Whole-body MRI promises a detailed look under the hood—but what can a quick screening scan actually see, miss, and send you chasing? Diagnostic radiologist Dr. Paul Clemons explains why a whole-body MRI is a limited study, how incidental findings can lead to further tests, and why standard screening remains the better choice for most people. Paul and Mike also compare MRI, CT, PET, and DEXA; unpack contrast, radiation, scan safety, and pacemakers; and discuss why a dramatic spine image does not automatically explain pain or point straight to surgery.
Matthew Paul Clemons, MD, is a diagnostic radiologist specializing in nuclear medicine and body imaging. He is Head of Nuclear Medicine at Radiology Partners Houston and a rectal and prostate cancer specialist.
Whole-body MRI promises a detailed look under the hood—but what can a quick screening scan actually see, miss, and send you chasing? Dr. Paul Clemons explains why a whole-body MRI is a limited study, how incidental findings can lead to further tests, and why standard screening remains the better choice for most people.
Expect to learn how MRI creates images and why scan protocols take time, why open MRI systems can have important image-quality limits, how PET/MRI adds functional information, why CT and MRI can be complementary rather than redundant, how radiation and implanted devices factor into decisions, why spine findings do not always match symptoms, when conservative care deserves consideration, and where DEXA versus MRI can be useful for tracking body-composition trends.
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Episode Timestamps:
1:50 Whole-body MRI and preventive screening
2:52 How MRI works: magnets, noise, and safety
7:05 Open MRI, magnet strength, and image quality
9:05 MRI sequences, scan time, and diagnostic protocols
11:47 Why whole-body MRI is a limited screen
12:46 Incidental findings and downstream testing
13:57 High-risk screening, rare genetic conditions, and lung limits
17:53 Sensitivity, specificity, and standard screening
24:15 PET/MRI and where whole-body imaging has a clinical role
27:05 Why MRI and PET/CT systems are expensive to install
31:59 MRI safety, implants, and pacemakers
36:36 CT versus MRI: why one scan can lead to another
38:52 Whole-body CT, radiation, and its limits
43:47 Back-pain scans: why an image may not explain symptoms
51:44 Physical therapy, surgery, and warning signs
58:46 Evaluating evidence for peptides, stem cells, and biologics
1:05:47 Choosing an orthopedic surgeon for athletic goals
1:15:24 DEXA versus MRI for body-composition trends
[00:00:00] Dr. Mike T Nelson: Hello?
[00:00:12] Dr. Mike T Nelson: Okay, there we
[00:00:12] Dr. Paul Clemons: go. Hello, hello.
[00:00:14] Dr. Mike T Nelson: How are you doing?
[00:00:15] Dr. Paul Clemons: I'm doing well. How about yourself? Um-
[00:00:18] Dr. Mike T Nelson: Good, other than my computer crashing right before I came on, I'm good.
[00:00:23] Dr. Paul Clemons: Well, that happened to me except it was with work, so, uh- Oh, no. That's not good ... yeah, it was just like, ugh, it's, uh, occasionally it, it, it happens. It decide, decided that it wanted to, um, update as I was trying to open my dictation software.
[00:00:37] Dr. Paul Clemons: Uh- Oh ... and yeah, so, but, but yeah, I'm getting to work from home today, which is always nice, in my, uh, my office. Nice. Technically mining. Oh, and say that again. You said you got to work from home today? Yeah, thankfully. Um, they, every now and then we get to, uh, with all, you know, basically I just read images remotely.
[00:00:58] Dr. Paul Clemons: Um, then, uh, it averages out to, like, maybe one day a week, one every other week. Um, some jobs though you can do completely remote. It just kinda depends on, you know, what, uh, kinda contract you get.
[00:01:14] Dr. Mike T Nelson: Yeah, I've heard of more, a couple radiologists were saying that they work almost exclusively remote. I, I don't know if they're for- Yeah
[00:01:20] Dr. Mike T Nelson: a bigger clinic or how their setup is or what they got going on, but
[00:01:25] Dr. Paul Clemons: Yeah, it all, it all depends. Um, you know, most hospitals don't employ their own radiologists. Um, uh, and ERs and whatnot, they contract out with a separate radiology group- Mm ... um, that manage them, so- Kind of like anesthesia does now. Yeah, yeah.
[00:01:41] Dr. Paul Clemons: Exactly, exactly. Um, so like for instance, my group, um, that I'm with is, uh, Radio- Radiology Partners Houston. Um, so, um, for anybody that's not in the Houston area, you wouldn't have any idea, uh, the areas I'm about to say, but, um, the, two of the, their main hubs in Memorial City and Sugar Land, um, kind of areas/suburbs if you will.
[00:02:03] Dr. Paul Clemons: Um, but we cover those, as well as a whole bunch of other scattered imaging centers and, uh, urgent cares and stuff all throughout, uh, mostly north Texas and, uh, southern Oklahoma. So-
[00:02:17] Dr. Mike T Nelson: Oh, wow. Okay, so that's quite the area.
[00:02:19] Dr. Paul Clemons: Yeah. So physically we're at the, um, uh, the Houston sites, but the rest of the sites we all re- remotely, 'cause, you know, middle of nowhere urgent care obviously not busy enough for one radiologist.
[00:02:33] Dr. Paul Clemons: So.
[00:02:34] Dr. Mike T Nelson: Yeah, totally. Awesome. Um, yeah, this is pretty just informal. Did you have any questions before we get started?
[00:02:40] Dr. Paul Clemons: Um, no, I don't think so. I mean, um, I've listened to, you know, some of the, some of your podcasts- Oh, thank you ... as, as, as Chris, you know, while, while we're- Chris forces you to
[00:02:50] Dr. Mike T Nelson: listen to it.
[00:02:51] Dr. Paul Clemons: Well, no, not exactly that.
[00:02:52] Dr. Paul Clemons: We, uh, like on, on car trips and stuff, um, he's always the one that drives, 'cause I... Uh, not that I'm scared of driving, I just dislike it. Um, but yeah, the, uh, the, I think the last one that we'd listened to was the one with, um, I can't remember his name, um, but the guy that tried to cross Antarctic and was discussing, um- Oh,
[00:03:15] Dr. Mike T Nelson: yeah
[00:03:15] Dr. Paul Clemons: uh, discussing, you know, removing weight, even if it seems minimal, with like removing his zippers and stuff. I'm like- Yeah, yeah ... oh, pass. Cutting his toothbrush. Yes. Oof. No, thank you.
[00:03:27] Dr. Mike T Nelson: Yeah, he's, he's a super cool dude, but he's crazy.
[00:03:31] Dr. Paul Clemons: Yeah, no. Absolutely no way. Like, good for you. Love that for you, but, uh, not for me.
[00:03:37] Dr. Paul Clemons: Um, but yeah, the, um, I put in the, um, little questionnaire thing, uh, whatever the, as far as topics to cover, I just listed just kind of a random, um, uh, kind of commonly asked questions, I guess. The main ones, obviously, I wanna talk about, um, since it pertains to, um, your, your channel is the, um, DEXA scans and, and whole body MRI for purposes of, you know, what healthcare uses it for and what the fitness industry uses it for.
[00:04:06] Dr. Paul Clemons: But-
[00:04:06] Dr. Mike T Nelson: Yeah. Cool. Yeah, anything else on the list that you are like, "Yeah, definitely wanna talk about that?"
[00:04:14] Dr. Paul Clemons: Um, probably, uh, I mean, I'll, I'll, I'll start out explaining what a radiologist is 'cause the vast majority of people don't know, um- Yeah,
[00:04:21] Dr. Mike T Nelson: yeah ...
[00:04:22] Dr. Paul Clemons: you know, like, unless you're, unless you know one or you're in healthcare, um, then you don't really know what we do.
[00:04:29] Dr. Paul Clemons: I didn't even know that radiology was a, like, its own thing when I started med school, you know? Like, I just found... I, I got introduced to it and I was like, "Oh, well this is cool," you know? Um, but yeah, most, most people I get all the time they'll ask, "Oh, yeah, w- you- they, they've got a school, school for that?
[00:04:49] Dr. Paul Clemons: Why didn't you do the two-year program over at
[00:05:58] Dr. Mike T Nelson: Awesome, and welcome to the podcast, Doc. How are you today?
[00:06:02] Dr. Paul Clemons: I'm doing well. How about yourself?
[00:06:04] Dr. Mike T Nelson: I'm doing good. And we got connected with you through our, our friend Chris, and I was looking for someone to answer the question about, seems like full body MRIs are kind of the thing. In all honesty, I've had this question from a couple clients, and even for myself I was kinda looking at it.
[00:06:22] Dr. Mike T Nelson: But it's one of those things where I know enough to know I don't know much of anything about MRIs, and then we got your name. And so what are your thoughts about just the full body MRI more on the preventive side, not that I've, I've got this sports injury, I've got this thing, but I can get a... I think Nuvo is one of the companies that does them, and it seems like- Yep
[00:06:42] Dr. Mike T Nelson: every time I turn around there's a new company offering them as sort of, uh, preventive medicine.
[00:06:49] Dr. Paul Clemons: Yeah. No, it's a totally valid question. Um, you know, you see signs now just driving on the road in, in a lot of cities, um, of, you know, uh, whole bod- body MRI offered, you know, at blah blah location. Um, it's, it's definitely become more of a, a thing.
[00:07:06] Dr. Paul Clemons: Um, and so, you know, with that there's... W- we have to take into account first what is, you know, the MRI and, and what makes... w- why is the whole body MRI just now a thing? Like, what, why is that? So an MRI, um, you know, it stands for magnetic resonance imaging. I could go into all kinds of fun, boring physics- ... um, but I'm not going to because I don't wanna put us to sleep.
[00:07:29] Dr. Paul Clemons: Um- ... but essentially, um, the way it works is, uh, it... you go into a giant magnet, um, and makes a lot of sounds as it's turning on different, uh- They're loud as hell too Oh, yes. I don't think people realize that. And they're- Very, very loud ... the inside tube is freaking tiny. Super small. Super small. Yeah. And that's where a lot of people don't quite realize it and, you know, even people that are not claustrophobic sometimes will have issues, um, just because the way it's constructed, um, it's essentially, you know, a giant tube except that the opening of the tube, you know, is maybe this big, obviously not to scale.
[00:08:11] Dr. Paul Clemons: Mm-hmm. Um, but the entire machine is, you know, like a giant block around that, and that's housing all the, the, the magnets, the wiring and everything. Um, and the reason it has to be like that is it needs all of that wiring, electricity, uh, magnetic fields in order to get a strong enough signal to essentially look into the body where we can make images.
