Ian’s two letters speak for themselves. He wrote the first at a time when he was becoming really desperate because of escalating neurological symptoms. He had seen two neurologists, had frequent consultations with his GP as well as visits to accident and emergency and his symptoms were getting worse. He felt too unwell to work for many months.

Dr ……
Outpatient Department (neurology) Dept Clinical Neurosciences Western General Hospital Edinburgh

Dear Dr……

16 July 2007

I understand that my doctor has written to you twice to report and update on my condition ahead of my appointment with yourself. I thought it would be useful if I put this in my own words too – not least because I always leave these appointments wishing I’d remembered to tell the consultant about this or that!

Unfortunately, I don’t know what is relevant and what is not so I’ll start right at the beginning.

Around three years ago I was involved in a head collision playing football. No concussion was involved but I broke two teeth and ended up with a titanium dental implant to replace one of these and a crown on the other. I had no problems with this implant. Last year, however, one of the neighbouring teeth developed an abscess at the root. After root canal had failed this tooth was removed and a second titanium implant was inserted to replace it. Unfortunately the infection returned high in the gum and appears to be around the titanium screw. On 09 February 2007 I went for an exploratory procedure to find the source of the infection. The procedure was interrupted after I had a ‘vaso vague’ episode shortly after the local anaesthetic was given. I felt dizzy, had a period of two hours worth of vertigo attacks and this infection now means that the titanium implant needs to be removed under a general anaesthetic and surgery is booked at Murrayfield on 07 August 2007 under the care of Professor ……. I have since developed a second infection above the crown mentioned earlier. This is not thought to be linked to the infection around the implant but will mean the removal of this tooth under the same surgical procedure. Both of these infections are at the upper front section of my mouth and ‘under the floor of my nose’.

On the 14th of February 2007, at work sitting in front of my computer, I had a vertigo attack. The room seemed to ‘move’ and I felt very unwell. A trip to the doctor suggested labyrinthitis or vestibular neuritis. Over the following few weeks I developed severe headaches, shaking and tremors in my limbs. I was seen by Dr….. at the Western General in March who reported that I did not have true labyrinthitis symptoms and suggested a possible inflammation to the nervous system. I was admitted to the Western General for a

few days for investigation. I had an MRI scan which I understand showed normal results. Dr ……. discharged me with a diagnosis of labyrinthitis with anxiety.

Since then the symptoms have changed. I have had a constant feeling of dizziness and light-headedness rather than the vertigo attacks alone. By constant I mean all day every day. All day every day I have a feeling as if I’ve had two or three glasses of wine on an empty stomach. I have a constant feeling of pressure across the top of my head and at the front of my head (it feels like it is coming from behind the sinuses rather than the sinuses themselves). I must stress that I would not describe the pressure sensation as pain – more a feeling of swelling or fluid and tightness in my head. When I apply pressure to the back of my head it increases the pressure sensation across the top of my head and in particular at the front of my head. I have a constantly stiff neck too. I saw Dr ……at the Western General for 20 minutes as an outpatient in June. She thought that the tension across my head and pressure sensation was coming from stiff muscles in my neck. I have been having physiotherapy and remedial massage to ease this but have since been discharged by the physio having made good progress with the tense muscles. The pain and stiffness in my neck remains. I often feel an area of swelling around the back of my neck and at the base of my skull. On three occasions when I have applied pressure to this swelling it has resulted in vertigo attacks and a tingling sensation across the top of my head and up and down my spine. It’s as if my neck and head go into spasm – it’s a very strange and disconcerting sensation that I find hard to describe.

I had started seeing a chiropractor (Optimal Chiropractic in Edinburgh) for back pains and neck pains from Dec 2006 to the start of Feb 2007. The chiropractor performed a number of spinal adjustments on my back and neck and I have wondered whether she has damaged my neck in some way. I have not visited the chiropractor since the first vertigo attack. I also often have numbness or tingling in my shoulders and down my arms.

Coupled with the light-headedness I often have what I perceive to be a slight difficulty in focussing my eyesight. Blurred vision would be too strong, but the focus seems to be slightly out. I visited an optician to have my eyes checked in July but they were found to be fine and the pressure behind my eyes was also tested and found to be normal. Still the sensation remains at times however.

During the last 5 months I have progressively developed aching joints and limbs. It started with aching under my arms and in my knees. My knees felt swollen though they were not visibly so. In the last couple of months I have developed cramp like pains in my legs and neck and back muscles without them actually being cramped. I often feel weak and ‘washed out’ and very low on energy – particularly when I have this pressure sensation in my head. I wake up almost every night, between the hours of 2am and 4am and can be awake for anything between 20 minutes and 2 hours. I don’t have problems falling asleep in the first place though and I always get back to sleep. I am usually stiff in the neck and back when I wake up. I have an orthopaedic mattress which has helped a little with the stiffness.

I have pains in my chest often but have had two ECGs at the ARU dept of the Western General and both have been normal so I assume this pain is muscular too.

I get a sensation in my ears often which I would best describe as a ‘flare up’. It’s similar to the popping of your ears on a plane or at altitude though not quite as clear cut. It’s like a mini popping of the ears. I also get a pressure or tightness sensation across the roof of my mouth and what I would best describe as the back of my throat and mouth and behind my nose. I have had a constantly swollen gland under my bottom jaw which swells and recedes frequently.

I was seen at the ARU at the Western General on Sunday 14 July 2007 having severe pressure sensation in the head and bad vertigo symptoms. These came on whilst watching the TV. I can best describe it as similar to the sensation when you stand up too quickly – the pounding at the front of your head and the vertigo – only instead of it lasting for a few seconds it lasted for an hour and a half. I was given Imigran at the out of hours doctor service in Bonnyrigg but when this didn’t ease the symptom they sent me to the ARU. I was discharged without treatment. I had blood tests which were normal. Indeed, I have had blood tests regularly over the last five months and all have shown to be normal.

Additionally, I developed prostatitis a few months ago and have had a 6 week course of antibiotics to clear this. Unfortunately it has developed into chronic prostititis (no infection remains) and ‘pelvic floor dysfunction’. I am now seen at the Urology clinic at the Western General every 3 months under the care of Miss Justine Royle, SpR in Urology.

The pressure and tightness sensation in my head and the dizziness and light-headedness are unbearable sensations and not something that I can learn to live with. I find this very debilitating and am unable to work through this. I have felt like this for six months now without any real relief. Any help to resolve this would be much appreciated. Additionally, Professor ….. has asked me to ascertain your opinion as to whether it’s safe for me to have a general anaesthetic.

Yours sincerely