Will the VA Expand HBOT Therapy for Veterans with PTSD and TBI?

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As reported earlier, the Department of Veterans Affairs (“the VA”) is now providing hyperbaric oxygen therapy of “HBOT” on a trial basis to Veterans with PTSD and TBI.  This marks an abrupt turnaround within the VA that has repeatedly claimed that there is insufficient clinical “evidence” to support the use of HBOT in treating Veterans with brain injuries.

HBOT Therapy

The VA’s position reportedly stems from some 32 “inconclusive” studies on the effectiveness of HBOT in treating TBI and PTSD. Most recently, the 2015 DoD trial of HBOT concluded that there was a “lack of evidence” that HBOT helped Veterans with PTSD or TBI.

Col. Miller, the DoD project manager, “didn’t see any value in moving forward with more studies.”  As SFTT reported earlier, Col. Miller is an infectious disease specialist and not a brain trauma specialist.  Fortunately, he now works for the Gates Foundation focusing on his specialty: infectious disease.

The VA and the DoD go to great lengths to discredit the use of HBOT in treating Veterans with brain injury. Nevertheless, their arguments seem rather spurious against the almost overwhelming scientific evidence that HBOT is effective in helping to improve brain functionality.

Some in the medical profession have questioned whether test protocols in the DoD 2015 study were manipulated to produce the “inconclusive” outcome.  More to the point, how is it possible for the VA to continue to defend its ONLY two non-invasive therapy programs: Prolonged Exposure Therapy (“PE”) and, Cognitive Processing Therapy (“CPT”)?   Patient outcomes for these two programs have been shown by independent studies to be next to useless.

In fact, so abysmal have been therapy results that the VA used highly addictive prescription drugs to treat the symptoms of PTSD and TBI rather than provide any long term cure.  Indeed, the VA has no small role to play in contributing to the opioid epidemic which is now ravaging America.

Hopefully, the lack of any meaningful success in treating PTSD and TBI has forced the VA to accelerate its exploration of alternative therapies.  Hopefully, HBOT will soon be incorporated into the treatment options currently provided to Veterans by the VA.

While Dr. David Cifu and his cronies at the VA may continue to put out disingenuous statements regarding HBOT, it is widely used all over the world to treat trauma.  Specifically, HBOT is the “go-to” option for the Israel Defense Forces (IDF).   As reported in an earlier SFTT article, Daniel Rona, who has fought with both the IDF and US military states that in Israel:

“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”.

Furthermore, as Dr. Paul Harch and others have pointed out, there are many independent scientific studies confirming the benefits of HBOT.  Specifically, Dr. Xavier Figueroa has written a compelling argument suggesting that the VA has dropped the ball on HBOT research.

There is plenty of anecdotal evidence to suggest that Veterans are seeking treatment centers all across the United States.  In many cases, clinics are opening their doors to Veterans to help them recover from the silent wounds of war.  Nevertheless, the treatment can be quite expensive as remains out of financial reach for most Veterans.

While Veterans and their support givers cope with this devastating war wound, SFTT remains hopeful that HBOT and other alternative therapy programs will soon be adopted by the VA to help these brave Veterans recover their lives.

Found below is an old (2012) but compelling video (caution, it takes a while to load) from a TV Station in Louisiana (WWL.com) which shows the remarkable recovery of Maj. Ben Richards mental and motor skills after having received treatment from Paul Harch:

While HBOT may not be “right” solutions for all Veterans suffering from brain injury, it does seem a far more compelling treatment alternative to the ineffective programs currently offered by the VA. More to the point, HBOT is non-invasive which suggests that we won’t have a new generation of addicts to contend with given failed VA programs.

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HBOT for Veterans: Infrastructure Largely in Place

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As SFTT reported earlier, the VA will soon be providing a limited number of Veterans with access to hyperbaric oxygen therapy or “HBOT” at the VA’s Center for Compassionate Innovation (“CCI”) facilities in Texas and Oklahoma.

