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.
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.
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.
“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 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.
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.
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.
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, 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.”
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.
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!
While watching the “Talking Heads” address the Russian hacking scandal through the prism of partisan politics, it struck me that much the same language is used by the VA when discussing the treatment of Veterans with PTSD.
While I have always thought that the proper use of language should be celebrated rather than used as a divisive instrument, I am very much bothered by the implications of blurring the meaning of words to suit one’s political ends.
Specifically, hacking DNC or private servers is very much different than “intervening” in the election process. Most, if not all, governments (including our own) hack foreign and often their own domestic communication’s networks.
While one can endlessly debate the ethics of hacking, it has been going on for centuries. It is simply a derivative of spying.
Using that purloined information to disrupt or interfere in our own or any other election process can most certainly be construed as an aggressive act.
The point here is that the act of “hacking” and “weaponizing the information” from that hack are two very different subjects. Blurring the meaning and intent of these two very separate activities is cause for alarm. Specifically, it introduces a number of conflicting and non-related elements into the equation that cannot be properly analyzed. Formulating an “appropriate response” will even be more difficult.
The intent here is not to discussing Russian hacking, but to show how the use of language can be used to create a distorted view of the efficacy of various VA programs to treat Veterans with PTSD and TBI.
Specifically, there is huge difference between the following statements:
The VA is treating Veterans with PTSD;
The VA is treating Veterans for the symptoms of PTSD.
As Maj. Ben Richards eloquently points out, there is no evidence that VA-prescribed therapies have “healed” or resulted in any significant improvement to Veterans suffering from PTSD and TBI.
Clearly, treating the symptoms of PTSD and TBI is quite a bit different than restoring brain function and permanently improving the physical and mental condition of military Veterans suffering from PTSD.
In effect, current VA programs seem to be designed to help Veterans cope with the side-effects of PTSD and TBI (i.e. depression, suicidal thoughts, alienation, etc.) rather than cure the underlying problem. In many cases, we have seen that lethal combinations of prescription drugs have had the opposite effect.
The semantics of VA administrators stating that they are “treating PTSD” rather than “coping with the symptoms of PTSD” is not a trivial distinction. In fact, there seems to be little evidence that the VA has provided Veterans with a clear path to restore some level of normalcy in their everyday life.
Clearly, with VA consultants like Dr. David Cifu suggesting unorthodox practices to deal with “concussive events” that no one in the medical profession seems to support, it is not surprising that the Veteran treatment outcomes have been so poor.
While there is clearly a need to help Veterans cope with the myriad of frightening symptoms that emanate from PTSD and TBI, we urgently need benchmarks to help provide Veterans with a path to recovery.
As long as a disproportionate amount of money is spent by the VA on drugs and ineffective therapy programs to deal with the behavioral symptoms of PTSD and TBI, then Veterans will be shortchanged by the organization responsible for their care.
With new leadership on the horizon at the VA, SFTT remains hopeful that Veteran trust in the VA will be restored and that the organization will be purged of the toxic leadership of Dr. David Cifu and others who defend the status quo. Our Veterans and those in the military are not well served by these corrosive and divisive administrators.
Stand for The Troops (“SFTT”) has long been critical of the manner in which the Department of Veterans Affairs (the “VA”) treats Veterans with PTSD and TBI. Other critics have singled out long wait times for Veterans seeking treatment and other issues that have prompted Congressional inquiries.
Sadly, one can no longer discuss this issue dispassionately considering that many stakeholders and political candidates seem to be positioning themselves on one side of the debate or the other. With a $170 billion budget and over 200,000 employees, a decision to make the VA more responsive to the needs of Veterans is never a black or white decision.
J. David Cox
Like many others, I was appalled by the outburst of J. David Cox, the President of the American Federation of Government Employees, who threatened VA Secretary with “physical violence”
Cox was “prepared to whoop Bob McDonald’s a – -,” he said. “He’s going to start treating us as the labor partner … or we will whoop his a – -, I promise you,”
According to U.S. Rep. Jeff Miller, a Republican from Chumuckla, Florida, and the chairman of the House Committee on Veterans’ Affairs as reported in Military.com
The exchange perfectly encapsulates the corrosive influence government union bosses are having on efforts to reform a broken VA. It’s a never-ending cycle in which pliant politicians and federal agency leaders bow to the boss’s demands to preserve the dysfunctional status quo of our federal personnel system, which almost guarantees employment for government bureaucrats no matter how egregious their behavior.
