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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PTSD and the Super Bowl

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As we all settle in to watch the Super Bowl tomorrow, let us reflect on the large number of brave Veterans who have suffered from PTSD and traumatic brain injury (TBI). Indeed, there are enough wounded Veterans from our wars in Iraq and Afghanistan to fill several Super Bowl stadiums.

PTSD and CTE

Nevertheless, I suspect that sports’ pundits will be more focused on CTE – chronic traumatic encephalopathy – found on the brain of former pro quarterback, Kenny Stabler caused by “repeated blows to the head.” Indeed, there is now a list on Wikipedia that lists the number of deceased pro football players that were diagnosed with CTE.

Veterans with post traumatic stress disorder and/or TBI now exceed some 200,000 and they are simply not receiving the treatment they require to reclaim their lives.  The Veterans Administration’s preferred solution is to mask the symptoms of brain trauma with an often lethal cocktail of pharmaceuticals. At the same time the VA blocks other far more inexpensive technologies, like Hyperbaric Oxygen Therapy,  used around the world.  Why?

PTSD by the Numbers

Less we forget, please find below a video from the late Navy S.E.A.L, Chris Kyle who explains how difficult it is for some Veterans to adjust after they come home from war.  We now believe that some 20% of Veterans are affected by some form of brain trauma, although many experts believe that the number is far higher.  Listen to Chris Kyle:


via: PTSD by the Numbers: Battling Post Traumatic Stress Video

As we watch the Super Bowl, let us reflect on the conditions of our brave Veterans and the personal demons they face each day.

UK Troops Suffering from PTSD and Depression

Traumatic brain injury is not only prevalent in the US, but the British Armed Forces are also coping with serious problem.  Based on the statistics below, they are probably underestimating the scope of the problem, but it is clear that they see clear evidence of “alcohol-related” behavioral disorders and Veterans try to “self-medicate.”  Substance abuse is rampant among Veterans in the US, particularly with those who suffer from PTSD.   One health specialist suggested it could be as high as 90%.

See what the British say about traumatic stress among their own troops:

Of those, 1,235 have been awarded compensation and discharged with post-traumatic stress disorder. The figures, obtained under a Freedom of Information request, show 718 were discharged for depression, while 130 were suffering from alcohol-related behavioral disorders.

Speaking yesterday Patrick Rea, of the charity PTSD Resolution, said: “Assuming that most of these cases involve the Army, it brings us to a ratio nearing one in 10. Previous figures suggest that around two per cent of troops across all branches are suffering from PTSD. Of course, the problem is that there is a latency about PTSD that may not show up in official figures.Then, five years after they leave, it results in breakdown of their marriage, loss of employment and even criminality.”
via: Rising toll of stressed out troops suffering from PTSD and depression

Mental Health Week: PTSD and Suicide

Jenny Hale, a Public Relations graduate student at the Newhouse School of Public Communications, discusses below the relationship between PTSD and suicide.   While Jenny is right to suggest contacting the CRISIS LINE at 1-800-273-8255 for help, the Veterans Administration has not done a good job in helping Veterans with PTSD.  I would take the advice provided below with a grain of salt.

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Post-Traumatic Stress Disorder (PTSD) is a mental health problem that can occur after someone goes through a traumatic event like war, assault, an accident or disaster. Symptoms can start immediately after an event or can develop years later. These symptoms usually include flashbacks or memories, sleep problems or nervousness. Indicators lasting longer than a month may be related to PTSD.

Since 2002, 128,496 service members have been diagnosed with PTSD after being deployed in post-9/11 wars. The highest numbers reported were in the year 2012, with over 20,000 total cases between deployed and non-deployed soldiers.

If you or someone you know is suffering from PTSD, there are several outlets for both civilians and military to find help.

  • VA Center—All VA hospitals have care for PTSD. Contact your nearest VA Medical Center for an appointment.
  • Consult a therapist—The International Society for Traumatic Stress Studies can help locate a clinic near you. Find a list here.
  • Call the Veterans Crisis Line—Family and friends, as well as veterans, can speak to VA workers 24/7 online or by phone for confidential support. 1-800-273-8255 or chat with a professional here.

Suicide is another serious mental health issue among veterans. A veteran commits suicide every hour, while a service member commits suicide every day. 8,000 veterans commit suicide every year.

24 percent of suicides include veterans with PTSD symptoms and 66 percent of those have been deployed. Over 50 percent of veterans had no sign of behavioral health disorders prior to their death.

Suicide is preventable. If you or someone you know is showing feelings of guilt, saying that life isn’t worth living or expressing failure, seek help through the Suicide Prevention Line at 1-800-273-8255.
via: Mental Health Week: PTSD and Suicide

While I too will be sitting around the television watching this great American tradition of the Super Bowl, I will think of our many Veterans suffering from PTSD who don’t have access to the latest therapies available to help them reclaim their lives.  CTE has surfaced as a “big issue” within the NFL.  I only wish Veterans with PTSD and/or TBI would receive the same level of national attention.

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