Case Summaries of Patients Treated by Dr. Hendler

The information below is a small sampling taken from files of thousands of actual patients who were treated by Dr. Hendler during their stay at the Mensana Clinic, which operated for thirty years in the Baltimore, Maryland area. Identifying information has been redacted due to doctor-patient confidentiality.

Case #1 - Patient Name: Mary Lou R - Ms. R. is a 39 year old white female, who had pain in the base of the head, top of the head, traps, and between the shoulder blades, following an auto accident March 2000. She stopped working after the accident, with a loss of income of $300 per week. More...

Prior to being seen in 2002, she was diagnosed with cervical sprain, and had 25 physician visits, X-rays, MRI, but no nerve blocks. Total expenses prior were $ 9,000, or about $4,500/year. She was seen for 2 visits at Pain Clinic, in Jan. 2002. While at our clinic, the doctors found that she did not have a cervical sprain, but that her pain was caused by occipital neuralgia, and a C3-4 disc with instability. She received occipital nerve blocks and she had 100% relief of her pain on a temporary basis. She was referred for an occipital neurectomy, which she had. Ms. R. was discharged from care on Feb. 27, 2002. Total charges for care provided by Pain Clinic were $ 1,166. The patient was sent for vascular flow studies, 3D-CT, flexion-extension X-rays, MRI, and EMG/NCV. Occipital neurectomies cost $ 4,500. The patient has now returned to work, per her referring physician. Had she not been accurately diagnosed and treated, ongoing expenses would have been about $4,500/year for another 20 years, or $90,000.

 

Case #2 - Patient Name: Richard R. - Richard R. a 53 year old real estate agent, was involved in a motor vehicle accident Sept 2003. He had trigger point injections between his shoulder blades, physical therapy, over 45 chiropractic visits, CT of the neck, and repair of two fractured molars from the accident, at a cost of $ 34,843 including follow-up care. He had not been able to work full-time for two years. More...

He came to Pain Clinic May of 2005 His long term disability payments were $ 2,000/month. While at Pain Clinic the patient received a series of facet blocks and root blocks as well as provocative discometry, 3D-CT, flexion-extension X-rays, EMG/NCV, and trigger point injections. He saw a thoracic surgeon, a neurosurgeon, an anesthesiologist, and an oral surgeon. He has received total relieve of his neck pain with a series of facet denervations C2-5, and is now back at work. Total charges for care provided by Pain Clinic were $13,725. Outside consultations and testing cost $ 10,860. Treatment costs were $12,300.

 

Case #3 - Patient Name:  Kari J. -  Kari J., age 23, was injured in a high school cheerleading accident on 1/2/92. After two years of misdiagnoses and inappropriate treatment her condition had deteriorated and she had accumulated $96,955.57 in accident related medical expenses. She was diagnosed with CRPS (RSD) More...
and treated with braces to stop her dystonia. She came to the Pain Clinic 5/17/94, and the treatment plan included a cervical fusion, nerve decompression on both upper extremities, and cervical and lumbar sympathectomies. Costs incurred for physician care and case management when converted to curent dollars were $27,722.16. The total charges for diagnostic testing, consultations and surgeries completed at the clinic's request were $63,788.08. Ms. J. is now married and working full-time. Prior to treatment at Pain Clinic, her annual medical expenses were averaging nearly $50,000.00 and were not providing any improvement. After completing the diagnostic testing and treatment process recommended by the Pain Clinic, Ms. J. no longer requires extensive medical attention.
Case #4 - Patient Name: Janis C. - Janis C., 39, a stock-broker, came to Pain Clinic with a prior diagnosis of Reflex Sympathetic Dystrophy of 18 months duration. She had received numerous sympathetic blocks prior to her admission. She was receiving Long Term Disability payments  More...
of $3,000 per month for a total of $54,000, and had spent over $110,000 of her own money on ineffective medical treatments.  After evaluation and testing at Pain Clinic, she was diagnosed with nerve entrapments of the common, deep and superficial peroneal nerves. She was referred for nerve decompression surgery, which was successful.
Costs for evaluation and treatment at Pain Clinic were $15,430. Additional testing completed outside the clinic was $2,367.  Costs for necessary surgery were $23,897.  After surgery on both legs she is now able to walk and even jog as she did before.  She has re-entered the job market, again as a stock broker. Given total projected cost estimates for ongoing work. comp. payments, long term disability, medical testing, medication, and physical therapy, expected savings until age 65 are shown below.

