Memorial Day was founded to honor those who paid the ultimate price to defend our liberty. Every Memorial Day we hold ceremonies and parades across the nation, honoring our war dead. These activities are very important and help us teach the next generation about patriotism and service while reminding our veterans that we as a nation will always remember the sacrifices of those who swore an oath to protect and defend our Constitution, and then put on a uniform went into harm’s way.
Traumatic Brain Injury – the Signature Injury of the Global War on Terror: For the last ten years my colleague William Duncan, PhD, a veteran of the US Army and of Capitol Hill has been working tirelessly to help active duty military, Reservist and Veterans living with Traumatic Brain Injury and/or Post Traumatic Stress Disorder (TBI/PTSD) obtain access to a safe and effective therapy which does not simply treat (or mask) symptoms, but helps the brain heal. The therapy has been around for over a century, it is FDA approved for more than a dozen indications (including 3 neurological conditions) and is even Medicare approved. The therapy has been validated through multiple studies in both animals and people, by multiple groups in the United States and abroad who have confirmed (1) safety, (2) dose, (3) benefit, and (4) that the response is not simply the placebo effect. I have reviewed the published research which have been through peer-review and even seen some of the yet to be published research, all which shows through both objective and subjective measures, including brain scans and IQ testing that those who follow the protocol at last to the half way point, improve.
I heard from a respected source about a retired Brigadier General who was hit by an IED in Afghanistan and spent about a year at Walter Reed, after a year, a doctor at Walter Reed referred him to a local facility for the therapy and the Brigadier General recovered, returned to his private life and a career in public service. His therapy was reimbursed by TriCare.
I have met a Navy Seal who was injured in a training exercise. It was not a brain injury, but could have been a career ending injury because the Navy doctors wanted to perform a surgery that would have forced him out of the Navy. He opted for this therapy, returned to full duty and deployed multiple times to war zones. The Navy did not reimburse this for the therapy.
Last summer I met a retired professional football player who suffered repeated concussions when playing football. He had begun using this therapy along with key dietary supplements and was seeing a tremendous recovery.
Meeting Major Richards: Earlier this month I had the honor and privilege of spending some time with Maj. Ben Richards (US Army Retired). The West Point graduate and father of four was in Washington just after appearing on 60 Minutes talking about the new Walter Reed Facility for TBI/PTSD and his injury. He is still a young man, in his mid-30s, clean cut, and dedicated to our country. He had planned to make the Army a career.
As I would learn, Major Richards was injured six years ago. He shared that 90 of the 100 men in his command had been in vehicles blown up with IEDs, some of them 4 or 5 times. When they returned to the United States, they were evaluated by the Army and not a single one of those 90 was diagnosed with a TBI. Major Richards would be diagnosed with PTSD, and was reassigned to a teaching position at West Point. His health deteriorated and he would get a referral to Walter Reed, where brain scans showed he had a TBI. With the TBI came intense headaches, body pain, severe fatigue, and myalgia. Major Richards shared that he got the best medicine of military medicine. He was given multiple medications, received behavioral therapies, alternative therapies, learned coping skills, and was being taught how to live with his new normal. He would return to West Point and be medical retired from the Army. While at Walter Reed, his doctor would tell him about brain neuroplasticity and that the current military thinking is that the brain does all of its healing within the first 2-3 years. So, five years post industry, what he had would be as good as it got.
The 60 Minutes story was not the first times Major Richards had been in the news. Last August he and his wife were interviewed by the New York Times Review about living with TBI/PTSD. Several retired Generals who were also West Point Alumnus saw the story, knew about the effective therapy I mentioned and reached out to Major Richards. They raised the funds for his treatment, which he completed just a few weeks ago. When I asked how he was doing, he said he felt he was about 50% back. The good news is that he sleeps now, he can read books again, he is taking less medication, and his memory is much better. He is now a dad to his children, and is planning to return to school this fall, where he feels he will really be able to tell how he is doing. He was in Washington sharing his story with legislators and their staff. He shared that he felt had Walter Reed offered the therapy he got this year while he was still in the Army, that he would have been able to recover and preserve his military career, to continue to be of service to his country.
Sadly the 60 Minutes story did not share anything about Major Richard’s recovery. The focus of the story had been on the Intrepid Centers being built by the Fisher Family, so while CBS taped him discussing his recovery, that video was not aired. And equally sad is that the Intrepid Centers are not likely to offer the therapy because the Defense Department (DOD) will be in charge of running them and while they are fully informed of the benefit of this therapy, and have used it for other treatments, and reimbursed some, they have been a part of the problem rather than a part of the solution.
