

Ben’s service dog has brought much needed comfort, safety and stability to his life.

Sadly, the VA is “studying” the efficacy of service dogs in helping other Veterans with PTSD.  This study will not be available until 2019.

What the VA should actually be studying are its own failed programs of Prolonged Exposure (PE), and Cognitive Processing Therapy (CPT) which the VA continues to tout as being so successful in helping Veterans with PTSD.

While VA administrators and consultants like Dr. David Cifu can continue to hoodwink Congressional committees with their disingenuous sales pitch, most Veterans have given up on the VA with their substandard and largely ineffectual services.

Many Veterans like Ben are gradually taking matters into their own hands despite threats by the VA to withdraw benefits.  Fortunately, many States, private hospitals and charitable institutions are rushing in to fill the void left by the VA.

Is it too much to expect that the VA step up to the plate and truly support Veterans rather than hand grants to people and institutions who are prepared to parrot a pollyanna party-line based on half-truths and downright lies?

Our brave men and women in uniform deserve better.

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Did the VA Hook Veterans on Opioids?

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Recent information suggests that 68,000 Veterans are addicted to some form of opioid (hydrocodone, oxycodone, methadone and morphine).  The VA argues that “more than 50 percent of all veterans enrolled and receiving care at the Veterans Health Administration are affected by chronic pain, which is a much higher rate than in the general population.”

Oxycontin and PTSD

According to the Center for Investigative Reporting obtained under the Freedom of Information Act,

. . . prescriptions for opioids surged by 270 percent between 2000 and 2012, leading to addictions and a fatal overdose rate that was twice the national average.

Citing a VA Office of Inspector General’s report, the Center for Ethics and the Rule of Law (CERL) said: “Between 2010 and 2015, the number of veterans addicted to opioids rose 55 percent to a total of roughly 68,000. This figure represents about 13 percent of all veterans currently prescribed opioids.”

The American Society for Addiction Medicine reports these startling facts on the opioid epidemic currently sweeping the U.S.

– 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.

– From 1999 to 2008, overdose death rates, sales and substance use disorder treatment admissions related to prescription pain relievers increased in parallel. 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.

While evidence provided by the Center for Controlled Disease and Prevention (CDC) suggests that the use prescription opioid painkillers has fallen some 41% since its peak in 2010, some 33,000 Americans died last year from addiction to opioids.  The addiction to prescription painkillers like Vicodin (hydrocodone) and Percocet (oxycodone) are rampant in the U.S.

The VA and Prescription Drugs for PTSD

For well over 5 years, Stand for the Troops (“SFTT”) has been reporting on the Department of Veterans Affairs (“the VA”) fascination with potent prescription drugs to treat Veterans with PTSD.

Despite the VA’s dismal record in effecting any meaningful change in patient outcomes, a cocktail of prescription drugs (generally opioids) are often the last resort since the VA’s Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT) treatment programs have proved largely unsuccessful.

In what continues to be standard SOP, the VA perseveres in treating the symptoms of PTSD without offering any compelling life-changing treatment alternatives.  In effect, the VA is tacitly admitting “we don’t have a clue,” while arguing that they are providing the best therapy available and to seek funding for new “clinical” studies that address symptoms and not causes (i.e. cannabis, for instance) of PTSD and TBI.

In our research (mostly anecdotal but with those “in the know”), SFTT discovered that many Veterans treated with prescription opioids for PTSD would become violent and often suicidal.  In fact, they would often either discard these potent drugs (“flush them down the toilet”) or sell them on the black market to civilians.

One former Veteran explained that his colleagues would often grind up oxycontin pills into a powder and sell it on the black market for approximately $500 a month.  So prevalent was this behavior, that the government forced a large pharmaceutical company to produce oxycontin only in gel.  The result:  sales at the pharmaceutical company dropped 60% once the black market disappeared.

Personally, I think the FDA and the pharmaceutical industry effectively colluded into turning many Veterans and a large percentage of our population into junkies.

The Rationale?:  The level of addiction in the U.S. and easy access by the public to potent prescription drugs is simply unprecedented if compared to other countries.

How to Fix the VA’s Opioid Credibility Problem

It is sad to read the daily stories of spouses and loved ones deal with ravages of PTSD.  A few days of reading the Facebook page of “Wives of PTSD Vets and Military” will give you some idea of the ravages of the silent wounds of war.

Sure, we can continue to medicate these Veterans and military personnel with prescription drugs to deal with the symptoms, but I would far rather see an attempt to reverse the causes of debilitating brain injury rather than mask the symptoms.

