Treating Veterans and Active Duty personnel suffering from TBI or PTSD with Hyperbaric Oxygen Therapy (“HBOT”) has always been regarded as “black magic” by both the VA and the DoD. In fact, earlier this year, 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.”
Conversely, the Israel Defense Forces (“IDF”) uses HBOT as a matter of course in treating personnel for traumatic shock. Roughly 120 patients a day are treated at the The Sagol Center for Hyperbaric Medicine and Research in Israel. In fact, many U.S. military veterans are now seeking treatment at the Sagol Center since they cannot receive treatment from the VA.
“In essence, our mental attitude is that we must take care of ourselves and through that process little Israel has become a blessing for the rest of the world…we treasure our soldiers, young and old. They are our only defenders….no one else will fight our battles. You can imagine that every concussive event will be treated with HBOT !” . . .“the policy of the IDF is that life has the highest value and they are committed to use any treatment, in any case, to save a life”.
It is hard to imagine that the VA and DoD don’t have the same commitment to the life and well-being of military Veterans as the IDF, but the facts suggest otherwise.
Should Vets Have Access to HBOT from the VA?
I suppose that the overriding question is how two nations at the forefront of international terrorism with state-of-the-art medical capabilities have widely different views on the efficacy of HBOT in treating Veterans suffering from PTSD and TBI.
Equally disturbing is the growth of HBOT treatment facilities in the United States which are attached to private clinics and hospitals. In fact, HBOT is currently reimbursed under Medicare Part B for certain conditions. It remains unclear whether this treatment is approved for reimbursement for Vets suffering from PTSD and TBI.
Despite VA and DoD “tests” to the contrary, there is an abundant of evidence worldwide that HBOT is effective in treating brain injury and restoring brain function by administering concentrated oxygen under controlled conditions. To argue otherwise is just plain foolish and self-serving.
Many have argued that the adoption of HBOT in treating Veterans would cut into the earning of Big Pharma, who continue to insist (read lobby) for a cocktail of opioids and antipsychotic medication. As a former military officer, I find it difficult to accept this premise; however, I now feel compelled to accept the obvious: the VA procurement process and treatment of Veterans is seriously flawed and, perhaps, criminally negligent.
In my opinion, the only way to destigmatize the use of HBOT for treating Veterans is for the VA to approve reimbursement for Veterans seeking treatment outside of the VA. Will this happen? Probably not. I would argue that it is highly unlikely that Vets with receive HBOT given the entrenched position of Big Pharma within the FDA, VA and Federal government.
For those who need more evidence on the efficacy of HBOT, please listen to this very informative video clip by Maj. Ben Richards, a U.S. Military Academy graduate, who underwent the HBOT treatment with Dr. Paul Harch:
Can we deprive our Veterans of this effective and relatively inexpensive treatment? If the answer is “No,” then contact your Congressman and Senator demanding action.
SFTT has long promoted the benefits of Hyperbaric Oxygen Treatment (“HBOT”) for Veterans with PTSD and TBI. Indeed, SFTT has seen many “transformative” recoveries of seriously affected Veterans who were treated to a series of “dives” in Hyperbaric Oxygen chambers over 30 to 60 days.
And yet, the VA and DOD steadfastly refuse to endorse HBOT to treat Veterans with PTSD or TBI. Why? The official reason is that “that the HBOT treatment is currently ‘off-label.’ In other words, it is an FDA-approved treatment for some conditions—but not for traumatic brain injury (TBI) or PTSD. Because of this, the Department of Defense does not allow HBOT to be prescribed for its veterans—they say they don’t prescribe off-label medications and treatments for these diagnoses, and claim that they can only use HBOT after it has been approved by the FDA for this use.”
Could it be that Big-Pharma’s cozy relationship with the FDA and VA might be threatened by a tested and relatively safe treatment alternative to the very dangerous and negative side effects of antipsychotic medication?” HBOT is commonly used in Israel for treatment of brain-related issues of members of the IDF (Israel Defense Forces) and many other countries use this safe and economic treatment to help restore brain function.
According to Dr. Harch’s new study, even three years after the vets sustained brain injury, one month of HBOT was able to induce improvements in brain blood flow, cognition, symptoms, and quality of life, while the veterans experienced fewer suicidal thoughts.
Specifically, improvements were seen in 92% of vets experiencing short-term memory problems, 87% of those complaining of headaches, 93% of those with cognitive deficits, 75% with sleep disruption, and 93% with depression. There were also improvements in irritability, mood swings, impulsivity, balance, motor function, IQ, and blood flow in the brain, as well as the reduction in PTSD symptoms and suicidal thoughts. And there was a reduction in—or complete elimination of—psychoactive and narcotic prescription medication usage in 64% of those previously prescribed the medication.