[00:08:35] Dr. Paul Clemons: Um, 'cause it's, you know, it's, it's all about magnets. Um, so, you know, it's like your normal, you know, desk magnet except, you know, on steroids. It's way, way, way higher strength. Um, and so the reason why it's loud is the alternating currents. Um, on a smaller scale, like in a computer or something, you wouldn't really hear it or notice it, but on a much larger scale like that- Uh, that's what causes the ah, ah, you know, lots of- Yeah, that's a good impression
[00:09:03] Dr. Paul Clemons: banging and, you know, uh- Someone sounds like they're inside trying to get out with a hammer. Yeah, I mean, it, it really is. Um, you know, and this is why you hear things like, uh, because the magnet strength is so strong, uh, of, you know, objects getting caught in the MRI. Um, so when the MRI technologist tells you Make sure you have no metal on your body.
[00:09:25] Dr. Paul Clemons: That does mean everything. Um, this is not just a, you know, "Oh, you know, we need to screen for it." No, that, um... We had a lady, uh, one time actually in residency that she was wearing leg weights. Um, just- Oh ... little five-pound, you know, like mostly filled with sand, but there was some metal in it. Um, I guess she forgot that she was wearing it or thought they didn't count, and she got stuck to the inside of the magnet, and it took four people to pull her out.
[00:09:53] Dr. Mike T Nelson: Oh.
[00:09:53] Dr. Paul Clemons: Um, 'cause the magnet is always on. Um, won't go into the specific details, but essentially in order to keep it functioning, it's hyper, hyper-cooled, and, uh, there's always a constant field even when it's not scanning. Um, and we can't just turn it off, because if we do that, the super, uh, cool gas, usually it's, uh, I think it's usually either nitrogen or helium, I can't remember.
[00:10:18] Dr. Paul Clemons: Um, but as soon as it gets cool or quenched, suddenly now, yes, the magnet's off, but then the room is flooded with that gas, so you run the risk of suffocating people, and it costs, you know, a good $5,000 plus to refill it. So, so it's not as simple as turning it off. So please, please listen to your MRI techs if you ever get one.
[00:10:40] Dr. Mike T Nelson: Um- Yeah. If you're bored someday, look at, uh, do an image search for objects stuck in MRI.
[00:10:45] Dr. Paul Clemons: Mm-hmm.
[00:10:46] Dr. Mike T Nelson: Like, you'll... I've seen mop buckets. I think the worst one I saw was, like, a small forklift. You know, like one of those- Yep ... pallet things they use to move pallets was literally stuck in the tube. I'm like, "Oh, my God."
[00:10:57] Dr. Paul Clemons: Yeah, yeah. And it's not just metals that are what you think are magnetic. Uh, so, you know, 'cause, uh, it, it, it, because the strength is so high, it can pull things that you wouldn't normally think it would. So just keep that in mind. Um, we're not playing around. So, um, but that being said, um, the opening is smaller.
[00:11:19] Dr. Paul Clemons: Um, they have some specifically that are designed for bigger patients, but it's still gonna be kind of tight, um, just because we don't have the technology quite to have that higher strength. Um, that leads me into open MRIs, quote unquote, where they look more like a CT scanner where, like, the back of it's open and you actually, like, you know, stick all, you know, all the way through.
[00:11:43] Dr. Paul Clemons: Uh, so it's not as claustrophobic. Um, however, I advise against those heavily for pretty much anything, unless it's, uh... there's a very few indications. If it's just, like, a simple joint, you know, knee MRI or something like that, y- you maybe can get away with it. But the reason I don't advise that for anything else is the strength of those magnets are much less because it doesn't have all of the equipment.
[00:12:06] Dr. Paul Clemons: So, like- Typically we scan on what's called 1.5 Tesla or 3.0 Tesla. That's the strength of the magnet. Um, and it's not necessarily just double in strength, 1.5 to 3. Um, it's, you know, got some formula. It's exponentially greater. Um, the open ones typically are at most .5 Tesla. Mm. So much lower strength, which means that, you know, it could miss something.
[00:12:34] Dr. Paul Clemons: So, um- Yeah. So lower strength in general, not as good a resolution quality, correct? Correct. And so you don't wanna, even if you're claustrophobic, generally don't go for an open one, um, you know, just 'cause you don't wanna get that false reassurance of, "Oh yeah, it's nothing," and well, turns out you actually had a small mass there, and then a few years later, big mass.
[00:12:53] Dr. Paul Clemons: So, um, so that's kind of brief overview on why the MRIs are as big as they are and why, you know, uh, it, it, it sucks. If you're claustrophobic, talk to your doctor, get them to prescribe, you know, something for you, um, so that way you're, you're, you're good. Um, but, um, with that, MRIs take a while. So a standard diagnostic MRI, so you get an MRI of your abdomen, for instance.
[00:13:19] Dr. Paul Clemons: Um, they order it. Um, it, you know, scans the abdomen, uh, does it with and without contrast. Um, and It's not like a CT scanner where a CT scan just does one, you know, pass, sometimes two through the body. The MRI, you basically sit in the magnet and it runs what we call multiple sequences. Um, so it's essentially different ways of the MRI activating, uh, to get different pictures, to highlight different things.
[00:13:49] Dr. Paul Clemons: Um, so, you know, one sequence is really good at looking for, uh, water, uh, you know, water content. Another one is really good at isolating fat content. Um, another one's really good for whenever we give the contrast to, uh, see things enhance like tumors or other things like that. So there's multiple sequences.
[00:14:10] Dr. Paul Clemons: We're talking like, you know, usually like 15 or more. Um, so that's why it takes so long, and it's not just a simple boom, you're out. So they generally, in, in MRI of the abdomen, with and without, typically it'll take about 20, 25 minutes. Um, you know, so that's a significant amount of time. Um, whereas, you know, if you do just a simple knee, probably can get away with maybe 15 minutes, um, you know, just because it's smaller, more focused, um, et cetera.
[00:14:40] Dr. Paul Clemons: So that's why when you talk about whole body MRIs, you know, if you're saying it's like 20 to 25 minutes kind of for a standard one, some protocols such as a, um, MRI of your pituitary gland or of, uh, your prostate, uh, can take up to an hour or 90 minutes.
[00:15:00] Dr. Mike T Nelson: Hmm.
[00:15:00] Dr. Paul Clemons: So, you know, they're, they're very specialized, um, and they take longer because it's doing different things.
[00:15:08] Dr. Paul Clemons: Um, so it's not a one size fits all. So if you take that and you say, "Oh, well, I wanna do the whole body," well, if you wanna do a full diagnostic MRI where you're, you know, doing everything, that's just not realistic. You know, the patient would be in the scanner for three, four hours, you know? Um, so That's just doesn't really make sense.
[00:15:36] Dr. Paul Clemons: That's the reason why we don't really use that, um, as a screening tool in general for most diagnostic purposes. Um, so the whole body MRIs, a lot of them say, "Oh, well, you know, they're gonna take maybe, you know, half an hour or 45 minutes to an hour," right? Um, so how do they do that if a regular diagnostic one can sometimes be an hour of one specific area, right?
[00:16:01] Dr. Paul Clemons: So the way they do that is it's a, you know, very cursory, uh, overview MRI. It's, it's very limited and only runs a few sequences. Um, you know, the, the slices that it does, um, where it images you, the, the gaps are bigger. You know, so it's, it's not a complete study. Um, and so that's why, one, insurance doesn't almost never pays for a whole body MRI.
[00:16:26] Dr. Paul Clemons: Um, and two, why most doctors don't, you know, recommend getting one is, while, yes, you can get a whole body MRI and, you know, you may catch some things, you're also probably gonna miss a lot of things. You're gonna have a false sense of security that, you know, "Oh, everything's fine." And then, you know, a few years later you turn out, "Oh, well, I have cancer in my pancreas.
[00:16:48] Dr. Paul Clemons: What, what, what the crap? I ne- I didn't... The whole body MRI didn't see it." Well, it's because it's a limited, you know, uh, evaluation. So that's one of the main things. The other thing is we're gonna find a whole lot of shit, um, and it's what we call incidentalomas. So we call it that because once we see it, we then need to work it up because we can't just ignore it.
[00:17:14] Dr. Paul Clemons: Um, you know, and because it's an incomplete, um- MRI of each area, you know, it's a limited, usually just one sequence or two, um, it almost never fully characterizes anything.
[00:17:27] Dr. Mike T Nelson: Mm.
[00:17:27] Dr. Paul Clemons: Which means that if it does see something, you're then going to have to usually get a dedicated MRI with and without contrast of that area or, and/or potentially a biopsy.
[00:17:40] Dr. Paul Clemons: So... And that happens all the time. Um, one of the most common things is adrenal nodules, um, or thyroid nodules. Tons of people have them, uh, and they, you know, the vast majority, I'd say probably 95%, uh, or more wouldn't do a damn thing and they're benign. Um, however, once you see it, you gotta work it up. So, uh, that's the other reason that I generally discourage whole body MRIs for that purpose.
[00:18:11] Dr. Paul Clemons: Um, there are a few select populations where it would be useful. Um, there's certain people with certain genetic, uh, conditions, uh, that make them much more prone to cancer. Uh, Li-Fraumeni, Li-Fraumeni syndrome is one. Uh, again, very rare. Um, but we don't recommend a whole body MRI in that sense. We instead recommend, you know, individual MRI of the brain, MRI of, you know, chest, abdomen, pelvis, et cetera.
[00:18:42] Dr. Paul Clemons: Um- For those specific populations and their full protocols. So, you know, it's not this abbreviated protocol that we're running just because you could potentially miss something. Um, side note, MRI is terrible for the lungs. Um-
[00:18:58] Dr. Mike T Nelson: Hmm ...
[00:18:58] Dr. Paul Clemons: so if you're looking to, you know, if you're worried about lung nodules and stuff, it's not gonna do you good.
[00:19:03] Dr. Paul Clemons: Uh, reason being- Is that
[00:19:05] Dr. Mike T Nelson: because of the air in the lungs? It's so much- It's- ... air is hard to... 'Cause I think you actually have to do a spin on water primarily via MRI. Mm-hmm. Is that correct?
[00:19:15] Dr. Paul Clemons: Yep, yep. Most of the, uh, imaging findings, uh, are based on what water con- content is in, in there, um, as well as, uh, the percentage of fat.
[00:19:27] Dr. Paul Clemons: Um- Hmm ... air typically causes, uh, some artifact. Um, so it's partly because of that, but two, it's mainly because of, you know, the nodules, usually most lung nodules until it's a big mass are small. They're- we're talking, you know, five, six millimeters, and even with a diagnostic MRI, your slices still can only be so small because otherwise you would make the scan take way longer.
[00:19:51] Dr. Paul Clemons: It'd be for hours on end. Right. You know, so we still have to have this trade-off between ti- length of the time of the scan versus, you know, how, uh, quote-unquote, accurate you are, you know? Uh, you can make a super, super thin sliced, uh, MRI, but you may sit there for two hours to scan your abdomen, you know, and that's just not feasible.
[00:20:12] Dr. Paul Clemons: Um, but the biggest thing with the chest is respiratory motion.
[00:20:16] Dr. Mike T Nelson: Mm.
