The War Within: Part II - Paths to Healing

The War Within: Part II - Paths to Healing

Tim Hecker joined the Army at 18 and soon decided to make a career of it. He served 22 years in all, in and out of combat, rising to the rank of master sergeant. In the summer of 1990, he married his high‑school sweetheart, Tina, and the couple had three children.

Then Tim couldn't remember having married Tina. He couldn't tell his sons apart. Their names escaped him.

Injuries suffered in two separate roadside-bomb explosions in a span of two months in Iraq in early 2008 left him with a traumatic brain injury and severe post-traumatic stress. He was no longer the man Tina had married.

"Didn't really remember us having kids," Tina explains. "Didn't remember us getting married. How do you explain to three teenage children that their father doesn't know anything about them anymore, doesn't know when they were born, doesn't know when their birthdays are, can't remember their names necessarily and can't remember any milestones from school? That's very difficult."

He forgot activities they used to share. "Simple little things, like going fishing with the kids. That just stopped. It's hard to explain to kids when you don't really have the answers yourself."

Tina had to quit her part-time job when Tim came home. His doctor appointments put them on the road five days a week, sometimes two-and-a-half hours each way. "You can't leave him by himself because he gets lost," Tina says. "You never know what he is going to do."

Frustrated with her husband's descent and the lack of progress with traditional care, Tina went online and found information about Dr. Paul Harch, a New Orleans-based physician specializing in hyperbaric medicine. His facility, Harch Hyperbarics Family Physicians' Center, uses high-pressure oxygen to treat basic pathophysiologic conditions.

Following a phone call and an initial interview, Tim was selected to be part of Harch's pilot study on the use of hyperbaric oxygen therapy (HBOT) for TBI and PTS. He claims the treatments have given him back most of his pre-injury life.

"By the fourth treatment, I started feeling like a new person," he says at his home in West Edmeston, N.Y. "I was more aware. I could see things. The deeper I got into the treatments, my cognition started to come back - my motor skills and my balance. My vision started to improve. The biggest benefit was my emotional control."

"We're talking a 180-degree turnaround," Tina says. "There are days when he's almost back to normal with his personality."

Tim's first encounter with an IED occurred while he was riding in a tractor-trailer in Iraq in January 2008. Two months later, he was riding in a convoy when the Humvee in front of his sustained a catastrophic hit. The blast was so severe that it impacted Tim's vehicle. A field physician examined him after the explosion and determined that he could return to duty. "I was in a (quality-assurance and quality-control) role, so I was traveling from building site to building site, and detached from my unit," Tim says. "So basically, as long as I was able to function, I stayed in the field."

Because he worked away from his unit most of the time, no one noticed that Tim's behavior had changed. "I was a miserable person," he says. "I had migraines. I was very irritable. But everyone assumed, ‘He's the ranking NCO. That's just the way they are.' But my communications and my writing and stuff were starting to show signs that something was wrong. I knew something was wrong, but I kept it hidden. In the military, any sign of weakness is not a good thing."

Tim couldn't hide it from his wife, though. "He became quiet," Tina says. "His phone calls, although daily, were very limited. He would talk about the weather, and that was about it. Never asked about kids, never asked about family, never asked about home, community, none of that. He started becoming very agitated, and the slightest little thing that most normal people might have some kind of reaction to, he would blow way out of proportion. It got to the point where I was hearing him threaten others working around them. He wouldn't threaten them directly; he would talk about it to me. That's when I got a hold of his (physician assistant) over there and said, ‘Somebody needs to pay close attention. There's something going on.' His only suggestion was, ‘We'll keep an eye on him, check him once a week. And when he gets home, maybe you should take him to the VA."

Tim redeployed stateside that June. A month later, he went to the VA medical center in Syracuse. "The initial diagnosis was severe PTSD and (mild) TBI," he says. "They started me on a bunch of antidepressants, and I forget what the other ones were. Basically, I was taking a bunch of pills.

"Things just got worse and worse. Finally, they gave me a diagnosis of post-concussive syndrome. They focused on the PTSD at first, figuring in time the brain-injury symptoms would wear off. That wasn't the case. They got progressively worse. I have prided myself in being a member of the military for over 20 years, and I felt my whole livelihood slipping away."

Tina became increasingly frustrated by the prescription-based treatment program. She says that in early 2009, "a pharmacist refused to fill his prescriptions because they were from different doctors, and he said that if he filled them, the combination would have killed Tim. Then he took all the pills he had and dumped them in the toilet. I didn't even have a say in that. At that point, we needed to do something with him. They really don't have any suggestions for TBI, other than pills and therapy. Some cognitive therapy. But it's kind of hard to give someone cognitive therapy when their brain's not able to process what you're trying to reteach them."

Tim stayed at an Army Reserve center three hours from home during that time, and Tina had to walk him through his daily routine by telephone. She had to remind him to eat breakfast, shower, get dressed and brush his teeth. When he came home, he spent days sitting in a chair and staring, unless instructed otherwise.

