After three combat deployments to the Gulf War, Iraq, and Afghanistan, something as simple as the smell of hay could trigger Rick Burth's post-traumatic stress disorder symptoms.
The smell of gunpowder and jet fuel put him on edge, too. He'd known he had PTSD for a long time, but he never talked about it.
"There was this stigma, so you didn't want to say anything," said Burth, 49, a Roseville resident and threat assessment specialist with the state Office of Emergency Services. "You just kept your head down and kept doing your job, but after awhile, it just got bad."
Other treatments hadn't worked, so Burth opted for a novel procedure that some say is a quick and effective way to quiet the anxiety and agitation that PTSD patients frequently experience. He traveled to the Chicago area, where a doctor injected a local anesthetic into his neck, targeting the nerves that regulate the body's "fight-or-flight" response to perceived threats.
An image depicted the stellate ganglion block procedure. Screengrab from ViewMedica video.
The treatment, called stellate ganglion block, has typically been used for pain management, but Dr. Eugene Lipov, an anesthesiologist, said he discovered in 2005 that it has the potential to relieve PTSD symptoms.
The 10-minute procedure halts the nerve impulses to the brain that trigger anxiety and jitters in trauma victims, Lipov contends.
Experts disagree on its effectiveness, but some doctors and patients say it seems to be a useful tool in combination with therapy and other medications, which may not always provide relief.
Burth said it helped calm his mind to the point where he could think more rationally about the traumatic events in his past.
The former Marine said he started noticing symptoms after returning from the Gulf War in 1991, and that his symptoms grew worse when he went to Iraq, where he was part of the anti-terrorism team for the California Army National Guard.
California Army National Guard troops in training. Photo from California National Guard Flickr.
"The day-in, day-out fighting -- getting shot at, shooting back, things blowing up around us -- that compounded the issue," he said.
When Burth came home, he couldn't sleep. He couldn't stand being in crowds. He was abusing alcohol. And it was all wearing on his wife and two young sons, he said. He'd been on anti-anxiety medication for years but never noticed much difference, he said.
"I was just really short-tempered. Always go, go, go. Didn't have time to stop and listen to folks because I was always so anxious," he said.
There are nearly 8 million Americans like Burth suffering from PTSD, many of them military veterans, according to the Department of Veterans Affairs. PTSD is the third most common psychiatric diagnosis in the Veterans Health Administration.
People can develop PTSD months after they experience a life-threatening event or trauma such as a mugging, sexual assault, or the sudden death of a loved one. Its symptoms are broad because everyone's PTSD manifests differently, said Dr. David Schafer, acting associate chief of staff for mental health at the Sacramento VA Medical Center.
Rick Burth. Photo from Sacramento Bee via NewsEdge.
People can relive a traumatic event such as an ambush or bomb attack in nightmares or flashbacks. They might also avoid places and situations that remind them of the trauma. Feeling anxious, jumpy, and experiencing panic attacks are common symptoms.
Burth, for instance, would become agitated at the smell of hay because he'd been in gunbattles in fields and orchards.
"For many, the easiest and safest thing to do is stay home with the door locked, sleeping on the floor by the closet," Schafer said. "The challenge with avoidance is that it works."
Approved treatments of PTSD include reintroducing patients to the people, places, and things they might find distressing. To work through the trauma, they attend therapy sessions for 10 to 15 weeks as they try to understand their reactions to events. Medications may also be prescribed to help take the edge off, Schafer said.
Burth had gone through months of therapy, including a month-long stint in a Texas rehabilitative treatment center, but his PTSD symptoms always returned, he said.
"It was helpful," he said, "but after you get back home and get back into the same old routine, things pop up again, and you try to remember how to work through it on your own."
Burth learned of stellate ganglion block through his mother-in-law, who volunteers with the Global Post Traumatic Stress Injury Foundation, which pays for veterans to receive the $1,600 treatment because it isn't recognized or covered by the VA. The foundation is having a fundraiser at the Granite Bay Golf Club on Sept. 11.
Chris Miller, a local developer and philanthropist, was moved by the testimonials he heard at a foundation event in Washington, DC, last year, where soldiers and veterans spoke of their symptom relief after receiving the anesthetic treatment. Because there is a large military population in the Sacramento area, he decided to host his own fundraiser for the foundation, he said.
In March, helped by the foundation, Burth went to Lipov's clinic near Chicago. After the first injection, he said he didn't feel much different.
If patients don't feel relief after the first injection, Lipov said, he'll give them another injection higher in the neck. The second injection has a 90 percent success rate, he said.
After the second injection, "I didn't feel different physically, but I felt different mentally," Burth said. "Things slowed down. I didn't have a million thoughts. I didn't have that anxious and paranoid feeling, always looking over my shoulder. All of that kind of dissipated."
Post-traumatic stress disorder, or PTSD, is a consequence of a traumatic experience. It consists of normal responses and reactions to a life-threatening event that persisted beyond what is deemed the normal period of recovery from the event. USAF photo by Tech. Sgt. Nadine Barclay
Lipov said he's performed stellate ganglion block procedures on 500 veterans with a 70 to 75 percent success rate.
So far, the anecdotal evidence about the procedure is mainly positive, but the scientific data is inconclusive as to whether stellate ganglion block is widely effective at treating PTSD, said Dr. Michael Alkire, an anesthesiologist at the VA Long Beach Healthcare System, who is studying the treatment with Dr. Christopher Reist, a psychiatrist.
The Department of Veterans Affairs has launched studies into the procedure because the long-term side effects remain unknown. One study is being conducted at the VA Long Beach Healthcare System.
In February, the VA Portland Health Care System found there was insufficient evidence to say stellate ganglion block was an effective treatment for PTSD. In trials, at least 75 percent of the subjects reported improvement. But when the treatment was tested against a placebo, a shot of the local anesthetic fared no better than a saline injection.
"The pattern suggests that, while it is possible that some patients benefit, the response rates seen in case series will not hold up in actual practice," the researchers said. "Substantial uncertainty remains about the potential harms of (stellate ganglion block) as well."
At VA Long Beach, Reist and Alkire have been performing stellate ganglion blocks to collect better data and understand when it can be effective. Their research has included 17 patients who are selected according to whether they've tried medication or psychotherapy without improvement. Of the 17 subjects, 13 reported immediate or gradual relief from their symptoms, the doctors said.
Anti-anxiety medications, like Prozac, are sometimes used to treat the symptoms of PTSD. Image from Wikimedia Commons.
While the sample size is small, Reist and Alkire have found the blocks are most successful for patients who have symptoms of hyperarousal, which is like being in a constant state of fight or flight. The stellate ganglion block eases the patients' tension and anxiety so they can engage in traditional therapies for PTSD, Reist said.
Alkire said it's important to note that the treatment doesn't work for everyone. He recalled the case of one patient who wanted it to work so badly that, when it didn't, he spiraled into a deeper depression.
No treatment erases the memory of trauma, Schafer said. "Part of trauma-focused work is walking through the trauma and putting it in context, expanding people's understanding of what happened."
Burth agreed. "This is not a be-all, cure-all," he said. "This is something that calms your mind and allows you to deal with the memories that are always there."
"Since the injection, I can look at things in a different light and deal with it. I had someone ask me if this is a miracle, and I said, I don't know if it's a miracle, but it's working for me."