Swimming with the Sharks and Veterans with PTSD

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Last month, the New York Times published an article entitled “Scuba, Parrots, Yoga:  “Veterans Embrace Alternative Therapies for PTSD.”  The article focuses on Veterans with PTSD who seek alternative treatment programs.

shark and veterans with ptsd

In this article, author Dave Phillips, suggests that Veterans with PTSD (Post-traumatic stress) are seeking alternative treatment since conventional treatments approved by the Department of Veterans Affairs (the “VA”) are not working:

Traditional medical approaches generally rely on drugs and controlled re-experiencing of trauma, called exposure therapy. But this combination has proved so unpopular that many veterans quit before finishing or avoid it altogether. This has given rise to hundreds of small nonprofits across the country that offer alternatives: therapeutic fishing, rafting and backpacking trips, horse riding, combat yoga, dogs, art collectives, dolphin swims, sweat lodge vision quests and parrot husbandry centers, among many, many others.

According to Mr. Phillips, one group of Veterans has even taken up swimming with sharks to help “overcome fears and build new experiences that put traumatic memories in perspective.”

Now, it is difficult to say whether swimming with sharks or parrot husbandry have any long term beneficial impact for Veterans, but it does speak volumes for the lack of treatment alternatives currently offered by the VA.

Prescription drugs and exposure therapy seem to be standard treatment procedures within the VA.  Sadly, the VA gatekeepers strongly discourage Veterans from seeking alternative programs provided by the private sector and charitable organizations (mostly small).

Hiding behind the cloak of “not FDA approved,” “lack of supporting clinical studies” or other bureaucratic protocols, the VA has effectively blocked many Veterans from seeking what many consider to be more effective treatment without the drug side-effects.

In fact, the VA has established itself as “Il Supremo” or the “Supreme Authority” in deciding what is “right” and proper for Veterans seeking help to cure themselves and re-integrate into society.

For many reasons, Veterans are finding that the VA’s recommended treatment for PTSD has its limitations and, in many cases, undesirable side-effects.  In fact, as we reported last week, the VA track record in treating PTSD is abysmal.

While VA administrators argue that they are open to “alternative therapies,” there is little in SFTT’s experience to suggest that the VA is openly encouraging Veterans to seek treatment outside the VA.  Quite the contrary, the gatekeepers at the VA consider alternative therapies as “black magic” with little or no scientific basis for support or VA funding.

As such, many Veterans are left to their own devices to find programs that may meet their particular needs rather than the VA pro forma cocktail of prescription drugs which masks symptoms and is often lethal.

While alternative PTSD treatment programs have grown exponentially,  it is difficult to gauge the efficacy of these programs given the vast differences in one program from another and the level of supervised care provided.  Who is to say whether swimming with sharks is better than parrot husbandry or which program may be best suited for a particular Veteran.

Despite these shortcomings, the VA would be wise to gather as much information as possible to evaluate the efficacy of these “alternative” treatment programs rather than simply dismiss them because there are no clinical trials or replicable results.

As the VA tries to redefine itself to provide more effective treatment programs for Veterans with PTSD, SFTT remains hopeful that the VA embraces other treatment alternatives and provides financial support to private foundations which try to make a difference in the lives of our brave Veterans.

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Throwing Snowballs at the Department of Veteran Affairs

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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.

Chairman Mao

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.

Veterans Cartoon by Gary Varval

Cartoonist Gary Varval

As if on queue, the New York Times asks the question:  Did Obama’s Bill Fix Veterans’ Health Care? Still Waiting.

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.

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

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

hyperbaric oxygen and the VA

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

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

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

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

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

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

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

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

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

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

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Latest Developments on Treating PTSD

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Much has been written about the terrible long-term consequences of Post Traumatic Stress or “PTSD,” but there appears to be no clear way of treating PTSD.  Some argue that PTSD is best treated using “psychological” methods to treat the trauma while others argue that certain war-related events (i.e. IEDs) cause physiological changes in the brain.

treating ptsd

This dilemma makes diagnosing and treating PTSD so difficult.  Based on SFTT’s experiences, we have found that Veterans with symptoms of PTSD respond differently to various forms of therapy.   In short, there seems to be no definitive solution to a very serious problem which is now reaching epidemic proportions.

In a recent article published in the New York Times, medical scientists now believe that traumatic war-related events may actually cause physiological changes in the brain.