The problem with union bosses like Cox is that they are more interested in protecting misbehaving VA employees than the veterans the department was created to serve.
The problem with VA leaders like McDonald is that, in their perpetual quest to placate big labor’s powers that be, the taxpayers and veterans they are charged with serving are paying the price.
Frankly, it is tough to find fault with Representative Miller’s assessment of the situation. If we want meaningful reform within the VA to provide Veterans with the support they deserve, then we need to confront entitled thugs like David Cox and others that block long overdue change.
It will not be easy, but we must admit that the VA is fragile – if not broken – and we need to fix it to provide Veterans with the level of care they deserve.
Veterans with PTSD and the VA
As regular readers of Stand For the Troops newsletter are aware, we are keenly focused on the level of care and treatment provided to Veterans suffering from Post Traumatic Stress.
Based on our research, we have found that the care and treatment provided by the VA leads to no lasting benefit to the thousands of Veterans affected by PTSD and TBI. We reported on this earlier, but it is worthwhile watching a video of Maj. Ben Richard’s explain the failure of the VA to provide meaningful solutions:
This sobering assessment by Maj. Richards was featured a couple of months ago in our article entitled “The VA Can’t Handle the Truth, So Why Bother.” SFTT’s goal is not to throw rocks at the VA, but to insure that Veterans get the needed treatment they deserve.
Many years ago I was reading a biographic sketch of the late Canadian Prime Minister, Pierre Trudeau. According to the biography, teenager Trudeau was arrested by the Chinese police for throwing snowballs at a statue of Mao Zedong in Tiananmen Square.
He was released by Chinese police after explaining that “it was a Canadian tradition to throw snowballs at statues of famous people.” I have no idea if this story is true, but it would not surprise me as the brilliant and iconoclastic Trudeau had a glib answer for most everything.
As readers of Stand For the Troops (“SFTT”) news are aware, we are not satisfied with how the Department of Veterans Affairs (the “VA”) treats Veterans with PTSD and TBI. As reported last week, Maj. Ben Richards cites numerous internal and external studies demonstrating that VA protocols in treating Veterans with PTSD and TBI have not been effective.
For the well-being of our Veterans and their loved ones, we can only hope that our well-meaning “snowballs” will ultimately have some effect on breaking through the entrenched bureaucracy at the VA.
Sadly, this is unlikely to be the case. But if hundreds, thousands and tens of thousands of concerned Americans were lobbing snowballs at the VA through their elected officials in D.C., “a thousand flowers might bloom.” I apologize to Chairman Mao for misquoting him.
If you listen to Dr. Xavier Cifu’s moronic defense of the VA’s “evidence-based” PTSD therapy programs to a Congressional committee, you get the sense that his “own personal opinion” is far more important than any scientific evidence.
Needless to say, not everyone within the VA is as oblivious to its shortcomings as Dr. Cifu. For instance, Paula Schnurr, who heads the National Center for PTSD, which is part of the VA, says
. . . she’s “not concerned about veterans seeking alternative strategies in addition to effective strategies,” as long as the alternative doesn’t replace a method with more evidence behind it.
Schnurr says 90 percent of VA centers across the country do offer some sort of alternative treatment for PTSD. And many have been studied through clinical trials — some, like meditation and yoga, with promising results.
Schnurr also points out one approach to trauma, once approached with broad skepticism, is now on the VA’s list of approved treatments. EMDR — devised in the late 1980s — uses bilateral eye movement, looking side to side, during cognitive behavioral therapy. Only after about a dozen clinical studies did Schnurr feel comfortable recommending it.
“I’m convinced the treatment works; I’m not sure why,” she says.
But as long as the treatment is based on rigorous science, she says, that’s evidence enough.
Ah, there are those magical words again: “rigorous science.” What do those words actually mean? Could the “observational model” be flawed? At least, Ms. Schnurr has an open mind.
Is the Department of Veterans Affairs too Big to Succeed?
