A model of Van Gogh’s severed ear: a routine ear operation caused years of head pain for one patient. Photo: Getty
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The man with his head in an invisible vice – and the puzzle that took a decade to solve

Dr Phil Whitaker’s Health Matters column. 

David was a patient during my earliest years in general practice: an otherwise fit man in his early sixties who needed an operation on his ear. The procedure went without a hitch but afterwards David noticed that he was markedly off-balance and he developed dreadful headaches. His description stuck in my mind: he said it was as if one side of his skull was being “squeezed and crushed in a vice”. He illustrated this with his hands, clamping and pressing them against his scalp as he tried to explain.

Initially, I hoped it was something that would settle spontaneously: side effects of the general anaesthetic or the painkillers, perhaps, or some deep bruising that would take a while to resolve. After a few weeks without improvement, I organised blood tests and examined everything my training suggested might be relevant. I drew a blank.

My ear, nose and throat (ENT) colleagues were similarly perplexed when he attended his six-week follow-up appointment. The surgery had been successful, they confirmed, and everything was well healed. They were at a loss to explain his new symptoms.

So began a tortuous process. The ENT surgeons approached the problem from every angle they could: head scan, X-rays, more blood tests, specialised tests of balance. Each flurry of activity was interspersed with interminable periods of waiting for the next outpatient review. Eventually, after many months, the verdict was delivered: they could find nothing wrong and could only suggest I refer David to a consultant neurologist. 

A year later, David was no further forward. He continued to complain bitterly of the grinding headaches and the disequilibrium. The neurologist and an ENT second opinion had failed to produce a diagnosis. As so often with “medically unexplained physical symptoms”, the spotlight began to shine on the psychosocial sphere – were these symptoms an expression of emotional turmoil?

David was emphatic: he had emotional turmoil, all right, but that was because the bloody operation had left him in pain and no one seemed to have the first idea how to put him right. His relationship with the medical profession reached rock bottom and though I tried to support him as best I could, I began to dread seeing his name on my appointment list, so impotent did his case make me feel and so angry had he become.

Eventually, I moved to another part of the country, leaving my first practice and David’s insoluble symptoms behind. A decade later, I went in for dental surgery under general anaesthetic. Shortly after getting home, I began to feel giddy and off-balance and I developed headaches that felt as though one side of my skull was being crushed in a vice. I tried various measures but nothing helped. Memories of David inevitably came back to me.

In the intervening years, I had seen a number of perplexing musculoskeletal problems respond to chiropractic treatment where conventional medicine had reached a dead end. I went to discuss my situation with an experienced chiropractor and he knew immediately what had happened: the surgeon, in manoeuvring my head to get access to the back of my mouth while I was under the anaesthetic, had unwittingly deranged the alignment of the bones at the top of my neck. With a few manipulations, my debilitating symptoms melted away.

Since learning this lesson, I have seen several similar cases in which patients can date the onset of back pain or headaches and dizziness to receiving a general anaesthetic. Most doctors are mystified because there is nothing in medical training that teaches us that this kind of thing can happen. To a chiropractor, however, it’s unsurprising. If you haul insensate bodies from trolleys on to operating tables – if you twist heads this way and that while the protective neck muscles are paralysed by anaesthetic – you will very likely put vertebrae out of kilter.

Medicine is a lifelong education. The training that we get in our early years is only a starter guide. Life experiences (our own and those of family and friends), the patients we encounter and the stories we hear continue to expand and refine our understanding of the myriad ways human beings work and don’t work. As well as learning lessons from chiropractors, I have also seen startling results with homoeopathy, acupuncture and psychotherapy. Yet these kinds of approaches are frequently derided by conventional doctors, who reject them because they can’t be understood in our current scientific terms.

If there is one thing that can be said with confidence about our understanding of the human organism today, it is that, like all bodies of scientific knowledge, it will be shown to be woefully inadequate over the next 50 years. The provisionality and partiality of our knowledge should serve to keep our minds open to other ways of thinking.

I can now direct patients with anaesthetic-related back or neck injuries to someone who can help them. My regret is that I didn’t have this understanding when David needed help. I can still see him, clamping and pressing his hands to his scalp, trying desperately to communicate what he was going through but being met with the incomprehension and impotence of his physicians. That has been one of the defining lessons of my career and I try to remember it whenever a patient presents puzzling problems that defy a conventional diagnostic approach. 