Quoting Dr. Daniel P. Perl, a neuropathologist who led a study for Lancent Neurology, evidence now exists that changes brain patterns:

Less understood is how the blast wave — the pulse of compressed air that shoots in all directions faster than the speed of sound and arrives before the wind — affects brain tissue after crashing through the helmet and skull. Blasts are also believed to compress the sternum and send shock waves through the body’s blood vessels and up into the brain. . .

The researchers examined the brains of the five veterans who had been exposed to blasts, and compared samples with those of 16 other veterans and civilians with and without brain injuries from military service or other activities. Scar tissue in specific locations of the cerebral cortex, which regulates emotional and cognitive functioning, was found only in the blast-injury cases.

Dr Perl and fellow researchers discovered the following changes in the brain following concussion like events:

Perl and his lab colleagues recognized that the injury that they were looking at was nothing like concussion. The hallmark of C.T.E. is an abnormal protein called tau, which builds up, usually over years, throughout the cerebral cortex but especially in the temporal lobes, visible across the stained tissue like brown mold. What they found in these traumatic-brain-injury cases was totally different: a dust-like scarring, often at the border between gray matter (where synapses reside) and the white matter that interconnects it. Over the following months, Perl and his team examined several more brains of service members who died well after their blast exposure, including a highly decorated Special Operations Forces soldier who committed suicide. All of them had the same pattern of scarring in the same places, which appeared to correspond to the brain’s centers for sleep, cognition and other classic brain-injury trouble spots.

Then came an even more surprising discovery. They examined the brains of two veterans who died just days after their blast exposure and found embryonic versions of the same injury, in the same areas, and the development of the injuries seemed to match the time elapsed since the blast event. Perl and his team then compared the damaged brains with those of people who suffered ordinary concussions and others who had drug addictions (which can also cause visible brain changes) and a final group with no injuries at all. No one in these post-mortem control groups had the brown-dust pattern.

Dr. Perl on Treating PTSD

While it will takes years of analysis and research to determine whether these neurological changes can be reversed, many Veterans will continue to suffer the “invisible wounds of war.”  Dr. Perl is justifiably worried:

 After five years of working with the military, he (Dr. Perl) feels sure, he told me (author Robert Worth), that many blast injuries have not been identified. “We could be talking many thousands,” he (Perl) said. “And what scares me is that what we’re seeing now might just be the first round. If they survive the initial injuries, many of them may develop C.T.E. years or decades later.”

This is not hopeful news, but at least we as a society are beginning to take PTSD seriously.  Hopefully, we will not try and bury the research in the way the NFL has sought to hide the effects of CTE on NFL players and downplay its significance to football fans who seem addicted to the violence of the spectacle.

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Prescription Drug Abuse Hits Center Stage

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Veterans have known for quite some time that something was amiss at the Department of Veteran Affairs (the “VA’) with their “go-to” promotion of prescription pain-killers to treat PTSD.

There are countless well-documented stories of extreme behavior changes – including suicide – of “over-served” Veterans that were provided a lethal cocktail prescription drugs by VA doctors.

A number of Veterans interviewed by SFTT indicated that they simply “flushed the drugs down the toilet,” while many others reported that there was a thriving black market for pain medication.    In quite a few cases, Veterans were reported to sell VA-prescribed pain medication to others to feed other substance-abuse habits or simply to support their family.

Homeless Veteran with PTSD

Using US government statistics, CNN provides these alarming statistics on prescription drug abuse for the general public:

Death from prescription opioid overdose has quadrupled since 1999, according to the Centers for Disease Control and Prevention.

The Substance Abuse and Mental Health Services Administration estimates that in 2014, about 15 million people in the United States older than 12 were non-medical users of pain relievers. On the agency’s website, it offers a behavioral health treatment services locator where individuals can type in their ZIP code and get directions to treatment centers in their community.

In fact, the CNN article goes on to suggest that Veterans should call  the Veterans Crisis Line which directs veterans and their loved ones to “qualified, caring Department of Veterans Affairs responders through a confidential toll-free hot line”: 1-800-273-8255, option 1.

Stand for The Troops (“SFTT”) has featured this Veteran Hot Line number prominently on its website for quite some time as well as other useful treatment options that Veterans or their loved ones may wish to consider.