As we have seen last week, the VA continues to use flawed procedures to treat PTSD and TBI yet insists that the “treatment is based on rigorous science.” Gosh, if the VA’s own internal and external audits demonstrate that standard therapies are not effective in helping Veterans with PTSD and TBI to achieve better outcomes, why not explore other alternatives?
Some weeks ago, we analysed the VA under the microscope of Nassim Taleb’s theory of Antifragility. Even a superficial analysis of the VA suggests that the organization is Fragile and, in my opinion, far too big to succeed in its mission.
When President Obama signed a sweeping $15 billion bill to end delays at Department of Veterans Affairs hospitals two years ago, lawmakers standing with him applauded the legislation as a bold response that would finally break the logjam.
It has not quite worked out that way.
Although veterans say they have seen improvement under the bill, it has often fallen short of expectations. Nowhere is the shortfall more clear than in the wait for appointments: Veterans are waiting longer to see doctors than they were two years ago, and more are languishing with extreme waiting times.
According to the agency’s most recent data, 526,000 veterans are waiting more than a month for care. And about 88,000 of them are waiting more than three months.
What we are seeing, is increasingly discouraging outcomes for Veterans no matter how much money we allocate to “fixing” the problem. In economics, one simply refers to this as “decreasing marginal returns on investment.” This is not to say that some Veterans have not benefited with this new taxpayer largesse, but we should have received far better results if the VA were not so big!
So, if you are wondering what to do on this warm summer day, just pick up a few snow balls and gently lob them in the direction of our Congress and Senate in D.C. Facing up to the realities that the VA is failing our Veterans is at least the first step toward helping these brave warriors reclaim their lives.
In a moving round-table discussion hosted by Stand for the Troops (“SFTT”), Maj. Ben Richards provides a devastating overview of why the Department of Veterans Affairs (the “VA”) is failing to provide adequate care to brave Veterans suffering from PTSD. Let Ben explain why in his own words:
Drawing from internal and external VA studies, Maj. Richards exposes the great fraud perpetrated by the VA that claims to be providing adequate treatment to Veterans who suffer from PTSD and TBI (“traumatic brain injury”). Clearly, those in VA management are well aware that current treatment protocols to treat PTSD and TBI are seriously flawed.
Why is it necessary, for VA spokespersons like Dr. Xavier Cifu to articulate banal nonsense to Congress that seeks to provide better treatment for our Veterans? More to the point, why don’t those in authority within the VA simply acknowledge that “we don’t have the answers,” rather than persevere supporting treatment therapies that simply don’t work and may, in fact, be harmful?
Everyone realizes that egos and big money are on the line, but shouldn’t the well-being of our men and women in uniform and Veterans come first?
SFTT has long been partnering with several alternative treatment therapies designed to provide Veterans with options. Sadly, most of these protocols are not endorsed or supported by the VA. We long ago concluded that the entrenched bureaucracy within the VA appears to be far more interested in promoting its own path to wellness rather than acknowledge that other alternative therapies may provide benefits.
As Maj. Richards points out, the recommended VA treatment protocols do not work and those in VA’s management know that they are ineffective. Therefore, it seems evident that Congress and others must look beyond the VA to provide Veterans with PTSD therapy alternatives.
There is a growing awareness around the country that the VA is simply out of step with reality and several states are taking matters into their own hands to provide privately funded therapy programs. In particular, Maj. Richards is able to avail himself of Hyperbaric Oxygen Therapy in his home state of Minnesota.
Also, it was recently reported that a Joint study by Tel Aviv University, IDF, Walter Reed Army Institute of Research and National Institutes of Health finds computerized training before deployment could prevent PTSD.
In fact, Dr. Yuval Neria, a Special Advisor to SFTT’s Medical Task Force, explains that computerized training protocols may help patients cope with PTSD more effectively.
Biased Threat Attention Computerized Training Protocols
Dr. Yuval Neria, Professor of Medical Psychology at the Departments of Psychiatry and Epidemiology at Columbia University Medical Center, and Director of Trauma and PTSD at the New York State Psychiatric Institute presents his Attention-Bias-Modification Treatment (ABMT) designed to implicitly modify a PTSD patients’ biased threat attention via computerized training protocols.