In fact, even more recent studies suggest that “oxygen” can regenerate neurons and brain cells. If so, shouldn’t our leaders within the VA and DoD embrace a fully vetted treatment procedure rather than continue to fund questionable and dangerous antipsychotic medication programs that even the F.D.A. recognizes as being addictive and potentially harmful.
Found below is a vey interesting Ted Talk by Sandrine Thuret which explains how certain activities restore brain cells and ward off brain-related disease:
Isn’t it about time that our military and political leadership rise up to the challenge and put an end to the bureaucratic and ineffectual treatment received by our brave warriors? Shouldn’t common sense prevail over the dangerous path chose by Big Pharma and the F.D.A. to over-medicate our society with clearly dangerous and addictive drugs. Many concerned individuals think our Vets deserve a playing field that is tilted in their favor so that they can regain their lives. I certainly do!
Let’s stand up for our Veterans with more than lip service.
SFTT consults with hundreds of Veterans with PTSD each year and many – if not most – are frustrated at the quality of treatment they receive from the VA. While most Veterans will acknowledge that VA staff members have their heart in the “right place,” the bureaucratic landscape facing Veterans suffering from PTSD are formidable. Why has it been so difficult to get Hyperbaric Oxygen Treatment to Veterans suffering from PTSD?
SFTT reported earlier in the week of a new grant by DARPA to embed sensors in the brains of Veterans to track brain waves to aid in the treatment of PTSD and TBI. While it is still unclear whether Veterans will volunteer for this new DARPA initiative, there are plenty of active programs in the private sector which have demonstrated considerable success in treating Veterans with PTSD. One of the most successful programs has been the Hyperbaric Oxygen Treatment (“HBOT”) promoted by Dr. Paul Harch. This program has been featured often by SFTT, but remains unappreciated by the folks at the VA.
In a scathing article by Xavier A. Figueroa, Ph.D. published by the Brain Health and Healing Foundation, the author calls to task both the press and malingerers at the VA who sit on the sideline and continue to discredit the benefits of HBOT. Found below are some of his comments and questions which have all of us at SFTT scratching our heads in wonder at the astonishing behavior of the VA:
If the VA and DoD are willing to try anything, why not HBOT? Why the hesitation? That is the real question that is lost amid this debate, but seldom asked. Hopefully, now that a few brave souls in the mainstream news outlets have entered the field of HBOT, other journalists might be tempted to ask some of these questions. I’m not holding my breath on it. If two solid science/medical journalists couldn’t see through the knot, it bodes very poorly for any therapy that cannot push through the noise of life.
The field of hyperbaric medicine has always been viewed with suspicion by outside practitioners. It has been called a “therapy in search of a disease” and ignored or ridiculed. Something relatively simple as breathing a gas just doesn’t seem like a real treatment for such a complex organ as the brain. Yet, the successes continue to pile up and rigorous science continues to show us promising venues for application with this therapy. There is something going on that will not go away with HBOT.
Kudos to Barry Meier and Danielle Ivory for reporting on the controversy surrounding HBOT, but the real controversy remains to be reported. Why does the VA and the DoD support unproven drug therapies for PTSD and TBI? If the VA and DoD allow unproven drugs or therapies to be used, why is HBOT singled out for exclusion? If HBOT is so ineffective, why are so many people demanding access? Simply ask Retired Army Brigadier General Pat Maney:
Now, I don’t have the answers, but when 22 Veterans are committing suicide on average each day you would expect the VA to take more than a second-look at this treatment which offers such promise for Veterans trying to reclaim their lives. Isn’t it time to DEMAND that our VETERANS receive the TREATMENT they deserve. If so, why not HBOT?
Editor’s Note: Found below is a very moving letter from Maj. Ben Richards and the benefits he received from being treated by Hyperbaric Oxygen from Dr. Paul Harch. The letter is quoted in its entirety.
In the spring and summer of 2007 I (Maj. Ben Richards) had the privilege of leading Bronco Troop, 1-14 CAV, a Stryker-equipped cavalry troop, during intense combat operations in and around Baqubah, Iraq. Bronco Troop was blessed with the deep bench of top- quality Noncommissioned Officers that distinguishes great units from good ones. Five of the six officers in the troop were West Pointers. At one point all six of us were captains and the experience paid dividends in a challenging operating environment.
