By JAKE GOODRICK - Associated Press
Saturday, March 6, 2021
GILLETTE, Wyo. (AP) - In his lifetime, Dr. John Mansell has witnessed firsthand the folly-filled progression of pain treatment.
As a kid, doctors who treated his grandfather’s lung cancer prescribed beer to treat the pain. When his uncle was later diagnosed with lung cancer, the options weren’t much better.
That was decades ago, before the Gillette physician made treating people and their pain his life’s work.
Now Mansell, 59, has a slew of medical patents, some of which are designed treatments in an attempt to further advance the study of pain.
One drug patent is pitched as a treatment for sepsis, a condition where the body has an extreme over-response to an infection, the Gillette News Record reports.
With sepsis, Mansell said the body commonly creates too much nitric oxide or substance P, which causes more problems for the patient. His patent, in overly simple terms, is for a drug that tells the body to stop overproducing substance P.
His goal is to advance “anything we can do to reduce suffering,” Mansell said. “What we’re doing here is trying to take mechanisms that fight where your body overdoes it.”
Another drug patent is for the treatment of fibromyalgia and migraines. He has one to fight obesity as well.
There is another patent for a surgical instrument table that continuously sterilizes itself through UV radiation and one that is for more cost effective and durable pacemaker leads, which are the wires that connect the pulse generator and the heart.
Another is meant to treat chronic abdominal pain, such as with Crohn’s disease. Basically, it is a smart port catheter. With it, instead of patients having to schedule appointments and physically visit the doctor’s office for a routine pain injection, the catheter would allow them to more conveniently perform the injection themselves. It saves time and money.
All of his innovations are a far cry from prescribing cans of brew.
Patents pile up
Mansell now has eight patents listed on this the website for his company, WyoBioTech, with more in the works.
“It’s an expensive hobby,” Mansell said about developing and patenting his ideas. “It would be nice to monetize one of them … make one profitable so I could put the money back into all the other research as well.”
Reaching the point where patents are publicly filed is one thing, but bringing them to market is a whole other journey.
“I’m not interested in building a drug company, but if it comes to that and I have to, I would,” Mansell said. “But I’d rather just license these. But some of these we could manufacture right here in Gillette.”
The ideas behind many of Mansell’s patents and pending patents stem from his decades as a physician. Through his business, Powder River Pain Clinic, he sees patients who come from various specialists, some with unknown ailments, seeking answers where others haven’t found them.
His past work in anesthesiology served a similar purpose.
There is no shortage of improvements to be made, and being a doctor in the least populated state does not deter him from eyeing the head of the pack in the national scientific community.
“We’re doing research, we’re not out here basing our decisions on information from five or 10 or 30 years ago,” Mansell said. “We’re actively engaged in keeping up with the latest stuff.
“I think it would be important for people to know that there are doctors in the state of Wyoming who are actively doing research and actively working on trying to expand the cutting edge.”
Living two lives
Balancing operating his own pain clinic, serving as chief of staff for Campbell County Health and juggling his patents sounds like a lot of work, and it is. But Mansell has a track-record of living a double-life.
Hearing that phrase may bring to mind spies or someone concealing one identity while presenting the facade of another, or something else nefarious. But that’s not the case with Mansell.
His double-life is more straightforward, yet somehow also more complicated.
Through school, he always balanced a work life on top of his studies. As a youngster in rural Alabama, he delivered newspapers and worked as a janitor.
When he attended the Massachusetts Institute of Technology for his undergraduate studies, he would work at a radio station during his college breaks. He even wrote software to pay for parts of medical school at the University of South Alabama.
But his focus truly bifurcated when he joined the Army National Guard. At that point, he became a physician through the week and switched gears to military for the weekends. Those two career paths merged when he was deployed four times for his service in aviation medicine as a flight doctor.
Those journeys took him to Iraq, Kosovo and the United Arab Emirates.
“I actually kind of miss it,” Mansell said about his time in the National Guard. “Every time you get deployed, it’s like a paid mid-life crisis. You get paid to go off and do something completely different.”