SFTT helped fund these experimental studies by Dr. Yuval Neria. In the video above, he describes in scientific terms some promising breakthroughs on computerized training protocols to assist both Veterans and civilians cope with PTSD.
While I guess we should take some solace in the fact that Veteran suicides have now fallen on a daily basis from 22 to 20, the fact remains that we have tens of thousands of Veterans who are receiving inadequate treatment. The suicide of one Veteran is too many, so let’s hope that the Department of Veterans Affairs wakes up to the challenge rather than disparage other treatment alternatives.
Treating Veterans and Active Duty personnel suffering from TBI or PTSD with Hyperbaric Oxygen Therapy (“HBOT”) has always been regarded as “black magic” by both the VA and the DoD. In fact, earlier this year, the VA concluded their trial “study” with the following observations:
“To date, there have been nine peer-reviewed publications describing this research,” Dr. David Cifu, VA’s national director for physical medicine and rehabilitation recently told the Oklahoman. “All the research consistently supports that there is no evidence that hyperbaric oxygen has any therapeutic benefit for symptoms resulting from either mild TBI or PTSD.”
Conversely, the Israel Defense Forces (“IDF”) uses HBOT as a matter of course in treating personnel for traumatic shock. Roughly 120 patients a day are treated at the The Sagol Center for Hyperbaric Medicine and Research in Israel. In fact, many U.S. military veterans are now seeking treatment at the Sagol Center since they cannot receive treatment from the VA.
“In essence, our mental attitude is that we must take care of ourselves and through that process little Israel has become a blessing for the rest of the world…we treasure our soldiers, young and old. They are our only defenders….no one else will fight our battles. You can imagine that every concussive event will be treated with HBOT !” . . .“the policy of the IDF is that life has the highest value and they are committed to use any treatment, in any case, to save a life”.
It is hard to imagine that the VA and DoD don’t have the same commitment to the life and well-being of military Veterans as the IDF, but the facts suggest otherwise.
Should Vets Have Access to HBOT from the VA?
I suppose that the overriding question is how two nations at the forefront of international terrorism with state-of-the-art medical capabilities have widely different views on the efficacy of HBOT in treating Veterans suffering from PTSD and TBI.
Equally disturbing is the growth of HBOT treatment facilities in the United States which are attached to private clinics and hospitals. In fact, HBOT is currently reimbursed under Medicare Part B for certain conditions. It remains unclear whether this treatment is approved for reimbursement for Vets suffering from PTSD and TBI.
Despite VA and DoD “tests” to the contrary, there is an abundant of evidence worldwide that HBOT is effective in treating brain injury and restoring brain function by administering concentrated oxygen under controlled conditions. To argue otherwise is just plain foolish and self-serving.
Many have argued that the adoption of HBOT in treating Veterans would cut into the earning of Big Pharma, who continue to insist (read lobby) for a cocktail of opioids and antipsychotic medication. As a former military officer, I find it difficult to accept this premise; however, I now feel compelled to accept the obvious: the VA procurement process and treatment of Veterans is seriously flawed and, perhaps, criminally negligent.
In my opinion, the only way to destigmatize the use of HBOT for treating Veterans is for the VA to approve reimbursement for Veterans seeking treatment outside of the VA. Will this happen? Probably not. I would argue that it is highly unlikely that Vets with receive HBOT given the entrenched position of Big Pharma within the FDA, VA and Federal government.
For those who need more evidence on the efficacy of HBOT, please listen to this very informative video clip by Maj. Ben Richards, a U.S. Military Academy graduate, who underwent the HBOT treatment with Dr. Paul Harch:
Can we deprive our Veterans of this effective and relatively inexpensive treatment? If the answer is “No,” then contact your Congressman and Senator demanding action.
SFTT consults with hundreds of Veterans with PTSD each year and many – if not most – are frustrated at the quality of treatment they receive from the VA. While most Veterans will acknowledge that VA staff members have their heart in the “right place,” the bureaucratic landscape facing Veterans suffering from PTSD are formidable. Why has it been so difficult to get Hyperbaric Oxygen Treatment to Veterans suffering from PTSD?
