The Chris Voss Show - The Chris Voss Show Podcast – Nelson Hendler, MD, MS CEO at Mensana Clinic Diagnostics, LLC

Episode Date: September 17, 2022

Nelson Hendler, MD, MS CEO at Mensana Clinic Diagnostics, LLC Painvaliditytest.com

You wanted the best. You've got the best podcast, the hottest podcast in the world. The Chris Voss Show, the preeminent podcast with guests so smart you may experience serious brain bleed. The CEOs, authors, thought leaders, visionaries, and motivators. Get ready, get ready, strap yourself in. Keep your hands, arms, and legs inside the vehicle at all times because you're about to go on a monster education roller coaster with your brain. Now, here's your host, Chris Voss. Here's your host, Chris Voss. I'm Chris Voss. If you haven't been here before, I'm Chris Voss. Hey,, welcome to the Chris Voss Show. We certainly appreciate you guys being here. As always, refer to the show to your family, friends, and relatives.

Give us five-star reviews over there on the iTunes network there. And tell people to subscribe to the show. You can go to LinkedIn. There's a free newsletter over there, a big group of 122,000 people. And you can go to all of our groups on Facebook, LinkedIn, Twitter, Instagram, all those crazy places that Chris Foss Show is at. Today we have an amazing doctor on the show. He is Dr. Nelson Hendler. He is a 1966

cum laude. I'm not sure if I'm pronouncing that correctly. Am I pronouncing that correctly, Dr. Hendler? No, that's not too good either, Chris. Close enough. Cum laude, I think is how it's said. Cum laude. I clearly didn't go to college. Can you tell?

Yeah, there you go. He's a graduate of Princeton University, where he also played varsity lacrosse. He received an MD in 1972 and an MS in neuropsychology in 1974 from University of Maryland and did his residency training in psychiatry at John Hopkins Hospital from 1972 and 1975, which is about from here to there as much time as it would take for him to fix everything that's psychologically wrong with me. Dr. Hendler was an assistant professor of psychiatry and neurosurgery at John Hopkins University School of Medicine for 31 years and an associate professor of physiology at University of Maryland School of Dental Surgery. He's published four books, 34 textbook chapters, and 71 articles.

He was the past president of the Reflex Sympathetic Dystrophy Association of America and the American Academy of Pain Management. He's testified before the U.S. Senate three times on medical issues for Senator Edward Kennedy, Senator Barbara Mikulski, and Senator Howard Metzenbaum. And I'm just going through a whole race, a relay race of things here. Welcome to the show, Dr. Handler. How are you?

Thanks for having me, Chris. Thanks for coming. We certainly appreciate having you on. Man, you've got quite the resume there. It's pretty good. I wrote it myself. There you go. There you go.

I wrote mine. I just graduated high school and I've been kicking around under Vidox ever since. So give us a.com so people can find out where you are, what you do, and get to know you better. Sure. Well, the major thrust of what we're going to discuss is the fact that 40% to 80% of chronic pain patients and headache patients are misdiagnosed. Ah, this should be interesting. And can you give people your website, your.com, or wherever you want people to follow you?

The website is www.painvaliditytest.com. There you go, painvaliditytest.com. So what does your company do? We provide accurate diagnosis for patients who have been misdiagnosed. And in what ways are they misdiagnosed, do you find? Is it physically, mentally, or when you say misdiagnosed, what areas does that cover? A vast majority of them are misdiagnosed physically, and that's for a variety of reasons. The major problem is that you make a diagnosis by taking a careful history. And right now, because of the crush of

insurance, because of other factors, physicians are under time constraints and don't spend as much time with patients as they should. So the average exam actually published in the medical literature, the average medical exam takes 11 minutes during which time the doctor speaks 80 to 11 minutes and interrupts the patient after the first 32 seconds. So you can't get a very good history that way, can you? Yeah. He just kind of barks at you what he thinks is wrong with you, and then he moves on. And then he goes off and he orders a test. Yeah, that's true. It's an MRI, right?

Yeah. That's good. So I just spent 10 minutes with you, and based on my misdiagnosis, I'm going to order the wrong test. Yeah. Like I'll usually be standing there in the doctor's office going, but my arm's missing, sir. And he goes, we'll get some penicillin for you. It'll be fine. Exactly. So the questionnaire we have asked 72 questions and has 2,008 possible answers and takes a patient 40 to 60 minutes to complete. So it asks all the questions a conscientious physician should ask if he spent an hour with a patient. That's a lot of questions.