SFTT has yet to learn when these programs will begin or how many Veterans will be enrolled in these initial programs.  As important, SFTT and the HBOT community at-large is interested in learning how “test protocols,” “metrics,” and “clinical trials” will be set by the VA and DoD to determine the benefits of HBOT.

As one sorts through the often nasty exchanges between proponents of HBOT and the VA gatekeepers like Dr. David Cifu, one cannot be oblivious to the fact that the VA does not want to encourage the adoption of HBOT in treating Veterans with PTSD and TBI.

The VA’s claim is that “patient outcomes’ using HBOT are inconclusive based on VA and DoD trials.

Could it be – as many have suggested – that the test protocols were flawed to produce “inconclusive” test results?   From SFTT’s experience in monitoring the DoD, it would NOT BE THE FIRST TIME that test procedures have been deliberately modified to produce outcomes more to the liking of current military dogma.

Since the VA has no experience in using HBOTin treating Veterans with PTSD, it seems to make sense to use established experts in the industry like Dr. Paul Harch, members of the International Hyperbarics Association or The Sagol Center for Hyperbaric Medicine and Research in Israel which provides HBOT treatment to 120 patients a day and to the Israeli Defense Force (“IDF”) to agree on standardized test protocols and monitor results.

Many will argue that further HBOT tests are not required given the wealth research currently available.  In fact, found below is an extract from a Jan, 2017 report:

Xavier A. Figueroa, PhD and James K. Wright, MD (Col Ret), USAF Hyperbaric Oxygen: B-Level Evidence in Mild Traumatic Brain Injury Clinical Trials. Neurology® 2016;87:1–7 “There is sufficient evidence for the safety and preliminary efficacy data from clinical studies to support the use of HBOT in mild traumatic brain injury/ persistent post concussive syndrome (mTBI/PPCS). The reported positive outcomes and the durability of those outcomes has been demonstrated at 6 months post HBOT treatment. Given the current policy by Tricare and the VA to allow physicians to prescribe drugs or therapies in an off-label manner for mTBI/PPCS management and reimburse for the treatment, it is past time that HBOT be given the same opportunity. This is now an issue of policy modification and reimbursement, not an issue of scientific proof or preliminary clinical efficacy.”

While Secretary Shulkin is wise to proceed slowly, he must exercise extreme caution in allowing the naysayers within the VA any authority over the initial CCI HBOT trial programs.

HBOT Infrastructure in Place to Help Veterans

Assuming the VA leadership can get beyond the hurdles they largely created, Veterans with “mild TBI” and “persistent” PTSD should be able to quickly access hundreds of HBOT facilities across the United States.  With equipment already in place around the country in hospitals and private health clinics, there is no need to hold up treatment for Veterans to wait for the VA to outfit its facilities.

Follow this link to see a directory of currently active HBOT treatment centers around the country.

Clear treatment protocols and directives need to be established for each private clinic providing HBOT to Veterans.  HBOT is administered in a series of dives or sessions (usually between 28 and 40) over a 6 week to 2 month time frame.  Supervision by a trained clinician is required at each dive.  Clearly, a larger “dive chamber” capable of offering therapy to a number of Veterans at the same will help bring down the costs of HBOT.

Costs “per dive” or “session” vary significantly around the country.    Some hospitals charge $1,800 per session, but most private clinics offer this service at a cost of between $250 and $350 per dive.  Given the bargaining power of the VA, it seems most likely that a series of battery of dives can be accomplished for well under $10,000, which is less than half of what the VA currently spends on Veterans with TBI/PTSD.

As SFTT has stated on many occasions, HBOT is not the “silver bullet” to eradicate this silent wound of war, but many more Veterans with brain trauma will begin to be able to reclaim their lives with less reliance on VA prescription drugs that simply mask symptoms rather than provide any lasting improvement in brain functionality.

This could be a BIG DEAL for ailing Veterans and family members who provide our Veterans such caring support.

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