The science is there for veterans with TBI/PTS – part three
*This is part three in a series on veterans who return home from the battlefield with varying degrees of Traumatic Brain Injury and/or Post-Traumatic Stress.
Last week the Veterans Affairs Department announced that 24,000 post-9/11 veterans with traumatic brain injuries who were denied disability compensation by VA between 2007 and 2015 might have another chance to receive their benefits.
In a statement, the VA said: “To ensure that TBI is properly evaluated for disability compensation purposes, VA developed a policy in 2007 requiring that one of four specialists – a psychiatrist, physiatrist, neurosurgeon or neurologist – complete TBI exams when VA does not have a prior diagnosis.”
But it’s the status quo that has left many veterans unhappy with treatment options and wait times. In May the Veteran Affair’s Secretary Robert McDonald started a firestorm when he said: “What really counts is how does the veteran feel about their encounter with the VA. We go to Disney. Do they measure the number of hours you wait in line? Or the number… you know what’s important? What’s important is, what’s your satisfaction with the experience.”
However, there are alternatives to the 2007 VA protocols that could make a difference in diagnosis and treatment of TBI and PTS. A long established and proven blood test that only three percent of doctors’ nationally use could provide many answers to those suffering from the effects of TBI or PTS, says Dr. Brooke Alexander. She says genetic testing on four types of metabolism should be the first step in personalized TBI and PTS treatment. This specific test determines if the right medication and dosages are being prescribed. So far, she says the VA has not been receptive to the idea.
Confirming her opinion is Randy Noller from the VA who told this reporter they only use their own protocols. “Clinical care for Service members and Veterans who have experienced a Traumatic Brain Injury has been consistently provided through VHA’s TBI/Polytrauma System of Care since 2007. This includes TBI screening, evaluation, and development of an individualized rehabilitation plan of care.”
However, former Green Beret Andrew Marr, who nearly died following military docs TBI treatment advice said: “The status quo isn’t working, the status quo is medication and psychotherapy, so we’re (WarriorAngels.org) challenging the status quo by providing a superior alternative.”
He continued to explain, “for a third of the cost (VA incurs) we can exponentially improve your quality of life in a fraction of the time.”
Further evidence supporting the evolving protocols arrived two weeks ago with a ground breaking new Lancet Study that confirmed combat service members do suffer physically discernable injuries to the brain, providing a new roadmap for doctors treating TBI patients. Part of the significance of this Lancet discovery is that treatment of wounded warriors with psychotropic drugs now becomes just one aspect of treatment and not the exclusive realm of psychiatrists.
Approximately 339,462 service members have been diagnosed with a Traumatic Brain Injury. One in three service members’ returns home experiencing severe Post Traumatic Stress (PTS) symptoms. Plus, 5.3 million non-veteran Americans are currently living with a long-term disability as a result of some level of TBI. Symptoms include irritability, depression, insomnia, anxiety as well as other cognitive and co-morbidity issues. If left untreated, TBI/PTS can result in the breakdown of family relationships as well as difficulties at work and most importantly, can lead to suicide.
But as the suicide numbers grow, many doctors are looking at well-established, albeit underused tests, to find relief and improve the quality of life of those living with TBI/PTS.
For example, a blood test can chart variations of polymorphisms in cytochrome P450 genes can affect the function of the enzymes and metabolism. “The effects of polymorphisms are most prominently seen in the breakdown of medications. Depending on the gene and the polymorphism, drugs can be metabolized quickly or slowly,” according to the National Health Institute’s US National Library of Medicine. “If a cytochrome P450 enzyme metabolizes a drug slowly, the drug stays active longer and less is needed to get the desired effect. A drug that is quickly metabolized is broken down sooner and a higher dose might be needed to be effective. Cytochrome P450 enzymes account for 70 to 80 percent of enzymes involved in drug metabolism.