[00:20:17] Dr. Paul Clemons: So for a CT, a CT usually only takes a few minutes, right? So you can, for anybody that's had one, um, you usually hear the machine say, you know, "Hold your breath," and then it'll tell you when to breathe again. Um, because you can do that, you, you can hold your breath for, you know, a minute or two.
[00:20:34] Dr. Paul Clemons: For an MRI, the sequences generally take, you know, like the sh- shortest sequence to run usually is, like, five minutes, and you generally can't hold your breath that, that long. So the way they do it is they'll scan it with breath holds. Um, so they'll have you hold your breath, and then scan part of it, let you breathe, hold your breath again, scan more.
[00:20:58] Dr. Paul Clemons: But because of that, you're never gonna have exactly the same amount- Mm ... of breath, even if you're trying.
[00:21:03] Dr. Mike T Nelson: Mm-hmm.
[00:21:03] Dr. Paul Clemons: You know? Um, so you're gonna end up inevitably in the lungs, you're gonna gap a, a good portion. Uh, it can affect other, uh, scans of, like, the abdomen, 'cause obviously the diaphragm's super close to that, but it's not as big of a deal, um, just because, you know, the, the amount of deviation's not gonna be that much, so, um-
[00:21:25] Dr. Mike T Nelson: Interesting
[00:21:27] Dr. Paul Clemons: So yeah, that's kind of MRI in a nutshell of why, you know, the main things for the whole body MRI from a healthcare diagnostic screening purpose, um, I don't advise it, and many doctors don't, uh, is because, you know, you can get a false assurance, r- uh, reassurance that there's nothing there when it's in- you know, it's an incomplete scan.
[00:21:47] Dr. Paul Clemons: Um, and we're usually gonna find something that most of the time is gonna end up resulting in nothing. So that's the, the, the main reasons why. Not to mention the cost is, you know, out of pocket, uh, 'cause insurance doesn't pay for it, can be anywhere from like 1,500 to $4,000, you know? So that's not an insignificant amount.
[00:22:07] Dr. Mike T Nelson: And so it sounds like the, if you use the fancy words, the sensitivity and the specificity of it kind of both suck. Right. Where usually you're looking at a, kind of a trade-off between one versus the other, if you wanna- Exactly ... explain that, how they sort of generally chara- characterize sensitivity, specificity, and how they use that.
[00:22:27] Dr. Paul Clemons: Right. Yeah, and that's, you know, that, that's essentially long and short of it. You know, most studies, you know, like you said, will have a trade-off where one's more sensitive, i.e. it catches more things, um, whereas it has less specificity, which means we may catch things that aren't a, that big of a deal, um, versus scans that are more specific, you know.
[00:22:47] Dr. Paul Clemons: Whereas this one, both sensitivity and, you know, specificity are kind of bad. Um, so that, that's kind of the long and short of it. Now, that's not to say I'm sure that people have had whole body MRIs and it's found something that turns out to be cancer or whatever, you know, and that of course is, is, is gonna happen.
[00:23:07] Dr. Paul Clemons: Um, but you have to take that into the context. You know, that's one person out of, you know, how many people are getting these whole body MRIs, and what would have happened if instead they just followed the standard screening protocols of, you know, mammograms, colonoscopies, you know, um- If, uh, for, for men, you know, getting the digital rectal exam and your PSA and all that.
[00:23:31] Dr. Paul Clemons: W- if they would've followed those normal screening programs, would they have still found that and cost less money and, you know, time? Um, and generally speaking, you're, it's gonna be, uh, better to just follow the standard screening.
[00:23:47] Dr. Mike T Nelson: Yeah, I feel like the marketing department gets a hold of stuff, and humans are horrible- Mm-hmm
[00:23:52] Dr. Mike T Nelson: with statistics. Yep. And all it would take would be, like, one story, which could be, like, a very much a true story, which I'm sure you could find of exactly what you said. "Oh, I didn't know I had X. I went in and had this full body MRI, and ooh, it found this thing, and I had a biopsy and I found out I had cancer," or-
[00:24:11] Dr. Paul Clemons: Mm-hmm
[00:24:11] Dr. Mike T Nelson: you know, whatever it is. And even though I know the statistics and have somewhat of an idea, but I also know listening to that story, I'm like, "Oh, shit, I, I really wonder, maybe I should do this thing."
[00:24:25] Dr. Paul Clemons: Yeah. Yep. And that, and that's how, that's how they get you, right? Uh, 'cause, you know, you, there are people like that.
[00:24:32] Dr. Paul Clemons: Um, and, you know, but they, they leave out the parts where, you know, would this have been something that would've been picked up on routine screening-
[00:24:40] Dr. Mike T Nelson: Mm-hmm ...
[00:24:41] Dr. Paul Clemons: you know? Or, um, uh, and also the fact that, you know, that's one person in, you know- How many that's done the, done the scans- Sure ... and ended up, oh, I found a, a lesion in my liver.
[00:24:55] Dr. Paul Clemons: Um, okay, then we'd go get an MRI of the abdomen with and without contrast. That's another 30 minutes and, you know, costs more money. Insurance will cover part of it obviously, but, um, okay, cool. Well, they still don't quite know what it is. Uh, oh, crap, uh, let's get another follow-up MRI. Uh, okay, well, the thing's, you know, slightly bigger.
[00:25:15] Dr. Paul Clemons: Oh, crap, is that suspicious? All right, let's biopsy it now. Turns out biopsy was nothing. It was some, some benign lesion and, oh, crap, now I've got a liver bleed and I'm hospitalized. And, you know, so it's... Th- those are the things you have to, have to, have to look out for that obviously the marketing teams for the whole body MRIs will not tell you.
[00:25:34] Dr. Paul Clemons: Yeah. So it may be something in the future. Um, you know, I don't doubt that if once we get better technology to be able to scan MRIs faster, um, you know, that, that is happening. Uh, but it's slow, so, you know. Uh, right now it's just not feasible, uh, from, from a healthcare or screening standpoint, for the most part.
[00:25:57] Dr. Mike T Nelson: Yeah. It, it does feel like potentially it could be a thing in the future, right? Mm-hmm. Like you said, if you could figure out a way of maybe they can do faster scans with more processing or I don't, again, I don't know. Yeah. I'm asking. Um- Oh, yeah.
[00:26:11] Dr. Paul Clemons: Yeah.
[00:26:12] Dr. Mike T Nelson: Do you think- Yeah ... it's something that m- might be possible in the future, like assuming, I don't know, faster scans, different technology, maybe higher resolution, et cetera, et cetera?
[00:26:23] Dr. Paul Clemons: Yeah. I think in the future, um, probably I'm, uh, gonna say probably not within, you know, my career, um, just because it, you know, it will have to get significantly better and faster to the point where a normal MRI, uh, would take like, you know, two minutes, like a CT scan. Um, but you know, we have had improvement in scan time, um, and, you know, the, the overall resolution of the imaging, um, since MRI's inception.
[00:26:58] Dr. Paul Clemons: You know, the, uh, you know, first MRI, uh, that they did had, you know, bigger gaps because they couldn't y- you know, scan, uh, as, as thinly. Um, you know, it would take much longer, so you got a p- you know, compared to today's standards, you know, you got a poor quality study for the same if not longer time. And magnet strength helps with that, um, shortens scan s- uh, speed, uh, but there's other factors too, uh, with figuring out different configuration of the, the coils and the magnet and, you know, the...
[00:27:34] Dr. Paul Clemons: It's not as simple as just increasing the, the strength, even though that is obviously a big part of it. So, so I do think s- that it will be, just not quite right now. Um, the only thing clinical that they will use- A whole body MRI for, uh, or near whole body, uh, is there are now, uh, PET MRIs. Hmm. Um, so a PET scan, um, which is one of the main things I read 'cause I'm, um- Not an MRI for your pets, a different type of thing.
[00:28:04] Dr. Paul Clemons: Right, right. Different, different. Yeah, positron emission tomography, uh, or topography, I'm sorry. Um, but, uh, my s- one of my main specialties besides body imaging is nuclear medicine. Um, and with that, uh, comes PET imaging. Um, and what that is, uh, is most of the time, uh, we inject a, uh, radiotracer for PETs.
[00:28:29] Dr. Paul Clemons: It's usually FDG, um, which is, uh, fluorinated, uh, F18 glucose. So essentially we attach it- It kind of lights up glucose on the screen, correct? Exactly. And so, you know, we can kind of map physiology, uh, and view it. Um, and so combining that with a CT, which is commonly what's done, uh, we can see more definitively where those, you know, areas light up so we can give a better, you know, um, uh, better read for the clinician and the patients.
[00:29:00] Dr. Paul Clemons: Um, now, uh, as MRI technology has gotten better, um, they are able to do that with, um, PET MRI. Hmm. Where instead of doing the CT, they do an MRI with it. Obviously it takes longer, um, and there's not, it, it's not a widespread thing yet. Um, for the most part, most insurances still don't cover it 'cause it's still, quote-unquote, in research.
[00:29:24] Dr. Paul Clemons: Uh, but at clinical hospitals you can still, you know, they'll, they'll still do it, and usually if it's a big, um, research facility, you know, it, it, it will, it will be, the cost would be covered. It wouldn't be like you're completely paying out of pocket. Um, so if they have them, those are cool. Uh, and that's nice because even though the whole body MRI is a limited study, right, it's only running a few sequences, we have the added benefit of PET to see where all of this glucose is going.
[00:29:53] Dr. Paul Clemons: And in general, most tumors, uh, and cancer like glucose, so they light up super hot. So you have that kind of added benefit. So that's about the only place that whole body MRI is being used in general in a clinical standpoint.
[00:30:08] Dr. Mike T Nelson: And I believe MRIs, even if you needed new technology to make full-body MRIs useful, MRIs in and of themselves are ungodly expensive.
[00:30:18] Dr. Mike T Nelson: Mm-hmm. And so, you know, so I... One of the guys I worked with briefly at the University of Minnesota years ago, they were working on, uh, gadolinium stains for cardiac mapping using MRI. Yep. And the big limitation of that research was even at the U of M that had more access to MRIs than almost any other university, and they were saying a lot of the studies they did were at, like, you know, 2:00 or 3:00 in the morning because, you know, technically the magnet's always on.
[00:30:46] Dr. Mike T Nelson: Mm-hmm. Yep. So university wants to maximize magnet time, and if you want a cheaper rate, well, you get, you know, 3:30 in the morning to do your little- Mm-hmm ... research. And they said even then, just trying to get stuff done was extremely expensive. And so if you think about- Mm-hmm ... a hospital that says, "Hey, you know, now we're- we wanna upgrade our MRI"- They're probably, what do you do with the old one?
[00:31:09] Dr. Mike T Nelson: How do you get the new one? And then just- Mm-hmm ... you wanna talk a little bit about how much expense there is. It's not a, not a simple thing like, "Ah, we got new software. Just, you know, load the new software."