This article first appeared in the 20 August 2014 issue of the New Statesman, What the Beatles did for Britain

Photo: Getty
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Is Britain about to leave the European Union?

A series of bad polls have pro-Europeans panicked. Are they right?

Is this what Brexit looks like? A batch of polls all show significant movement towards a Leave vote. ORB, a phone pollster, has Leave up four points to 46 per cent, with Remain’s leave cut to four points. ICM’s online poll has Leave up three points, putting Brexit ahead of Remain by 52 per cent to 48 per cent once don’t-knows are excluded. ICM’s phone poll shows Leave up six points, a Brexit lead of three points.

That two phone polls are showing advances for Leave are particularly significant, as telephone polling has tended to show lower figures for Brexit. There is a lively debate over which method, phone or online, is likely to be more effective at predicting the referendum, although no-one knows for certain at the present time.

In any case, whether on the telephone or the Internet, the latest polls have pro-Europeans worried, and Brexiteers jubilant. Who’s right?

There are reasons to start trusting the polls, at least as far as voter ID is concerned

So far, the performances of the political parties in local elections and by-elections has been about par with what we’d expect from the polls. So the chances are good that the measures taken post-2015 election are working.

Bank holidays are always difficult

I would be deeply cautious of reading too much into three polls, all of which have been conducted over the bank holiday weekend, a time when people go out, play with their kids, get wasted or go away for a long weekend. The last set of bank holiday polls gave Ed Miliband’s Labour party  large leads, well outside the average, which tended to show the two parties neck-and-neck.

Although this time they might be more revealing than we expect

One reason why the polls got it wrong in 2015 is they talked to the wrong type of people. The demographic samples were right but they were not properly representative. (Look at it like this – if my poll includes 18 actors who are now earning millions in cinema, I may have a representative figure in terms of the total number of Britain’s millionaires – but their politics are likely to be far to the left of the average British one percenter, unless the actor in question is Tom Conti.)

Across telephone and online, the pollsters talked to people who were too politically-motivated, skewing the result: Ed Miliband’s Labour party did very well among young people for whom Thursday night was a time to watch Question Time and This Week, but less well among young people for whom Thursday is the new Friday.  The polls had too many party members and not enough party animals.

But the question no-one can answer is this: it may be that differential turnout in the European referendum means that a sample of hyper-politicos is actually a better sample than an ordinary poll. Just as the polls erred in 2015 by sampling too many political people, they may be calling the referendum wrong in having too many apolitical people.

These three polls aren’t the scariest for Remain released today

IpsosMori released a poll today, taken 15 days ago and so free from any bank holiday effect, without a referendum voting intention question, but one taking the temperature on which issues the British public believe are the most important of the day.

Far from growing more invested in the question of Britain’s European Union membership as the campaign enters its terminal phase, concern about the European Union has flatlined at 28 per cent – within the margin of error of last month’s IpsosMori survey, which put Britain at 30 per cent. The proportion who believe that it is the biggest single issue facing Britain today also remains static at 16 per cent. Evidence of the high turnout necessary to avert Brexit seems thin on the ground.

Pro-Europeans should be further worried by the identity of the groups that are concerned about the European Union. Conservative voters, the over-65s and people from social grades A (higher managerial, administrative and professional workers) and B (intermediate managerial, administrative and professional workers), are more concerned about the European Union than the national average. The only one of those three groups that is more likely to favour Remain over Leave are ABers, while Conservative voters and the over-65s are likely to vote for Brexit over the status quo.

Among the demographics who are least concerned about the European Union, the only pro-Brexit group that is significantly less concerned about EU membership than the national average are people from social grades D (semi-skilled and unskilled manual workers) to E (state pensioners, casual workers and jobseekers). The other groups that are least concerned with the European Union are people who live in urban areas and people aged from 18 to 24, the two most pro-European demographics.

The prospects of a Brexit vote are rather better than the betting odds would suggest. 

Stephen Bush is special correspondent at the New Statesman. He usually writes about politics.