DOD medicine it seems would rather hand out very strong mental health drugs to manage the symptoms of TBI/PTSD, many with FDA required Black Box Warnings for risk of suicide, than actually provide the therapy that actually facilitates brain healing.
A Modern Tuskegee: That the DOD for 10 years has been informed of an effective therapy for TBI/PTSD and not moved to make it available to me is as bad as the Tuskegee experiments. Many members of Congress have done everything within their power to make sure our war wounded had access, and military leadership, in particular the Surgeons General have blocked access, and blocked reimbursement. During one Congressional interaction, the DOD representative said the DOD could not pay for it because the therapy was being used ‘off label’. This was a false statement given that about 60% of medicine is given ‘off-label’ including almost all of the drugs the DOD prescribes for TBI/PTSD.
A Congressional Hero: Congressman Walter Jones is so frustrated with the DOD that he has introduced legislation to make this therapy available. I applaud his tenacity and his dedication to the military families of North Carolina and the rest of the country. The truth is the DOD and the VA can make this therapy available today. They can do so in house as well as refer to the hundreds of facilities across the country that provide this therapy. TriCare could today determine that they would reimburse the therapy routinely rather than only when someone has the ability to fight them until they comply.
It is Unconscionable Not to Provide A Safe and Effective Therapy: I cannot fathom why DOD and VA are not listening to the evidence and to the war wounded who have gotten better. They dishonor those who died in service to this country by refusing to make this therapy widely available immediately. They have contributed to the pain and suffering of 750,000 war wounded. Thousands who could have been healed have instead taken their lives in suicide, some as an adverse reaction to the medicine prescribed, some because they were forced out of the military without benefits and never were diagnosed and treated. Their deaths are on the shoulders of those within the DOD and VA leadership who failed to act, who acted with malice, and who refused to do something within their power to be a part of the solution rather than to continue being a part of the problem.
So What is This Therapy? Hyperbaric Oxygen Therapy at 1.5 atmosphere (ATA). The protocol is to treat for 1 hour a day, 5 days a week for 40 treatments, take a break of a month or two and repeat. A total of 80 treatments are considered optimal. The cost using Medicare Reimbursement Rates is around $16,000. The protocol has been used safely and effectively thousands of times each year around the world. Hyperbaric Oxygen Therapy often simply referred to as HBOT at 1.3 ATA is the military’s recognized treatment for altitude sickness. The military also uses HBOT to treat ‘decompression sickness’ often referred to as ‘the bends’. HBOT is so widely available, that even the hospital in my little bitty home town now has an HBOT facility.
$16,000 One Time or Every Year? The onetime cost of the full treatment may seem like a lot – $16,000; but when you look at what it will cost each year to keep doing what the VA is doing for our TBI patients, it is not. We know that the VA will spend about the same amount annually to treat TBI patients. So which is smarter – $16,000 once or $16,000 x 30-50 years.
Its Oxygen Under Slight Pressure: Most of us know that oxygen is essential to life. Oxygen under the slight pressure stimulates healing throughout the body, including the brain. Frankly I believe that every soldier and marine combing out of a war zone should be given HBOT therapy before they return stateside to stimulate healing throughout the body. If you have been in close proximity to an explosion or bounced around a military vehicle, your brain has been jostled around and you may have a mild TBI.
Reimbursement Means Access: Because TriCare is not reimbursing for HBOT 1.5 consistently there are tens of thousands who cannot access this therapy. While many clinics have been donating therapies, they cannot do this for all that need it, and frankly they should not have to. We waste more money providing ineffective therapies than it would take to help everyone of the TBI/PTSD patients of the last decade. HBOT and those who desire access are being discriminated against. This needs to stop.
Calling on the Commander and Chief: As frustrated as I get with government officials, I still have faith that our country can and will do the right thing for our war wounded. The challenge is whether it will happen in 2013 or 2023? President Obama has the power today to fix the access issue. He inherited this problem, but he has an opportunity this Memorial Day to issue a command to DOD, VA and TriCare to make HBOT at 1.5 ATA available to all of our war wounded and veterans with TBI/PTSD. What will it take for him to do so?
If you want to learn more about HBOT, please visit the website of the International Hyperbaric Medical Foundation (http://www.hyperbaricmedicalfoundation.org/)