It sounds like my Tinder date last night. Yeah, what happened to my, so I was going to ask you, when was the last time a doctor spent an hour with you? Not a lot. And I think the last time I did did i had to pay a lot for the surgery and it was i was mostly unconscious most of the time it's funny i was i was on a radio show out in palm springs with an attractive radio show hostess and i asked her when's the last time the doctor spent an hour with you she says oh when he took me to dinner. That's a good one. That was a great answer.

That was Joey English in Palm Springs. It sounds like you specialize in helping people with chronic pain, headaches, things of that nature. I try to, yes. Can you do anything about my five previous ex-wives that I've divorced?

That's kind of a headache. That's a little out of my realm of expertise. Oh, damn it. Okay. Even if I answer the 72 questions, okay. So, how many people do you find in your studies and work have chronic pain and headache and stuff?

The research shows that 20% of any population in any developed country has chronic pain. So, in the United States, that would be 66 million people. Wow. And then plus me, of course. That's another 1% right there.

And 40 to 80% of those are misdiagnosed. Wow. So what happens when people are misdiagnosed like what what what what uh what you know what what kind of things can happen that um make things worse for someone who's suffering from chronic pain well if they're misdiagnosed guess what happens yeah they don't get well yeah the pain probably gets worse or they don't get they don't get the proper treatment they don't get the proper testing and they get't get the proper testing. And I'll give you one example. You ever heard of fibromyalgia?

Yeah, yeah. Oh, yeah, right. It's advertised all the time. Take Lyrica for fibromyalgia. Well, in a study we did looking at 38 patients, referring to me with the, quote, diagnosis of fibromyalgia, we found that 37 of the 38 patients, that is 97% of them, did not meet the diagnostic criteria for fibromyalgia. And this is published, by the way.

And in those 37 patients who were told they had fibromyalgia and didn't have fibromyalgia, we found 133 other medical diseases documented by objective medical testing, objective medical tests, which required surgery. So, you know, so, and why is it being promoted? Well, if you have a pharmaceutical company and doctors are misdiagnosing fibromyalgia, you sell more Lyrica, don't you? Yeah. I got fibromyalgia from watching all those commercials and hearing all the side effects. A lot of misinformation creeps into the public domain as a result of these fallacious and erroneous things. The other one is like, what do you call it?

Injections, Botox for migraine headache. Oh, yeah, Botox. Well, let's talk about that. What is a migraine headache? A migraine headache is a damage to vessels inside the brain, inside the skull, inside the doormatter. So what makes you think getting an injection into a muscle outside the skull is going to do anything for migraine headache? Well, the reason that Botox works is not because it's helping migraine.

It works because the patients don't have migraine headache. They have mixed muscle tension, vascular headaches, and the Botox takes the muscle out of spasm and treats the headache. And that's what it treated, but it didn't treat the migraine headache because the pathophysiology, the chemistry of migraine is completely different and wouldn't respond to an injection outside the head.

So don't forget, a lot of the medical information creeps into our lexicon because of pharmaceutical companies promoting misinformation to sell the drugs. Yeah, it's pretty amazing. I mean, I think we're one of the few countries in the world that lets advertising run that way. And some of it's pretty ambiguous. Like, they'll be like, are you seeing with both eyes? You probably need our medicine. So call your doctor today and demand that you get lobotomies.

You know, that sort of thing. But, you know, they'll like say, you know, stuff that you're like, do you have frequent headaches? And you're like, I'm getting one now from your commercial. But anyway. Go ahead. So when people go to your website, they can go there and get basically a diagnosis of the same thing they get with your experience from John Hopkins Hospital doctors. Well, the questionnaire on the website. I'm losing the video.

Is that something in my computer or yours? There we are. Okay. Well, you go to the website, www.painvaliditytest.com. There's a questionnaire for patients themselves. Legally, we cannot give a diagnosis over the internet because we violate the internet practice of medicine laws in practicing medicine in the state without a license. So we give them information and they take that information to their doctor. And the information that they get is what we think might be wrong with them.

Now we can't call it a diagnosis, but they can review it with their doctor, confirm the diagnosis with their doctor, and then get the appropriate medical test. Oh, that's good. That's good because I was amazed at how much inaccuracies there are on the diagnosis. Unbelievable. Unbelievable. And so when you fill out the questionnaire and you get an answer back from you guys, does that come later or does that

come immediate? Within five seconds. Oh, wow. You finish the questionnaire. We score it. We score it using Bayesian analysis in a proprietary program, and then you have the results back within five seconds after you complete the test. That's pretty amazing, man. And so how often do you guys get it right? Do you have a percentage on that? Yeah, we've published articles on this. We find that when we look at the diagnosis generated by the website, we find that the diagnosis generated by the test correspond with diagnosis of Johns Hopkins Hospital doctors 96% of the time.