The Heckers' daughter, Brianne, was 16 when she became a caregiver for her dad. "I started trying to figure out how to help," says Brianne, now a freshman at the State University of New York. "We had to continuously ask how he was doing, what he was doing, what he was supposed to be doing, where he was going - sort of keeping him in check. We were always raised to help others and put others before ourselves. It was a change, yes, but I was glad I was able to help."

Still, Tim's condition worsened, and Tina sought help elsewhere. A frequent visitor to military websites, she came across a comment about a story on hyperbaric oxygen treatments that specifically referenced Harch's program. "I started looking up Dr. Harch myself, and that's when I realized he was running a pilot study. I called Tim and asked him, ‘What do you think?' He was at zero. I got nothing out of him. He didn't really want to do it. He was sluggish. I told him, ‘I'm going to go ahead and do it, and let's see what happens.'"

Tim did a phone interview with Harch and met the study's criteria. In April 2009, he traveled to New Orleans to receive HBOT.

"He went in with a migraine, came out, and it was gone," she says. "He starting picking up in his attitude, and the brightness in his eyes was coming back. He started to remember how to get back to the facility we were staying at. (Before the treatments) he couldn't get from home to a gas station without a GPS. Now he was remembering a place we'd only been in four days."

After the first round of treatments, the Heckers returned to West Edmeston. Brianne quickly sensed a difference in both of her parents. "When they came back, it was like getting new parents back," she says. "It's a big relief to know we won't hit rock bottom again with him."

Tim goes to New Orleans for treatments twice a year; the number of oxygen-chamber "dives," as they are called, is now down to seven per trip. He can always tell when it's time for another round. "It's like you take a flashlight that's got a dim bulb, and you put fresh batteries in it and get this bright light," he says. "That's how I feel emotionally, mentally and physically. As the treatments wear off, I start to get tired. I forget things. My balance gets off. It's just a huge difference."

As a result, Tina is an enthusiastic promoter of Harch and HBOT. "I carry his information with me," she says. "I've brought it to families who've had people who've had injuries. I tell them, ‘Give it a chance.'"

In recent years, Harch has treated dozens of veterans using hyperbaric oxygen. He conducted a study of 15 PTS/TBI patients by administering a battery of tests before and after the treatments. They showed an average IQ improvement of nearly 15 points. Thirteen out of those 15 reported fewer headaches. Nine of the 12 who had insomnia before the treatments cited improved sleep. Seven of the 11 subjects on prescription medication for their conditions cut back on or quit the medications.

Harch also used the military's PTS checklist to score subjects before and after treatments. They showed 30-percent reductions in their PTS scores after hyperbaric oxygen treatments.

"The purpose of this is to give them their lives back, give them back their families," Harch says. "We sent them off to war, and they allow me to sit here in my comfort and do what I'm doing and not worry about being blown up or worry about the security of my family. They put it all on the line, and they need to be rewarded for that. They deserve, at least, an attempt to get back some of that lost function. And that's what this can do."

Harch says the federal government's reluctance to accept HBOT as a legitimate treatment form for PTS and TBI comes down to money. "I firmly believe that's No. 1," he says. "We charge $200 an hour at our clinic. The Medicare rate is about $275 an hour. This is billed in hospitals at $2,000 an hour. DoD has thrown out a figure that you need $500,000 lifetime to treat a brain-injured veteran for these symptoms and problems. First of all, there's no evidence for that. Secondly, if you even took the 80-treatment protocol that I developed, that's $160,000 at the billed hospital rate ... The reality is that treatment with drugs and all these other therapies is doubly expensive."

Also, there's an outdated perception about the procedure, Harch says. "This is my generation of doctors. We were taught that (HBOT) is a fraud. Nobody understood how it worked. It got a bad name when it was applied to multiple sclerosis. People stood up and claimed it affected impotence, balding and cancer. There is so much misinformation. We're working against this past body of misperceptions."

During a lunch break in his office in Shalimar, Fla., Okaloosa County Court Judge Patt Maney makes short work of a sandwich before speaking easily about how hyperbaric oxygen treatment has benefited him. Four years ago, like Tim Hecker, Maney was in what seemed a permanent daze caused by combat brain injury.

In 2005, Maney - a brigadier general in the Army Reserve - was assigned to the U.S. Embassy in Kabul. As part of the Afghanistan Reconstruction Group, his job was to lend civilian expertise to military efforts in the wartorn nation. One day, while searching for a potable water source in the mountains above Kabul, Maney's convoy came under attack. An IED exploded, blowing his vehicle into the air and flipping it upside down.

Maney and two other passengers walked away from the blast. He went to the embassy, and then to a German army field hospital for evaluation. After several days of treatment, he was assigned back to the embassy, and 10 days later he went to Walter Reed Army Medical Center. "(Our) injuries at that point were probably underdiagnosed," Maney says. "I don't remember what the initial diagnosis was. Ultimately I ended up at Walter Reed with a traumatic brain injury diagnosis. At different times it was called other things: post-concussion syndrome, closed cranial injury, consciousness unknown, cognitive difficulties not otherwise specified."