There are several noninvasive solutions used by other countries.  First and foremost is hyperbaric oxygen therapy or HBOT that is widely used by the IDF.  For reasons that seem incomprehensible, the DoD claims that there is no scientific evidence to suggest that HBOT is effective.

Gosh, there doesn’t seem to be much evidence that suggests that prescription opioids, Prolonged Exposure (PE), and Cognitive Processing Therapy (CPT) are effective either.  Yet, the VA continues to push it’s stale and misleading agenda that it is providing our Veterans with the best available treatment programs.

Surely, we can do better than “talk the talk.”  Let’s look for real solutions.  If it can’t be found in the VA, let’s give the private sector an opportunity to help our brave Veterans.

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What do NFL and Military Helmets Have In Common?: Not Much!

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Like many, I am moved by the tributes paid to military Veterans and active service members at NFL games.  Nevertheless, both the NFL and the military have come under sharp criticism regarding the number brain injuries suffered on both the playing field and battlefield.

chronic_traumatic_encephalopathy

Both the NFL and military have stonewalled the problem for many years, but it now appears that the NFL is taking action to introduce a “safer” helmet in the hope that they can reduce concussions and permanent brain injuries for professional athletes. Hopefully, better protective gear will work its way through college and high school football programs.

The Vicis Zero1 helmet has now been purchased by 25 NFL teams and will be introduced during the 2017 season. According to initial press releases:

In testing against 33 other helmets to measure which best reduces the severity of impact to the head, the Vicis ZERO1 finished first. Included in the study were helmets from Schutt and Riddell, which currently account for approximately 90 percent of helmet sales.

Vicis was founded by neurosurgeon Sam Browd and Dave Marver, former CEO of the Cardiac Science Corporation, with the goal of reducing the high rate of concussions in football. While it would take years of play and further studies to conclusively prove that they’ve been successful, the studies show that they’re on their way to making an impact.

Found below is a video explaining how this helmet helps provide additional protection to football professionals:

While the safety requirements for battlefield and football helmets differ significantly, it does appear that the NFL has acted a lot quicker than the military to protect its professionals.

Reducing brain injuries at their point of origin is far preferable to treating neurological damage to sensitive brain cells in the aftermath.

The US Army – and other DoD components – have long been aware that current helmets offer battlefield personnel little protection against IED devices typically found in Afghanistan and in the Middle East.  Indeed, SFTT has been reporting on various studies by the military embedding sensors into military helmets.

According to my calculation, the US Army has over 10 years of sensor data to draw on.  Surely, this is sufficient to draw some conclusions and develop a better-designed helmet capable of providing additional protection against concussive brain injury.

While the military continues to “study” the issue, it is encouraging to see the NFL to take action.  Frankly, I don’t buy the NFL sales pitch that the league rushed in to protect the health and safety of its players.  If true, they would have done so long ago when the NFL first started studying brain injuries.

As the New York Times reported earlier, the NFL leadership buried extensive “concussion” evidence collected between 1996 and 2001 to deflect potential claims by former NFL players who had suffered brain damage.

As we have seen in the case of body armor,  DoD leadership and the NFL have much in common:  a strong propensity to hide the facts from their employees and the public at large.

While one can find many faults in the way the NFL leadership has acted “to protect the safety of its players” and the integrity of their franchise, NFL teams are now treating brain injuries far more seriously than the DoD.

In addition to helmets, several NFL teams are now treating players with suspected brain injury with hyperbaric oxygen therapy (HBOT).    Sadly, the Department of Veterans Affairs continues to block the use of HBOT in treating Veterans with PTSD and TBI.

Could it be that DoD personnel charged with evaluating HBOT therapy failed to employ the proper protocols in 2010 clinical testing procedures?  If so, why?

SFTT remains hopeful that both the VA and the DoD will act quickly to introduce helmets that afford more protection to battlefield personnel and approve HBOT as an acceptable treatment procedure for PTSD and TBI.

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Hyperbaric Oxygen Therapy (HBOT) by Grady Birdsong

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Hyperbaric Oxygen Therapy HBOT Grady BirdsongGrady Birdsong, a USMC Veteran from Vietnam, has co-authored a book with Col. Robert Fisher (USMC – Ret) that deals with hyperbaric oxygen therapy (“HBOT”) entitled “The Miracle Workers of South Boulder Road:  Healing the Signature Wounds of War.”

The book is a 2016 Best Book Awards finalist and details how HBOT helps reverse the damage of traumatic brain injury.   In a must-hear interview, Grady Birdsong explains his experience with HBOT (and now his advocacy)  to Jerry Fabyanic on his “Rabbithole” program at KYGT in the Idaho Springs/Denver area.

