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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Celebrate Christmas with a Toast to Our Brave Warriors

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Charles Dickens’ classic “A Christmas Carol” is an entertainment staple of the holiday season. In the story, a wealthy and miserly Ebenezer Scrooge is visited on Christmas Eve by a procession of three ghosts who accompany him through scenes of Christmases past, present, and future.  It is a story that resonates with us.

A Christmas Past

In a Christmas past, I found myself searching house to house through a Baghdad neighborhood for hidden  weapons and explosives being used by various insurgent groups to conduct a brutally violent civil war. As we were moving between houses, a single shot rang. One of my soldiers was knocked backwards by the impact of a high-powered sniper’s bullet.  The soldier’s body armor stopped the round and saved his life. The round had hit the extreme edge of the ballistic plate. A quarter inch higher and it would have punctured his chest close to a number of vital organs.

Within a few minutes, with a new armor plate insert and very bruised chest, this incredible soldier was again leading his men in operations. However, that Christmas morning his family erroneously received a call from an Army casualty notification team informing them that their son had been shot in the chest. We did not discover the error until the operation concluded several days later and the soldier was able to call him. In intervening days three more of my soldiers were nearly killed by a skilled, but very unlucky sniper. One soldier’s sleeve was ripped by near miss. A shot intended for another soldier’s head was stopped by a slab of bullet-proof glass. A third bullet actually entered another soldier’s helmet, grazed his head, and exited without causing harm.

We were truly blessed that my unit’s Christmas Past so narrowly avoided deaths of serious injury, but the ghosts of such Christmases past spent so challenged continue to haunt our present.

A Christmas Present

Since returning home, I have tried to stay in contact with many of the incredible men that I served with. Some of them are doing well. More of them remain haunted by the past in the form of brain damage from IED-caused traumatic brain injuries and from Posttraumatic Stress Disorder for the prolonged exposure to danger and violence we collectively experienced.

In the last few months I have watched the hope for a merry Christmas Present of one of these soldiers vanishing. His wife  was overwhelmed by  caring for him and the rest of their family. And, frankly, people struggling with the effects of the invisible wounds of war are hard to live with. So he is alone, in pain, both physical and emotional, and dreading the reminders the Christmas season brings of all that he has lost as a consequence of serving his country for more than a decade.  It is a scene too often repeated that tears at my heart.

A Christmas Future

In spite of the hope this season brings, the prospects for Christmases Future are dim and discouraging. As we have repeatedly reported, the Department of Veterans Affairs, paralyzed by bureaucratic inertia, divided by competing interests, and anxious to avoid accountability for negligence and squandered billions, is unable to provide effective care for the roughly one-million veterans currently disabled by the invisible wounds of war. Many non-profit organizations allegedly dedicated to helping these veterans instead deliver large paychecks to their staffs, voluminous “educational” fund-raising material, and branded blankets, ball caps and backpacks. There is a lot of talk about hope, but little action to help.

At Stand for the Troops, we believe strongly in the hope of Merry Christmases Future for the combat-disabled veterans struggling through this Christmas Present. Our world-class medical advisory board has identified a range of effective treatments based on an extensive and growing body of scientific evidence and clinical experience.

We invite you to join us this Holiday Season in delivering a future of Merry Christmases to  those who have given up their past and present Christmases for us.

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SFTT Offer “Thanks” to our Brave Military on Thanksgiving

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SFTT joins millions of Americans in offering our thanks this Thanksgiving to the Veterans and active duty personnel who valiantly defend our freedoms.

US military Thanksgiving

As we all sit down to enjoy the traditional Thanksgiving turkey, SFTT is reminded of those who have sacrificed their lives for our country and the many Veterans who continue to suffer from the silent wounds of war.

While the battlefield war may be over, tens of thousands of Veterans suffer the effects of brain trauma.  The effect of this debilitating injury not only affects the Veteran, but their family and loved ones who act as caregivers.  While one would like to think that we are close to finding a life-changing solution for Veterans who suffer from PTSD and TBI, no credible solution appears imminent.