Wow. That's pretty awesome, man. That's a great record. And that's published. That's published and verified. And then do people pay for this knowledge? How does it work that way? Well, for a consumer who's taking the test, it's only $19.95.

Wow, that's a great deal. That's pretty awesome. Yeah, so they can just go on there, painvaliditytest.com. Is that correct? Yeah, www.painvaliditytest.com. That's correct correct yeah www pain validity test.com that's correct they can go on there they take as much time as you want to answer the questions uh and then you'll get the results you have to go back in in order to be HIPAA compliant and get the results and then you there you are you can take that to your doctor print out the results go to your doctor there you are. You can take that to your doctor, print out the results, go to your doctor.

There you go. And what was interesting to me is you talked about what are the wrong tests and what are the right tests, like MRIs can miss stuff. Tell us a little bit about that. Let's talk about that. The MRI, say you're injured in an auto accident, hit from the rear. The doctor does an evaluation and says, oh, you have a normal MRI, a normal CAT scan, and normal x-rays. Okay? You have whiplash. You have cervical sprain.

No. Here's what you have. Here's what you have. Here's what you have. The MRI misses disc pathology 77% of the time compared to a provocative discogram. Wow. And so what is disc? I'm going to explain all this to you. And a CAT scan misses bony pathology 56% of the time compared to a 3D CAT scan. Wow.

And x-rays miss pathology 99.8% of the time compared to flexion extension x-rays with obliques and open mouth odontoid views. And I've just mentioned three tests to you that the average physician, A, never uses or never even heard of. So let's talk about what that is. Okay. You can't measure pain. The pain fibers are too small.

They don't show up on MRI. You can't tell whether a pain fiber is damaged or not. And importantly, the disc in your neck and the disc in your lower back are like jelly donuts. Okay? It's probably a little jelly donut, say. The annulus is the donut, and the jelly inside is called the nucleus pulposa. I won't bore you with that. But I'm going to tell you something now that 99% of the doctors don't know.

In the rear portion of the disc, in the rear portion of that donut, in the rear portion of the annulus are pain fibers. And if these pain fibers get disrupted, you feel pain just as if you had a herniated disc and just as if you had the disc pushing on the nerve root going down your leg, but it doesn't show up on MRI. Okay. So if you get the MRI and the MRI says normal disc, so you do a provocative discogram. And the provocative discogram consists of putting a needle into the disc and injecting saline while the patient's awake.

And you're asking the patient, does this reproduce the pain that you normally feel? And if your patient says, yes, this is exactly the pain I feel, then you know that that's the disc causing pain. And then to further confirm that, you inject local anesthetic agent into the very same needle and see if it takes away the pain. And that gives you proof positive that that's the disc causing the pain. Now let's look at an example. You got a patient comes in and the MRI, not only does it have a 77%

false negative rate, it has a 28% false positive rate. 28% of the time, it tells you the disc is damaged when it's not causing the pain. Wow. Now you have a patient who's injured in an accident, gets an MRI. The MRI says, oh, there's a herniated disc at L4, I'm sorry, at L2, L3. But the patient has symptoms of an L5, S1 disc, but the MRI is normal. So the doctor looking at the MRI says, uh-huh, disc damage, L2-L3, not taking into account that the symptoms the patient have are really referable to L5-S1. So he goes in and operates on the L2-L3 disc,

and the patient doesn't get well. Wow. That's got to stop. Not only does the patient not get good care, he gets worse because the doctor doesn't really understand the sensitivity and specificity of the test that he's using to make the diagnosis. Wow. Had he had a provocative discogram, the doctor would have said, well, L2, L3, when we did the injection, didn't produce any pain. But L5, S1 did.

That's the disc that's causing a problem. That's where we're going to go operate. So that's one classic example. I've never heard of these provocative discograms. You join 99% of the physicians in the United States. Wow. So they don't even know. Wow.

That's crazy, man. Why don't they know? Is this just, you know, they're just so used to doing like mainline, quick and easy. There's not one single medical school in the country that teaches a course on chronic pain diagnosis. Wow. We just throw medicine at it and say, here's some, you know, what was that one, the heroin stuff that everyone was on for a while? Well, the worst thing is doctors treat chronic pain like acute pain.