Referral Diagnosis:  

Complex Regional Pain Syndrome Type I (CRPS I)                                              (formerly called Reflex Sympathetic Dystrophy (RSD))

Pain Clinic Diagnoses:  

Entrapments of the superficial, deep and common  peroneal nerve

Pre-Clinic Expense:                            $  110,000
Pre-Pain Clinic Disability:                                  54,000
Projected Future Costs, disability
  without Pain Clinic intervention:                   936,000
Projected medical expenses                       230,000 
total expenses without Pain Clinic:            1,330,000
Cost of Pain Clinic:                                  15,430
Costs of outside treatment,
recommended by Pain Clinic:                          26,264
Total Pain Clinic expenses:                              41,694

Total projected savings:                      $ 1,288,306

Case #5 - Patient Name:  Deborah M.  - Deborah M. a 47 year old nurse with a BSN, was injured when a patient fell and pulled her to the ground, in 1986. She had an L5-S1 laminectomy and received only 3 days of relief. Over the years she had over 112 doctor visits,  More...
post-op MRI and CT, facet blocks under fluoroscopic control, 3 epidurals, and physical therapy. Estimated costs of these treatments was $ 47,500.  She has worked full-time despite her pain, but frequently missed days at work due to her pain. She was first seen at Pain Clinic June of 2003.  While at Pain Clinic the patient received a series of facet blocks and root blocks as well as provocative discometry, 3D-CT, bone scan, flexion-extension X-rays, EMG/NCV, and trigger point injections. She saw a thoracic surgeon, and a neurosurgeon. Lumbar facet denervations reduced her pain 75%. She has returned to work. Total charges for care provided by Pain Clinic were $15,384. Outside consultations and testing cost $ 15,450. Treatment costs were $ 4,500.


Referral Diagnosis:        Cervical sprain

Pain Clinic Diagnoses:   

C4-7 facet syndrome, C2-4 disc, with instability, C5-6 disc and radiculopathy, thoracic outlet syndrome, tempro-mandibular joint syndrome

Pre-Pain Clinic Expense:                                            $  47,500
Projected lost wage from missed
time without Pain Clinic intervention:                            28,000
Projected medical costs x 18 yrs.                               54,000
Total expenses without Pain Clinic:                            129,500
Cost of Pain Clinic:                                                15,384
Costs of tests and consults:                                        15,450
Costs of facet denervations,
recommended by Pain Clinic:                                          5,300
Total Pain Clinic expenses:                                            36,134
Total projected savings: $   93,366

Case #6 - Patient Name: Wanda K. -  Wanda K. a 52 year old transcriptionist for a physician, had a slow, progressive onset to her pain over a 15 year period of time. She was tested for Lyme's disease, which was negative, but More...
not tested for gout nor arthritis. She was told she had fibromyalgia, and had 39 chiropractic treatments. Over the years she had over 90 doctor visits, MRI and CT, and physical therapy. Estimated costs of these treatments was $ 48,500.  She has worked full-time despite her pain, but frequently missed days at work due to her pain. She was evaluated at Pain Clinic May of 2004.  While at Pain Clinic the patient received a series of facet blocks and root blocks as well as provocative discometry, 3D-CT, bone scan, flexion-extension X-rays, EMG/NCV, and trigger point injections. She saw a thoracic surgeon, and a neurosurgeon. She was referred for an anterior cervical fusion, lumbar discectomy and fusion and thoracic outlet surgery. She continues to work. Total charges for care provided by Pain Clinic were $ 4,609. Outside consultations and testing cost $ 12,100. Outside surgery costs were $ 84,000.

Referral Diagnosis:                   Fibromyalgia

Pain Clinic Diagnoses      

C4-7 facet syndrome, C5-7 Disc, instability and radiculopathy, L5-S1 discectomy and fusion, bilateral Thoracic outlet syndrome

Case #7 - Patient Name: Margarita C. -  Margarita C. a 44 year old professional had sinus surgery in 2001, and subsequently developed pain in her nose, cheek, forehead and temple. She had subsequent surgical evaluations, and 2 more instrumentations. She finally was "diagnosed" More...
with RSD (CRPS I). She continued to work despite her pain. Estimated medical cost prior to her visits to Pain Clinic were $34,500. She was evaluated by the professor and chairman of plastic surgery at Johns Hopkins Hospital, and referred to Pain Clinic for consultation.  While at Pain Clinic the patient received an evaluation and neurometer testing. She was referred back to the surgeon for surgery, and had 80% relief post-operatively. Total charges for care provided by Pain Clinic were $ 1,200. Surgery costs were $12,000.