Some promising new therapies have surfaced in recent years, but the Department of Veterans Affairs (“the VA”) seems stuck in a time-warp defending outdated and failed programs.  SFTT remains hopeful that the VA will come to its senses and begin adopting some successful third-party programs that have worked wonders for Veterans.

Hiding behind the mantra of “evidence-based medicine” sounds good, but loses its luster when the evidence strongly suggests that the VA programs have failed.

Our Veterans and their loved ones need solutions now!

As 2017 draws to a close, SFTT would like to thank a few people and organizations that have made a difference in the lives of Veterans this year.  By no means is this an all-inclusive list, but one that offers our Veterans a path to recovering their lives:

Paul Harch and Hyperbaric Oxygen Therapy

Dr. Paul Harch is one of the leading practitioners of Hyperbaric Oxygen Therapy or “HBOT.”  HBOT is a commonly used therapy provide patients with oxygen administered under pressure in a series of “dives” in an HBOT chamber.  Used widely around the world for decades, HBOT has been shown to stimulate brain cells and help reverse the symptoms of PTSD and TBI.   While many Veterans have found dramatic improvement in their condition, HBOT is not recommended by the VA to treat Veterans with PTSD and TBI.

Colin and Karen Archipley of Archi’s Acres

Thanks to combat-decorated Marine Sergeant Colin Archipley and his wife, Karen, a successful fashion industry entrepreneur in her own right, Archi’s Acres provides dedicated Veterans with the skills necessary to run a successful organic farming business  in their community. With meaningful jobs in short supply for Veterans returning from multiple deployments to Iraq and Afghanistan, Archi’s Acres gives Veterans a lifeline to become entrepreneurs in a rapidly growing and eco-friendly business.

Yuval Neria and Equine Assisted Therapy

Dr. Neria is Professor of Medical Psychology at the Columbia University Medical Center and “Scientific Advisor” to Stand for the Troops (“SFTT”).  He is now deeply involved in the Man O’War Project which is the first-ever clinical research study to determine the effectiveness of equine-assisted therapy (“EAT”) and establish guidelines for the treatment of military veterans who suffer from Post-Traumatic Stress Disorder (“PTSD”).

Maj. Ben Richards and Service Dog Bronco

Maj. Ben Richards is the Director of Veterans Operations at SFTT.  Over a year ago, Maj. Richards acquired a service dog, Bronco, which 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.

service dogs for Veterans

Dr. Henry Grayson and Neuro Pathways

 Dr. Grayson is co-chairman of SFTT’s Medical Task Force and has provided several day-long training programs to caregivers and clinical psychologists  dealing with veterans suffering from Post Traumatic Stress (“PTSD”).  The author of Use Your Body to Heal Your Mind,  Dr. Grayson presents a radical view of health and healing based on an equally radical world view that we are all intrinsically connected rather than separate and that our belief in our separateness is a causal source of emotional and physical illness. Positing the body as the recipient of our beliefs, he shows that reading and responding to the body is a reliable path to emotional and physical healing. This is a challenging read with practical help for all willing to explore beyond the borders of traditional beliefs.”

 

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Reflections on Veterans Day

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Maj. Ben RichardsYears ago when I was a young Army lieutenant, my reconnaissance platoon was preparing to conduct a night-time helicopter insertion far behind enemy lines to seek out intelligence critical for a large-scale operation to be conducted 48 hours later. The operation was high risk. That night as I back-briefed my Troop commander over the hood of a Humvee  in the German woods, I expressed my concern about the level of danger the platoon was facing.

My boss, an experienced cavalry scout himself who had served as an enlisted soldier and noncommissioned officer before earning an officer’s commission, replied directly: “If you get into trouble, we will roll this entire brigade to come and get you.”

