Thank you.
Evidence of meeting #42 for Veterans Affairs in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was brain.
A recording is available from Parliament.
Evidence of meeting #42 for Veterans Affairs in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was brain.
A recording is available from Parliament.
4:45 p.m.
Conservative
Cathay Wagantall Conservative Yorkton—Melville, SK
Thank you.
I have a question for Dr. Merali, and then one for Dr. Thirlwell.
Dr. Merali, we've been working a lot with veterans exposed to the malaria drug mefloquine. It causes permanent damage to the brain stem and it mimics PTSD. The U.S., Britain, Australia, and Germany have all limited the use or completely removed the use of this anti-malarial drug. Health Canada has recently, this last summer, changed the label to indicate that it can cause damage to the brain stem, and depression, hallucination, nightmares, psychotic behaviour, numerous physical side effects, and suicidal ideation. There is a strong correlation that we're finding between suicide rates and mefloquine use.
We had David Bona, a veteran from Somalia, from our Canadian Airborne Regiment, saying that after 20 years he was finally able to get proper treatment and relief after a brain scan. He was previously treated for PTSD and was now able to see that he had mefloquine toxicity. It causes a physical brain stem injury.
Looking at the work that you're doing here and seeing the results of this study, has your facility been asked, or has it ever considered doing brain imaging with respect to identifying mefloquine toxicity to see the scarring on the brain?
4:50 p.m.
President and Chief Executive Officer, The Royal's Institute of Mental Health Research, Royal Ottawa Health Care Group
Yes, it's a very interesting observation and I think an area of concern.
No, we have not been asked. What we're doing right now is providing the platform, which for the first five years is strictly going to be for research. Anybody who has a research project and who is interested in studying any issue that may have an impact on brain functioning is free to do so, and we facilitate that. However, we had not had a request for that particular type of a scan on people who have been on anti-malarials.
4:50 p.m.
Conservative
Cathay Wagantall Conservative Yorkton—Melville, SK
In light of the ongoing concerns about this, if the government were to seek out this type of a study, it would be possible to do that.
4:50 p.m.
President and Chief Executive Officer, The Royal's Institute of Mental Health Research, Royal Ottawa Health Care Group
Absolutely.
4:50 p.m.
Conservative
Cathay Wagantall Conservative Yorkton—Melville, SK
Okay, thank you very much.
Dr. Thirlwell, I so appreciate what we've heard from you today. I think that around this table what we want to find is an effective way to deal with PTSD and suicide.
We talk a lot about this whole concept of building up a soldier. Can we not, then, when they come home, rebuild them, build a proud veteran? I started to write down “fight, flight” when you were talking about whether it can be...and you talked immediately about it being reset.
I would like to hear more about that, but I also want to make note of something. In your notes to us, you indicated that PTSD and depression are treatable, which means they can be prevented. So much of the cost and the pain we are seeing is due to it being dealt with in a crisis: the house is already on fire.
Could you share more on that, please?
4:50 p.m.
Psychiatrist, Executive Health Team, Mission Butterfly Inc.
I want to draw a bit on your questions about the civilian versus the veteran population in terms of PTSD. My background is in neuroscience. I'm a neuroscientist first, a clinician second. Much of what medicine runs on now is dogma. Wars have been won with innovation; we need medical innovation.
What's happening is that when the brain is in PTSD fight-or-flight mode, it's in the reptilian brain, the lower part of the brain, and it cannot access higher centres to use for CBT, to use to see how you connect to other people. Where the civilians might not be in the same fight-or-flight mode, a military person is in fight or flight. Until you take them out of that fight-or-flight mode, many of the treatment modalities we use for common civilians will not work. That's why I emphasize taking them out fight-or-flight mode.
Please refer to Stephen Porges' polyvagal theory. It will explain to you the fight-or-flight mode being stuck in this brain stem, the reptilian part of the brain, where the autonomic nervous system disregulates, going into the limbic system where the emotional part of the brain is and not being able to access the frontal brain, where there are societal cues. When we're stuck in fight or flight, we can't access those other parts of the brain and our executive manager can't control the emotions. It can't control the fight or flight, which is why we see these anger outbursts and physical outbursts.
Part of polyvagal theory also talks about attachment, and this is what we've done: we've detached these servicemen, through training, from their heart so they can kill. To reintegrate them back into society, you have to undo that programming to get them to reconnect with their hearts, which is why I suggested we do it through positive missions. That is why the dog therapy is so effective: they can finally attach to a trusted entity, a trusted being. Part of our therapy also uses horses, equine therapy, which has been shown to be very successful, and followed with neurofeedback. That also has to speak to attachment. When you take them out of fight or flight and they learn to reattach, they can use the executive processing again, but as long as they're stuck in fight or flight, we're not getting anywhere. That can be from physical trauma, mental trauma, emotional trauma, drug trauma, viruses, or bacterial trauma.