Referral Diagnosis:            Complex Regional Pain Syndrome Type I (CRPS I)
(formerly called Reflex Sympathetic Dystrophy (RSD))

Pain Clinic Diagnoses:      

Entrapment of sensory branch of Vii (palatal branch of trigeminal nerve)
Case #8 - Patient Name: Fred W.  -  Mr. W. is 53 years old, with pain following a biopsy of his left first toe on January 14, 1993. Prior to being seen at the Pain Clinic, he was diagnosed with Reflex Sympathetic Dystrophy (RSD), for which he received 3 sympathetic blocks, and More...
ongoing physical therapy. Total expenses prior to Pain Clinic were $14,570, or about $5,000/year. He was first seen at the Pain Clinic on May 13, 1996. While at Pain Clinic, he has peripheral nerve blocks. It was found that he did not have RSD, but that his pain was caused by entrapment of the superficial peroneal nerve, as well as a cyst on the distal metatarsal bone one.

Mr. W. was discharged from care on June 19, 1996. Total charges for care provided by Pain Clinic were $9,535. Surgery cost $6,500. The patient has now returned to school and is pursuing an undergraduate degree. Had he not been accurately diagnosed and treated, ongoing expenses would have been about $5,000/year for another 20 years, or $100,000. 

Referral Diagnosis:   Complex Regional Pain Syndrome Type I (CRPS I)

                                                    (formerly called Reflex Sympathetic Dystrophy (RSD))

Pain Clinic Diagnoses       Entrapment of the superficial peroneal nerve

                                                     Cyst on distal metatarsal.

Case #9 - Patient Name: Marty O.  -  Marty O., age 45, a computer consultant, was involved in two motor vehicle accidents and a slip and fall. The first accident occurred in 1993. She had both a cervical and lumbar fusion for a total cost of $126,521 including follow-up care. More...
She had not been able to work full-time for two years when she first came to Pain Clinic on February 25, 1997. Her long term disability payments were $3,000/month, or $720,000 'til age 65.

While at the Pain Clinic, she had provocative discogram, facet blocks, root blocks, bone scan, gallium scan, Indium 111 scan, 3D-CT, arthrograms, vascular flow studies, and nerve blocks.

Total charges for care provided by Pain Clinic were $13,701. Although she has had previous failed surgeries, after lumbar and cervical fusions recommended by Pain Clinic at a cost of $89,560. she was able to return to work on a full-time basis in September of 1998, earning in excess of $120,000/year.

 

Referral Diagnosis:   Failed Back syndrome, "whiplash" – cervical sprain

Pain Clinic Diagnoses:      

1.    Wedge compression fracture T12
2.    LI wedge compression fracture
3.    C6-7 disc bulge and spondylosis
4.    LS-SI fibrosis
5.    L4-5 disc herniation
6.    Thoracic outlet syndrome bilaterally
7.    Disrupted disc L3-51
8.    Disrupted disc L4-5
9.    Disrupted disc C4-5
10.  Disrupted disc C6-7
11.  Disrupted disc C3-4
12.  C4-7 facet syndrome
13.  Left lateral meniscus tear
14,  Avascular necrosis of the hips bilaterally
15.  Left sided tempro-mandibular joint syndrome
16.  Severe reactive depression

Case #10 - Patient Name: Linda K.  -  Linda K., age 52,  was injured in a motor vehicle accident in October of 1996.  Three days after the accident she returned to work, but was only able to tolerate working for five additional days, before leaving work, as a supervisor in the post office. More...
She received conservative care, P.T., medication, and some minimal testing at a cost of $15,980.She began receiving private disability payments of $1600 per month, or $249,600, over a 13 year course. Projected medical expenses over 13 years would have been $6,000/year for medication, doctors visits, and P.T., or $78,000

While at the Pain Clinic she had flexion extension X-rays with obliques, 3D-CT, provocative discograms, vascular flow studies, and peripheral nerve blocks. Her total charges were $11,074.  She had one surgery to release the right radial and ulnar nerves and a second surgery to release nerves in the left arm, for total costs of surgery and follow-up care of $14,590.  After receiving disability payments for 15 months, she returned to work on March 1, 1998, at her same position in an office.