At that time the war in Iraq was still over a year in the future, and the risk was largely hypothetical, but I wondered whether the Army would really risk a brigade of 3,000 to 4,000 soldiers and hundreds of armored vehicles to rescue a few men in a desperate situation. And then I didn’t think about it again.

That is until I was leading men in a real war in Iraq. In November of 2006, my Cavalry Troop was in the process of moving from Tal ‘Afar in northwest Iraq to Taji, a large operating base just outside of Baghdad. The night before our movement, a special operations team had been conducting a raid deep in the al Qaeda-controlled hinterlands of the infamous Anbar province. The raid had run into trouble and a large force of al Qaeda fighters was closely engaged with the small special operations team.

A pair of Air Force F-16 fighters scrambled to provide air support for the troops, but because the fighting had moved to such close range, they could not use their normal load of bombs without risking the lives of the men they were trying to save. With no good options, one pilot, Major Troy Gilbert, volunteered to conduct a highly-dangerous low-level night-time strafing mission in order to employ his aircraft’s 20mm cannon which could be used much closer to friendly troops.  On completing the diving attack, his plane was unable to pull out in time and crash landed in the Anbar desert.

Although he had been unable to eject, the aircraft was largely intact and it was possible that MAJ Gilbert had survived. On that chance, my Troop and over two thousand other US combat troops—an entire Army Brigade’s worth – were quickly dispatched to rescue the pilot. We had just arrived in Taji and had not even unpacked, when we sortied into the desert.

The area had never been under US control and the roads were littered with large and deadly Improvised Explosive Devices (IEDs). The going was slow and occasionally punctuated by the ambush of al Qaeda fighters. We reached the crash site and then searched the surrounding desert and villages for four days until we were able to find forensic proof that MAJ Gilbert had not survived the crash. After an extended search other soldiers were able to locate and bring home his remains.

During those nights in the desert, I remembered another night in the German woods and realized that I was helping to fulfill a promise made not just by my commander, but by millions of American soldiers over hundreds of years. The risk MAJ Gilbert accepted was extraordinary. As an experienced pilot, he was fully aware of the danger and the cost he might have to pay to save the lives of a few Army soldiers.

Our mission to find MAJ Gilbert was the most dangerous we had conducted up to that point. As we rolled out into the desert, we also knew the risks and willingly accepted them—also at a cost. In my unit, Corporal Billy Farris, also a young father, was killed in an ambush during the operation.

What stands out about Troy Gilbert and the incredible men and women I had the privilege of serving with was their belief in the infinite value of the life of another soldier.

Unfortunately, after returning home from Iraq as an “invisibly wounded” veteran with Traumatic Brain Injury and Post Traumatic Stress Disorder, that was not the ethos I found at home, particularly in the very institutions created to care for nearly one million combat-disabled veterans like me. In 2012, Pulitzer Prize-winning journalist Nicholas Kristof observed in the New York Times, “if you want to understand how America is failing its soldiers and veterans, honoring them with lip service and ceremonies but breaking faith with them on all that matters most, listen to the story of Major Richards.”

What is exceptional about Kristof’s statement is that he made it after I had been provided the top level of care available within the DOD and VA medical systems—a level of care only a few hundred service members a year were given access to. However, these alleged best efforts were only a façade.

Suffering from daily, debilitating pain and unable to function in most facets of life including interacting with my wife and our four children, I began to seriously consider suicide. That was when Stand for the Troops came to my rescue and joined me in my personal battle against the invisible wounds of war. They arranged for me to receive several months of Hyperbaric Oxygen Therapy (HBOT) from one of the leading practitioners in the country, Dr. Paul Harch at Louisiana State University (who provided the treatments for me at his own expense).

It was the first genuinely effective medical care I had received since returning home, and it has restored much of my life. Today I am a productive and contributing member of society, with a loving family and a high quality of life.