At the peak of operations a new second lieutenant arrived straight from the basic course to take over a scout platoon. I greeted him shortly after he arrived at our dilapidated combat outpost and told him we would have a Combat Action Badge for him the next day. His face showed that he clearly thought I was joking. By the following evening he had survived an IED hit to his Stryker, been in two firefights and earned his CAB. The rest of us had earned our CABs on our first day in town two months earlier as well. A few weeks later he was wounded by a grenade fragment while leading his platoon in a dismounted close combat assault on an al Qaeda fighting position. The courage, competence and character of these young officers was in every way a credit to our alma mater and a testimony to West Point’s continuing role as the corner stone of our Nation’s defense.
During those several months of combat operations, ninety percent of my men hit at least one IED- often more than one. In May 2007 a suicide-bomber driving a sedan laden with explosives rammed into my Stryker and destroyed it. A few weeks later we hit a second ‘plain vanilla’ IED buried in the road that damaged our second Stryker sufficiently that it was later coded out as not being worth fully repairing. After each hit, we got back up and returned to the fight because we knew that there was going to be a fight and we fight as a team, even when it hurts.
On returning home I, like so many others, began a personal movement to contact battle against an enemy that I could not see, could not anticipate and was neither trained nor equipped to combat. Six months after arriving back at Fort Lewis, I was diagnosed with PTSD. To be honest, I only sought help after being ‘command directed’ by my wife. At that time, I was not intimidated by PTSD. I had every confidence that it was something I could beat. I was surprised and not a little embarrassed that I had it all. I gave it a year, tops. By then I would be fully back in the saddle. The extent of damage to my brain caused by the pair of mild traumatic brain injuries was not recognized until over three years after the injuries and not fully diagnosed until yet another year had passed.
While I was serving in Iraq, I was extremely fortunate to be selected by the History Department at the Academy to return for a tour as an instructor. I arrived in the summer of 2010 in pretty rough shape. Less than a year into the assignment I collapsed under the weight of disabling chronic pain, memory problems, cognitive deficits, sleep deprivation, drugs (the legal kind), emotional problems and all the detritus that often accompanies invisible injuries. At one point, heavily under the influence of prescription medications, I even seriously considered taking my own life.
West Point was up to the challenge. The History Department leadership kept me in the department so that they could personally oversee my care. My fellow instructors, both civilian and military, took on the burden of my workload without complaint, as they would have carried me, my rifle and my ruck to the CASEVAC point. I’m sure theirs was a long, hard walk out. It was real leadership, at real personal cost and sacrifice.
The Department’s Colonels breached every administrative and bureaucratic obstacle to ensure I literally received the best care available in the Department of Defense for my injury profile. When it turned out that the best care was not enough, and after they had done everything within their power to assure my future well-being, they fare welled me with honors and fanfare well beyond those merited by a junior major.
The day I took off my uniform for last time was one of the saddest in my life. I saw only an empty husk of the new cadet who had marched in the rain on R-Day eighteen years earlier and so full of the potential that enables a Firstie to sit with generals and presidents while a second lieutenant hides from majors in the motor pool. I was permanently broken. The natural processes of neural plasticity had run their course and come up wanting at the end. Medications could only partially mitigate the pain while causing new problems of their own. The results of evidence-based psychotherapies became part of the new canon of evidence that those therapies, so promising for victims of rape and traffic accidents, are disappointingly much less effective against combat-related PTSD. Acceptance and accommodation were all that was left to aspire to.
It was at that moment of hopelessness that the Long Gray Line extended its hand to drag me back from the edge. John Batiste, class of ’74 , a retired general officer and president of the veteran-serving non-profit Stand for the Troops founded by the legendary COL David Hackworth (SFTT.org), hunted me down to deliver a life-changing message.
We will help you, he told me, and by that I mean really help you and not in the sense of providing a palliative weekend retreat or the cathartic commiseration of other wounded warriors.
Had John not been a grad and a soldier of such well-known reputation, I would have hung up the phone. I did not have the hope left to waste on vain promises with unlikely outcomes, but because John was who he was I gave him the time. He gave my life back.
The problem of invisible wounds and injuries was one that merited a Manhattan project. Instead it had the Army medical corps bureaucracy that ran Walter Reed into scandal, regularly abused invisibly wounded warriors exiled to Warrior Transition Units and never seemed to get past the word excuse, so clearly bookmarked in their dictionary, to the word execution. It was a corps of capable and dedicated medical operators who did not deserve their uninspired and ineffective leaders. Their obvious failures were difficult for me to understand after having spent a career in the company of men and women I would follow anywhere. And then there was the VA.
Unwilling to accept defeat at hands of inefficacious bureaucracies, John and SFTT recruited a team of medical experts and began scouring the country for new and more effective approaches to treating TBI and PTSD. Their rescue mission had led them to Doctor Paul Harch, a practitioner of Hyperbaric Medicine at the Louisiana State University Medical School in New Orleans. Harch, John said, would treat me.
