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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The private renting sector enables racist landlords like Fergus Wilson

A Kent landlord tried to ban "coloured people" from his properties. 

Fergus Wilson, a landlord in Kent, has made headlines after The Sun published his email to a letting agent which included the line: "No coloured people because of the curry smell at the end of the tenancy."

When confronted, the 70-year-old property owner only responded with the claim "we're getting overloaded with coloured people". The letting agents said they would not carry out his orders, which were illegal. 

The combination of blatant racism, a tired stereotype and the outdated language may make Wilson seem suspiciously like a Time Landlord who has somehow slipped in from 1974. But unfortunately he is more modern than he seems.

Back in 2013, a BBC undercover investigation found 10 letting agent firms willing to discriminate against black tenants at the landlord's request. One manager was filmed saying: "99% of my landlords don't want Afro-Caribbeans."

Under the Equality Act 2010, this is illegal. But the conditions of the private renting sector allow discrimination to flourish like mould on a damp wall. 

First, discrimination is common in flat shares. While housemates or live-in landlords cannot turn away a prospective tenant because of their race, they can express preferences of gender and ethnicity. There can be logical reasons for this - but it also provides useful cover for bigots. When one flat hunter in London protested about being asked "where do your parents come from?", the landlord claimed he just wanted to know whether she was Christian.

Second, the private rental sector is about as transparent as a landlord's tax arrangements. A friend of mine, a young professional Indian immigrant, enthusiastically replied to house share ads in the hope of meeting people from other cultures. After a month of responding to three or four room ads a day, he'd had just six responses. He ended up sharing with other Indian immigrants.

My friend suspected he'd been discriminated against, but he had no way of proving it. There is no centrally held data on who flatshares with who (the closest proxy is SpareRoom, but its data is limited to room ads). 

Third, the current private renting trends suggest discrimination will increase, rather than decrease. Landlords hiked rents by 2.1 per cent in the 12 months to February 2017, according to the Office for National Statistics, an indication of high demand. SpareRoom has recorded as many as 22 flat hunters chasing a single room. In this frenzy, it only becomes harder for prospective tenants to question the assertion "it's already taken". 

Alongside this demand, the government has introduced legislation which requires landlords to check that tenants can legitimately stay in the UK. A report this year by the Joint Council for the Welfare of Immigrants found that half of landlords were less likely to rent to foreign nationals as a result of the scheme. This also provides handy cover for the BTL bigot - when a black British tenant without a passport asked about a room, 58 per cent of landlords ignored the request or turned it down

Of course, plenty of landlords are open-minded, unbiased and unlikely to make a tabloid headline anytime soon. They most likely outnumber the Fergus Wilsons of this world. But without any way of monitoring discrimination in the private rental sector, it's impossible to know for sure. 

Julia Rampen is the editor of The Staggers, The New Statesman's online rolling politics blog. She was previously deputy editor at Mirror Money Online and has worked as a financial journalist for several trade magazines.