As we reflect this Veterans Day on the blessings derived from the service and sacrifice of so many men and women and their families, we begin to realize the magnitude of the task before us in living up to legacy heroes like MAJ Troy Gilbert.

I am pleased to report that there remain many great Americans, both in and out of uniform, who share the belief in the infinite value of a soldier’s life. Please join me in supporting Stand for the Troops in making sure the nearly one million veterans disabled by TBI and PTSD finally get the genuinely effective care they deserve.

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The Department of Veterans Affairs and Service Dogs

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The Department of Veterans Affairs (“the VA”) receives considerable public criticism for its failure to provide service dogs to Veterans with PTSD and TBI.

As reported earlier by SFTT, the VA provides service dogs to blind Veterans, but has balked at providing service dogs to Veterans who are less than totally physically disabled.  The recurring argument from VA spokespeople is that there is a lack of “clinical evidence” to support the benefits of service dogs.

service dogs for Veterans

Consider this testimony by Dr. Fallon of the VA:

“I would say there are a lot of heartwarming stories that service dogs help, but scientific basis for that claim is lacking,” said Michael Fallon, the VA’s chief veterinary medical officer. “The VA is based on evidence based medicine. We want people to use therapy that has proven value.”

The argument is a brief synopsis of Dr. Fallon’s testimony to the House Subcommittee and Government Reform provided in April, 2016.

Dr. Fallon’s testimony and defense of the VA’s status quo is similar to the testimony of Dr. David Cifu on PTSD therapy and Dr. Alvin Young (aka Dr. Orange) on the lethal side effects of Agent Orange used on the deforestation of Vietnam.

The VA has set itself up as “judge and jury” to determine what range of medical services it will provide to Veterans.  Any “new” therapy that has not been blessed by “evidence based medicine,” is summarily dismissed by the gatekeepers at the VA.  In fact, the VA often uses spokespeople and expensive long-term clinical studies to avoid providing much needed therapy to Veterans.

Furthermore, there is strong evidence to suggest that the DoD purposely manipulated testing procedures on hyperbaric oxygen therapy (“HBOT”) to produce clinical outcomes more to their liking.

As reported earlier,  Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT) have been largely ineffective in reversing brain damage to Veterans suffering from PTSD and TBI.   And yet, the spokespeople steadfastly defend these therapies and argue that other therapies “lack evidence” to justify their endorsement, read “funding.”

“The VA has very little evidence to show that PE and CPT therapy programs have done much to reduce the incidence of PTSD symptoms among Veterans against the “gold-standard” standardized PCL-M tests currently used by the VA.   The chart below illustrates the point (50 is considered base level):

Veterans Affairs Fails at PTSD

Aside from being very expensive to administer, the “evidence based medicine” supporting the effectiveness of PE and CPT programs currently administered by the VA is SADLY LACKING.”

While the general public and Congressional leaders may buy the pitch from VA Spin Doctors, Veterans are seeking other forms of therapy outside of the VA.  The problem is that few can afford to do so.

The Case for Service Dogs for Veterans

Training a service dog is relatively expensive.  Most estimates suggest that the cost of training a service dog to be in the neighborhood of $20,000.  The training of a dog can last some five months after the dog reaches maturity (about six months) to another 18 months depending on the rigorousness of the training.  In addition to training the dog, the Veteran needs to spend a considerable amount of time with the service dog to develop an effective relationship.

As we reported earlier, Maj. Ben Richards spent seven weeks in intensive training with his new service dog, Bronco.  According to Ben, it was about 4 hours of training a day (generally in the morning) and a few weekend sessions.  Taking into account “training the Veteran” could add considerably more to the overall cost.  For those interesting in learning more about the steps involved in training a service dog, I refer you to this excellent FAQ provided by Psychiatric Service Dog Partners.

While the VA currently does authorize the use of service dogs for Veterans, many State and charitable organizations have sprung to the support of Veterans.  In addition to Ben’s heartwarming story, many other Veterans have benefited from the companionship of service dogs.