Now, here's a problem with that. The neuroanatomical pathways that carry the message of acute pain and the neurosynaptic transmitters, little chemicals that make the nerves work, that carry the message of acute pain are different than those that carry the message of chronic pain. So if you start trying to treat chronic pain like acute pain you're not going to get any benefit from using medicine and that's why the narcotics don't work so that's another long story is the misuse of medicine in chronic pain patients you have to match up the correct medicine with the type of tissue damage if you have nerve damage, you should use an anticonvulsant. If you have muscle damage, use an antispasmodic. If you have

inflammatory damage, use an anti-inflammatory. And then if you have mental pain, use vodka, right? That's usually what I do. That works. That works really well, especially with some caveats. It's not healthy for you. We should just make that disclosure. I'm walking proof of that. I think you and I could get into trouble together, Chris.

We probably could. We don't want to get in trouble. You know, quit drinking, folks. One of the best things I ever did. I didn't have a problem, but just not having that is bad. So stay away from the kids. So why don't more doctors order these types of tests? And should you, I mean, you should obviously go to your website, fill out the form,

but you should probably go to your doctor and say, Hey, can we check this other stuff out? Yeah. All the, all the articles I told you about are on that website, the www.painvaliditytest.com. So if the physician wants to read up on the appropriate medical test and the ways of making diagnosis, they're there.

And the other thing that happens after like a whiplash injury, your, your, your head goes backwards and it goes forward. And when it does that, it tears the muscles and ligaments and blood vessels in here in the thoracic outlet area. And it gives you numbness and pain in your arms when you use them.

Doctors never ask about that. They never do a simple maneuver called the ruse maneuver. And the ruse maneuver is very simple. You hold your arms up like this. You hold it that way for two minutes. And then you ask the patient, what do you feel? And if the fingers go numb and are painful, you know the patient has thoracic outlet syndrome. Oh, wow.

It's a simple test. And the flexion extension, look, patient comes and says, look, doc, my pain gets worse when I lean my head backwards or I lean my head forward. Okay. I said, well, how is it when you hold it straight? Oh, it doesn't bother me. But when I lean forward, lean back, I said, well, let me see your x-rays. All the x-rays are upright x-rays. They're not taking when the patient is leaning forward or leaning backwards. Now, Chris, we're not talking medicine here. We're talking common sense. Wouldn't it make sense to say, I get worse pain when I lean forward. Okay, let's take an

x-ray when you're leaning forward. My doctor would just say, well, stop leaning forward. My mom would say that. Quit leaning forward, dummy. Yeah, so you understand that it's really applying some very simple logic and common sense. There you go. I mean, it's funny how much, how little common sense seems to be in our medical thing. Yeah, well,

common sense isn't very common. Yeah. I mean, they just, like, you see these drugs that they have on TV now, and now they have, like, you have to drugs that they have on TV now, and now they have, like, you have to take a drug for the side effect of the other drug that's on TV. So, like, are you taking Parallax or what? I don't even know if that's a real drug. You're taking any psychotic drugs.

So take this, like, the stuff that you'll have, normal movement disorders. Are you having a problem with jitters when you take Parallax and you're going like this all the time? Well, that's a side effect. So now if you take our drug, you'll be going the other way with this. And then you'll probably need another drug for making you go this way. I don't know. It's all just a joke.

The funniness. So this is really interesting to me. You know, like you mentioned, doctors don't spend enough time diagnosing you or really caring. It's almost like they just kind of throw stuff at you. I remember one time I went in for a really bad third-degree burn that I had, or second-degree burn that got infected.

And then it was starting to encroach upon maybe bone infection. And the doctor wouldn't give me penicillin. And they're just like, yeah, we'll just give you this. That should do the trick. And it got worse to a point that I almost had to have a bone scrape. And eventually they gave me some really solid,

uh, penicillin, but it was like, you know, they just, they're just throwing stuff around like, ah, whatever the kid gets born,

needs a bone scrape, who cares? Whatever. Uh, it was just phoning it in medication sort of stuff. It's crazy. Yeah. Well, you have to match up the tissue for the right medicine and you can't understand which tissue is damaged until you have a correct diagnosis. There you go. So how many charts

have you reviewed over a 17 year period time, and how did you develop these questions to get these perfected? Well, we reviewed 10,000 charts over a 17-year period of time, and the questions in the questionnaire are derived from the questions I asked the patient and the answers I got, and then match them up with results on the medical test. And that's why we know that the MRI misses disc pathology because the provocative discogram picked up pathology missed by the MRI. Wow. And the extension x-rays picked up pathology missed by the regular x-rays.

And the 3D CAT scan picked up pathology missed by the regular CAT scan. Go ahead. I was going to ask you, what's some of the responses you've gotten from the tests that you've provided to people? What's sort of been the results of that?