[00:31:19] Dr. Paul Clemons: Right, right. Uh, uh, if it was only that simple. Um, yeah, no, uh, scanners are expensive. Um, any, uh, any new scanner, even if it's a, uh, like, a basic x-ray unit, obviously that's gonna be much cheaper than a big CT or- Sure
[00:31:34] Dr. Paul Clemons: um, uh, or a, uh, um, MRI, but, um, it's, it's still a decent cost. So one of the, the ones that I'm more familiar with is, um, like, a, a, uh, recently, uh, because we're looking at getting a, uh, PET CT scanner down in, uh, at our Sugar Land location. Um, and, you know, the bids for those, um, started at, like, 800,000. Oof. Um, whereas i- in, like, the one that we settled on, uh, as far as I'm aware, I need to confirm to make sure they actually listened to me-
[00:32:13] Dr. Paul Clemons: with my recommendations. Um, but, uh, that was, like, one point, I wanna say it was 1.2 or 1.3 million.
[00:32:20] Dr. Mike T Nelson: Mm.
[00:32:20] Dr. Paul Clemons: Um, but they also had some that were better quality, but they were, like, three million. Oof. You know, and it's like, uh, do we really wanna, you know... Um, as far as an MRI, MRIs are about as expensive. Um, so, you know, for a, for a 1.5 or a 3 tesla magnet, the ones that we kind of use right now, um, they're average of about one to two million, um, sometimes three million.
[00:32:47] Dr. Paul Clemons: Um, and, you know, that's just for the unit itself. And so then it takes a whole lot of time to build it, so that's the other thing the hospital or imaging center or whatever has to keep in mind. If you're putting a new MRI, replacing the old one, well, that means the old one has to come offline.
[00:33:06] Dr. Mike T Nelson: Yeah.
[00:33:06] Dr. Paul Clemons: And so you're not getting that scan time to be able to reimburse and make up for it.
[00:33:12] Dr. Paul Clemons: Um, so a- and these things take a very long time to build, um, you know, MRIs especially because they have to have- You know, even more sort of protection, uh, around it, uh, both one, uh, to make sure that the magnetic field, you know, doesn't extend too far out and affect, you know, people that are- that are outside, uh, of the scan room.
[00:33:35] Dr. Paul Clemons: Um, they have- we have what's called zone one, two, three, and four for, like, how close you are to the magnet, right? Um, so it has that protection for that, but also if it does- doesn't have the appropriate protection and, um, uh, build of the room, it also can affect the magnet quality. Hmm. And you can have really bad artifacts, so that's another thing they have to keep in mind.
[00:33:56] Dr. Paul Clemons: So i- it takes, you know, months and months. Like, I think the quickest that I've seen, you know, at least with me in residency and fellowship and as an attending, was, like, a six-month turnover. Oof, yikes. Um, you know, and that's getting the old pieces out, you know, getting the new pieces in. You know, thankfully, if they're installing the magnet in a room that had a magnet before, they don't have to do as much reconstruction of the walls, right?
[00:34:22] Dr. Paul Clemons: Yep. But i-i-it's still sizable. Um, so you have- And I think even the floor and stuff too, because those things are heavy as fuck. Mm-hmm. Exactly. Because yeah, I mean, it has to be reinforced and- Yep ... you know, that's one thing that you, you can't think about, uh, w-when the hospital or, or imaging center is, is thinking about getting one of these, you have to think about the structure of the room itself, the floor it's on, but also the floors above and below.
[00:34:50] Dr. Mike T Nelson: So you have... Because you have to have shielding above and below because you don't want somebody with, you know, a pacemaker walking the floor above that's a doctor's clinic and then suddenly, you know, their pacemaker goes crazy and starts shocking them repeatedly.
[00:35:04] Dr. Mike T Nelson: Mm-hmm.
[00:35:05] Dr. Paul Clemons: So, so it's, it's a definitely a, a ni- nightmare as far as logistics goes.
[00:35:11] Dr. Paul Clemons: So that's why most of the time they try to have them on the first or basement floor, but-
[00:35:16] Dr. Mike T Nelson: Yeah. In my previous life, I worked in technical support for a pacemaker defibrillator company. So one of the questions we got a lot was MRIs in, in general, which the good part is, in general, most of them don't have a lot of ferromagnetic material, but the biggest concern, like you mentioned, was you have little leads, little wires that run down into the heart.
[00:35:37] Dr. Mike T Nelson: And if you, you know, via just simple physics or we used to call like the, the right hand rule- Mm-hmm ... if you have a, a B field or a magnetic field that's your fingers, you can induce current to flow down a wire. Yeah. And so that was the biggest concern of just by the fact that you've got wires in your chest.
[00:35:55] Dr. Mike T Nelson: They may not be super ferromagnetic, but there's a risk- It's on the screen ... that you can induce some current or the device could pick up on it and that kind of stuff.
[00:36:03] Dr. Paul Clemons: Yeah. Let me open the door here to let the- Yeah, no worries ... my, my, my helper out.
[00:36:07] Dr. Mike T Nelson: Oh,
[00:36:08] Dr. Paul Clemons: isn't he cute? Little Faith. Hi, buddy. Come on. You need to go outside.
[00:36:13] Dr. Paul Clemons: Um, so yeah, no, it's, it's a big, um, uh, it- it's a big concern. Uh, pacemakers used to we were much more worried about, um, you know, there was certain pacemakers that were just absolutely not allowed in MRIs. Yep. Uh, and then others that we called conditional. Um, and so that's why, again, another point for anybody that's listening, um, if you have anything in your body, um, but especially if it's a pacemaker, um, you know, but generally anything, make sure you bring the information for it.
[00:36:45] Dr. Paul Clemons: Oh, yeah. They usually give you a little card. Um, make sure you keep that, bring it, because a lot of times if we don't have the right information, we may not be able to scan you until we get it. Because by the, the name, with it being conditional, that means, yes, you can put it in the scanner, but you have to limit the conditions to the scan a certain way, i.e.,
[00:37:05] Dr. Paul Clemons: you know, you may have to... The, the tech may have to change where you have longer, um, pause periods between scanning, um, or, you know, the s- strength can't go up to a certain amount. So that's, you know, that's why it's important. Um, nowadays in general- Um, we're kind of getting away from, like, cer- certain pacemakers being not scannable.
[00:37:29] Dr. Paul Clemons: Mm-hmm. Um, there's been some, some newer studies. Um, actually when I was in residency and fellowship, uh, at Baylor Dallas, uh, the, um, heart hospital that was directly across from us, Baylor, uh, Heart and Vascular, um, they were a part of a study to scan, um, pacemakers that previously were not conditional, i.e.,
[00:37:50] Dr. Paul Clemons: you know, like we couldn't scan them. Um, and reason being is 'cause that hospital obviously had a ton of cardiologists- Mm-hmm ... and cardiothoracic surgeons right on hand, you know. Uh, and they found out with, um, you know, their, their study, I don't know if it's still ongoing or not, um, as well as the other places that participated, that, you know, pretty much any pacemaker can be scanned.
[00:38:10] Dr. Paul Clemons: It's just you have to have, you know, the, the knowledge of what conditions to put it in and, and, um, all of that. So that's at least one plus for patients, um, that, you know... Uh, but not all centers are still comfortable doing that. So if you get turned away then, you know, just find a bigger academic place, and they're usually okay with it.
[00:38:32] Dr. Paul Clemons: Um-
[00:38:33] Dr. Mike T Nelson: Yeah. And that's always a trade-off too, like- Okay, here's the, you know, so we used to advise, you know, obviously it's up to your physician, here's the risk of what could happen. Mm-hmm. Here's how you would take care of the device to mitigate the risk, and then, you know, while it's technically not recommended, it's up to your physician, your radiologist, and your team to figure out- Yep
[00:38:51] Dr. Mike T Nelson: okay, here's the risk, but I really need, I can only have an MRI because I need this specific type of imaging, imaging for what I have. Yep. And, you know, you have to kind of just figure out, again, you're back to here's the risk, here's the pros, here's the cons, and at least they're aware of what to do in those cases.
[00:39:10] Dr. Paul Clemons: Yeah. Yeah, it's always a, it's always a balance of the, the risk to benefit. Um, and most of the time with most things that we do, um, in, you know, at least in radiology, um, and in general medicine, uh, you know, usually the risk is very low, but it is still there. So it's, you know, one thing to always keep in mind, like, well, is this worth it?
[00:39:31] Dr. Paul Clemons: Can we get it through another means? Um, and sometimes we can in radiology, because there's different types of scans. Um, you know, x-ray, ultrasound, CT, MRI, um, nuclear medicine scans, PET scans, um, all of those, but they each serve a different purpose and function. Um, so, you know, certain things you may see on a CT that are not completely worked up and you need an MRI later, you know?
[00:39:58] Dr. Paul Clemons: So if you, for instance, get a CT scan, and then they're like, of your abdomen and pelvis, and they're like, "Okay, now we need an MRI," you know, most people that aren't, you know, familiar with, with medicine may go, "Are you kidding me? You're just wanting to charge me, right?" Like, "What, what, what the fuck is this?"
[00:40:17] Dr. Paul Clemons: Um, and that's not necessarily true, uh, one, because it's your, your, your doctor that's ordering your studies, uh, and the radiologist that is reading it, um, don't get a kickback for the scans. They're not getting paid per scan- That's just, that's, uh- ... of like, "I recommended
[00:40:34] Dr. Mike T Nelson: 70% more scans this week,
[00:40:35] Dr. Paul Clemons: so I'm going on
[00:40:36] Dr. Mike T Nelson: vacation next year."
[00:40:38] Dr. Paul Clemons: Right, right. Yeah, it's like that, that's just not a thing. You know, I mean, maybe years and years ago when more radiology groups owned their own scanners, maybe that was true to a partial degree. But now- nowadays, that's usually not the case. And two, even if they do, there's like laws in place to prevent that.
[00:40:58] Dr. Paul Clemons: Mm-hmm. We c- we can't self-refer. Um, so the, the, so, so don't get that out of your head if you think so. Um, but, uh, you know, the reason being is because we may see something on CT, and CT is great for a lot of things, um, and not to mention it's cheaper and faster than MRI. Um, but it can't fully characterize things sometimes, so that's why you need the MRI.
[00:41:19] Dr. Paul Clemons: Now, you may be thinking, "Well, why don't we just start with the MRI?" Sometimes you can, right? Um, but there's also sometimes when you get the MRI- And you may, you know, mostly characterize whatever it is, and they may still say, "Hey, you know, get a CT or an X-ray, uh, for confirmation," because, um, you know, there are limitations to MRI.
[00:41:43] Dr. Paul Clemons: Um, for instance, definitely in the, the lungs like we talked about. Uh, and then Uh, if you have, uh, any kind of m- metallic density in your body, um, you know, whether it be like a hip replacement or, um, you know, prior fracture repair from a plate and screw fixation or a surgical clip- Yeah, any hardware ... gun shot.
