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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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).

Brain Function after HBOT

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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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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Hyperbaric Oxygen: What the VA Doesn’t Want You To Know

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The gatekeepers at the Department of Veteran Affairs (the “VA”) remain intransigent in providing urgently need care to Veterans suffering from PTSD and/or TBI. Standard Operating Procedure (“SOP”) at the VA is to argue that FDA-approved clinical studies are needed to sanction treatment methods – regardless if these treatment alternatives have been used with success in many other countries for decades and, in some cases, hundreds of years.  

hyperbaric oxygen and the VA

Instead, the VA serves our Veterans a cocktail of potentially lethal prescription drugs that do carry the FDA’s “Good Housekeeping Seal of Approval.”   How is this possible when the Centers for Disease Control and Prevention (“CDC”) reports  an epidemic in addiction to prescription drugs?

Unfortunately, the VA’s SOP in prescribing these opioids to Veterans with PTSD and TBI hasn’t changed in many years.   Why?  Could it be that the benefits to Big Pharma outweigh the benefits of providing our Veterans with the treatment they merit?   I am most hesitant to ask this question, but I can think of no other explanation.

For instance, treating head injuries with Hyperbaric Oxygen Therapy (“HBOT”) has been around for decades.  It is the standard procedure provided to wounded soldiers and civilians with head injuries by the Israeli medical profession for decades.

This short video below is in Hebrew with English subtitles, but it provides a very compelling argument why our Veterans should have access NOW to HBOT while the bureaucrats and FDA twiddle their thumbs and continue to ingratiate themselves with Big Pharma lobbyists.

Gordon Brown  of Team Veteran argues that  “We need this type treatment in our VA and military hospitals instead of the DRUG therapy they are now using. Most TBI cases have been misdiagnosed as PTSD and drug treatment cause further complications for our veterans.”   Gordon’s views reflect my own and those of hundreds if not thousands of Veterans.

In fact, some hospitals in the private sector are taking radical steps to curtail the use of opioids in treating pain.  In an recent New York Times article, St. Joe’s hospital is implementing wide-ranging changes to comply with CDC recommendations:

“St. Joe’s is on the leading edge,” said Dr. Lewis S. Nelson, a professor of emergency medicine at New York University School of Medicine, who sat on a panel that recommended recent opioid guidelines for the Centers for Disease Control and Prevention. “But that involved a commitment to changing their entire culture.”

In doing so, St. Joe’s is taking on a challenge that is even more daunting than teaching new protocols to 79 doctors and 150 nurses. It must shake loose a longstanding conviction that opioids are the fastest, most surefire response to pain, an attitude held tightly not only by emergency department personnel, but by patients, too.

Is it too much for that lumbering behemoth VA to show the same sense of urgency?

I suppose we can continue to get distracted with the many other “big” issues facing our country, but providing our Veterans with proper therapy is one issue where Americans can easily unite.  Let’s not let the bottom line of Big Pharma distract us from that mission.  The brave men and women who have served our country deserve no less.

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Gut Check for Veterans with PTSD

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The search to help Veterans and active duty military personnel cope with Post Traumatic Stress (“PTS” or “PTSD”) continues to attract much attention from within the scientific community and alternative medicine pundits.

It seems that almost weekly some promising new cure to treat Veterans with PTSD appears on mainstream media, with the caveat that “it will take years” to prove its efficacy.  Must our Veterans wait so long?

While many doubt the efficacy of holistic medicine and practices that date back centuries in the Far East, the Western medical profession now agrees that bacteria from our digestive system may offer potential benefits in combating stress.

Bacteria to treat Veterans with PTSD?

In an article published by Science.mic entitled “The Military Wants to Cure Soldiers of PTSD by Hacking their Gut Bacteria,” researchers found

. . .  a means to improve the smaller mice’s moods: by feeding them the same bacteria found in the poop of the bigger, calmer mice. Subsequent brain scans showed the smaller mice’s moods improved significantly.

Past research has shown similar results. One 2015 study found that probiotics in fermented food — such as sauerkraut and yogurt — change the bacterial environment in the gut, which in turn affects our anxiety levels.

Indeed, these scientific “revelations” are hardly new to those remotely familiar to Traditional Chinese Medicine.  In fact, the New York Times reported some time ago that:

It has long been known that much of our supply of neurochemicals — an estimated 50 percent of the dopamine, for example, and a vast majority of the serotonin — originate in the intestine, where these chemical signals regulate appetite, feelings of fullness and digestion.

For centuries, Traditional Chinese Medicine has been using a variety of techniques including acupuncture, reflexology and herbs to reduce stress and treat stress-related disorders.

While I have no idea how these “new”  scientific studies will pan out in the long run, it seems to me that stress-related injury is not new and that societies all over the world have been treating “stress” for centuries.

While I am not advocating that the Department of Veteran Affairs (“VA”) drop its reliance on prescription drugs to manage the symptoms of PTSD and embrace alternative medicine, it does seem disingenuous, if not foolish, to ignore the benefits of other treatment programs.

SFTT has long been supportive of several programs to treat Veterans with PTSD that have been shown to provide positive short and medium term benefits to Veterans.  In particular, Hyperbaric Oxygen Therapy (“HBOT”) is regularly used by the Israel Defense Forces (“IDF”) to treat military personnel for PTSD.

Sadly, the VA claims that their own tests on the efficacy of HBOT are inconclusive.

Many more examples of the intransigence of the VA can be cited, but with Veteran suicides at 22 a day and with well over 20% of returning Veterans showing symptoms of PTSD or TBI, one must ask whether the leadership of the VA is doing what is necessary to support the men and women who have served our country so valiantly.

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Can Oxygen Help Improve Brain Function for Veterans with PTSD

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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.

Indeed, independent studies confirm the benefits of HBOT:

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.

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Why Not Hyperbaric Oxygen for Veterans with PTSD?

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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?

 

 

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