Grady Birdsong spikes up interest in hyperbaric oxygen therapy with a down-to-earth radio interview with KYGT Radio with the following introduction:

In our advocacy campaign to make this clinic and treatment known, I had the good fortune of being interviewed on KYGT Radio over the weekend by Jerry Fabyanic on his “Rabbithole” program in a mountain town close to Denver. He has so graciously provided me with a link to that interview about our book. We most gratefully appreciate his voice and his audience at KYGT in the Idaho Springs/Denver area. Likewise my close friend and veteran Marine, David T. “Red Dog” Roberts, 1st Bn, 4th Marines, Delta Company in Vietnam and his Doc, Corpsman, Kenneth R. Walker produced two songs that are complementary to this advocacy of healing the signature wounds of war. You will hear them in the interview.

CLICK HERE for the entire and very educational 50+ minute podcast.

SFTT has long recommended the use of hyperbaric oxygen therapy or HBOT to treat Veterans with the symptoms of PTSD and TBI.  There are many studies that prove conclusively that the supervised application of HBOT helps improve brain function and restores cognitive abilities.

While Mr. Birdsong points out the many restorative benefits of HBOT, follow-up supervision is recommended to help deal with some of the symptoms of PTSD.

Sadly, in many online forums dealing with the ravages of PTSD, most military families are unaware of the benefits of regular supervised “dives” in HBOT chambers.  I would argue that the Department of Veterans Affairs has purposely discredited the use of HBOT in treating PTSD and TBI to promote their own failed agenda and the prevalent use of addictive prescription drugs.

One only needs to listen to the likes of Dr. David Cifu, Senior TBI Advisor to the Department of Veterans Affairs, to see the cynicism and blatant disregard for clinical evidence adopted by the VA against HBOT.   One can only speculate why, but HBOT seems to offer Veterans a far better solution than the cocktail of drugs served up by the VA.

Found below is a very moving and instructional video by Grady Birdsong of a young woman who “recovered her life” from the “signature wounds of war” with the use of HBOT:

Thanks to the effort of Grady and many other dedicated Veterans, we can all join together and help Veterans reclaim their lives. It is simply the right thing to do!

Nevertheless, the benefits of HBOT will not be widespread until the restrictive and self-serving barriers to this treatment are adopted and encouraged by the VA. Secretary Shulkin of the VA wants change to occur at the VA.  What better way to demonstrate his commitment to reducing Veteran suicides than by embracing HBOT to treat PTSD?

If you want to learn more about how HBOT can be used in treating PTSD and TBI, I suggest that you purchase The Miracle Workers of South Boulder Road:  Healing the Signature Wounds of War.  Share it with family and friends to encourage them not to give up hope on our brave Veterans.

For those tired of watching the lives of loved one end in pain, depression and hopelessness; write Dr. Shulkin and members of Congress and ask for action.  Don’t allow naysayers and self-serving bureaucrats like Dr. Cifu block Veteran access to HBOT.

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Saluting our Veterans on Memorial Day

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Memorial Day

As we gather together to celebrate Memorial Day, I am struck by the outpouring of love and heartfelt admiration for the men and women in uniform – past and present – who have served our country so valiantly.

Often overlooked as we celebrate Memorial Day are the spouses, family and loved ones who continue to support Veterans and active duty personnel with debilitating injuries.

Stand for The Troops would like to acknowledge these courageous men and women who labor on so courageously in providing daily care to loved ones who are no longer quite the same person they were before combat.

On this Memorial Day, SFTT would like to list several organizations that continue to provide great service to our Veterans, particularly those suffering from Post Traumatic Stress Disorder (“PTSD”).

Hyperbaric Oxygen Therapy (“HBOT”)

The Department of Veterans Affairs (“the VA”) continues to block the use of hyperbaric oxygen therapy or HBOT in treating Veterans with PTSD.  Nevertheless, Dr. Paul Harch and many others continue to provide FREE or greatly discounted treatment to Veterans suffering from PTSD.

More to the point, Dr. Harch and many other evangelists go out of their way to promote the benefits of using HBOT to treat PTSD.    On this Memorial Day weekend, SFTT remains hopeful that Dr. David Shulkin, Secretary of the VA, will begin providing Veterans with better treatment alternatives, such as HBOT.

It is time to rid the VA of institutional dogma based on self-serving agendas and seek real solutions that help Veterans with PTSD and their loved ones.

Archi’s Acres, Escondido California

Karen and Colin Archipley have dedicated their lives to helping Veterans recover their lives by providing training in “sustainable organic agriculture.”  At Archi’s Acres, students receive a six-week course in hydroponics, drip/micro irrigation, environmental control, soil biology, composting and much more.