He spent nearly 20 months there. "A lot of rehab, several surgeries," he says. "The problem with many of the ... blast-type injuries is that there isn't an outward physical manifestation of the injury. I wouldn't remember conversation. I couldn't follow directions, couldn't comprehend. Couldn't balance a checkbook. Couldn't drive.

"At one point, I went over to the National Naval Medical Center in Bethesda, which is about eight miles from Walter Reed," he adds. "I was in uniform. I stopped at a little PX gas station, and I couldn't figure out how to operate a self-service pump. I ended up asking the lady at the other side how to work it. You can imagine her surprise - somebody standing there in a general's uniform asking how to turn on a gas pump."

Maney couldn't concentrate. He had trouble sleeping. Treatment included several different medications that had little effect. "The world became kind of frightening," he says. "You couldn't do what you used to be able to do. I was faced with the realization I was not only going to lose my military position, but I would also lose my civilian occupation and go from being a rather successful independent person to being really dependent on my wife for just about everything."

About that time, Maney called a doctor friend in Fort Walton Beach "just to say hi," he says. His friend suggested HBOT. Maney contacted his doctor at Walter Reed and asked about it, and the doctor said that while he didn't know much about the treatment, he was willing to try it. In October 2007, Maney began the treatments at George Washington University Hospital.

"The protocol runs for 40 one-hour dives," Maney says. "After about 10 or so dives, my wife thought she saw improvement, but she didn't say anything - not even to me - because she was afraid it was a false hope. After about 12 or 14, I started thinking I was getting better, but I didn't want to say anything. After about 20 dives, people who had seen me both before and after the injury started commenting to my wife and me: ‘You're doing better. You look like you're doing better. You seem to be more engaged. You don't have the long pauses in your conversations. Your sentences tie together. You're talking in paragraphs.'"

After 40 dives, Maney showed substantial improvement. After a 30-day break, he did an additional 40. "By that time, I was able to start reading again," he says. "It had been very frustrating for me to not be able to read. I could pick up a page and read the first sentence. I could pronounce the words and understand the words. But by the time I read the second sentence, I'd forgotten what the first sentence said. As I started getting better and started reading, I did the other 40 dives, and I was able to come back and work full time as a judge."

When Maney meets current and former servicemembers in his community who he suspects are suffering from PTS or TBI but haven't been screened or diagnosed, he recommends HBOT. "I became much more sensitive to the plight of these soldiers and what they go through as they try to navigate what is a very complicated system that is not set up - was not and is not well set up - to deal with traumatic brain injuries or PTSD," he says.

"I ran into a young man who lost both legs in Iraq. His hand was also mangled in an IED blast. He had never been treated, never been evaluated for PTSD or traumatic brain injury. As I've gotten active trying to help these young troops, I've been contacted by people - one Marine, several Air Force, several Army. I've been able to direct them into hyperbaric oxygen therapy. Every single one has shown improvement. Not all of them have gotten back to 100 percent, but if you're functioning at 40 or 50 percent and you get back up to 75 or 80 percent, that's a major quality-of-life improvement."

When The American Legion's PTS-TBI Ad Hoc Committee met in early August, VA's Alison Cernich said that as a TBI treatment, hyperbaric oxygen is unproven and requires more research.

"Hyperbaric oxygen really has limited data right now," says Cernich, acting senior liaison for TBI in VA's Office of Rehabilitation Services. "I wouldn't say I recommend or don't recommend hyperbaric oxygen. I would say that in terms of its application, I think some of the claims that are being made are relatively wide, with the evidence relatively sparse."

She adds that VA and DoD are co-funding a clinical trial on HBOT, and a report is expected within a year. She also referenced six severe TBI patients who were treated with hyperbaric oxygen at the University of Pittsburgh but experienced no improvement. "They're not showing any improvements, say, on a functional-independence measure. That rates how well the person can do things independently: stand, sit, walk."

Cernich warns against veterans and families setting expectations too high for an alternative treatment like HBOT.

Even so, Patt Maney and Tim Hecker see themselves as successful case studies for treating the signature wound of the war on terror with hyperbaric-oxygen dives.

"Everybody who has argued against hyperbarics, they don't know what they're talking about," Hecker says. "Until you have suffered from a traumatic brain injury and felt that frustration and anger at not being yourself, and then get it back ... it's amazing.

"If it hadn't been for Dr. Harch, I'd have been labeled with conversion disorder and medically discharged. I understand that with the extent of my injuries and the disabilities I have, cognitively, I can function in society, but I can't function at the level I need to as a master sergeant in the Army. That I can accept. I am going through the process of being retired out of the Army. I can accept it now. I'm going out on my terms. It's not that I'm being pushed to the side. This is what needs to happen."

Steve B. Brooks is multimedia editor for The American Legion.

Alternative roads to recovery

National Intrepid Center of Excellence
Phone: (866) 966-1020

The Pathway Home
Phone: (707) 948-3031

(877) 311-4P2V (4728)

DoD's T2 Virtual PTSD Experience