Referral Diagnosis:  Lumbar strain, Cervical sprain

Pain Clinic Diagnoses: 

1.         C5-6 spondylosis with associated cord compression
2.        Retrolysthesis C5 on C6
3.        Instability C5-6
4.        Disc space narrowing at L5-51
5.        Thoracic outlet syndrome bilaterally
6.        Bilateral ulnar nerve entrapment
7.        Right radial nerve entrapment
8.        Right carpal tunnel syndrome



Case # 11- Patient Name: Minerva R. -  Minerva R., age 35, was injured In a motor vehicle accident on 8/14/93.  She continued to work for some time following the accident.  She had two TMJ surgeries and facet rhizotomies in the cervical and lumbar spine. More...
In August of 1997 she stopped working because she could no longer tolerate her pain.  She received $125 per week from the auto carrier and $250 per week from her employer. Medical expenses from the date of her injury to the time she was seen at the Pain Clinic, were in excess of $27,000.

While at the Pain Clinic, Minerva R. received provocative discograms, flexion-extension X-rays, a trial with a body jacket, and facet denervations. Total charges for care provided at Pain Clinic were $20,548.00. Ms. R. underwent an anterior cervical fusion as recommended by the clinic on June 1, 1998, at a total cost of $47,879  Exactly four months later the Ms. R. returned to her job.

 
 
Testimonials

I enclose my note today for (patient). Her recovery has been quite spectacular. I wish we understood these injuries a bit better. I wish even half of our patient's could have the kind of recovery she has had. I trust she has continued to be in contact with you regarding her return to an active, functional life. Certainly, patients like this, who are able to recover so well, make some of the difficulty in taking care of these complex disorders more tolerable. Thanks again for the opportunity to participate in her care. Sincerely, Stuart D. Miller, M.D. Greater Chesapeake Orthopaedic Associates, LLC

I received your letter reqarding your wife, ____. I recommend that my colleague be involved in her evaluation and work-up. I will forward a copy of this letter to him and ask that he directly contact you with regard to instituting an evaluation plan. I will be available on a consultancy basis should this prove indicated. My colleague is a superb diagnostician in difficult pain disorders such as this and I know you will be in good hands under his care. Sincerely, James N. Campbell, MD Johns Hopkins Medicine >

Mr. is seen in the office in follow-up. I reviewed the MRI scan of his thoracic and lumber spines, which were performed after his last office visit. The studies, as reviewed by Dr. S, demonstrate evidence of enhancing epidural scar tissue; this is not a particularly large volume of tissue but may be responsible for the patient's discomfort. In addition, and perhaps more ominous, there appears to be adjacent clumping of the nerve roots and the arachnoiditis may additionally be responsible for pain. Because of the extent of his post-operative discomfort, the failure of conservative management, and also considering that he has some hesitancy about returning to Dr. B for any additional injections, I suspect that he would be best managed at multi-modality Pain Clinic. My feeling is that he should be seen by the Pain Clinic in Baltimore. There is not a facility in our immediate area which provides the services that (this clinic) does and certainly, their reputation is national and they are quite respected. I will contact the clinic and send copies of Mr. __'s medical records. I would like to have the cooperation of his insurance carrier and we will also speak with his rehabilitation coordinator. EDWARD J. ZAMPELLA, M.D. NEUROSURGICAL GROUP OF CHATHAM, P.A. Pain Clinic, Baltimore, MD 21153

I am writing to thank you for the excellent care you provided my patient. She is now completely pain free, has returned to work and is tapering off her antidepressants. Thank you again for your excellent care. Sincerely, R. Gary Hopkins, M.D. Manheim Family Health CenterLancaster Medical Group

Dear Dr.: In the past you have helped us with difficult patients, here is another. Kevin was originally seen by us sometime in 1992 s/p two lumbar leminectomies with protracted low back/leg pain. He continues to have pain the right lower extremity. He has had spinal cord stimulator placement in March 1996 which gave temporary relief and was positional. Readjustment was attempted in June 1996 and then more recently in August 2, 1996. The last adjustment was done by a neurosurgeon here, Dr. J whose operative report I enclose. Despite adequate placement in the prone position on the OR table, while upright Mr. _____ is not getting relief. During this time, we have attempted weaning the methadone 40 q 8 and Dilaudid prn without success. I feel his options here have been fully explored and discussed with him referring him to you which he is agreeable to. We have started a wean on the methadone again and he has signed a contract to decrease to methadone 10 mg q 8 in two months. Please see him as soon as possible. If there are any other questions we can answer, please do not hesitate to call.  Karen M. Park, M.D. Georgetown Pain Management Center GEORGETOWN UNIVERSITY MEDICAL CENTER