Several organizations like 4PawsforAbility and Train a Dog and Save a Warrior,- SFTT Rescue Coalition Partner – are actively training and providing service dogs to Veterans.  These organizations and several others rely on the generous contributions of others to support our Veterans.

While the VA continues to study the benefits of service dogs, new results are not expected until 2019.

One might justifiably ask why it takes the VA 9 years to study the benefits of service dogs for Veterans with PTSD (yes, Congress mandated a study in 2010), but Dr. Fallon and the VA spinmasters will provide you a compelling answer if you are naive enough to buy it.

Based on the sound work of many charitable organizations training service dogs, it is beyond reasonable for the VA to soft-peddle its failed therapy programs and help these struggling organizations provide service dogs to Veterans.  Wouldn’t it help provide “real” evidence to support their long overdue study?

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Veterans with PTSD: The VA Way or the Highway

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It is easy to find fault with the Department of Veterans Affairs (“the VA”), particularly when it comes to Veterans with PTSD.

Department of Veterans Affairs

Secretary of Defense, Robert McNamara, tried to employ body count statistics to assess our progress in the war in Vietnam.  Similarly, the VA has erected a statistical house-of-cards to deceive Veterans and their loved that the VA has the answers for Veterans coping with PTSD and TBI.

Like McNamara, the VA “knows what is best for Veterans” and has erected insurmountable statistical barriers to prop up their failed strategies.  In effect, the VA is telling Veterans:  “It is my way or the highway!

Paraphrasing a joke: “The VA uses statistics as a drunk uses a lamppost — For support rather than illumination.”

Sadly, it is no laughing matter when we consider the thousands of combat Veterans suffering from PTSD and TBI.  More importantly, reflect on the often tragic consequences for their families and loved ones.

While Congress and the public continue to be seduced by the steady stream of assurances that the VA provides the best possible care to Veterans with PTSD and TBI, the FACTS tell a far different story.

FAKE NEWS from the VA on Veterans with PTSD

Found below is a video of Dr. David Cifu, Senior TBI Specialist at the VA, testifying before a Congressional Committee:

The VA 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 (“CBT”)and,

– Prolonged Exposure Therapy (“PET”).

As these “therapy” programs have failed miserably according to independent studies (see below), the VA has “coped” with the problem by prescribing a lethal concoction of prescription drugs which treat the symptoms of PTSD rather than deal with the underlying problem.

And we wonder why we have an opioid epidemic in this country?

REALITY CHECK at the VA

While Dr. David Cifu continues to entertain a Congressional Committee on the efficacy of the VA’s protocols, experience for yourself one woman’s harrowing experience with the VA which eventually led to husband’s suicide:

The story of Kimi Bivins is not the exception to the type of treatment Veterans with PTSD receive at the VA. Based on many similar stories, the VA is failing our Veterans and their loved ones.

I encourage readers to read Kimi’s harrowing description of what actually takes place at a VA facility.

While the folks at the VA casually dismiss anecdotal stories, VA claims that Veterans receive the best therapy possible is simply not supported by the evidence.

No less of an authority that the National Academies of Sciences (Medical Division) reported in a 2014 study entitled “Treatment for POSTTRAUMATIC STRESS DISORDER in Military and Veteran Populations,” that CBT and PET barely made a statistical dent in providing Veterans with PTSD any lasting improvement in their condition.

Consider Maj. Ben Richards‘ compelling evidence documenting the failed experiments at the VA in helping Veterans with PTSD.

Standing behind a well-entrenched bureaucracy of statistical inaccuracies and dogma, the VA goes out of its way to discredit other treatment alternatives. Consider this bitter “scientific” debate between Dr. Cifu and Dr. Paul Harch on the efficacy of hyperbaric oxygen therapy or HBOT in treating PTSD and TBI.

Finding a Middle Ground for Veterans with PTSD?