In fact, I found it somewhat surprising that the CDC (Center for Controlled Diseases) should announce that “medical errors are the third largest cause of death in the U.S.” after cancer and heart disease.    The timing of this release over the public uproar of prescription drug abuse seems suspicious.

If we add “medical errors” and deaths attributed to “prescription drugs” together, one could argue that visiting a doctor is hazardous to your health.

It would be totally unreasonable and a specious assault on the integrity of the medical profession to suggest that malpractice and an undo reliance on prescription pain-killers is evidence of a medical profession that is out of control.

Clearly, more “good” is being done by the medical profession than “bad,” but it seems clear that individuals need to take more responsibility for the drugs they are ingesting.    In fact, our school system seems to have it right with their “Just Say No” campaign to cut back on drug addiction and substance abuse in general.

Just Say No

Veterans with PTSD and Treatment Alternatives

While the VA has often been singled out by SFTT and others – most notably by the GAO – for chronic mismanagement of Veteran care, most would acknowledge that this huge organization does a reasonable job to support our Veterans.

Nevertheless, there is clear evidence that the VA has been over-reliant on prescription drugs to treat Veterans with PTSD and publicly dismissive on other alternative treatment therapies recommended by third-party providers that conflict with their own treatment methodologies.

With substance abuse now rampant throughout the United States and fueled by a lackadaisical approach by an unsuspecting public and unscrupulous medical practitioners, it seems high time that the VA begin to encourage Veterans to seek alternative treatments that seem to provide better patient outcomes.

Indeed, SFTT lists a number of alternative treatments under its Rescue Coalition that provides community-based programs to Veterans without the dependency on addictive pain-killers.  Isn’t this the way forward?

The VA should take the lead in both nurturing and encouraging the  growth of these programs rather than rely on dated and stale practices which continue to rely on prescription drugs.

Samples of alternative treatments abound.  In fact, in a recent New York Times report, Dr. Denzil Hawkinberry, an anesthesiologist and pain management consultant for Community Care in West Virginia, imposes very rigorous standards on who should be prescribed opioids.  Perhaps, the VA could take a page out of Dr. Hawkinberry’s book and dial back the use of prescription drugs in favor of other treatment methodologies.

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Wounded Warriors Project: Mea culpa? Not really!

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Wounded Warriors Project -  Con Game with Veterans

In yet another chapter of supreme arrogance and/or delusional behavior, Wounded Warriors Project (“WWP”) is issuing the following note to “dedicated supporters” – excerpts of which are quoted below:

The Board of WWP has received the results of a review about allegations raised in the news about WWP.  In connection with this independent and objective review, Simpson Thacher & Bartlett has been serving as the Board’s legal counsel and FTI Consulting has been providing forensic accounting services.

The review found that 80.6 percent of the donations given to WWP go to support warriors’ and their families’ participation in our 20 free, direct programs and services. The organization’s commitment to injured service members, their caregivers and family members remains steadfast.

However, the review also found that some policies, procedures and controls at WWP have not kept pace with the organization’s rapid growth over the last few years and are in need of strengthening.

To put these changes into effect and help restore the trust in the organization among all of the constituencies WWP serves, the Board determined the organization would benefit from new leadership.  As such, effectively immediately, CEO Steve Nardizzi and COO Al Giordano are no longer with the organization.

What remains undisputed is that WWP has helped and continues to help thousands of wounded veterans on a daily basis, and we remain extremely grateful to people like you whose extraordinary generosity makes that work possible.

Now, if you sincerely believe this self-serving nonsense, I have a lovely bridge in Brooklyn that I will sell you quite cheaply.

Clearly, this is a desperate appeal to donors who have been fleeced by an organization which – at best – has “lost its way,” or – in my opinion – cynically used the tragic plight of Veterans to line the pockets of WWP’s organizers and administrators.

WWP - Meetings

Source: www.actionnewsjax.com

 

Pardon me, but you don’t need “forensic accounting services” to tell you that fund-raising has always been a more important priority to its organizers than helping Veterans recover their lives.  Most of WWP’s expenditures for the 20 or so WWP programs to aid Veterans can be classified as “feel good” programs with little tangible long term benefits for either the Veteran or their loved ones.

Nevertheless, these “feel good” programs are great fund-raisers, which simply exploits Veterans for the benefit of their organizers.  Such hypocrisy!