RE: Patricia D/A Dear Sir: Ms. _____ returns stating that the stellate ganglion block is wearing off. Her right hand is now cold and purple again. Her pain has increased. She has had good results from the trigger point injections. The examination shows that there is allodynia of the hand. The hand is cool and dusky. There are multiple trigger points in the axial musculature. She is given five trigger point injections, two into the paracervical area and three into the paradorsal and paralumbar area, all on the right. 10 mg. of Depro-Medrol was added to the Lidocaine. At this time, I will refer her to one of the world's experts on reflex sympathetic dystrophy. Unfortunately, her comp carrier has never seen fit to permit this and I will ask her to use her Medicare coverage to see him.  I have also been reading about the use of Zostrix cream for reflex dystrophy. We will give her a trial of Zostrix to be applied four times a day. She understands that this may cause some initial burning. Unless the area gets red or looks inflamed, she is to continue with it if the burning is not too severe. She understands that if she does not use it three to four times a day, every day, the benefit may not occur. She may need to have the dose increased to the Zostrix HP. She is given samples as well as a prescription. Sincerely yours, ANDREW R. KLIPPER, M.D., F.A.C.P., P.A. Founding Fellow of the American College of heumatology Practice Limited to Rheumatology, Osteoporosis & Chronic Pain Medical Director: Baltimore Osteoporosis Imaging & Diagnostic Center

 

Dear Ms. ____ Please be advised that I have reviewed extensively your history and physical examination and investigations. It is my medical opinion that you suffer from a complex pain problem involving the cervical spine and right upper extremity region. In patient's such as yourself, it is imperative that one physician well trained in the discipline of pain management take control of your case and oversee other consultants, treatments, etc. It is certainly reasonable for Dr. Hendler to assume this pivotal role as he is a nationally recognized authority in pain diagnosis and management as well as being director of a clinic that specializes in complex pain problems. I therefore urge you to maintain Dr.Hendler as your primary physician in charge of coordinating and managing this complex pain problem you suffer from. I look forward to serving as a consultant for you in the future and will certainly keep Dr. Hendler advised of my thoughts concerning your problems. Sincerely, Allan Belzberg, M.D., F.R.S.C.S. Johns Hopkins Neurosurgery

As we discussed on the telephone, I saw your client and my patient, Shirley in the office for re-evaluation on September 28, 1992. I had not seen her since January of this year. I had referred her to Dr. Samuel Hawken, who subsequently referred her to Dr. Wan Shin, the physiatrist at Fairfax Hospital. Apparently, Dr. Shin and Dr. Hawken wish to refer Mrs. ______ to a pain clinic and referral was made to a clinic apparently associated with Mt. Vernon Hospital (I was unaware of its existence until Mrs.____ mentioned it to me). I certainly agree that Mrs. _____ has chronic pain in her left neck and face and in the left hip, related to her injury on the job in February 1990, and/or her subsequent automobile accident in October 1990. I also agree that it is medically necessary to refer her to a pain clinic for treatment of ongoing symptoms related to her injuries, but I would suggest that she be referred to (another) Clinic in the suburbs of Baltimore run by the founding physician in the pain center at Johns Hopkins Hospital. That was a seminal center in the development of pain clinics across the country. In my opinion, (it) is amongst the very best pain centers in the country. Sincerely, James Franklin Grim, M.D. Neurology Center of Fairfax LTD.

 

Dear __, Jim has forwarded to me the letter you sent him regarding pain clinic proposals, and asked that I get back to you on this. I am only too happy to do so, since (the doctor heading the clinic) is indeed one of the premier pain evaluation and pain management experts in the country, and someone for whom I have great personal respect. More... Sincerely yours, Michael W. Kita, MD Senior Medical Director, UNUM Unum Life Insurance Co. of America

 

I am writing to you in reference to _________. I saw her in my clinic today following her sciatic nerve decompression While she is experiencing typical postoperative pain from the approach to the sciatic nerce, she claims that the prior sciatic nerve pain that readiated down to her foot, is completely resolved. I have been following her for some cellulitis of her skin and a fluid collection which is now resolving as well. I wanted to thank you very much for your correct diagnosis of Leslie and wanted to follow-up with you to let you know that he pain is now resolved. Yours sincerely, Dror Paley, M.D., F.R.C.S.C. Professor of Orthopaedic Surgery University of Maryland School of Medicine University of Maryland Medical System Maryland Center For Limb Lengthening & Reconstruction

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