Origins of Stellate Ganglion Block for veterans

ASHLAND — Sean Mulvaney, a doctor from Annapolis, Maryland, has been a pioneer in Stellate Ganglion Block treatment for post traumatic stress disorder. 

Mulvaney is a former Navy Seal who studied at the Uniformed Services University of Health Sciences. He served as an Army physician for 22 years. Today he has his own practice. 

His first run-in with SGB happened at a musculoskeletal medical conference in Madison, Wisconsin more than a decade ago. 

Somebody at the conference showed him a news clip about a doctor in Chicago using SGB to help women going through hot flashes during menopause. The person asked him if he thought it could help with PTSD.

Mulvaney said he called the doctor — Dr. Eugene Lipvov — and talked to him about the procedure’s potential.

But he had no idea then that he and his office would become one of the leading researchers for the treatment’s use to help those struggling with PTSD.

Mulvaney stresses that there’s still work to be done with SGB and understanding all that it can do. 

“I take people that are frankly, suicidal … and we get them to where they can maintain, they’re back to level,” Mulvaney said. “Is this a cure-all? No.

“It is a part — a very effective part — of a treatment plan for their PTSD and their anxiety, and that is what we are showing and that is why we are moving this rock forward, because we see in clinic these life-changing things happening.”

Bringing it home

Mulvaney said back then, one of his patients fell asleep at the wheel and got in a car accident.

According to Mulvaney, the patient revealed he’d received a prescription for Seroquel, an antipsychotic medication. It was a treatment for his patient’s PTSD, which came as a result of his Army service. One of Seroquel’s side effects is drowsiness. 

The patient didn’t want to be on medication anymore, and Mulvaney promised him he’d look into an alternative treatment.

So, after talking to Lipvov about SGB, he brought it back to his patient and the pair decided to try it. 

SGB had long been an FDA-approved treatment for chronic pain, but Mulvaney didn’t know how it would affect his patient’s mental health.

“We did this first one at Walter Reed,” Mulvaney said. “I will never forget, on the table, after we did it, he said, ‘I haven’t felt this good since I was 18.’” 

Mulvaney wrote it off as a coincidence at first, and followed up six months later with the patient. He was still doing well, not struggling as much with his PTSD. Mulvaney measured success using the PCL-5, a self-reporting test used for diagnosing PTSD. 

For six months, I watched this kind of miraculous turnaround until even I believed it.

Sean Mulvaney, a Doctor studying Stellate Ganglion Block

It goes up to 80 as a total score, but a score of 31-33 is likely indicative of PTSD, according to the U.S. Department of Veterans Affairs. 

A change of 10-20 points in a person’s PCL-5 score is considered clinically significant. Veterans who spoke with Ashland Source about receiving the treatment described seeing changes of 20 or more points.

Then, a few months later, another patient arrived. He’d asked Mulvaney for a Viagra prescription at 27 — something that raised a flag for Mulvaney. 

The patient admitted he was taking Paxil, an antidepressant used to help treat the symptoms of PTSD. One of the side effects of Paxil can be erectile dysfunction. 

The patient didn’t want to be on his prescription, but didn’t think there were other options. 

Mulvaney suggested trying out SGB again. It was the same result as the first patient. 

“They both had really profound and durable improvements in symptoms,” Mulvaney said. “I didn’t believe it until I watched them for six months.

“Within a month, both of them were tapered off all their medications. They were doing great. For six months, I watched this kind of miraculous turnaround until even I believed it.”

Mulvaney decided to write about his findings. It became the first case series looking at SGB as a treatment for military-related PTSD. That case series published in 2014. 

His website, The Stellate Institute, now boasts 14 studies he’s published on SGB. According to the website, The Stellate Institute has provided nearly 4,500 SGB procedures.

Others have also continued giving SGB treatment, like Lipvov in Chicago. 

“We have treated people from 47 states. (People from) the District of Columbia and 10 different countries have flown to us to have this treatment done,” Mulvaney said.

While Mulvaney isn’t the only person to provide the treatment, he remains at the center of efforts to train others to give it.

His goal is to help people with PTSD from across the country and world to receive it and continuing to study the treatment’s implications.

An Ashland connection

Tim Chandler and his work with Silent Watch is one example. Silent Watch is a nonprofit organization in Ashland working to bring awareness to veteran suicide. 

Chandler serves as president of the organization and is an Afghanistan veteran himself. After connecting with Mulvaney and receiving the treatment, Chandler sends people to Mulvaney directly.

“The hardest part to get a veteran to do this is to get him to take that first step, because they feel that there is no help and they’re afraid to ask for help because they feel it’ll make them weak,” Chandler said. 