The New York Times reports today that Senator Charles E. Grassley, an Iowa Republican and a member of the Senate Finance committee “is asking for a detailed accounting by the country’s largest veterans’ charity.”   Senator Grassley correctly argues that:

“If true, these allegations are a breach of faith with donors, taxpayers, and, more importantly, veterans,”

As a “dedicated supporter” of Veteran causes, WWP has lost my trust and I believe that this self-serving apology is simply an indication of WWP’s continued arrogance and insincerity.

If WWP wants to regain my support and the support of other genuinely concerned donors, then the Board of Directors and current executive leadership should resign immediately.   Furthermore, any existing monies or new contributions should be placed in an escrow account and disbursed only through a court-appointed Trustee.

This Trustee should appoint an independent third-party to administer existing programs, review all personnel practices and funding decisions and make recommendations as to which of the 20 or so programs should be allowed to continue, scrapped or modified.

Anything short of getting rid of the current crop of “bad apples,” who are currently running or overseeing WWP, is simply a slap-in-the-face to this organization’s donors, Veterans and their loved ones.

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Rebuilding the VA One Bureaucrat at a Time

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“There are no two words more harmful in the English language than ‘good job,'” according to J. K. Simmons in his riveting role as a jazz instructor in Whiplash.


President Obama and the VAWith all due respect, “good job” now must take back seat to “chipping away,” as President Obama declared in a recent visit to a VA facility in Phoenix. According to an article published in the Columbus Dispatch, President Obama declared that his new VA leadership is “chipping away at those problems.” Certainly the Government Accountability Office “GAO” and President Obama don’t seem to be reading from the same script as earlier reported by SFTT on veterans with severe depression:

10% of vets treated by VA have major depressive disorder and 94% of those are prescribed anti-depressants
86% of audited files of vets on anti-depressants did not receive a follow up evaluation within the required 4-6 weeks
40% of the same group of veterans on anti-depressants did not receive follow up care within the recommended time frame
63% of suicide cases were inaccurately processed

This means 500,000 veterans have major depressive disorder and 470,000 of those are prescribed anti-depressants. This means it is possible that 404,200 veterans on anti-depressants are not receiving timely follow up assessments.

Frankly, Mr. President “chipping away” at the problems of the VA is simply no where near a “good job,” let alone “mission accomplished.”

Simplified Model to Fix the VA

While I have no intention of engaging in partisan “gotcha” games, some problems are simply too big to fix with a bureaucratic house-cleaning.  With 340,000 employees, the  VA seems managerially adrift and totally unresponsive to the needs of our brave Veterans.   Can it be “fixed” from within?  I doubt it.   Responsiveness to address the needs of our Veterans clearly seems to have taken backseat to a bureaucratic structure that is both self-serving and adrift from the needs of the constituents it is mandated to serve.

In these situations, it is generally best to segregate the organization into activities or functions that “work” from those that have manifest problems.  Sure, some Veteran support functions may not be “broken” and in those cases it might well to determine what resources are required to fix the problem – and, if adequate resources are allocated to borderline cases, will the desired outcome be acceptable.

These need not be a complicated exercise, but is certainly one which VA bureaucratic insiders will sabotage.  The following decision tree results:

  1. VA Functions that “Work”:  Staff appropriately and allocate resources to either enhance or maintain capabilities;
  2. VA Functions that “May be Viable”:   Determine what problematic functions are viable and invest, or eliminate;
  3. VA Functions that are “Not Viable as Presently Administered”:   Current VA activities that are not viable or cannot be fixed within the current VA structure should be eliminated and/or outsourced to the private sector.

Simply throwing more taxpayer money at an institution with a stunted bureaucratic hierarchy  makes absolutely no sense.   I can sense President Obama’s frustration, but sadly the chronic neglect of our brave Veterans requires more that “chipping away” political soundbites.

The “Choice Card” Thwarted by VA Bureaucrats

Lat summer with great fanfare, Congress passed emergency legislation designed to provide Veterans with emergency healthcare in the private sector if adequate service was not available from the VA.   In general, the “Choice Card” was provided to Veterans who were more than 40 miles from a VA facility, however, it now appears that the VA disqualified some 80% of those Veterans who applied for medical help from the private sector.