I have over a thousand unsolicited letters. Wow. Unsolicited. I didn't say, write me a letter. I got a thousand letters saying, thank you, doctor, if it hadn't been for you, I would have committed suicide. Thank you. I'm off medicine. I've had letters from patients' attorneys saying, thank you. Mr. Jones is back at work. He's off narcotics. He's feeling great. You know, this is wonderful what you did. And I've let patients, uh, attorneys write me, uh, saying, my God, this fellow was, uh, you know, dysfunctional and we, I'm glad you got him well. And PS, instead of getting $3,500 for the case, we got $25,000. Wow.

Well, that happens about 65% of the time. Wow. For any attorneys who are listening, trial attorneys, I can take an average whiplash case with normal x-ray, MRI, and CAT scan for which you're getting offered $3,500, and I can convert that into a policy limit case where you get at least $25,000, if not more, by having objective medical pathology documented by medical test. That's pretty amazing. Irrefutable evidence.

So not only can patients do a pain diagnostic screening on your website, you also do provider service or you help provider service organizations and different people. Tell us a little bit about that. Yeah, we can. For physicians who are really dedicated to their patients or the rush for time, they want to get a history ahead of time, the longest portion of a medical evaluation is taking a careful history.

I used to spend an hour and a half on my patients and get finished, and the patient would go out and turn to the secretary and say, oh, can I go back in? I forgot to tell him something. So you really have to take a careful history. It helps the physician see patients faster and more accurately. It helps attorneys get a better picture of what's really wrong with their clients if they're involved in an accident. And it's a win-win-win situation.

And paradoxically, the test actually saves money. That's pretty awesome, too. So everybody wins in this deal. There you go. There you go. The patient gets better care. The attorneys and the doctors make more money, see more patients. And eventually the insurance companies will find instead of having the patient going on for two years or more being misdiagnosed and paying them all that time while he's not getting well, if you get an accurate diagnosis all that time while he's not getting well, if you get an accurate diagnosis and properly treated, he's back at work in two to three weeks

or months. One article I did with Tom Emmerich, Tom was vice president of Burger King, vice president of British Petroleum, and lastly, vice president of Walmart in charge of human resources. And he and I published an article showing that the accurate diagnosis saved insurance carriers between $20,000 to $175,000 a case for the long-term cases. Wow, that is wild. So you also work with HMOs, self-insured companies, hospitals, insurance companies, et cetera. We published one article showing we can save self-insured companies, union hospitals, insurance companies, etc. We've published one article showing we can save self-insured companies 56% on their workers'

compensation costs, just like Johns Hopkins Hospital did, published by Ed Bernanke. You know, I mean, if you can diagnose the pain and get rid of it so they're not continually suffering, constantly going back to the doctor's office. That just makes sense. What a novel idea. Yeah, what a novel idea. You've written a lot of books. How many books have you written? I see a lot here on Amazon for coping with pain.

Yeah, I've written four books. One is for the general public and the other three are sort of medical textbooks. There you go. There you go. So you've been studying this for, I mean, I think your first book goes back to 1979. Yeah, I've been doing this actually since about 72. Wow.

That's awesome. That's awesome. So anything more we need to know about you and what your website does? The website is www.painvaliditytest.com. And what it does it gives you the opportunity of getting accurate information about what's wrong with you if you have a chronic pain problem you really need to know what's causing your pain before you can fix it it's just like a flat tire i mean a flat tire you you can't come in and say, I got a flat tire. And the guy says, well, what's wrong with it? Well, you need to know if it's a leaky valve stem or cut sidewall or is your nail in the tread.

Now, here's one very important concept, Chris. Sometimes you can have two things wrong with that tire. And if you fix only one of them, guess what? Your tire's still flat. Your tire's still flat. Your tire's still flat. So you have to do a thorough diagnostic evaluation, explore all the possibilities, and really address them all. There you go.

There you go. Well, this has been really insightful. I'll be referring it to all my friends, neighbors, relatives. I know everybody I know experiences pain, and they're always trying to resolve it. So this is good data for them. Well, thank you. I appreciate it. There you go.

Give us that.com one more time, if you would, please. Sure. It's www.painvaliditytest.com. There you go. Well, thank you very much for coming on. We certainly appreciate it. Thanks for having me, Chris. I appreciate it.

There you go. All right, and thanks to my having me, Chris. I appreciate it. There you go. Alright, and thanks to my audience for tuning in. Go to youtube.com, Forge says Chris Foss. See everything we're reading and reviewing over there. And goodreads.com, Forge says Chris Foss as well. Thanks for tuning in. Be good to each other. Stay safe. And we'll see you guys next time.