SFTT reported earlier in the week of a new grant by DARPA to embed sensors in the brains of Veterans to track brain waves to aid in the treatment of PTSD and TBI. While it is still unclear whether Veterans will volunteer for this new DARPA initiative, there are plenty of active programs in the private sector which have demonstrated considerable success in treating Veterans with PTSD. One of the most successful programs has been the Hyperbaric Oxygen Treatment (“HBOT”) promoted by Dr. Paul Harch. This program has been featured often by SFTT, but remains unappreciated by the folks at the VA.
In a scathing article by Xavier A. Figueroa, Ph.D. published by the Brain Health and Healing Foundation, the author calls to task both the press and malingerers at the VA who sit on the sideline and continue to discredit the benefits of HBOT. Found below are some of his comments and questions which have all of us at SFTT scratching our heads in wonder at the astonishing behavior of the VA:
If the VA and DoD are willing to try anything, why not HBOT? Why the hesitation? That is the real question that is lost amid this debate, but seldom asked. Hopefully, now that a few brave souls in the mainstream news outlets have entered the field of HBOT, other journalists might be tempted to ask some of these questions. I’m not holding my breath on it. If two solid science/medical journalists couldn’t see through the knot, it bodes very poorly for any therapy that cannot push through the noise of life.
The field of hyperbaric medicine has always been viewed with suspicion by outside practitioners. It has been called a “therapy in search of a disease” and ignored or ridiculed. Something relatively simple as breathing a gas just doesn’t seem like a real treatment for such a complex organ as the brain. Yet, the successes continue to pile up and rigorous science continues to show us promising venues for application with this therapy. There is something going on that will not go away with HBOT.
Kudos to Barry Meier and Danielle Ivory for reporting on the controversy surrounding HBOT, but the real controversy remains to be reported. Why does the VA and the DoD support unproven drug therapies for PTSD and TBI? If the VA and DoD allow unproven drugs or therapies to be used, why is HBOT singled out for exclusion? If HBOT is so ineffective, why are so many people demanding access? Simply ask Retired Army Brigadier General Pat Maney:
Now, I don’t have the answers, but when 22 Veterans are committing suicide on average each day you would expect the VA to take more than a second-look at this treatment which offers such promise for Veterans trying to reclaim their lives. Isn’t it time to DEMAND that our VETERANS receive the TREATMENT they deserve. If so, why not HBOT?
Editor’s Note: Found below is a very moving letter from Maj. Ben Richards and the benefits he received from being treated by Hyperbaric Oxygen from Dr. Paul Harch. The letter is quoted in its entirety.
In the spring and summer of 2007 I (Maj. Ben Richards) had the privilege of leading Bronco Troop, 1-14 CAV, a Stryker-equipped cavalry troop, during intense combat operations in and around Baqubah, Iraq. Bronco Troop was blessed with the deep bench of top- quality Noncommissioned Officers that distinguishes great units from good ones. Five of the six officers in the troop were West Pointers. At one point all six of us were captains and the experience paid dividends in a challenging operating environment.
At the peak of operations a new second lieutenant arrived straight from the basic course to take over a scout platoon. I greeted him shortly after he arrived at our dilapidated combat outpost and told him we would have a Combat Action Badge for him the next day. His face showed that he clearly thought I was joking. By the following evening he had survived an IED hit to his Stryker, been in two firefights and earned his CAB. The rest of us had earned our CABs on our first day in town two months earlier as well. A few weeks later he was wounded by a grenade fragment while leading his platoon in a dismounted close combat assault on an al Qaeda fighting position. The courage, competence and character of these young officers was in every way a credit to our alma mater and a testimony to West Point’s continuing role as the corner stone of our Nation’s defense.
During those several months of combat operations, ninety percent of my men hit at least one IED- often more than one. In May 2007 a suicide-bomber driving a sedan laden with explosives rammed into my Stryker and destroyed it. A few weeks later we hit a second ‘plain vanilla’ IED buried in the road that damaged our second Stryker sufficiently that it was later coded out as not being worth fully repairing. After each hit, we got back up and returned to the fight because we knew that there was going to be a fight and we fight as a team, even when it hurts.