That's the beauty of sleep studies. We can pick that up before they go into service, while they are in service, and after service, which is why we have sleep studies as part of our program, so I can actually see just how unstable the fight or flight is. It's called the autonomic nervous system. It was believed that you couldn't control it, but you can through yoga and other modalities that we use. They've shown scientifically that we can boost the parasympathetic nervous system. That's why it's so important for us, as you were suggesting, to screen before they go into service, while they're in service, and once they come home. When they get off the plane, immediately have a sleep study, and a scan as well.
I would also suggest using SPECT-II, which isn't well regarded and necessarily in the mainstream field, but in cutting-edge neuroscience, SPECT scanning is also showing very subtle changes and different connectivity of the brain. There are subtle connectivity processes that change and aren't picked up by regular MRIs and might not even be picked up by PET.
4:55 p.m.
Conservative
4:55 p.m.
Liberal
4:55 p.m.
Conservative
Cathay Wagantall Conservative Yorkton—Melville, SK
Thank you.
Can we get that study as part of our research?
4:55 p.m.
Liberal
The Chair Liberal Neil Ellis
Yes, we can ask for that.
Could you send that study to us, please, or to the clerk? Thank you.
Ms. Lockhart will be splitting her time with Mr. Bratina.
February 13th, 2017 / 4:55 p.m.
Liberal
Alaina Lockhart Liberal Fundy Royal, NB
Thank you.
Thank you very much. It's great for us to have so many professionals at the table today, and we have tons of questions.
I want to carry on with what you were just talking about. What benchmarks are you using now to gauge success with the type of therapy you're doing with those you're working with?
4:55 p.m.
Psychiatrist, Executive Health Team, Mission Butterfly Inc.
We use multiple self-report inventories, but right now I'm looking at getting a wristband from MIT that monitors the autonomic nervous system. The participants in our program can wear it for the duration of our program so we can get more objective data about how we're helping the fight-or-flight system and the relax and restore system.
4:55 p.m.
Liberal
Alaina Lockhart Liberal Fundy Royal, NB
At this point we're back to the need for more research, so we're still building that body of research.
4:55 p.m.
Psychiatrist, Executive Health Team, Mission Butterfly Inc.
Yes, we're still building that body of research.
4:55 p.m.
Liberal
Alaina Lockhart Liberal Fundy Royal, NB
Okay, very good.
You also mentioned the Canadian Armed Forces cultural workshop.
Can you tell me about that? That's the first time I've heard about that.
4:55 p.m.
Psychiatrist, Executive Health Team, Mission Butterfly Inc.
John will speak to that.
4:55 p.m.
Vice-Chair, Mission Butterfly Inc.
In order for anybody to bridge the gap with a military member, trust is required. The military people don't trust very easily. That's why you'll always find them sitting with their back to the wall and facing the door.
Anybody who is going to do any therapy needs to understand where these people are coming from. We talk a different language. It's all TLAs, three-letter acronyms. If you don't understand what they're saying, how can you help them?
Right now we have an eight-hour immersion on “military-ese”, on rank structure, brotherhood, family, brother and sisterhood, the dynamics within units, the regiments, the military as a whole.
If you get an army person, an air force person, and a navy person in a bar, they're likely to start a fight, but if there are three of them in a bar and a civvy starts a fight with them, they're all jumping in together to help each other.
4:55 p.m.
Liberal
Alaina Lockhart Liberal Fundy Royal, NB
Who's offering this? Are you offering this cultural workshop?
4:55 p.m.
Liberal
Alaina Lockhart Liberal Fundy Royal, NB
You developed it. Thank you.
Back to the research question again, I have a question about therapy dogs as well. What research were you relying on for your program?
4:55 p.m.
Chief Executive Officer, Companion Paws Canada, The LifeLine Canada Foundation
There have been studies that have been going on all across the United States and internationally for many years. Because I'm in a position where I do my own type of research with effective programs that are out there, I am able to create them here in Canada.
For several years, I had gone across the United States and internationally to other organizations that are doing this exact same thing, which has just kept growing. It gets better. There are more studies that are being done to prove how effective dogs are. That is the reason we decided to take it on, understanding that this has been going on for so many years and has shown its effectiveness.
When we're talking about PTSD, of course, that's a bit of a different story. That is new. There are studies all over.
There are service dogs for PTSD, and they are trained in specific tasks. What we have realized is that many times a service dog is not required for PTSD; however, a very highly trained companion animal is. That's what we have surmised through the studies.