With so little known about the brain and how to treat trauma, it seems absurd for the VA to insist that they have all the answers.  The evidence clearly suggests that the VA doesn’t have a clue.

Nevertheless, the VA argues that “alternative therapies” that do not pass scientific scrutiny and FDA approval will not be endorsed by the VA.  As we have seen countless times – from body armor testing to hyperbaric oxygen studies – the DoD uses test protocols that deviate from accepted standards.

If the tests are flawed, one is likely to draw the wrong conclusions!

For the vast majority of Veterans with limited economic means, the VA is effectively making life and death decisions based on flawed testing and a reluctance to embrace other treatment alternatives.

This is probably done with the intent of protecting Veterans from charlatans and snake oil peddlers, but doesn’t it also block Veterans from receiving promising therapies from legitimate sources?

When dogma or “approved” therapies become the LAW, then it seems unlikely that much progress will be made to help our brave Veterans recover their lives.  The VA would do well to encourage Veterans to seek alternative therapies and provide an interactive sounding board for Veterans to voice their opinions on these programs.

Honesty and transparency and a willingness to accept mistakes is the sign of a responsive institution.   Today, the VA hides behind a dogma based on self-delusion and falsehood.

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Marijuana and Veterans with TBI

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Thomas Brennan, a former sergeant in the Marine Corps, is the founder of The War Horse, a veterans’ news site, and a co-author of “Shooting Ghosts: A U.S. Marine, a Combat Photographer, and Their Journey Back from War,”  makes an impassioned plea to “make pot legal for Veterans with TBI.”

Cannabis for Veterans with PTSD and TBI

In an “Opinion” piece for the New York Times of September 1, Mr. Brennan states to following:

“Most of the major veterans groups, including the American Legion, Iraq and Afghanistan Veterans of America, Veterans of Foreign Wars and Disabled American Veterans, support regulated research into the medical uses of cannabis . . .

“What I know is that it works for me. If I hadn’t begun self-medicating with it, I would have killed myself. The relief isn’t immediate. It doesn’t make the pain disappear. But it’s the only thing that takes the sharpest edges off my symptoms. Because of cannabis, I’m more hopeful, less woeful. My relationship with my wife is improving. My daughter and I are growing closer. My past is easier to remember and talk about. My mind is less clouded. More than anything, it feels good to feel again. My migraines and depression don’t control my life. Neither do pills.

“But I live in fear that I will be arrested purchasing an illegal drug. I want safe, regulated medical cannabis to be a treatment option. Just like the sedatives and amphetamines the V.A. used to send me by mail. And the opioids they still send to my friends.”

Personally, I am delighted that Mr. Brennan feels better and is recovering his life, but one man’s (or woman’s) experience with “alternative medication” hardly makes a compelling argument to justify universal endorsement.

Superficially, one could argue that pot is far less “addictive” than opium and the opioid variants currently endorsed by the FDA and the AMA, but I suggest that Mr. Brennan compelling argument touches on a far more important issue:

Officially sanctioned / LEGAL therapies to treat Veterans with PTSD and TBI are not working! 

No one should be surprised that Mr. Brennan and many other brave warriors are seeking alternative therapies – either not sanctioned or “illegal” – because the limited treatment options provided by the Department of Veterans Affairs (“the VA”) are tragically failing the needs of our heroes and their families.

Last week, Maj. Ben Richard’s commented on a disturbing series of videos that trace a widow’s tragic quest to seek help from the VA for her husband who committed suicide when denied alternative therapy.

The tragic suicide of Veteran Eric Bivins is just another example of the abuse of power at the VA that literally makes “life and death” decisions based on a long history of failed treatment programs:  Cognitive Process Therapy (“CPT”) and Prolonged Exposure Therapy (“PE”).

If the only choice for Veterans with PTSD and TBI is institutional abuse and lethal prescription drugs, why not run the risk (illegal or unsanctioned) and seek help that works?  In the case of Mr. Brennan, cannabis might be the answer, but SFTT seeks out programs that may offer life-changing therapies rather than medication that simply deals with the symptoms.

