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Some Doctors Operate on People
Diagnosed With Chronic Fatigue

By THOMAS M. BURTON
Staff Reporter of THE WALL STREET JOURNAL

 (Article review by Dr. Robert Bennett)

This was the headline in the Wall Street Journal on November 11th. 1999.

It referred to an article about a controversial surgery that some doctors are performing on patients with chronic fatigue and fibromyalgia.

To quote:  “A new belief among a few neurosurgeons is that these patients' troubles can stem from a squeezing of the brain or spinal cord by a too-tight skull or spinal canal. For about $30,000 a case, they are drilling and snipping away bone from the backs of people's skulls and spines to "decompress" their brains, spinal cords and central nervous systems.”

Some of the proponents were very enthusiastic.  "This is like telling the story of the discovery of insulin," said Chicago surgeon, Dan S. Heffez. You're talking about a completely new insight about a condition that has baffled people since the beginning of the modern world."

Other surgeons were very critical.  "Is this on a par with insulin? Not on your life," says Peter Carmel, neurosurgery chairman at New Jersey Medical School in Newark and an authority on the skull malformations at issue. "Would I offer a patient an operation the way they do? No."

The article goes on to note that this surgery may succeed because this group of patients may be particularly susceptible to a placebo effect.  Dr. Clauw a rheumatologist at Georgetown University in Washington was quoted as saying, “My feeling is that Rosner and Heffez are moving way too rapidly." But he agreed that a small proportion of fibromyalgia and chronic-fatigue patients probably have brain or spine compressions.

The proponents of this form of surgery believe that the problem facing some patients with symptoms of fibromyalgia and chronic fatigue is a congenital skull malformation called Chiari I malformation.  The other condition that they believe causes similar problems is cervical spinal stenosis (a too-narrow spinal canal at the level of the neck).

This surgery is currently being performed by:

1. Dr. Michael Rosner at Park Ridge Hospital in Fletcher, N.C

2. Dr. Daniel Heffez at the Neurosurgical Institute in Chicago.

3. Dr. John D. Weingart at Johns Hopkins University Medical Center.

Dr Rosner has performed about 250 of these operations. Drs. Heffez and Weingart have performed about 75 such operations.

The article ended on a positive note.  Ms. Plaza who was operated on by Dr. Heffez, was ecstatic . Before the four-hour operation, she says, she had headaches, blurred vision and fatigue "so powerful I had to lean against the wall." Now, she says, many of these symptoms have abated so much that "I feel like I could conquer the world."
 

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