Throughout his 23 years in the National Guard, he found kinship with some of his brothers in arms who could relate to managing concurrent careers.
“You have all these guys who have these hidden superpowers in the Guard because they have another life completely,” Mansell said.
As a kid, he dreamed of becoming an astronaut, which he said led him to the military. Although he did not become one of the select who transitioned to astronautics, he liked it enough to stick around for more than 20 years.
His more than 6-foot frame makes a space voyage all the more unlikely, but he holds on to a glimmer of hope.
“There actually is no limit on the age of an astronaut application,” Mansell said. “I think my parents would be sort of (upset) if I left the planet.”
Looking for answers
In his day job, identifying and diagnosing the cause of pain in his patients is an enduring mystery to solve.
The investigation begins with trying to find the cause of pain, where it is occurring and why. Within those simple questions lie hundreds of more finely tuned queries as he searches for the most precise diagnosis possible.
“I never get the three-day earache, I get the, ‘I fell off my horse when I was 14 and after my sixth back surgery,’” he said. “That means that depth of information is much greater and it also means that numbing the locations of the pain is much more nuanced and important.”
The routine physical examination he performs consists of 300 questions. A level of depth he and Sarah Barrett, the practice manager at his pain clinic, both said is not common practice nowadays. There are no computers in his examination rooms. Instead, he relies on paper charts and focusing on the patient, not an MRI.
Is the pain deep, achy and throbbing? Then it may be more visceral, coming from inside, maybe even arthritic. Or is it more of a burning, electric sensation? Well, that more likely signals nerve damage.
The range of severity also is important. When does it hurt more: morning or night? What activity makes it worse? Does activity make it worse? Then maybe it is muscular or skeletal, rather than fatigue-related. Or maybe it’s something else the other 290-some questions will address.
“You’re deconstructively taking apart their day-to-day, minute-to-minute existence,” Mansell said.
Barrett, 31, has worked for Mansell for about 10 years. In that time she rose from a receptionist to practice manager, which basically means she is second in command of the clinic.
She works the front-of-house and back-of-house, to use restaurant industry parlance. She’ll manage those taking orders up front and treating patients in the back examination rooms.
“I boss him around actually, because I tell him what to do day-to-day,” she said.
Mansell is married but does not have kids, so Barrett said she’s become somewhat “the daughter he never wanted.”
She’s close to finishing her nursing degree and from there, her sights are on becoming a nurse practitioner. She may even take over the practice one day.
“He loves seeing the potential in people and helping them get to it,” she said.
Knowing the doctor as she does, Barrett compared him to a bloodhound. While comparisons to dogs are often unflattering, hers is an exception.
First, she said he’s naturally very curious. But he also hunts for clues, following one to the next until he gets to the bottom of whatever mystery he’s chasing and piecing together the medical portrait of a patient along the way.
“He likes to work a puzzle,” she said.
There may be no greater puzzle than the human body, and finding the cause of pain is his primary curiosity.
Mansell refers to it as his own “Columbo moment,” referencing the detective show that began airing in the late 1960s.
What separated “Columbo” from other whodunits is how it subverted the murder-mystery genre by beginning each episode showing the crime in question and its perpetrator. The show then brings in Columbo, disheveled and in the dark as to who committed the crime, starting his investigation from scratch while the audience already knows the answer.
Playing off of expectations, Detective Columbo often ends his lines of questioning with what became the series’ main catchphrase, “just one more thing,” at which point he often, with a subtle question, pins the perpetrator.
Mansell is not a detective and his patients are not, presumably, suspects in major crimes, but similarities remain. It’s not that he approaches problems with skepticism, but rather with curiosity.
He isn’t solving crimes, but sometimes determining someone’s unknown source of pain can be an even larger mystery.
And in a way, it is that curiosity that led him to labor over patents that may or may not make it to market, that may or may not help people the way he hopes they will.
Those patents have potential. So do his patients, some of whom live with chronic pain and others who are looking for someone to solve theirs.
Science has come a long way from the days of patients drinking the pain away.
From his office in Campbell County, Mansell wants to push it even further.
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