[00:42:06] Dr. Paul Clemons: You know, generally speaking, those things can be scanned, uh, but they do still cause artifact in the scan itself. And so, you know, we may say, which, you know, I had to do for one of the studies I read earlier, uh, today, um, that, you know, there's no, you know, definite suspicious abnormality of, you know, the, the, the pancreas, but it's degraded by, you know, this surgical clip from their previous endoscopy, uh, that they put in the stomach.
[00:42:34] Dr. Paul Clemons: You know, so either you can get a follow-up MRI after the clip passes, um, but a lot of times whatever the object is is permanent, right? And so in that case, I would say, you know, think about getting a CT pancreas protocol, and so that way, whatever limitations of the MRI, the CT can pick it up. So, um, so yeah, it's not always just a, "Hey, we want to give you, uh, g- get you to do more scans so that way our radiologist can add to his bank account, and I can-"
[00:43:02] Dr. Mike T Nelson: you know, kick back." It's just not a thing.
[00:43:06] Dr. Mike T Nelson: Could there ever get a point where because CT is so much faster, could you do full body CT, or is it just not... You run into the same issue where you, you just, it's too time expensive, and I know there's also additional potential radiation exposure- Yep ... with CT, correct?
[00:43:23] Dr. Paul Clemons: Yeah. And no, that's a, that's another good question. So, um, yes, actually, um, CT, we can actually do, you know, a whole body CT if we wanted. Um, you know, a- and it could be of diagnostic quality. Um, it would just be, you know, whole body. The problem with that is, um, and the reason that we don't really do it that often, um, the- at most you would get like a CT of your chest, abdomen, pelvis.
[00:43:52] Dr. Paul Clemons: Um, uh, but the reason we don't do that is because of, like you said, radiation. Um, so MRI, uh, does not use radiation. It's all, all to do with magnets. Um, it, it's non-ionizing is what we call it. Um, whereas CT and x-ray produce ionizing radiation, i.e., the stuff that can kind of screw up, um, you know, your, your DNA potentially and cause, you know, the theoretical risks of increased cancer and all that.
[00:44:22] Dr. Paul Clemons: Um, generally speaking, um, that's not anything to really worry about for your average person, even if you're getting a decent amount of scans. Um, that usually only comes up if you're a kid, um, and you have some kind of condition where you do have to get frequent CTs, and kids are more susceptible to it, and then they could potentially have cancer later in life.
[00:44:45] Dr. Paul Clemons: Um, your average person- Due to, you know, all the safety precautions and whatnot, never really have to worry about that. Um, so, you know, y- yes, Linda, you can get a chest X-ray when you have- when you're pregnant. It's not gonna kill the baby. You're fine. Mm-hmm. You know, uh, and that's a big, that's a big question, right?
[00:45:04] Dr. Paul Clemons: Sure. But, um, but that's the main reason that we don't do it, is because if you're getting whole body CTs, um, you know, repeatedly on the same person, that, that adds up. Um, and the CT scan that we use and PET scans for a PET CT, um, is, it's pretty good. It's not quite, like, 100% diagnostic CT, so it's slightly less quality.
[00:45:27] Dr. Paul Clemons: Um, still really, really good. Um, but it's, uh, for the trade-off of slightly less quality of that CT scan, the radiation is actually a lot less. Um, and in general, we only go from, like, the skull base to the mid-thighs. Um, you almost never need scanned of your, uh, CTs of your extremities, um, you know, your, your, your legs and arms, uh, just because any cancers that are gonna be there, um, you won't really evaluate it well on the, the CT.
[00:46:00] Dr. Paul Clemons: You'd need a dedicated MRI and all this stuff. And if you're worried about skin cancer, for instance, um, we generally cannot detect skin cancer on, uh, CT, MRI, or PET scans.
[00:46:12] Dr. Mike T Nelson: Hmm.
[00:46:13] Dr. Paul Clemons: With the exception of if it has progressed enough, uh, to where it will be big enough for us to notice, 'cause, uh, uh-
[00:46:21] Dr. Mike T Nelson: Hmm ...
[00:46:22] Dr. Paul Clemons: they, the PETs- Those are
[00:46:23] Dr. Mike T Nelson: affecting other tissues.
[00:46:24] Dr. Paul Clemons: Correct, and that's typically, like, with melanoma, right? Um, a, a lot of times they will af- you know, sometimes before, but a lot of times it'll be after they excise the melanoma and they see, oh, you know, it went beyond a certain millimeter of depth. Can't recall the exact amount, but, um, once it gets past a certain depth, there's more of a chance that it has spread, and so in that time they'll do the PET scan.
[00:46:47] Dr. Paul Clemons: Um, but if they did it before, if they're, you know, suspicious, like, oh, you know, they have this on their leg, you know, uh, and they've got- You know, worse in symptoms that may have, uh, spread. It, they may go ahead and scan it, but if that melanoma is not large enough, we may not pick it up. Um, just because it's on the skin, you know, it's not, you know, it may be pretty sizable, but it's still very thin.
[00:47:14] Dr. Paul Clemons: Uh, and resolution for a PET CT, uh, for frame of reference, average it needs to be at least about seven, eight millimeters-
[00:47:23] Dr. Mike T Nelson: Hmm ...
[00:47:23] Dr. Paul Clemons: for the PET scan portion, the, where the, the, uh, radioactive glucose goes for us to see it, um, even if it's clearly cancerous. So, you know, um, your melanoma, while it may be kinda big, you know, on your arm, if it's still less than that, you know, we, we won't see it.
[00:47:43] Dr. Paul Clemons: So, um, so that's kind of why you usually don't need to have the, the, uh, CT scans or MRIs go all the way down to the legs and feet just 'cause you don't really need it. Um, we'll make that exception for certain cancers and stuff, but yeah.
[00:48:01] Dr. Mike T Nelson: Yeah, one of the things that surprised me too, and I can't remember the first time I read this study, it was, it was a while ago, that they scanned a bunch of people for low back pain- Mm-hmm
[00:48:11] Dr. Mike T Nelson: and they sent it to a bunch of radiologists. They said, "Hey, read these. Tell us what's going on."
[00:48:16] Dr. Paul Clemons: I
[00:48:16] Dr. Mike T Nelson: think I know where
[00:48:16] Dr. Paul Clemons: you're going, but yeah.
[00:48:17] Dr. Mike T Nelson: Yeah, and I think it was like, f- I can't remember the exact number, but it was like 40%, it was a pretty high number came back and said, "Hey, you know, this person should have, you know, lower back pain," blah, blah, blah.
[00:48:27] Dr. Mike T Nelson: But what they didn't tell them was that they scanned all completely asymptomatic people. Mm-hmm. And I think that study was even ... You could ... You probably know. I think it was actually even repeated again, different population, like similar outcome. And- Yeah,
[00:48:41] Dr. Paul Clemons: they- they've had a couple. Uh, I, I can't recall exactly when, but yeah, it's
[00:48:46] Dr. Mike T Nelson: Yeah, and so I always get, especially with back pain because that's what the studies were done on, with clients I get a little worried because they're like, "Well, I wanna go get an MRI." And I'm like, "Well, I'm not your physician. I'm not telling you not to get an MRI, but it's not that painful. You don't have numbness.
[00:49:05] Dr. Mike T Nelson: Like you don't have anything that you, that we know are signs of like, 'Yes, go in. Please get this checked out ASAP.'" Because my fear is they're gonna do an MRI, and if it's a lifter or someone who's an athlete-
[00:49:18] Dr. Paul Clemons: Yep ...
[00:49:19] Dr. Mike T Nelson: I can guarantee that they're gonna find some crazy stuff, and then you have to talk them off the ledge of this may be related, this may not be related to what we have going on.
[00:49:30] Dr. Mike T Nelson: 'Cause I think there's something very impressionable of seeing an image of, "Oh shit, that's my fucked up back. Oh, no wonder I have this pain." Right? And they might be related- Yeah ... and they might not be related.
[00:49:42] Dr. Paul Clemons: Yeah. No, that's, that's a, a, it's another one I, uh, that happens all the time. Um, and so I'll kind of preface this, um, with saying that, you know, the CTs and MRIs, um, of, you know, the, the spine essentially, we get those a lot.
[00:50:01] Dr. Paul Clemons: Sometimes it's to evaluate for a fracture, you know, in a trauma, um, or, you know, if they're having this chronic issues of back pain. Um, you know, the problem is, um, you can have ... Oh, there's my other little helper. Um, the problem is you can have, uh, you know, a scan of your spine and it could just look like dog shit.
[00:50:27] Dr. Paul Clemons: Like- Oh
[00:50:27] Dr. Mike T Nelson: yeah ...
[00:50:28] Dr. Paul Clemons: have- I've seen some
[00:50:28] Dr. Mike T Nelson: scary ones ... you know- And I'm not a radiologist, but just me as a layperson- Well you- ... looking at it goes, "Holy shit."
[00:50:34] Dr. Paul Clemons: Yeah. You know? Like a- and, and for somebody that doesn't look at scans, if you see that and can recognize it, you know, it's ... You know, and you get that and then you talk to them and they're like, "What are you talking about?
[00:50:45] Dr. Paul Clemons: I'm fine." Yeah. "
[00:50:45] Dr. Mike T Nelson: I don't know.
[00:50:46] Dr. Paul Clemons: I don't have any
[00:50:46] Dr. Mike T Nelson: pain."
[00:50:47] Dr. Paul Clemons: Like and it's, it's the most bizarre thing. Um, whereas other people, uh, you know, you can get a scan of them and they've got just this one little tiny disc herniation- But to them, it's like, "Holy crap, the, you know, someone is, is actively trying to hack my lower back into pieces."
[00:51:06] Dr. Paul Clemons: Mm-hmm. You know? And it's so variable, and it's not to say that that person that's screaming about the tiny disc bulge is lying. Correct. 'Cause they're probably not. It's just this strange thing and we don't really know why. Um, there's thought processes of why that your, the symptoms that you have of back pain, um, does not always correlate to the, what we see on scans.
[00:51:34] Dr. Paul Clemons: Um, main things we talk about on scans are disc bulges or herniations, um, fissures in the disc, um, you know, uh, facet arthropathy, um, spinal canal stenosis, neural foraminal stenosis, nerve impingement, those kinds of things. Those are the u- usually the things that we talk about. Um, but the shocking thing is, you know, if you...
[00:52:01] Dr. Paul Clemons: Because we, we read all kinds of scans, you know, for, for different things, right? Like I'll, I'll read a, a, a CT abdomen and pelvis for somebody that came to the ER with, you know, concerns for appendicitis, right? Well, you know, I s- I see the spine in that as well. It's not quite as, um, the same quality as a dedicated CT lumbar spine just because they zoom, you know, cone in more and all that stuff.