We tip our hat to both Karen and Colin for having the imagination and perseverance to help provide Veterans with an opportunity to acquire new skills on their road to recovering their lives.

Wives of PTSD Vets and Military

I often come across some inspirational stories of families coping the ravages of PTSD on a Facebook Page entitled “Wives of PTSD Vets and Military.”  While depression and a sense of helplessness affects many Veterans (active duty personnel), their caregivers often bear the brunt of their frustration.

There are many similar Facebook Page support groups such as “PTSD:  The Wives Side,” but all provide some useful advice in helping loved ones cope under circumstances that are most difficult to comprehend.

This Memorial Day my thoughts and prayers go out to caregivers that do much of the heavy day-to-day lifting,

This is not an easy journey.  Frankly, we must move beyond coping and do everything possible within our power to help our brave Veterans recover his or her life.  Only by doing so, will we be able to recover our own.

On this Memorial Day, I wish all resilient warriors the strength and courage to continue to support our Veterans.

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First Steps to Overhaul the Department of Veterans Affairs

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Dr. David Shulkin continues to impress by tackling some rather entrenched “special interest” groups within the Department of Veterans Affairs (“the VA”):

– Personnel;

– Infrastructure

Earlier this week, VA Secretary Shulkin informed a Congress that he was considering closing some 1,100 underutilized VA facilities.  The Associated Press reports that:

Shulkin said the VA had identified more than 430 vacant buildings and 735 that he described as underutilized, costing the federal government $25 million a year. He said the VA would work with Congress in prioritizing buildings for closure and was considering whether to follow a process the Pentagon had used in recent decades to decide which of its underused military bases to shutter, known as Base Realignment and Closure, or BRAC.

“Whether BRAC is a model that we should take a look, we’re beginning that discussion with members of Congress,” Shulkin told a House appropriations subcommittee. “We want to stop supporting our use of maintenance of buildings we don’t need, and we want to reinvest that in buildings we know have capital needs.”

Last week, President Trump signed an Executive Order protecting VA whistleblowers from retaliation in a quest by the VA to shed incompetent employees.

Department of Veterans Affairs

While these measures may seem rather insignificant given the overall size and reach of the VA, they could mark an important change in the direction of the VA to help respond to the needs of Veterans.

The VA has evolved into a mammoth organization intent on serving the needs of all Veterans and their families.  Roughly 60% of the VA’s $180 billion budget (2017 budget) is allocated to mandatory benefits programs.

The VA’s discretionary budget of $78.7 billion is allocated to a variety of Veteran services,  but by far, is the the $65 billion allocated to medical care facilities.   Despite regular reports of shortcomings at VA facilities, the Rand Corporation recently (2016) reported that “the Veterans Affairs health care system generally performs better than or similar to other health care systems on providing safe and effective care to patients.”

While it appears that many Veterans – quite possibly the vast majority – receive quality health services from the VA, many Veterans complain about the timeliness and quality of service provided to them.

Like other healthcare providers in the private sector, the VA has determined what health events are covered, the type of coverage provided and where the health services are administered.

One program that has come under particular attack is the Choice Program, which gives Veterans access to medical services in the private sector if the VA can’t dispense services within 30 days or a VA facility is not located within 40 miles of the Veteran.

At his confirmation hearings, now VA Secretary David Shulkin, requested that Congress expand the coverage of the Choice program and eliminate many of its administrative constraints.  Needless to say, changes in the Choice program would certainly provide a greater number of Veterans with access to private sector care.

In cases of emergency, even minor improvements to the Choice program could be of major benefits to Veterans.

Nevertheless, these changes do not provide Veterans with access to alternative therapy programs not currently approved by the VA.  As SFTT has reported on numerous occasions, PTSD is currently treated with demonstrably ineffective “approved” treatment procedures while far better and less-intrusive programs like hyperbaric oxygen therapy (HBOT) are widely used with success throughout the world.

In effect, there are a number of activities within the VA that can best be performed by third-party services.  In fact, integrating these services with community resources may prove to be more of a long term benefit to the Veteran and his or her family.

Stand for the Troops remains hopeful that Secretary Shulkin and the dedicated employees of the VA will find the right balance in helping Veterans recover their lives.

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Hyperbaric Oxygen Therapy (HBOT) to Treat Veterans with PTSD

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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.

More to the point, Dr. Cifu dismisses  other treatment alternatives arguing that there is no scientific basis to support them.  In particular, Hyperbaric Oxygen Therapy (HBOT) has been singled out for particular disdain by Dr. Cifu.