The metabolic rate of TBI/PTS medications can give a false indicator of the patients’ compliance with a treatment plan that can lead to service members being dismissed from the military, which only further exacerbates the 22 suicides committed each day by service members, Dr. Brook Alexander explains. “Once you kick them out of the military they (veterans) start self-medicating.”
This theory dovetails with Mayo Clinic research. “Medications for depression are usually prescribed based on symptoms and medical history. For some people, the first antidepressant tried relieves depression symptoms and has tolerable side effects. For many others, however, finding the right medication takes trial and error. For some people, it can take several months or longer to find the right antidepressant.”
“Genotyping tests, such as cytochrome P450 tests, may speed up the identification of medications that are more likely to be better processed by the body. Ideally, better processing would lead to fewer side effects and improved effectiveness.”
This type of genetic testing works with the body’s physiology to evaluate the scientific pairing with the medication a patient is prescribed. Dr. Alexander said it’s imperative to identify what kind of metabolism a person genetically possesses. There are four metabolizing categories: poor, intermediate, extensive, and ultra-rapid. Determining the metabolic rate of the patient will go a long way to improving success rates.
Psychology Today broke it down this way. “A poor metabolizer (PM) is a person whose metabolism takes in the medication very slowly, resulting in increased levels of the medicine in the bloodstream. This sluggish process causes significant side effects and poses toxicity risks such as serotonin syndrome—a potentially life-threatening condition caused by toxic levels of serotonin. If you’re a poor metabolizer, you not only have the hardship of experiencing side effects and toxicity, you also continue to have depressive symptoms.
An intermediate metabolizer (IM) is a person whose metabolism of a drug occurs at a slower rate than normal. People in this category experience side effects and mild toxicity but not as intensely as do poor metabolizers. As you might expect, medication success is guarded in this category. You notice some symptom relief, but it won’t be substantial.
Extensive metabolizers (EM) have an average expected range for metabolism. Herein, you absorb medication effectively and are able to experience symptom relief with little or no side effects.
Ultra-rapid metabolizers (UM) quickly process medication, rendering drug treatment virtually ineffective. Because your genetic metabolism synthesizes the medication too fast, you cannot experience its therapeutic effects. If you’re an ultra-rapid metabolizer, you feel no symptom relief whatsoever.”
This is good news for those taking psychotropic medications. Being well versed, knowledgeable and prepared can lead to a more individualized treatment plan, but patients cannot forget the science side as well. As the lead researcher in the Lancet study, Daniel Perl, a neuropathologist discovered the brain could receive physical damage. “What we found was a pattern of scarring that in 40 years of examining thousands of brains at autopsy I’ve never seen before and as far as I know is not described in any of the medical literature.” He also believes the implications of this discovery are weighty.
For those who want to treat TBI/PTS with a more homeopathic method, there are also several options. This individualized type of treatment centers on the replenishment of brain hormones called neurosteriods.
“Once these are lost, the brain’s ability for rational thought, cognition, creativity, understanding, and love are curtailed,” Dr. Mark Gordon of the Millennial Center explained. Dr. Gordon said that his treatment was so successful with one military service member that he was able to return to the Middle East battlefield. “When he returned home we retested his hormone levels and found only a slight drop.”
This case is encouraging for those struggling with the decision to get treatment through the military or outside medical facilities. Andrew Marr, the founder of Warrior Angels knows the tough choice enlisted members face- seek help and risk active duty status or hope it goes away on its own. However, for those who wait the consequences can be dire. That’s why Marr, a retired Army Green Beret, is encouraging those suffering the TBI/PTS symptoms to reach out to his organization where he can provide them with all the information he has collected during his road to recovery.
Unfortunately, the Departments of Defense and the Veteran Affairs do not endorse or support the brain hormone treatment program yet. Many doctors are stuck in the 20th century thinking that synthetic drugs can provide a cure, Marr says. While it may be a relatively new therapy, Dr. Gordon said the research has been around for a couple of decades and isn’t “new science” at all.