It is no wonder that the entrenched bureaucracy at the VA is fighting tooth-and-nail to avoid letting Veterans determine the care they wish to receive.   James Tuchschmidt of Concerned Veterans argues that:

“We are now entering a realm where we, quite frankly, are running a health plan, where the veteran, the patient, decides what happens to them, and where they go, and how they get care, and what care they get. And this is a huge cultural shake-up, quite frankly, for us as an organization.”

Will the VA allow this initiative to succeed?  I doubt it, unless both the President and Congress insist on VA leaders who are prepared to effect “real” change rather than administer the status quo which is largely broken and ineffective in dealing with the needs of our Veterans.

For those looking to find help near you, PLEASE CLICK ON THE FOLLOWING LINK to find Community Resource Centers near you.

 

 

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F.D.A. on Prescription Drugs

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People complain that the F.D.A. takes far too long in approving “new” drugs, but they seem to be equally obtuse in pointing out the dangers of using drugs they have already approved.  According to a new article appearing in the New York Times, the F.D.A seeks tighter control on prescriptions for class of painkillers.     I suppose we should be grateful that the guys and gals in the white robes in D.C. have finally come to their senses and realize that we now have a nation of addicts: addicted to prescription and generic pain killers all approved by the F.D.A.   How sweet!

The “debate” is not without its polemics as this lengthy excerpt from the New York Times article suggests:

 

“In 2011, about 131 million prescriptions for hydrocodone-containing medications were written for some 47 million patients, according to government estimates. That volume of prescriptions amounts to about five billion pills.

Technically, the change involves the reclassification of hydrocodone-containing painkillers as “Schedule II” medications from their current classification as “Schedule III” drugs. The scheduling system, which is overseen by the D.E.A., classifies drugs based on their medical use and their potential for abuse and addiction.

Schedule II drugs are those drugs with the highest potential for abuse that can be legally prescribed. The group includes painkillers like oxycodone, the active ingredient in OxyContin, methadone and fentanyl as well as medications like Adderall and Ritalin, which are prescribed for attention-deficit hyperactivity disorder, or ADHD.

In recent years, the question of whether to tighten prescribing controls over hydrocodone-containing drugs has been the subject of intense lobbying.

Last year, for example, lobbyists for druggists and chain pharmacies mobilized to derail a measure passed in the Senate that would mandate the types of restrictions that the F.D.A. is now recommending.

At the time, the lobbying arm of the American Cancer Society also said that making patients see doctors more often to get prescriptions would impose added burdens and costs on them.

Senator Joe Manchin III, Democrat of West Virginia, expressed dismay when the proposal died in the House of Representatives.

“They got their victory – but not at my expense,” said Mr. Manchin, whose state has been hard hit by prescription drug abuse. “The people who will pay the price are the young boys and girls in communities across this nation.”

As SFTT has been reporting for many months,  prescription drug abuse with terrible side-effects is chronic among the many brave warriors returning from combat in Iraq and Afghanistan.   Sadly, treating the symptoms with OxyContin and other toxic pain-relievers has been the panacea prescribed by the VA.  Despite clear and irrefutable evidence that this was causing more harm than good for warriors suffering from PTS and TBI, the lobbyists and their political pundits in government were reluctant to pull the plug on what is little more than government-sponsored drug addiction.

Finally, we may get an opening to help these brave young men and women rebuild their lives without the terrible consequences of addiction.

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PTSD and the VA: A Disservice to Disabled Troops

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In an editorial opinion published in the New York Times on May 26th entitled ”

QUOTE

The Departments of Defense and Veterans Affairs have repeatedly promised to do a better job of handling the medical evaluations of wounded and disabled service members. Instead, they are doing worse.

The processing of disability cases is getting slower, not faster. Efforts to ensure a “seamless transition” out of the military are falling short. Men and women are languishing without treatment, struggling to readjust to civilian lives as they cope with post-traumatic stress disorder, brain injuries, drug addiction and other service-related afflictions. The system that should be producing reliable results is mired in delays and dissatisfaction.

A new report by the Government Accountability Office lays out the problem. In 2007, the two departments began combining their separate, complicated and cumbersome processes for disability evaluations into one system. The system is now in place worldwide, and officials from both departments promised the Senate Veterans’ Affairs Committee a year ago that it had become “more transparent, consistent and expeditious.”