When a veteran does opt to get the treatment through Silent Watch, the nonprofit foots the bill for the SGB treatment — $800 for one side, and $1,600 to get it on both sides — and hotel costs of veterans it sends to Annapolis. It does this through donations. 

Adam Boyce, the director of Ashland’s Veterans Service Office, is one veteran Silent Watch has helped.

While Boyce was overseas serving in the military, he got stuck in an ambush in Baghdad, investigated villages to find out if people were making bombs and had his first son. 

After he got back to the United States, he worked a construction job. But when the market fell out in 2009, he applied to be a veterans service officer in Richland County. In 2014, he transferred to Ashland County, and took over as the Ashland Veterans Service Office director in 2017. 

“Basically, we are the first and last place somebody should go for anything related to veterans’ benefits, education, home loan and community resources,” Boyce said. “We try to be the first and only stop that they should need to go to answer anything.” 

Boyce struggled with PTSD when he returned though. He tried out SGB treatment for the first time after seeing Jane Roland, his former boss, post about it on Facebook. That was in 2019, and it worked then. 

But he needed it re-upped. 

“I was nervous about going out the second time,” Boyce said. “What if it didn’t work? Was I going to be stuck feeling like this? It was nerve wracking. I was afraid it wasn’t going to do anything the second time.

“But it did. It just, it was definitely slower … it was just that weight being taken off, I don’t know any other way to describe it.” 

Silent Watch paid for Boyce’s treatment — a total cost of about $1,600 — and for his hotel room in Annapolis, Maryland. Boyce only had to cover the cost of gas and food. He said knowing the treatment’s cost was covered made it feel like there wasn’t a risk. 

There are 38 people other than Boyce across the county, state and country who have received funding from Silent Watch to have the procedure done, according to Chandler. 

“It’s even more than I thought,” Boyce said in a Sept. 12 interview with Ashland Source.

Chandler said he had another veteran lined up to get the procedure in October.

Roland, Boyce’s former boss and a board member of Silent Watch, said the organization has nearly a 100% success rate.

A nationwide cure?

Other nonprofits in the country do similar work. Andrew Ward, a former member of Louisiana’s Army National Guard, started Acadiana Veteran Alliance in New Orleans, Louisiana, in 2021. 

He wanted to bring together the veteran community in his region to grapple with the economic downturn caused by COVID.

“We knew early on that we were going to be funded by corporate partners, but we also knew that we wanted to be able to address the veteran suicide rate,” Ward said.

Instead of opting to use Mulvaney’s office in Maryland, Ward’s group sends people to the Stella Center, which Ward said is under Lipvov, another doctor who has a relationship with Mulvaney. 

That group has a network of physicians across the country that offer SGB treatment, which was a factor in AVA’s decision to use it. 

“We’re in south central Louisiana, and if there’s somebody that’s a few hours away, I don’t want to necessarily have to make the drive, or if they’re from another state,” Ward said.

“We got in with those guys at Stella, and now we have physicians in New Orleans and physicians around the country.” 

Ward said AVA has funded treatments in Utah, Minnesota and other parts of the country that found out about his group’s work and wanted help accessing it. He said the Stella Center has a location in Cincinnati that would be accessible for Ohioans.

They’ve done 42 procedures and have close to an 80% success rate, measured by the PCL-5.

Mulvaney’s motivations

Mulvaney said his work on SGB allows him a chance to see lives change every day. 

He’s not a doctor putting a dollar in his pocket. He’s a veteran helping a veteran, and it means everything to a veteran to have that.

Tim Chandler, President of Silent Watch

According to him, his work on SGB is not about ego. He said he’s not doing it based on entrepreneurial drive. 

He said he takes extra time when he’s not running his practice to do research, and that research is effective. Mulvaney views it as gratifying and humbling to help people. 

Chandler, the Ashland veteran who formed Silent Watch, said Mulvaney is telling the truth. 

“The man is beautiful inside and out,” Chandler said. “He’s a veteran, so he cares about veterans.

“He’s not a doctor putting a dollar in his pocket. He’s a veteran helping a veteran, and it means everything to a veteran to have that.” 

The Annapolis-based doctor said he has research awaiting publication that shows SGB can help with traumatic brain injuries. 

He has also observed it helps people with cases of long COVID, improving altered senses of smell or mind fog symptoms that came as a result of the disease. Mulvaney said that the treatment requires more research. 

“It’s like I’m sitting on the edge of Terra Incognita every day,” Mulvaney said. “It’s just waiting for someone to explore it and figure this out, and it’s actually really rewarding and exciting.

“I understand for this work to move forward, it has to be done ethically and only with the patient’s best interests.”