I spent the day yesterday at Fort Carson in Colorado, speaking to colleagues about the use of SPECT imaging in traumatic brain injury. As you likely know, brain injuires are the signature wound of the Iraq War. 15% of soldiers have suffered brain injuries, many with long term damage.
In many ways going to Fort Carson was like coming home. I was an infantry medic during the Vietnam War, and did my psychiatric training at Walter Reed in Washington, DC and Tripler in Hawaii and, after my training was the chief of Mental Health at Fort Irwin in the mojave Desert. Soldiers hold a special place in my heart.
At Fort Carson, the nuclear medicine department, headed by Col. Reed Smith, MD have been using SPECT for the last 10 months with great results. Dr. Smith took my 5 day brain SPECT course for clinicians last summer. When I found out where he was from I offered to help. It was so gratifying to see how he was using the technology and how helpful it had been to soldiers, their families and to clinicans. I urged him to start doing before and after scans to see how their treatments were working. In the military, follow up care can be a challenge because soldiers are often transfered or the ones with head injuries leave the service and are picked up by the VA. But they are making exciting progress.
Of course, there are skeptics, but once they see the power and extensive body of research (over 72 studies on over 3,000 patients) that underlies brain SPECT in brain injury, they usually become converted.
Have a blessed day,
Daniel
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7 Comments
Dear Dr. Amen,
I work at Ramstein Air Base near Landstuhl Regional Medical Center in Germany where many of the injured from Iraq and Afghanistan travel for treatment prior to going on the the US. I am very interested in the research results you speak of regarding the value and progress in using SPECT with brain injured soldiers. I know the Army is doing some pre-deployment neurological testing (computer quiz-type evaluation) for a baseline and then they have something to compare to if the soldier returns with TBI. But their use of SPECT is seriously lacking. What can you tell me about the important findings your research is showing in how to assist the TBI military members returning from war. I have several years experience training miltary members on how to manage critical incident stress and traumatic reactions (this is through debriefings, discussion, and support), but the SPECT angle may have further utility, more than we ever had previously imagined.
Thank you for your response.
Dr. Tom Appel-Schumacher
Fellow, American Academy of Experts in Traumatic Stress
Approved Trainer, International Critical Incident Stress Foundation
Hi,
I would like to know if there were common results in the SPECT scans of folks who had been exposed to blast waves without direct impact by an object. Do you have more detailed data?
Thanks,
Lyn
How much does a spect scaner cost and who could I contact about setting up a clinic in st. Louis MO?
My husband is a soldier who had a SPECT scan at Fort Carson, unfortunately for him he has a sever TBI and to make matters worse the psychological impact has left him a mess. I am having trouble getting his physicians to understand how seriously his injury has affected him psychologically. How can I get my husband help?
In comment to your Blog article “Brain Injuries, Soldiers and Imaging” I have two items, the first a comment and the second a question.
First, I want to say thank you to Dr. Amen and his fine staff in the Newport Beach, CA clinic. Thru their SPECT imaging, my husbands brain issues were correctly diagnosed and he was able to obtain both legal disability status as well as the proper care and medication. For this, we are both eternally grateful.
Secondly, the question is regarding PTSD and our returning military personnel and their families as well as Police personnel and their families. Our church is creating a network of every type of assistance and information database for the people in our church and community, as well as a group of supportive veterans and their families that have been thru previous wars &/or brain injuries.
Many already need or want SPECT imaging but are not able to obtain it, mostly because of cost. What other form of diagnosis and or treatment, in your opinion, would be the next best thing? If there is any, please advise.
Dear Dr. Amen,
Your use of SPECT scan imaging and recommendation that it be used in the diagnosis and treatment of psychiatric illness is brilliant.
I’m puzzled, however, that you haven’t said anything about the use of hyperbaric oxygen. Dr. Paul Harch, as you may be aware, has pioneered the use of hyperbaric oxygen for the treatment of traumatic brain injury, as well as a number of other conditions. His research, and that of others in the use of hyperbaric oxygen treatment is readily available on the web.
The physiology of hyperbaric oxygen is not rocket science. Any layman can understand that use of 100 percent oxygen under increased atmospheric pressure will deliver more oxygen to damaged tissue. It is now considered “on-label” for use of non-healing diabetic ulcers, and greatly improves healing.
Perhaps it is because physicians are not routinely taught about hyperbaric medicine in training that the concept seems so foreign or “far out.” I am a board certified family practice physician, and while hyperbaric medicine was never discussed during my otherwise first rate medical training,(University of Texas–San Antonio, University of Iowa Hospitals, Iowa City, and Hennepin County Hospital, University of Minnesota, Minneapolis) I’m also a certified PADI scuba diver. I learned about the effect of pressure on gases and the potential for getting “the bends” and the use of hyperbaric oxygen chambers to treat the bends as part of the PADI certification.
The concept of using 100 percent oxygen under 1.5 to 2 atmospheric pressures, for example, makes sense physiologically, as it allows increased oxygen to be delivered to damaged brain tissue with impaired circulation. With hyperbaric pressure, oxygen concentration is much greater, and oxygen can diffuse into the blood plasma, the lymphatic system, and directly to the damaged tissue. The theoretical model assumes an area of dead brain tissue, call the “umbra,” surrounded by an area of damaged, living but dormant neurons. Presumably this tissue has suffered damage directly from the initial insult to the brain, and/or in part, from the cytotoxins released by the dying brain tissue.
As a pioneer who has not allowed convention to confine your thinking, you’ve made a huge leap forward in the use of SPECT imaging for diagnosis. I would encourage you to take a serious look at hyperbaric oxygen treatment as another modality, which from my reading of the research data, shows great promise for improving a number of conditions, including traumatic and acquired brain injuries such as stroke and cerebral palsy. It has been beneficial also in treating autism and certain rare mitochondrial diseases.
It will not bring dead tissue back to life. I’m sure there are physicians who fear that their patients will see hyperbaric oxygen as a miracle cure–but it will not raise the dead, nor can the effects will halt the march of time.
Nevertheless, as physicians, when we can improve the quality of life for patients, even though we may not cure them, we have a moral obligation to provide and not withhold treatment. I think in many cases of mild to moderate traumatic brain injury or stroke or other acquired brain injury, with hyperbaric oxygen treatment, we can potentially keep people independent and productive. The cost/benefit ratio favors two rounds of 40 hyperbaric treatments versus, without treatment, potentially complete disability, and possibly assisted living or nursing home placement, not to mention months or even years of neurocognitive rehabilitation, drugs, physical therapy, occupational therapy, speech therapy and so forth.
Certainly some patients may require repeated rounds of hyperbaric oxygen treatment, along with all of the other modalities of treatment we have to offer. But the necessity of on-going treatment for difficult conditions should not be a reason for withholding an effective form of treatment. I’ve been told by at least one physiatrist that hyperbaric oxygen treatment “has not been proven,” but from my own reading of the literature, that suggests more to me about his ignorance than it does about the science.
I would respectfully suggest that physicians and medical researchers read the literature before making such sweeping statements. In my experience, in 23 years in medical school, residency and clinical practice, we have embraced many forms of medical treatment with much less scientific evidence to support their use. The blind spot that many in the medical community have for hyperbaric oxygen is frankly an embarrassment.
I am not a soldiers but I am interested in some of the effects others have experienced and how they have over come them. I was hit by lighting and have many of the symptoms of brain injury. There does not seem to be many people who understand what I had and do go thorough to function in my life.