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New PTSD treatment gaining recognition

The facts behind a promising approach helping some Servicemembers

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Vietnam veteran Raleigh Showens gripped his shotgun tightly as he sat in his car outside the pain management clinic. This was his last chance - if this treatment didn't work, he knew what he had to do.

Suffering from post-traumatic stress disorder (PTSD) for decades, Showens left the gun behind and entered the clinic with little hope of his nightmares, anger and suicidal tendencies subsiding. 

"Within hours of treatment, he and his wife went to dinner," said Dr. Eugene Lipov, the physician who performed the procedure. "When a waiter dropped a tray in the restaurant, Showens didn't notice - his wife did. She said he didn't even jump."

That night was the first time the former Army medic slept all night in more than 40 years. "(SGB) literally saved my life," said Showens, who is currently the vice president and department commander of AmVets in Illinois. 

Lipov is a Chicago-based anesthesiologist and pain management expert who developed a PTSD treatment called Chicago Block, commonly known as stellate ganglion block (SGB). A novel approach to treating PTSD, the protocol involves two injections of anesthesia into a cluster of nerves in the neck at the site of the stellate ganglion - nerves that are connected to the parts of the brain responsible for PTSD and the fight or flight stress response.

He has treated more than 57 PTSD patients and currently has a success rate of 80 percent - proof, he claims, that SGB resets the brain's chemistry back to baseline levels.

Lipov is the author of "Exit Strategy for Post-Traumatic Stress Disorder" (2011), the director of research at Northwest Community Hospital and medical director of Advanced Pain Centers; he's also the founder of Chicago Medical Innovations. He has been practicing medicine for more than 25 years (and pain management for 21 years), and believes three things about PTSD:  It isn't apsychological issue but a medical condition, and neurobiological treatment is required; it's best diagnosed with physical evidence like a MEG scanner (image of the brain); and it should be renamed "complex cerebral injury," which is more indicative of the condition. 

"Many of my patients are active-duty Soldiers and veterans," he said, "and they all experienced relief within minutes of treatment. This wouldn't be the case if it were a mental health issue."

Former Army sergeant Eric Fowler wholeheartedly agrees. "A huge weight lifted off my shoulders almost immediately," said Fowler, who served two tours in Iraq.

Diagnosed with PTSD by the U.S. Department of Veterans Affairs (VA), Fowler said he became addicted to painkillers when therapy failed. He was unable to focus, had nightmares, and was twitchy and hyper vigilant.

"I don't carry a weapon anymore," he said, "nor do I look over my shoulder in crowded places. That's huge for me. I'm noting new things every day and so are my wife and friends. I'm actually thinking about the future again."

"Flashbacks were real and not dreamlike," said Chris Carlson, a 20-year Navy veteran who retired after his PTSD was diagnosed by the VA. "Now it's more like reading a book in black and white versus watching a 3D movie in color. It doesn't affect me the same anymore."

Initially, Carlson was a skeptic and didn't think an injection in his neck would work, but now wishes every Soldier had access to this treatment upon redeployment.

Showens, Fowler and Carlson have discontinued all medications and therapies for PTSD.

Dr. (Army Lt. Col.) Sean Mulvaney from the Walter Reed Medical Center in Washington, D.C., concluded in a clinical report that the treatment was safe, minimally invasive and, "may provide durable relief from PTSD symptoms, allowing the safe discontinuation of psychiatric medications." The two patients in the study experienced "significant and durable relief of PTSD symptoms," and both successfully stopped using antidepressant and antipsychotic medications. Mulvaney indicated that SGB warranted further investigation in larger trials because the treatment is promising and may reduce the overall cost of PTSD care and excessive use of medications.

"(SGB) success would make other methods and expensive pharmaceuticals obsolete," said Lipov, adding that because it is such a simple solution to a complex problem, many find it hard to believe.

Since Oct. 2010, the Naval Medical Center San Diego (NMCSD) has been conducting a double-blind, placebo-controlled prospective study of SGB.

Several patients have had excellent responses thus far, but, "because the study is still ongoing, it's hard to determine the potential application for the larger population as a whole," said Dr. Robert McLay, author of "At War with PTSD" (April 2012), a psychiatrist and the research director for the Mental Health Directorate at NMCSD. 

"It's a complex procedure and a lot of questions need to be answered," he said. "However, this is an important first step in treating PTSD in combination with other solutions."

NMCSD utilizes a similar method to Lipov's, but has adopted additional safety measures to counteract SGB's possible side effects (seizures, and, though rare, the injection can puncture a vessel).

McLay's counterpart, Dr. (Navy Capt.) Anita Hickey, the director of pain research and integrative pain medicine at NMCSD, initiated the study through her research as an anesthesiologist. She said to reduce risks and avoid seizures, NMCSD uses ‘live' ultrasound technology to identify the line placement of the needle and administer a less potent dosage.

Lipov agrees that the procedure is very precise, and warns against physicians who claim to administer it, further stating that the Chicago Block treatment is unique to him.

He had been denied military research funding in the past, but has since received $2 million in funding from the state of Illinois and invested more than $3 million of his own funds to advance research. His greatest wish: more funding, not only to prove the treatment works on a larger scale, but also to have it reach those who need it most now.

"We need to have a ‘reverse surge,'" said Lipov, referring to the 2003 Iraq ‘surge' during Operation Iraqi Freedom. "We need to figure out PTSD now, before all of our Soldiers return home." He believes their stability ensures a stable Army and a stable society with less PTSD-related issues. "What allegedly happened to Sgt. Bales is a classic example of how PTSD can be made worse by TBI (traumatic brain-injury) and psychiatric drugs," he said.

Lipov's patients live in 17 different states, and have travelled from places such as Georgia, Ohio, Arizona and California to seek treatment. 

He is currently looking for more participants for his study, and has even done the procedure pro-bono.  "I will do whatever it takes to help Soldiers and those suffering with PTSD," he said.

For more information or to contact Dr. Lipov, visit http://chicagomedicalinnovations.org or call (847) 760-9307. For NMCSD contact Sonja Hanson at sonja.hanson@med.navy.mil.

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