Personally, I don’t think that potentially addictive drugs are the long term answer for PTSD and TBI, but I can certainly understand why many Veterans seek relief outside the limited number of options and callous disregard currently shown by the VA.

Perhaps Secretary David Shulkin can bring about much needed reform at the VA, but the odds are firmly stacked against him.

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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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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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Will Vincent Viola as Army Secretary Help Veterans with PTSD and TBI?

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By all accounts, the selection of Vincent Viola for Army Secretary by President-Elect Donald Trump has received widespread bipartisan support.  Hopefully, a man of his military record and impressive private-sector track record can bring about competent leadership within the Army.

Vincent Viola

Vincent Viola, Forbes Photo

SFTT certainly hopes so, but is concerned that certain National Hockey League (“NHL”) Florida Panther business connections may cloud his judgement regarding Veterans and active duty personnel that have symptoms of PTSD and/or TBI.

Mr. Viola is a West Point graduate and the owner of the Virtu Financial.  In Sep 2013, Mr. Viola and minority shareholder, Douglas Cifu purchased the NHL Florida Panthers.   “Douglas A. Cifu is the Vice Chairman, Partner and Alternate Governor of Sunrise Sports & Entertainment, the Florida Panthers Hockey Club, BB&T Center, and SSE’s additional operating entities.”

Like the NFL, the NHL is also under the gun for its approach in treating concussions:

As has been the case in the NFL, repeated hits to the head in hockey can cause brain injuries, like chronic traumatic encephalopathy (CTE), a degenerative disease that leads to suicidal thoughts and erratic behavior. But unlike the NFL, which has been heavily criticized for its handling of concussions on the field, the NHL won’t acknowledge the risk of CTE.

Dr. David Cifu (the brother of Doug) is Senior TBI Specialist in the Department of Veterans Affairs (the “VA”).  In recent Congressional testimony (see video excerpt below) Dr. Cifu claims that he has treated “twenty thousand” brain injuries and “provides care for an NHL team” in treating concussions.  Could it be the Florida Panthers?

 

Clearly, Dr. Cifu is out of touch with the majority of physicians who treat PTSD and TBI. In fact, Dr. Cifu is largely responsible for blocking less expensive and far more effective therapy for Veterans suffering from PTSD. Will Dr. David Cifu’s toxic legacy continue after Mr. Viola is appointed Secretary of the Army?

As a counterpoint to Dr. Cifu’s grandstanding at the Congressional hearings, I recommend West Point graduate Maj. Ben Richard’s stunning analysis of how the VA treats Veterans with PTSD and TBI. How sad!

 

Rather than simply point fingers, SFTT has proposed a number of alternative treatment therapies.  One existing therapy, Hyperbaric Oxygen (“HBOT”) has been used around the world for some 50 years and many hospitals currently use HBOT to treat a variety of brain-related traumas.  More specifically, it is the go-to option for the Israel Defense Forces (“IDF”) for soldiers suffering a head injury in combat.

Nevertheless, the VA continues to avoid endorsing HBOT for lack of sufficient clinical evidence.  As SFTT reported last week, 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.

HBOT in chronic TBI

While other new therapies may emerge, HBOT currently provides tangible improvement in brain function.  Furthermore, it can be provided at a fraction of the cost of currently administered VA programs.    Best of all, it is available at hundreds of hospitals around the United States (SFTT highly recommends that all HBOT treatment protocols be reviewed to insure proper application).

On behalf of our men and women in uniform and the tens of thousands of Veterans currently suffering from some form of brain injury, we are hopeful that Secretary Vincent Viola can put an end to current dysfunctional leadership within the VA.

Please, no more time for glib lobbyists like Dr. David Xavier Cifu.    Secretary-elect Viola, our brave heroes need you to act NOW!

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