[00:52:25] Dr. Paul Clemons: Mm-hmm. But, but I can still see the spine and comment on it, and I'm just like, "Oh, fuck. You're like- "How is your sp- your spine is, spinal canal has got..." Which the spinal canal is the, the part where your spinal cord goes through, is like maybe measuring like four millimeters. Four millimeters. For reference, it needs to be, generally speaking, is 9 to 10, you know?
[00:52:48] Dr. Paul Clemons: So that's like half, so it's getting- But then, you know, I talk to the ER doc, and they're like, "Yeah, no, they're, they're, they're fine. No, no issue. Not..." And then they'll check with the patient and it's like, "Yeah, the patient's not talking about back pain", you know? So it's very weird. Um, you know, some of it has to do with how long whatever, uh, degenerative changes have been there, um, in your body, you, you just adapt to it.
[00:53:11] Dr. Paul Clemons: Um, and then, uh, some of it can be, you know, from a acuity, um, of, you know, they just did something to herniate this disc, and even though it's only a little bit, because it's such a quick acute change, that's why they're feeling it. Um, you know, and then other things for, like what happened with, uh, actually my father-in-law, um, Chris's dad, uh, you know, he ended up just all of a sudden one day, you know, he was walking fine.
[00:53:44] Dr. Paul Clemons: He'd go, go with us to the gym, you know, and then all of a sudden he started getting, like, very rapidly progressing leg weakness-
[00:53:53] Dr. Mike T Nelson: Hmm ...
[00:53:53] Dr. Paul Clemons: um, and back pain. Um, you know, but the biggest thing was the weakness, and he was like, "Oh, my God, what's, what's wrong?" Well, you know, we, I get him, uh, get, get him scanned and all that, and, you know, he obviously had degenerative changes and stuff like what we expected, but he, his L4 vertebral body, um, slid forward on his L5.
[00:54:16] Dr. Mike T Nelson: Hmm.
[00:54:16] Dr. Paul Clemons: And so what that did was that basically pinched off and squished his, uh, nerve roots, uh, as they were going out. And so looking at, you know, a study that he had, you know, years ago, it was slid forward a little bit, but at that time wasn't enough. And so essentially it just over time had more and more degenerative changes, and then it just got to the point where the body couldn't compensate and then just, you know, boom.
[00:54:41] Dr. Paul Clemons: So, so all of that long story short, um, 'cause I tend to ramble, as you probably guessed by now- No, all good ... um, you know, in general, getting a scan of your spine, uh, because you have back pain, you can do it, but you need to keep in mind that, you know, just because you see something doesn't necessarily mean that's the specific thing causing your pain.
[00:55:06] Dr. Paul Clemons: Mm-hmm. So, like, for instance, if you're having primarily, like, right-sided, you know, back pain, uh, you know, lower back, well, you know, when they're scanning your spine up in the lower thoracic, uh, 'cause it goes cervi- cervical, thoracic, lumbar. In the lower thoracic, they see, oh, you, you're, you've got advanced degenerative disc disease where it's completely squished and there's not really a disc in there, a- anywhere there.
[00:55:35] Dr. Paul Clemons: Okay, well, but your, your pain is down into your very lower back, almost like by your sacrum. That's probably not causing anything, you know? But people will be like, "Oh, God, do I need to have surgery?" You know? Um, and leading into that, um, surgery is generally not the option you wanna jump for. Um- Yeah,
[00:55:58] Dr. Mike T Nelson: especially for back stuff.
[00:55:59] Dr. Mike T Nelson: Like the outcomes on it are just, from what I've read, just generally not that good. There's a time and a place obviously for everything- Yeah ... but.
[00:56:07] Dr. Paul Clemons: Yeah. 'Cause there's, there's definitely indications for it, right? Um, however, in general, uh, this is excluding like you having like an acute fracture of your spine.
[00:56:18] Dr. Paul Clemons: Mm-hmm. Right? Um, but in general, for like, you know, you've got, um, it could, could be acute back pain from like a dis- disc herniation or whatever, um, or chronic pain. In general, uh, the outcomes of just physical therapy, uh, alone, um, versus surgery, surgery was at most as good as physical therapy.
[00:56:44] Dr. Mike T Nelson: Hmm.
[00:56:45] Dr. Paul Clemons: Whereas- Most of them had, you know, either less effectiveness over time where the back pain recurred, um, and then you had to have another surgery, um, or you end up having complications and you have some kind of hardware infection or anything like that.
[00:57:02] Dr. Paul Clemons: You know, obviously I'm not a neurosurgeon, um, you know, uh, so I, I don't... uh, or a back surgeon. Um, so, you know, th- there may be instances where surgery is for you. Sure. Um, however, at least from my reading of scans and talking to a lot of surgeons as well as a physical therapist and looking at, you know, studies done myself, surgery should not be your first go-to.
[00:57:28] Dr. Paul Clemons: Um, you know, unless it's just something where, like, you've actually got symptoms of, like, leg weakness or, um, you know, neuropathy, that kind of stuff, then you may need to have surgery. But if it's just pain, generally speaking, stick to physical therapy, you know, first. Try all that strengthening exercises, um, first before you jump down to surgery.
[00:57:50] Dr. Paul Clemons: 'Cause once you have surgery, it's only a matter of time before you have to have another one because it fuses a segment, but then the parts above and below become hypermobile-
[00:58:01] Dr. Mike T Nelson: Yeah ...
[00:58:01] Dr. Paul Clemons: to compensate, and then they get faster degenerative changes, then they have to fuse that, et cetera, et cetera.
[00:58:08] Dr. Mike T Nelson: Yeah, there's a lot of case reports.
[00:58:09] Dr. Mike T Nelson: And even, like, with, you know, in theory what happened to Ronnie Coleman, like, he had some issues, had his first surgery, and just has had multiple surgeries since then. Again, I don't know any of the details or, or what's happened, but I've- Mm ... seen that with clients in the past for exactly what you said is, like, if...
[00:58:24] Dr. Mike T Nelson: especially if you're putting in hardware, it's like, oh, we gotta stabilize L4, L5s, we'll put some hardware around it. And yeah, did you solve that issue? Yes, you did, but you took away one of the main movements there. So now, like you said, above and below tends to be hypermobile, and then over time they tend to have an issue there, and then they get- Yeah
[00:58:44] Dr. Paul Clemons: more hardware, and then the same issue happens again with that area, and yeah, it just gets to be kinda freaky.
[00:58:51] Dr. Paul Clemons: Yeah. No, and it's, it's... it happens all the time. So, you know, it's one of those if, if, if you do end up having to have surgery or your, your doctor thinks that, you know, you, you need to, um, after you've done all of the other things, um, if you absolutely have to, try to put it off for as long as you can because, you know, especially if you're a younger person, um, you know, if you're, if you're 70, o- okay, you know, by the time you may need- Sure
[00:59:16] Dr. Paul Clemons: another surgery you probably won't have to worry about it. But, you know, say you're in your early 40s, you know, and you got a herniated disc, you know, well, if they need to go in and have surgery, try to put it off for as long as you can trying everything else, because if they end up having to fuse that segment, then you're gonna have to have another surgery in the future.
[00:59:38] Dr. Paul Clemons: It's just gonna be a matter of time.
[00:59:40] Dr. Mike T Nelson: Yeah, and I think a lot of disc issues, what is it, 90 days or something, will actually start to- Yep ... heal themselves, correct? Mm-hmm.
[00:59:47] Dr. Paul Clemons: Yep. And that's, that's why. Which I don't think
[00:59:49] Dr. Mike T Nelson: a lot of people
[00:59:50] Dr. Paul Clemons: understand. Yeah. Yeah, a lot of people think that, you know, oh crap, it's, you know, I herniated.
[00:59:53] Dr. Paul Clemons: It's, it's, it, that, that's it. Well, no. Your, your body does repair. It takes a lot longer than most things. Um, you know, like s- like you said, that most of the studies show 90 days. Um, but the reason being, the reason why it takes so long to heal is because essentially that area of the body does not get as much blood flow.
[01:00:15] Dr. Paul Clemons: Like, the, the discs themselves- Yeah ... and the area around it, they don't get as much blood flow as, you know, your arm. You know, just due to where they're at and, you know, they're being constantly under pressure. Um, so it takes longer. It's just like when you have a, a cartilage in- injury, you know, in your, in your knee or something.
[01:00:32] Dr. Paul Clemons: Um, so you have to give it time to be able to heal itself, and it eventually will. Um, you know, maybe a steroid injection may help, you know, that kinda stuff. But you, jumping to surgery's almost never the, the option. With the caveat of if you have an actual fracture, then they probably need to fix that.
[01:00:48] Dr. Mike T Nelson: Yeah. That's my general advice for any time people are looking to get hardware. And again, obviously depends upon what, what you've got going on, what your quality of life is, how old you are. I mean, right now my dad's got his right hip replaced, his left hip, his left knee, and then two years ago he had, he had fractured his femur in a toboggan accident, I think when he was 18.
[01:01:12] Dr. Mike T Nelson: And so he- Yep. So he probably had hardware
[01:01:13] Dr. Paul Clemons: from that.
[01:01:14] Dr. Mike T Nelson: Yep, a lot of huge, old plate. And then unfortunately he had some stress shielding because of the stem of the hip replacement. Mm-hmm. And he would just walk down to the bottom of the stairs one day and just fell over. And they thought he had fallen- Exactly
[01:01:28] Dr. Mike T Nelson: or whatever. And long story short, it probably was just stress shielding from the, the stem of the implant next to where the plate was. Yep. And so he had, we had to find a- Yep ... basically a trauma orthopedic person, which took- Four and a half days. I'll save the medical story, but-
[01:01:47] Dr. Paul Clemons: Yeah, I
[01:01:48] Dr. Mike T Nelson: can imagine though
[01:01:48] Dr. Mike T Nelson: he had to literally custom make a whole plate to go around all of the hardware that he had in because they could only get part of the plate out because he was, you know, close to 80 at that time, and- Mm-hmm ... plate had been in since he was 18, and luckily he's doing good. Like, you know, he's, uh, moving around, everything is, is, is good now.
[01:02:07] Dr. Mike T Nelson: But I've had the same thing where a client was 35, and I'm just like, ah. It, it wasn't so debilitating. It wasn't anything where their physician's like, "Yep, you need to replace this. You're gonna have long-term issue." It was just low-level to moderate pain, and my question with that is do you think with, you know, stem cells and PRP and biologics and things like that are appear to be advancing at a pretty rapid rate that- Mm
[01:02:37] Dr. Mike T Nelson: my advice in general is, again, each person, talk to your doctor. You have to make your own decision. But if you can even wait I think like even two to three years, I just, I have this feeling we're gonna have more options at that point than what we have now, and eventually at some point in the future we're gonna look back at all this hardware we stuck in people and just kinda go, "What were we doing?"
