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

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Will the collapse of the EU/Canada trade deal speed the demise of Jean-Claude Juncker?

The embattled European Comission President has already survived the migrant crisis and Brexit.

Jean-Claude Juncker, the embattled President of the European Commission, is likely to come under renewed pressure to resign later this week now that the Belgian region of Wallonia has likely scuppered the EU’s flagship trade deal with Canada.

The rebellious Walloons on Friday blocked the Comprehensive Economic and Trade Agreement (CETA). The deal for 500 million Europeans was at the final hurdle when it fell, struck down by an administration representing 3.2 million people.

As Canada’s trade minister, Chrystia Freeland, walked out of talks in tears and declared the deal dead, fingers were pointed at Juncker. Under pressure from EU governments, he had agreed that CETA would be a “mixed agreement”. He overruled the executive’s legal advice that finalising the deal was in the Commission’s power.

CETA now had to be ratified by each member state. In the case of Belgium, it means it had to be approved by each of its seven parliaments, giving the Walloons an effective veto.

Wallonia’s charismatic socialist Minister-President Paul Magnette needed a cause celebre to head off gains made by the rival Marxist PTB party. He found it in opposition to an investor protection clause that will allow multinationals to sue governments, just a month after the news that plant closures by the world’s leading heavy machinery maker Caterpillar would cost Wallonia 2,200 jobs.

Juncker was furious. Nobody spoke up when the EU signed a deal with Vietnam, “known the world over for applying all democratic principles”, he sarcastically told reporters.

“But when it comes to signing an agreement with Canada, an accomplished dictatorship as we all know, the whole world wants to say we don’t respect human right or social and economic rights,” he added.  

The Canadian Prime Minister Justin Trudeau was due to arrive in Brussels on Thursday to sign CETA, which is backed by all EU leaders.

European Council President, Donald Tusk, has today spoken to Trudeau and his visit is currently scheduled to go ahead. This morning, the Walloons said they would not be held to ransom by the “EU ultimatum”.

If signed, CETA will remove customs duties, open up markets, and encourage investment, the Commission has said. Losing it will cost jobs and billions in lost trade to Europe’s stagnant economy.

“The credibility of Europe is at stake”, Tusk has warned.

Failure to deliver CETA will be a serious blow to the European Union and call into question the European Commission’s exclusive mandate to strike trade deals on behalf of EU nations.

It will jeopardise a similar trade agreement with the USA, the Transatlantic Trade and Investment Partnership (TTIP). The Commission claims that an “ambitious” TTIP could increase the size of the EU economy by €120 billion (or 0.5% of GDP).

The Commission has already missed its end of year deadline to conclude trade talks with the US. It will now have to continue negotiations with whoever succeeds Obama as US President.

And if the EU cannot, after seven years of painstaking negotiations, get a deal with Canada done, how will it manage if the time comes to strike a similar pact with a "hard Brexit" Britain?

Juncker has faced criticism before.  After the Brexit referendum, the Czechs and the Poles wanted him gone. Hungary’s Prime Minister Viktor Orban muttered darkly about “personnel issues” at the Commission.

In July, it was reported that Angela Merkel, the most powerful politician in Europe, was plotting to oust Juncker. Merkel stayed her hand, and with German elections looming next year is unlikely to pull the trigger now.

When he took office in November 2014, Juncker promised that his administration would be a “political Commission”. But there has never been any sign he would be willing to bear the political consequences of his failures.

Asked if Juncker would quit after Brexit, the Commission’s chief spokesman said, “the answer has two letters and the first one is ‘N’”.

Just days into his administration, Juncker was embroiled in the LuxLeaks scandal. When he was Luxembourg’s prime minister and finance minister, the country had struck sweetheart tax deals with multinational companies.  

Despite official denials, rumours about his drinking and health continue to swirl around Brussels. They are exacerbated by bizarre behaviour such as kissing Belgium’s Charles Michel on his bald head and greeting Orban with a cheery “Hello dictator”!

On Juncker’s watch, border controls have been reintroduced in the once-sacrosanct Schengen passport-free zone, as the EU struggles to handle the migration crisis.

Member states promised to relocate 160,000 refugees in Italy and Greece across the bloc by September 2017. One year on, just 6,651 asylum seekers have been re-homed.

All this would be enough to claim the scalp of a normal politician but Juncker remains bulletproof.

The European Commission President can, in theory, only be forced out by the European Parliament, as happened to Jacques Santer in 1999.

The European Parliament President is Martin Schulz, a German socialist. His term is up for renewal next year and Juncker, a centre-right politician, has already endorsed its renewal in a joint interview.

There is little chance that Juncker will be replaced with a leader more sympathetic to the British before the Brexit negotiations begin next year.

James Crisp is the news editor at EurActiv, an online EU news service.