Specifically, the VA concluded their trial “study” with the following observations:

“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 fact, HBOT is the preferred therapy of  the Israeli Defense Forces (“IDF”) for service members with head injuries.  Frankly, this assertion alone trumps any argument to the contrary by Dr. Cifu.

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.

HBOT Brain Functionality Over Time

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.

Dr. Figueroa asks, What are we Waiting For?

Almost 3 years ago, Dr. Xavier A. Figueroa, Ph.D., in an article entitled “What the <#$*&!> Is Wrong with the DoD/VA HBOT Studies?!!” clearly sets forth a compelling scientific argument why Veterans with TBI and PTSD should be treated with 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.

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

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

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

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

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

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

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

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

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

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

Dr. David Cifu

Dr. David Cifu

In fact, the VA, represented by its spokesperson, Dr. David Cifu, continues to push a stale and failed agenda that states that the only two effective treatment therapies offered by the VA are:

– Cognitive Behavioral Therapy and,

– Prolonged Exposure Therapy.

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

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

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

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

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

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

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Gun Control and Veteran Suicides: Is Research Lacking?

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Like most everyone, the gun control debate is front and center on both sides of the political spectrum.  Sadly, very few – if any – of proposed changes to existing gun control laws would have a major impact on Veteran suicides.

ptsd

I recently came across an interesting article published in the Washington Post entitled “The reasons we don’t study gun violence the same way we study infections.”    The gist of the article is that well over half (actually 62%) of gun-related deaths in the United States reported by CDC are suicides.  Sadly, very little money is allocated to the study of suicides.  Some of these reasons stem from restrictions on gun research, but a chronic lack of funding suggests that other topics receive the lion’s share of research money.

The article, written by Carolyn Johnson,  states the following:

There are a few reasons for the gun violence research disparity. First, there are legislative restrictions on gun research. For two decades, the Centers for Disease Control and Prevention has been prevented from allocating funding that could be used to advocate for or promote gun control. Although that doesn’t explicitly exclude all research on gun violence, it is said to have had a chilling effect on funding.

Aside from political pressure, there is a more philosophical one in which injuries are treated differently than disease. Injuries are a public health issue, but the debate over gun research often becomes mired in a debate over whether a person who intentionally wants to hurt himself or another person will do so, with or without a firearm. Research is also often driven by where researchers see the biggest scientific opportunity to come up with a cure or therapy, and infections or cancer may simply be easier to study than gun violence using traditional tools.

One of the complications of a study like this is that it uses broad categories to look at spending trends. For example, if the majority of gun violence is suicides, it might make more sense to study suicide, regardless of whether it involves a firearm. But suicide, too, has been chronically underfunded compared with its health burden. The number of deaths annually from breast cancer are now about the same as suicide. But breast cancer research received $699 million in NIH research funding in 2016; suicide and suicide prevention received $73 million.

While it is difficulty to draw too many conclusions from Ms. Johnson’s article, it would appear that cure or therapy-related research “may simply be easier to study than gun violence using traditional tools.”   In other words, simple evidence-based studies seem to attract more funding rather than complex studies, such as suicide prevention.

Using Ms. Johnson’s analysis, it is not surprising that the VA feels more comfortable funding marijuana studies which help Veterans cope with the symptoms of PTSD rather than treat brain injury.  In fact, over the last 15 years, the VA has done little – if anything – to treat Veterans with PTSD.

Citing a National Institute of Health 2014 study of the VA, Maj. Ben Richards points out that despite the most sophisticated therapy provided by the VA the average PCL-M score to assess Post Traumatic Stress has fallen only 5 points.  In fact, PCL-M scores for “treated” Veterans is still well above the 50 benchmark considered adequate by the military.

Ben Richard's PTSD VA Study

For more of Maj. Ben Richard’s analysis of the Department of Veteran’s Affairs costly and rather futile effort to help Veterans with PTSD, please CLICK HERE.

While the VA embarks on yet another study to combat the symptoms of PTSD, tens of thousands of needy Veterans are deprived of necessary research to help them reclaim their lives rather than simply cope with their problems.

A well-tested program, Hyperbaric Oxygen therapy (“HBOT”) has allowed Maj. Ben Richards to recover much of his cognitive function.  Yet, Dr. David Cifu and others at the VA still refuse to fund HBOT for Veterans with PTSD.

Veteran suicide rates are currently 22% than the normal population.  Doesn’t it make sense to provide workable therapy programs to Veterans rather than embark yet again on studies that treat symptoms rather than the problem?  Our Veterans deserve much more.

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

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

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

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

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

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

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

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

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

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

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

Why?  Indeed, that is the $64 question.

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

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

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