Dr. Harch had become the point man for league of medical practitioners and researchers using Hyperbaric Oxygen Therapy to treat brain damage caused by TBIs. By the time I arrived in New Orleans, these practitioners had already treated over a hundred invisibly wounded warriors as well as several well-known NFL football players to include the legendary quarterback Joe Namath. Harch had personally completed a research study with 20 soldiers and marines whose brains had been damaged by combat TBIs. The results were unprecedented.
When I was being evaluated by the military’s top neurologists in 2011, the prevailing medical wisdom was that modern medicine could do very little, if anything, to help a brain heal after being damaged by a mild TBI. There was a period of natural healing of up to several years, but at four years post injury, they had no expectation that my brain would improve and many reasons to suspect that it would instead begin to degrade. I arrived in New Orleans with repressed expectations.
I found Dr. Paul Harch to be a dedicated and innovative professional. He exhibited a reserved persona that I soon found to be a façade masking a burning passion for healing and especially for healing those that hope had passed by. Harch is a man of great moral courage, conviction and compassion. A classical gentleman endowed with the noblesse oblige of an heir of a great inheritance of character and natural capacity.
Harch and his colleagues had pioneered a protocol for using hyperbaric oxygen therapy (HBOT) to treat brain injuries. The medicinal effects of oxygen at higher the atmospheric pressure have been recognized empirically for over a century. It is perhaps best known as a treatment for diving injuries. It is also widely used for healing hard-to-treat wounds and is approved by the FDA for over a dozen different medical conditions. Using HBOT to treat brain injuries, like most of the prescription medications I had been prescribed by the DOD and VA, is considered off-label but its safety has been recognized by Institute of Medicine.
Treatment consisted of 40 one-hour ‘dives’ in a Plexiglas tank that I would describe as similar to a torpedo tube at a rate of one dive, sometimes two, a day. The tube is filled with 100 percent oxygen which is then pressurized to 1.5 atmospheres. Protocols for wound healing and dive injuries use higher pressures. The pressure loads oxygen into the blood stream like carbonation in an unopened can of soda. The introduction of the extra oxygen into the brain initiates a cascade of chemical interactions that my star-man roommate could probably explain but that I would struggle to elucidate here. The end result is the creation of new blood vessels (angiogenesis) and the repair or regrowth of brain cells.
Before I began treatment, we did a SPECT neuro-imaging scan of my brain. A SPECT scan uses an injective radioactive agent to image blood flow in the brain. It is one of the more sensitive imaging tools for detecting brain damage caused by mTBIs and in many cases is superior to CT or MRI scans, especially if more than a few months have elapsed since the time of injury. The images showed the poor blood perfusion typical of a brain damaged by TBIs- not unexpected as previous scans of other types had verified multiple points of structural damage. The image meant that my brain wasn’t using the amount of oxygen that a normal brain would have been. That difference was apparent not only in the scans but in the neuropsychological testing and other measures of cognitive and emotional impairment with which I had been evaluated.
By the time I had completed 20 ‘dives’ the changes I was experiencing were becoming undeniable. Nearly every facet of my injury profile began to improve. Pain levels dropped. Sleep improved. Memory improved. Attention span lengthened. Irritability decreased. I started feeling things I hadn’t felt in years. Good things. Happy things. I was able to sustain a light workout program for the first time since 2008. We scanned my brain again. The amount and extent of blood perfusion had increased significantly, matching the subjective results that even my guarded skepticism was compelled to recognize. The SPECT image is one of the most reliable predictors of the long-term prognosis of brain injury and mine had just changed radically.
The Harch’s covered the cost of my treatment from their own pockets, as they have for dozens of other veterans before me at no small sacrifice. John and SFTT rallied donors, mostly West Pointers, to help cover living expenses for four months of care. Gulf coast alumni quickly assumed an overwatch position and contributed several thousand dollars. I couldn’t have covered the costs alone. Even a 100% VA disability rating only matches the pay of a private first class. Not enough to maintain dual household with four kids at home.
HBOT has not completely healed my wounds, but it has given me more back than I thought possible. More than five years after leaving Iraq, a husband and a father finally come home to his family. The treatment that Dr. Harch provided unquestionably saved my marriage. It has enabled me to participate in and experience life in ways that I, and my DOD and VA doctors, had assumed were gone for good. I have even been able to contribute a little bit back. I am no longer a husk. Looking back on those dark days, I don’t think it would be unfair to say that Paul Harch and SFTT probably saved my life.
Editor’s Note: This very moving story by Maj. Ben Richards highlights the benefits of HBOT in treating PTSD and Traumatic Brain Injury. Shouldn’t we be doing more for our brave veterans.