[01:03:00] Dr. Paul Clemons: Yep. No, no, it's, it's, it's very true. You know, currently a, there's only a few, um, like FDA-approved- Correct ... therapies and stuff. Um, but the reason why is because it takes a long time once something is discovered, you know, there's, uh, you know, people are like, "Oh, they're just keeping drugs from us," and I mean, to, uh, on a side note, FDA kinda does compared to Europe, but that's a separate conversation.
[01:03:26] Dr. Paul Clemons: Um, but it does take a while for enough studies to be done to show, you know, long-term, you know, oh crap, did we induce some, you know, something else- Mm-hmm ... um, with whatever treatment we give. Um, you know, that has happened, you know, many times in the past with, you know, this product that was, you know, used for, um, you know, female hygiene.
[01:03:51] Dr. Paul Clemons: Um, oh crap, turns out the, you know, increased the risk of cervical cancer. Oh crap, you know? Um, so that's why they go through extensive studies to try to r- make sure that doesn't happen. Um, and the thing to keep in mind is if you do see some kind of study, um, that touts it as, you know, oh, this is the next big thing, you know, oh, you got a rotator cuff repair, um, you know, inject, you know, a peptide four three six, you know, um, and this study shows that, you know, people recovered and all that, y- you have to make sure that the study was done properly, that they've got enough people enrolled in it.
[01:04:27] Dr. Paul Clemons: Um, you know, uh, lots and lots of different factors. That's not, not to say that you couldn't necessarily try something, um, but- A lot of things that you see online are going to say that this is the magic cure- Yeah ... when, you know, they've got a study of maybe 10 people that's been going on for six months.
[01:04:47] Dr. Mike T Nelson: Or-
[01:04:47] Dr. Paul Clemons: You know, it's not really- ... BPM
[01:04:48] Dr. Mike T Nelson: rabbits.
[01:04:49] Dr. Paul Clemons: Right, right. You know, from that- From Croatia. Right, right. You know, uh, we, we start with animal studies, but they generally don't, y- you know, we have to make sure that it correlates to people 'cause they- Mm-hmm ... they don't always. Um, you know, uh, with that, as far as, uh, you know, people with joint pain, um, or, or anything else that they would be looking at doing, you know, stem cells, the peptides or anything like that, that is one thing that you have to find the right doctor.
[01:05:18] Dr. Paul Clemons: Um, because a- at least, you know, like in my training, in the vast majority of, um, you know, uh, medical doctors during their, uh, four years of medical school and then however long years of residency, mine was, you know, five. Um, I think orthopedic surgeons I wanna say is five, maybe six. I can't remember. Yeah.
[01:05:39] Dr. Paul Clemons: But- It's a while ... you know, i- i- it's a long time. You know, during the medical school portion, um, you, you, we don't learn any of that. Like, that's, that's just not a thing 'cause we need to get all the basics, right? Mm-hmm. And so then in your residency, a lot of times y- they also won't cover that either because you're trying to get the competency in your, you know, surgical skills and, you know, in, in the case of surgeons obviously.
[01:06:03] Dr. Paul Clemons: Um, a- and you know, they may briefly kinda cover it, but a lot of times because this is such new information, a lot of doctors just aren't familiar with it. Yeah. You know? Um, they have to teach themselves. So i- if you're interested in that, you know, you do have to find a doctor that has, you know, researched that or is willing to.
[01:06:25] Dr. Paul Clemons: Um, 'cause it's not to say that, you know, oh, they're a bad doctor 'cause they don't know about this. It's just that it's such a new thing. Um, the stem cell, uh, treatments, you know, uh, have, have gotten a little bit more, uh, scrutiny I guess. Um, but you know, especially with peptides, tons of doctors, you know, uh, are, just don't, don't know about them.
[01:06:46] Dr. Paul Clemons: Um, so, you know, finding a, a, a provider that i- is and not your- How do I say this nicely? Um Your, um, alternative medicine doctor- Mm-hmm ... who doesn't have a doctorate, um, rather than just going to them and them selling you a bunch of snake oil. Um, you know, uh, I feel very strongly about that. You can do whatever you want for, for your healthcare, obviously.
[01:07:15] Dr. Paul Clemons: Um, but make sure that if you are seeing an alternative practitioner, uh, or any kind of things like that, please make sure you review it with your medical doctor as well, because some of the things- Oh, yeah ... that they give you may actually counteract whatever treatment that they're trying to do. That's my only aside with that.
[01:07:34] Dr. Paul Clemons: Um, but- And
[01:07:35] Dr. Mike T Nelson: there can be actual, little legitimate safety concerns too, and you're-
[01:07:38] Dr. Paul Clemons: Right ...
[01:07:39] Dr. Mike T Nelson: you know, even if you're using something that's a gray area or maybe illegal or whatever, your physician's job is to take care of you, not to rat you out to the cops.
[01:07:48] Dr. Paul Clemons: Correct. Always be honest to your doctor.
[01:07:51] Dr. Mike T Nelson: Yeah.
[01:07:51] Dr. Paul Clemons: Because, yes, we are required by HIPAA not to do that.
[01:07:54] Dr. Mike T Nelson: Yeah.
[01:07:55] Dr. Paul Clemons: Um, so just keep that in mind. Um, but yeah, find- finding a, a, a physician that's, that's familiar with, with peptide treatments and, uh, stem cell treatments and things like that is, is the main key. And I do think, you know, o- obviously we don't have a lot of studies out right now that are, um, you know, have enough strength behind them, quote, unquote.
[01:08:18] Dr. Paul Clemons: You know, not enough data. Mm-hmm. Um, but there are still a lot of promising studies out there, and so I do believe in the next few years, probably not even, uh, you know, uh, you know, maybe in the next three or four years, relatively soon, um, that there w- we'll have enough data to show that, yes, this, you know, uh, this peptide or, or this stem cell therapy or whatever, um, can repair a rotator cuff tear under a certain severity, you know, without surgery.
[01:08:47] Dr. Paul Clemons: You know, oh, awesome, that's great. We just kinda have to wait and see, and you can try it in the meantime just, you know... I- if it's a surgery you can put off to maybe wait and see if there's more research, you know, in the next few years, I'd say probably put it off if you can, um, just 'cause, you know, nobody wants to have a, an unnecessary surgery, uh, unnecessary surgery if you don't have to.
[01:09:10] Dr. Mike T Nelson: Yeah. Another tip is that, uh, especially when you're so far out there on- the bleeding edge. If you can find someone, in my experience, who works with relatively high-level athletes-
[01:09:23] Dr. Paul Clemons: Yes ...
[01:09:24] Dr. Mike T Nelson: you're probably gonna be a little bit better because they're usually only in business if they're getting results. Like, I have some friends who I know I could call now, and I may not even agree with all the stuff they're doing, but I've seen crazy MRIs pre and post of a hamstring that miraculously healed in record time.
[01:09:44] Dr. Mike T Nelson: I've seen just crazy stuff that I would not think is possible, which again, doesn't mean it's gonna work for everyone else. But- Right ... you're, that's what you're kinda left with because it's- Yeah ... they're only gonna be around if they get a, a result, and the marker is actually a performance marker on the opposite end instead of, "I don't know, I feel pretty good," right?
[01:10:09] Dr. Mike T Nelson: Right. Like, you have a legitimate, like if they- Measurable ... yep, if their hamstring wasn't back to normal, they would not be playing at an elite level. So there is some sort of, uh, you know, N of 1 proof there, so to speak.
[01:10:21] Dr. Paul Clemons: Yeah. Yeah, no, that's definitely true. Um, a- a- and, you know, I, I will, um, you know, second the, uh, the making sure that if you're, you know, fitness inclined, which of course a lot of your followers are- Mm-hmm
[01:10:35] Dr. Paul Clemons: um, you know, you definitely want, if you're going to see an orthopedic surgeon, you definitely want one that primarily treats athletes.
[01:10:42] Dr. Mike T Nelson: Yes.
[01:10:43] Dr. Paul Clemons: Um, because reason being You know, and there, there's no... This isn't necessarily a bad thing, uh, but the vast majority of orthopedic surgeons are used to treating degenerative, you know, o- old busted joints, right?
[01:11:00] Dr. Paul Clemons: Yep. And so, you know, they know, okay, yep, it's gotta, gotta come out, gotta replace it, you know, bec- because that's just what they're used to, um, because that's their primary patient population. Um, but you obviously wouldn't jump to that with a young athlete. Um, and while, yes, they can maybe still take care of you appropriately, you s- probably wanna go with the one that actually tr- you know, treats athletes and sees it every day, um, because they probably have a few more tricks up their sleeve than your standard ortho surgeon.
[01:11:30] Dr. Paul Clemons: Just 'cause, you know, uh, this, this actually came up with, um, uh, my father-in-law when he was getting his hip replacement that he had to have after his back surgery.
[01:11:40] Dr. Mike T Nelson: Mm.
[01:11:40] Dr. Paul Clemons: Um, which we, we knew was coming. Uh, I, you know, I, I looked at his scans, and I'm like, "Oh, yeah, we're gonna have to deal with that later." But, uh, you know, the first surgeon that he went to wanted to do, um, a...
[01:11:54] Dr. Paul Clemons: There's two primary ways of doing a hip replacement. One is they use, um, this kind of cement-like material to essentially- PMMA, I think, right? Yeah. Yeah. Yes, to essentially adhere the replacement, you know, to the bone, right? There's another way of doing it, um, where they essentially, they don't use cement.
[01:12:16] Dr. Paul Clemons: It's cementless, uh, and the way they do it is by driving, um, uh, the, um, hip replacement basically into the bone- Yeah ... um, kind of causing- It's like a press fit ... microfractures and, yeah, causing microfractures and, and, you know, kind of damage, but the sides of it are, like, a little jagged. And so the idea is it does that, so that way then the bone can grow around it, so the bone itself is holding it in place rather than the cement.
[01:12:46] Dr. Paul Clemons: Reason why it matters, you know, the cement, uh, uh, way of doing it is totally valid, totally fine. Um, however- You run the, uh, the problem of hardware loosening over time, i.e., the bone around where the cement is, because it's not getting as much, you know, pressure and, you know, uh, impact, starts to just kind of resorb.
[01:13:11] Dr. Paul Clemons: And so that's when you run into problems that have to have, like, a complete, you know, revision. Um, that whereas the other, uh, while, you know, yes, the, uh, act itself, you know, is a little more painful and involved, it generally has much better outcomes in the long run because the bone itself is holding onto it.
[01:13:31] Dr. Paul Clemons: Um, and the, uh, rate at having to get it revised is much, much, much lower. But you can only do that if you have the correct, you know, bone density. Which if they're working with the older patients, primarily that's why they just use cement, because that's all the patient population and they don't have the density for it.
[01:13:51] Dr. Paul Clemons: Um, whereas if it's a young athlete that does have to have some kind of replacement, um, you know, hopefully they don't, but if they do, you know, they'll recognize that and not just go with the faster, um, less reliable route, so.