On returning home I, like so many others, began a personal movement to contact battle against an enemy that I could not see, could not anticipate and was neither trained nor equipped to combat. Six months after arriving back at Fort Lewis, I was diagnosed with PTSD. To be honest, I only sought help after being ‘command directed’ by my wife. At that time, I was not intimidated by PTSD. I had every confidence that it was something I could beat. I was surprised and not a little embarrassed that I had it all. I gave it a year, tops. By then I would be fully back in the saddle. The extent of damage to my brain caused by the pair of mild traumatic brain injuries was not recognized until over three years after the injuries and not fully diagnosed until yet another year had passed.
While I was serving in Iraq, I was extremely fortunate to be selected by the History Department at the Academy to return for a tour as an instructor. I arrived in the summer of 2010 in pretty rough shape. Less than a year into the assignment I collapsed under the weight of disabling chronic pain, memory problems, cognitive deficits, sleep deprivation, drugs (the legal kind), emotional problems and all the detritus that often accompanies invisible injuries. At one point, heavily under the influence of prescription medications, I even seriously considered taking my own life.
West Point was up to the challenge. The History Department leadership kept me in the department so that they could personally oversee my care. My fellow instructors, both civilian and military, took on the burden of my workload without complaint, as they would have carried me, my rifle and my ruck to the CASEVAC point. I’m sure theirs was a long, hard walk out. It was real leadership, at real personal cost and sacrifice.
The Department’s Colonels breached every administrative and bureaucratic obstacle to ensure I literally received the best care available in the Department of Defense for my injury profile. When it turned out that the best care was not enough, and after they had done everything within their power to assure my future well-being, they fare welled me with honors and fanfare well beyond those merited by a junior major.
The day I took off my uniform for last time was one of the saddest in my life. I saw only an empty husk of the new cadet who had marched in the rain on R-Day eighteen years earlier and so full of the potential that enables a Firstie to sit with generals and presidents while a second lieutenant hides from majors in the motor pool. I was permanently broken. The natural processes of neural plasticity had run their course and come up wanting at the end. Medications could only partially mitigate the pain while causing new problems of their own. The results of evidence-based psychotherapies became part of the new canon of evidence that those therapies, so promising for victims of rape and traffic accidents, are disappointingly much less effective against combat-related PTSD. Acceptance and accommodation were all that was left to aspire to.
It was at that moment of hopelessness that the Long Gray Line extended its hand to drag me back from the edge. John Batiste, class of ’74 , a retired general officer and president of the veteran-serving non-profit Stand for the Troops founded by the legendary COL David Hackworth (SFTT.org), hunted me down to deliver a life-changing message.
We will help you, he told me, and by that I mean really help you and not in the sense of providing a palliative weekend retreat or the cathartic commiseration of other wounded warriors.
Had John not been a grad and a soldier of such well-known reputation, I would have hung up the phone. I did not have the hope left to waste on vain promises with unlikely outcomes, but because John was who he was I gave him the time. He gave my life back.
The problem of invisible wounds and injuries was one that merited a Manhattan project. Instead it had the Army medical corps bureaucracy that ran Walter Reed into scandal, regularly abused invisibly wounded warriors exiled to Warrior Transition Units and never seemed to get past the word excuse, so clearly bookmarked in their dictionary, to the word execution. It was a corps of capable and dedicated medical operators who did not deserve their uninspired and ineffective leaders. Their obvious failures were difficult for me to understand after having spent a career in the company of men and women I would follow anywhere. And then there was the VA.
Unwilling to accept defeat at hands of inefficacious bureaucracies, John and SFTT recruited a team of medical experts and began scouring the country for new and more effective approaches to treating TBI and PTSD. Their rescue mission had led them to Doctor Paul Harch, a practitioner of Hyperbaric Medicine at the Louisiana State University Medical School in New Orleans. Harch, John said, would treat me.
Dr. Harch had become the point man for league of medical practitioners and researchers using Hyperbaric Oxygen Therapy to treat brain damage caused by TBIs. By the time I arrived in New Orleans, these practitioners had already treated over a hundred invisibly wounded warriors as well as several well-known NFL football players to include the legendary quarterback Joe Namath. Harch had personally completed a research study with 20 soldiers and marines whose brains had been damaged by combat TBIs. The results were unprecedented.