But the accountability office found otherwise. It said processing times for disability cases had actually gone up — to an average of 394 days for active-duty troops and 420 days for National Guard members and reservists in 2011, well over the departments’ goals of 295 and 305 days. In fiscal year 2010, 32 percent of active-duty troops and 37 percent of Guard and Reserve troops completed evaluations and received benefits within established timelines. Last year, those figures fell to a dismal 19 percent and 18 percent.

What’s going on? The report says the causes are not fully understood, but it points to persistent staffing shortages, problems in collecting and reporting data, and differences among the service branches and between the Pentagon and the Veterans Affairs Department in the way cases are diagnosed and tracked. The accountability office says it will make recommendations later this year as it sees whether promised improvements are taking hold, including a hiring push by the Army — a huge source of processing bottlenecks — and the V.A.

Senator Patty Murray, chairman of the Veterans’ Affairs Committee, deserves credit for focusing attention on these and other failings in a series of hearings, including one last Wednesday that examined the bureaucratic delays. She also used the hearing to bring up disturbing reports that doctors at an Army base in Washington State had repeatedly — and wrongly — rejected soldiers’ legitimate post-traumatic stress disorder claims.

Wounded and disabled service members should not be forced to wait endlessly without treatment or benefits while the government evaluates their injuries. Nor should they have to battle their own government for honest treatment. The evaluations should be accurate, not consistently wrong. Ms. Murray noted on Wednesday that there were about 27,000 military personnel in the system, three times the number in 2010. Many more are on the way. “Clearly, much work remains to be done,” she said. She is right. There is no excuse for more backsliding and delay.

UNQUOTE

Enough “lip service” as Hack would say.  Let’s rollup our sleeves and help these brave heroes.

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J.D. Salinger and PTSD

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J.D. Salinger BiographyIn a fascinating book review in the  New York Times last Sunday,  Jay McInerney writes extensively on a new biography on the reclusive J.D. Salinger entitled J.D. Salinger: A Life by Kenneth Slawenski.   This iconic author, best known for Catcher in the Rye, was a transformational author who did much to goad the thinking of young men and women growing up in fifties and sixties.  What was unknown to me, was Mr. Salinger’s military service during World War II.

From Mr. McInerney’s perspective,” the great achievement of Slawenski’s biography is its evocation of the horror of Salinger’s wartime experience. Despite Salinger’s reticence, Sla­wenski admirably retraces his movements and recreates the savage battles, the grueling marches and frozen bivouacs of Salinger’s war. It’s hard to think of an American writer who had more combat experience. He landed on Utah Beach on D-Day. Slawenski reports that of the 3,080 members of Salinger’s regiment who landed with him on June 6, 1944, only 1,130 survived three weeks later. Then, when the 12th Infantry Regiment tried to take the swampy, labyrinthine Hürtgen Forest, in what proved to be a huge military blunder, the statistics were even more horrific. After reinforcement, ‘of the original 3,080 regimental soldiers who went into Hürtgen, only 563 were left.’ Salinger escaped the deadly quagmire of Hürtgen just in time to fight in the Battle of the Bulge, and shortly thereafter, in 1945, participated in the liberation of Dachau. ‘You could live a lifetime,’ he later told his daughter, ‘and never really get the smell of burning flesh out of your nose.’”

It is hard to imagine a more harrowing battlefield experience and the devastating impact of War on those around him.   Mr. McInerney goes on to write that  by “July (1945)  he checked himself into a hospital for treatment of what we would now recognize as post-traumatic stress disorder. In a letter to Hemingway, whom he’d met at the Ritz bar shortly after the liberation of Paris, he wrote that he’d been ‘in an almost constant state of despondency.’  He would later allude to that experience in ‘For Esmé — With Love and Squalor.’ Readers are left to imagine the horrors between the time that Sergeant X, stationed in Devon, England, meets Esmé and her brother, Charles, two war orphans, and the time that Esmé’s letter reaches him in Bavaria a year later, after he has suffered a nervous breakdown.'”

Certainly, it is cause for reflection that we are only just now beginning to understand the symptoms of post traumatic stress disorder (PTSD).  Furthermore, judging from the numerous reports circulating within military circles, we appear to have a growing epidemic of psychological and nerological disorders with little evidence of an “effective” solution on the horizon.  I fear that the “unintended consequences” of our wars in Iraq and Afghanistan will be with us for many years as brave young men and women who have served on those battlefields return with PTSD.  How we insure these brave heroes receive proper care and treatment will say much about our society.

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