The Wall Street Journal Interactive Edition (http://interactive.wsj.com/archive

[Guest guest]

Please to all: read this article paying particular attention to the last paragraph prior to " Success Story " . I would be very curious as to the comments of the group.

Ken Mailly, PT

President

Mailly Consulting Inc.

khmailly@...

November 11, 1999

Page One Feature

Some Doctors Operate on PeopleDiagnosed With Chronic Fatigue

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

CHICAGO -- Jozan Plaza, a 45-year-old Alabama woman, visited Chicago recently to have part of the back of her skull drilled off.

Was this a good idea?

Ms. Plaza is among the roughly eight million Americans diagnosed with a condition called fibromyalgia syndrome, which involves widespread muscle pain, sleeplessness, fatigue and depression. It is poorly understood and controversial. Many doctors aren't convinced it is a disease at all, suspecting that in some patients it is really depression with physical manifestations.

Patients who are told they have fibromyalgia -- or the closely related chronic fatigue syndrome -- are usually just prescribed sleeping pills, antidepressants and physical therapy. Treating patients with these diagnoses, in short, isn't brain surgery.

Except that at a handful of American hospitals, it now is.

Spinal Tap

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.

" This is like telling the story of the discovery of insulin, " says Ms. Plaza's 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. " He and two other doctors, one in Baltimore and one who recently moved to North Carolina, have operated on hundreds of such patients in all.

But other prominent doctors are aghast that such complicated and potentially dangerous operations are being offered to patients diagnosed with conditions they regard as primarily psychiatric in some instances. " Is this on a par with insulin? Not on your life, " says 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. "

Neurological Difficulties

Surgery proponents contend that these patients, mostly women, have been ignored or ridiculed by much of the medical profession, and as a result often don't get proper neurological exams and diagnoses. These proponents say the problem facing many such patients is a congenital skull malformation long recognized as causing neurological difficulties in a small number of people. It is called " posterior fossa compression " -- or, in a reference to the doctor who identified it, a Chiari malformation. The other condition that surgery proponents point to is a too-narrow spinal canal, called " cervical spinal stenosis. "

This is what they are operating for, the surgeons say; they reject the notion that they use surgery to treat chronic fatigue syndrome or fibromyalgia.

But Dan Clauw, a rheumatologist at town University in Washington, contends that only an " extremely low percentage " of chronic-fatigue and fibromyalgia cases have such a neurological basis. He says his research group did magnetic resonance imaging of the skull and spine in 28 fibromyalgia patients and 14 other people and found " no difference in the MRIs between the fibromyalgia group and the control group. " At the very least, he says, a controlled clinical trial should be done before subjecting hundreds of patients to highly invasive surgery.

The pioneer of the surgery, J. Rosner, says that he plans to publish a medical-journal article on the topic. " Unless you're looking for this or you have a high degree of suspicion, you say there is nothing wrong with the patient, " he says. " I don't operate on somebody who doesn't have an abnormal exam. "

A case that proved a big spur to his surgery involved a patient who was himself a doctor. Sam Banner, a family practitioner with a storefront office in Dothan, Ala., was diagnosed with chronic fatigue syndrome in 1989. He found himself so weak and tired he could no longer practice medicine, so he took a desk job reviewing workers' compensation claims for a local manufacturer. In that job, he noticed that lots of spine and skull surgery was being done by Dr. Rosner at the University of Alabama in Birmingham