[01:14:07] Dr. Mike T Nelson: Yeah. That's a good point, because there's different procedures they can do- Sure
[01:14:10] Dr. Mike T Nelson: and a lot of times, and I don't think physicians necessarily are doing this consciously, they're so used to making a decision of, okay, maybe this procedure's a little bit more complex, but the person is gonna be having more pain, they have to do more rehab, they have to do more- Yep ... things on the back end to get that function back, even if it is a higher level of function.
[01:14:31] Dr. Mike T Nelson: And a lot of times they know, "Eh, most people don't wanna do that." And so again, having a discussion of, okay, are there any other options? And the big thing I always advise my clients too is that make sure your surgeon knows that if you, whatever it was you did when you got injured, that you wanna go back, and if at all humanly possible, probably do that thing again.
[01:14:53] Dr. Mike T Nelson: Mm-hmm. And emphasize to them, like I know people have blown biceps doing Strongman, so I'm like- Oh, yeah ... "Okay, make sure, there's different ways you can repair the biceps, so make sure your physician- Mm-hmm ... knows you would like to get as close to 100% function as possible, and that you're gonna go back and compete again in, in Strongman."
[01:15:10] Dr. Mike T Nelson: So they know, okay, this person is kinda crazy, they're gonna go back and do the thing again. But-
[01:15:15] Dr. Paul Clemons: Yep ...
[01:15:16] Dr. Mike T Nelson: okay, they're probably more willing to have a little bit more pain to do a different procedure. They're probably more willing to do the actual follow-up, the physical therapy, and, you know, just have a li- an actual conversation of the pros and the cons.
[01:15:29] Dr. Mike T Nelson: And if you don't like that particular surgeon, you can always get another opinion too.
[01:15:33] Dr. Paul Clemons: Get a second opinion. Yep. And they will, you know... I- if, if a doctor gets offended by you getting a second opinion- probably don't wanna see that doctor. Yeah,
[01:15:43] Dr. Mike T Nelson: yeah.
[01:15:43] Dr. Paul Clemons: Um, just because that's just the way medicine works, you know, especially with these more complicated questions, right?
[01:15:51] Dr. Paul Clemons: Like sure, if you get a second opinion for your pneumonia, well, okay, you're just gonna- Yeah. But y- y- you know, uh, especially in this case where you're wanting to preserve certain function, et cetera, um, because the basic ortho teaching, um, at least in general, is, you know, h- get the person back to functioning, but not, r- you know, it, it's not necessarily to make them quite to the functioning status they were or better.
[01:16:20] Dr. Paul Clemons: Yeah. Whereas if they're- A lot of times
[01:16:21] Dr. Mike T Nelson: 85% is, "Eh, that's good enough."
[01:16:22] Dr. Paul Clemons: That's good enough. Yeah. You know, whereas if you're an athlete and you're wanting to get back to doing whatever you're doing, uh, or even if you're not an athlete and you're just, you know, your kinda average person, but you still want to, you know, still go, uh, rock climbing or kayaking, whatever.
[01:16:37] Dr. Mike T Nelson: Yeah.
[01:16:37] Dr. Paul Clemons: Um, you know, you wanna go with a person that's primarily dealing with athletes because they obviously, if they're treating an athlete, they wanna make sure that athlete is at least as good as they were, but has the potential to, you know, be better and get stronger. Um, so that's, that's another big, big component.
[01:16:56] Dr. Paul Clemons: Has, you know, nothing against the other orthos, it's just that that's just not their patient population usually. So.
[01:17:03] Dr. Mike T Nelson: Yeah. My other little two cents is- Just because an orthopedic works with a professional team does not automatically mean he or she is the best either. So just FYI, doesn't mean they're- Yep
[01:17:15] Dr. Mike T Nelson: I wouldn't say they're automatically bad. Obviously, they're probably pretty decent, but I would not use that as my be-all, end-all. I would still do all the normal homework that I would normally do with- Yep ... anyone else.
[01:17:27] Dr. Paul Clemons: Yep. Nope, exactly. And it's, it's hard to find, it's hard to find a, a, you know, doctors that, uh, a- and tease out that information, you know?
[01:17:35] Dr. Paul Clemons: Definitely helps if you, you know, know somebody that's worked with them, um, but not everybody has that. So- Mm-hmm ... um, you can go with, go with reviews. Or when you go to see them, kinda how the feel is, if they're, if you're wanting to, for instance, since, just since we're talking about hips, you know, if they're, uh, talking about the technique and they're auto- automatically saying cement, um, you know, yeah, that'll work for your 80-year-old grandma, but-
[01:18:03] Dr. Mike T Nelson: Yeah
[01:18:03] Dr. Paul Clemons: you know, you're, you know, 40, 50, you know? And like, well, you know, isn't that, uh, isn't the cement-less better and all that, and they just brush you off without wanting to discuss it, you know, maybe you should get your second opinion somewhere else. And, you know, doctors are busy, um, you know, I am. Um, you know, but the ultimate goal still should be patient care and making sure you provide the right treatment.
[01:18:30] Dr. Paul Clemons: So if, if you want a doctor that's willing to talk to you.
[01:18:34] Dr. Mike T Nelson: Yeah. Awesome. Well, thank you so much for all your time. I don't know, do you have things on the internet if people wanna find you, or do you just stay, uh, hidden so people can't find
[01:18:45] Dr. Paul Clemons: you? So y- generally speaking, uh, uh, you know, radiologists, uh, I'm probably one of the more personable radiologists that you will ever meet.
[01:18:52] Dr. Paul Clemons: We have a reputation for a reason, uh, 'cause my job is mostly reading scans all day. Um, I do some- Aren't those the docs
[01:18:59] Dr. Mike T Nelson: that just hide in the basement and never talk to anyone-
[01:19:01] Dr. Paul Clemons: Yep ...
[01:19:01] Dr. Mike T Nelson: and just look at a computer?
[01:19:02] Dr. Paul Clemons: Oh, yeah, yeah. There's that episode of Scrubs, uh, where you see the radiology resident one time and he's, like, you know, seeing the sun, he's like, "Ah."
[01:19:11] Dr. Paul Clemons: You know. Uh, we have a reputation for a reason, 'cause there, there are a lot of us, um, that are that stereotype, you know? They're kind of antisocial, awkward around people and, you know. Uh, yeah, I'm, I'm awkward and geeky in a way, but I still talk to people and enjoy it. Um, so, uh, but I, I do, I do have, uh, social media and whatnot, but it's, uh, it's just personal, private.
[01:19:35] Dr. Paul Clemons: Um, I, I don't really have, like, a, a professional one. Yeah, no worries. Um, so, but, uh, but yeah. Um, you know, I'm happy to come back any- anytime. Um, uh, oh, only other thing I was gonna, um, make a note of, uh, uh, just 'cause we were talking about whole body MRIs, uh, and DEXA scans, uh, just a quick, uh, note about that.
[01:19:57] Dr. Paul Clemons: You can get a accurate fat content, um-
[01:20:06] Dr. Mike T Nelson: Oop, your, uh, voice cut out there. You said you can get an accurate fat content?
[01:20:10] Dr. Paul Clemons: Um-
[01:20:11] Dr. Mike T Nelson: Oh, now you're back.
[01:20:12] Dr. Paul Clemons: Oh, uh, oh, it's, it's switched for some reason. Uh, but you can still hear me?
[01:20:17] Dr. Mike T Nelson: Yep, we can hear you now.
[01:20:18] Dr. Paul Clemons: Okay, sorry about that. Yeah, you can get, you can get a, an accurate fat content of the visceral and the subcutaneous fat, uh, with an MRI, uh, the whole body MRI.
[01:20:26] Dr. Paul Clemons: However, most people are not gonna need that, as I'm sure you know- Mm. Yeah, yeah ... you can probably explain. It's only the higher end athletes typically that are gonna want that differentiation, um, especially longstanding like bodybuilders and, uh, power lifters, you know, to s- to get that idea.
[01:20:47] Dr. Mike T Nelson: Oop, and your voice- Um-
[01:20:47] Dr. Mike T Nelson: cut out
[01:20:48] Dr. Paul Clemons: again there. Oh, now you're back. Oh. Oh, it's because Chris just walked in and it reconnected to his. Uh, it was- Oh,
[01:20:53] Dr. Mike T Nelson: okay.
[01:20:53] Dr. Paul Clemons: Uh, but, uh, but yeah, you, you don't really need that if you're an average person. But if you do want it for higher end athletes, um, you know, you can get it from the whole body MRI.
[01:21:05] Dr. Paul Clemons: Just keep in mind, still gonna have all those problems with the other things that we find. Uh, and you have to make sure you go to a, a right place that does that fractionation for you. Um, so that's kinda my only other aside. DEXA scans generally are fine for your, for most of your athletes. Um, it's just kinda the higher end ones.
[01:21:25] Dr. Mike T Nelson: Yeah. And if you're trying to do something and you wanna change it, then shocker, you'd have to go back and have another freaking full body MRI- Yep ... to see if a difference, because trying to use a DEXA, it's... I mean, you could probably get an idea, but it's not as comparable because now you're using a different measurement system- Yep
[01:21:40] Dr. Mike T Nelson: to see
[01:21:40] Dr. Paul Clemons: if there's a
[01:21:41] Dr. Mike T Nelson: change.
[01:21:42] Dr. Paul Clemons: Exactly. Yeah. If you, if you do decide to use DEXA or MRI, uh, for that, you know, I would generally say DEXA. Um, but either way, whichever you did, it, you would generally wanna go to the same machine, you know- Yep ... every time 'cause the, even though, you know, it gives you percentages, the biggest thing that it helps with is trends, making sure you're trending down.
[01:22:03] Dr. Mike T Nelson: So even if it's off by, say, you know- 40 cubic inches of fat, right? Um, well, as long as it's going down still, that means you're doing something right.
[01:22:16] Dr. Mike T Nelson: Yep.
[01:22:16] Dr. Paul Clemons: So.
[01:22:17] Dr. Mike T Nelson: You're going in the right direction.
[01:22:18] Dr. Paul Clemons: Yeah. But no, that's about it. Um, I guess if you get any, um, questions later about, uh, people wanting to ask a radiologist since they've never met one, something-
[01:22:28] Dr. Paul Clemons: um, just send it to Chris and I'll, uh, I'll, I'll get back to you.
[01:22:32] Dr. Mike T Nelson: Awesome. Well, thank you so much for your time. I really appreciate it. This was super helpful, and I think people have some good takeaways of everything from full body MRIs to how to have discussions with their physician, and, um, more knowledgeable in that area, which I think is a good idea.
[01:22:47] Dr. Paul Clemons: Yeah. Yeah. And-
[01:22:48] Dr. Mike T Nelson: Awesome ...
[01:22:48] Dr. Paul Clemons: like I said, happy to come back anytime. Awesome to finally get to do this.
[01:22:52] Dr. Mike T Nelson: Yeah. Thank you so much. Really appreciate it.
[01:22:54] Dr. Paul Clemons: Thank you.