“Silver bullets only work on vampires.” That’s why there is no easy cure for patients, including Vietnam veterans, with post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI), according to Dr. David Cifu.
Dr. Cifu is a physiatrist--a physician who specializes in rehabilitation--at Virginia Commonwealth University’s School of Medicine where he is Associate Dean of Innovation and System Integration and Chairman of the Department of Physical Medicine and Rehabilitation. He is also a staff physiatrist at Hunter Holmes McGuire Veterans Hospital and a senior traumatic brain injury (TBI) specialist for the U.S. Department of Veterans Affairs.
About one third of those who go to war, including Vietnam veterans, develop PTSD and, of those with mild TBI from combat concussions, 90 % return with some form of chronic pain, especially knee pain, according to Dr. Cifu.
PTSD results from exposure to, or witnessing, an extremely traumatic event that threatens death or serious injury. The event causes intense fear, helplessness or horror and may result in “persistent re-experiencing of the event and persistent avoidance of stimuli associated with the trauma,” according to the Diagnostic and Statistical Manual of Mental Disorders.
The Centers for Disease Control and Prevention defines TBI as a disruption in the normal function of the brain that can be caused by a bump, blow or jolt to the head, or a penetrating head injury. PTSD and TBI are closely linked and treatment is not simple.
“Americans want surgery, a pill or a machine to treat their illnesses,” Dr. Cifu said. But PTSD and TBI are polytraumas with multiple causes and effects. They often require varied treatments, including mental health care, psychological and family counseling; physical, occupational and speech therapy; and lifestyle changes like diet and exercise.
The Food and Drug Administration (FDA) is placing the recreational drug MDMA on a fast track for review in treating PTSD. The FDA said the drug, known as Ecstasy, is a “breakthrough therapy” for PTSD, according to recent news reports. “I’m not particularly hopeful of any eventual success,” Dr. Cifu said, noting that MDMA may help certain patients respond better to psychotherapy. “The cost and potential misuse are so high that I doubt that there would be any long term value, even if it does work.”
There have been more than 50 studies of various pills to treat brain injuries. “None of them worked for humans,” Dr. Cifu said. Narcotic addiction is a big problem among Vietnam vets, partly because drugs were readily available, according to Dr. Cifu.
Exposure to Agent Orange in Vietnam injured many soldiers, but no scientific link was ever found with the powerful herbicide used to clear jungle vegetation, although many injury claims were paid. “Agent Orange may have made brain injuries and PTSD worse,” Dr. Cifu said.
“Many who returned from Vietnam were not normal. They survived but weren’t equipped to return to civilian life,” Dr. Cifu said. “They were vilified, spat on and called baby killers.” Since many Vietnam vets were teenagers when they enlisted or were drafted, they lacked the experience and skills needed to enter the workplace. “At least Iran and Afghanistan war veterans were called heroes, but still they had no jobs,” Dr. Cifu said.
These multiple conditions create pressure on veterans, so complex treatment is required. There are no shortcuts. That’s why Dr. Cifu objects to the hyperbaric chamber as the “ultimate cure” touted by some doctors, lawyers and others as a “way to make money.”
Hyperbaric oxygen therapy involves breathing pure oxygen in a pressurized room or tube. Hyperbaric oxygen therapy is a well-established treatment for decompression sickness, a hazard of scuba diving, and a few other conditions, according to the Mayo Clinic. Hyperbaric therapy has been claimed to cure autism, stroke, Parkinson’s disease, cerebral palsy, multiple sclerosis, Alzheimer’s disease and many more ailments like PTSD and TBI. But the Food and Drug Administration (FDA) does not approve hyperbaric therapy for any of these conditions.
“The science is not very strong,” Dr. Cifu said. Previous well-planned studies show little difference between those who did and didn't receive hyperbaric treatment, except a clear placebo effect. “Even that washed out after six weeks,” he said. The Mayo Clinic warns of risks from hyperbaric therapy, including middle ear injuries, lung collapse and seizures. While undergoing this therapy, “the patient typically is not receiving proper treatments,” Dr. Cifu pointed out.
Dr. Cifu was the featured speaker at a recent Science Pub RVA and was involved with the production of a Community Idea Stations documentary, Polytrauma Rehab in the VA: Compassionate Care which premieres on September 14 on WCVE PBS at 9:00 p.m.
Be sure to watch The Vietnam War, a ten-part, 18-hour documentary film series directed by Ken Burns and Lynn Novick, that will air on WCVE PBS / WHTJ PBS September 17, 2017.