When I was being evaluated by the military’s top neurologists in 2011, the prevailing medical wisdom was that modern medicine could do very little, if anything, to help a brain heal after being damaged by a mild TBI. There was a period of natural healing of up to several years, but at four years post injury, they had no expectation that my brain would improve and many reasons to suspect that it would instead begin to degrade. I arrived in New Orleans with repressed expectations.
I found Dr. Paul Harch to be a dedicated and innovative professional. He exhibited a reserved persona that I soon found to be a façade masking a burning passion for healing and especially for healing those that hope had passed by. Harch is a man of great moral courage, conviction and compassion. A classical gentleman endowed with the noblesse oblige of an heir of a great inheritance of character and natural capacity.
Harch and his colleagues had pioneered a protocol for using hyperbaric oxygen therapy (HBOT) to treat brain injuries. The medicinal effects of oxygen at higher the atmospheric pressure have been recognized empirically for over a century. It is perhaps best known as a treatment for diving injuries. It is also widely used for healing hard-to-treat wounds and is approved by the FDA for over a dozen different medical conditions. Using HBOT to treat brain injuries, like most of the prescription medications I had been prescribed by the DOD and VA, is considered off-label but its safety has been recognized by Institute of Medicine.
Treatment consisted of 40 one-hour ‘dives’ in a Plexiglas tank that I would describe as similar to a torpedo tube at a rate of one dive, sometimes two, a day. The tube is filled with 100 percent oxygen which is then pressurized to 1.5 atmospheres. Protocols for wound healing and dive injuries use higher pressures. The pressure loads oxygen into the blood stream like carbonation in an unopened can of soda. The introduction of the extra oxygen into the brain initiates a cascade of chemical interactions that my star-man roommate could probably explain but that I would struggle to elucidate here. The end result is the creation of new blood vessels (angiogenesis) and the repair or regrowth of brain cells.
Before I began treatment, we did a SPECT neuro-imaging scan of my brain. A SPECT scan uses an injective radioactive agent to image blood flow in the brain. It is one of the more sensitive imaging tools for detecting brain damage caused by mTBIs and in many cases is superior to CT or MRI scans, especially if more than a few months have elapsed since the time of injury. The images showed the poor blood perfusion typical of a brain damaged by TBIs- not unexpected as previous scans of other types had verified multiple points of structural damage. The image meant that my brain wasn’t using the amount of oxygen that a normal brain would have been. That difference was apparent not only in the scans but in the neuropsychological testing and other measures of cognitive and emotional impairment with which I had been evaluated.
By the time I had completed 20 ‘dives’ the changes I was experiencing were becoming undeniable. Nearly every facet of my injury profile began to improve. Pain levels dropped. Sleep improved. Memory improved. Attention span lengthened. Irritability decreased. I started feeling things I hadn’t felt in years. Good things. Happy things. I was able to sustain a light workout program for the first time since 2008. We scanned my brain again. The amount and extent of blood perfusion had increased significantly, matching the subjective results that even my guarded skepticism was compelled to recognize. The SPECT image is one of the most reliable predictors of the long-term prognosis of brain injury and mine had just changed radically.
The Harch’s covered the cost of my treatment from their own pockets, as they have for dozens of other veterans before me at no small sacrifice. John and SFTT rallied donors, mostly West Pointers, to help cover living expenses for four months of care. Gulf coast alumni quickly assumed an overwatch position and contributed several thousand dollars. I couldn’t have covered the costs alone. Even a 100% VA disability rating only matches the pay of a private first class. Not enough to maintain dual household with four kids at home.
HBOT has not completely healed my wounds, but it has given me more back than I thought possible. More than five years after leaving Iraq, a husband and a father finally come home to his family. The treatment that Dr. Harch provided unquestionably saved my marriage. It has enabled me to participate in and experience life in ways that I, and my DOD and VA doctors, had assumed were gone for good. I have even been able to contribute a little bit back. I am no longer a husk. Looking back on those dark days, I don’t think it would be unfair to say that Paul Harch and SFTT probably saved my life.
Editor’s Note: This very moving story by Maj. Ben Richards highlights the benefits of HBOT in treating PTSD and Traumatic Brain Injury. Shouldn’t we be doing more for our brave veterans.