Medical documentary series. Dr Rangan is called to help a mum battling cluster headaches, considered the worst pain that any human can experience.
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What would a doctor discover if they lived with you 24 hours a day?
-Come and meet the doctor.
How much would you be willing to reveal?
I'm scared that I may get bullied for how I look and my weight.
I feel like I'm drugged.
But Nicola, you're right, you are drugged.
Would they be shocked by what they find?
Nobody's explained to her in language that she understands
how to manage her condition.
It's not acceptable.
Most GPs only get about 10 minutes with each patient.
Dr Rangan Chattergee wants to try a different approach.
All the time in my consultation room I'm seeing problems that are
lifestyle problems, and they don't need a pill,
they need a lifestyle change.
He's about to spend time with families who struggle with
Everything I've tried has basically failed.
He'll gain insight into every aspect of his patients' lives.
How do they eat? How do they sleep?
How do they move and exercise and how do they sort of switch
off and relax?
He'll detect undiagnosed illnesses...
It probably puts you at high risk of early death.
..deliver some home truths...
I think this fear is holding you back.
Please don't turn it into... this is a...
This is because I'm mentally fearful.
..and discover ways we could all live longer, healthier lives.
It's amazing how many times, when you get those basics right,
all the other problems get so much better.
Feeling good, energy up.
I can even dance.
I've not had any lunch.
Meet the Hughes family from Macclesfield.
There we go, that's my chore for the day.
..dad Simon, who's 45 and an aircraft engineer,
and mum Gemma, who's 34.
For 13 years, she has suffered from excruciating headaches up
to 16 times a day.
Right in the back of my head at the moment.
I want to rip my head off right now.
It's like somebody is driving a hot poker into your eye, but it's
in the back of my head as well.
There's no pain that...
I mean, I've given birth twice and it doesn't even compare.
You eat that and look after your sister.
Doctors have diagnosed her with a condition called cluster
headaches, sometimes referred to as suicide headaches, because the
pain is said to be the worst that any human could experience.
Let's have a look.
-Please go away.
Come on, get some deep breaths.
Come on, big breaths.
With a two-year-old to look after, Simon can't always stay with Emma.
Come on, there's a good girl.
So nine-year-old Ethan steps in to comfort his mum.
Gemma has seen countless specialists,
but no-one knows what is causing the attacks.
Could be five minutes, could be 45 minutes.
Every single one is different.
Just painful to watch.
It's sad. That the...you know... What is causing this?
I don't remember Ethan ever reacting badly.
He's never really said it, but I know it bothers him.
If these attacks didn't happen any more,
it would probably change my life forever.
She would be able to do more, take me to more places, she wouldn't...
So, like, football, sometimes she has to leave because of her head
and go to the car. And if she didn't have to do that,
she could stay for the whole time and it would be loads better.
Just as quickly as the attacks arrive,
they are gone and life continues as normal.
-You were reassuring your mum, weren't you?
Today, Rangan will meet the Hughes for the first time.
Headaches can be caused by pretty much anything.
I've seen stress patterns causing headaches,
I've seen particular dietary patterns causing headaches.
One in six of us have severe headaches on a regular basis.
Gemma is at the extreme end of the problem.
-Hi. I'm Dr Chattergee, nice to meet you.
-Gemma. Nice to meet you.
-Hi, Gemma. Hello.
-This is Sienna.
-Hi, Sienna. How are you?
-Aawww. Ethan, hi.
How do you do, Ethan? Nice to meet you.
Dad Simon has just come off a night shift at the airport.
Simon? Oh, you're there.
Just tired. Long night. Yeah.
-Afternoon, whatever it is.
Rangan will investigate every aspect of the family's lives, in the hope that
he can find the cause and finally a cure for Gemma's headaches.
-I'll probably be awake then, so...
-You'll be awake at 2:30?
-In the morning?
-Do you get headaches that often?
I've always, since...
Well, my head is worse at night, so...
It varies, but I always say from around 11,
midnight is kind of like when it would normally, you know,
start, and then normally by 7:30, eight-ish in the morning, it varies.
What do you want?
Since Gemma's headaches arrive with sufficient warning,
she's able to do everyday activities like cooking and driving.
-So what have you got to do? Lots of...
-I'm a taxi.
-Yeah. You're a full-time taxi service.
That's all I seem to do is taxi them around.
-We don't have to pay either.
-You don't. Exactly.
Mummy's a free taxi, isn't it? That is brilliant.
-Do you work or... You must be a full-time mum, right?
-But I'm chair of the PTA at Ethan's school, I'm involved...
Well, I was involved with organising the Cheshire Festival here
last year for his age group.
-For the rugby.
I've just done a circus the cricket club.
I'm just doing a firework display at the moment.
I'm getting a headache thinking about how busy you are, actually.
Tackle him, Ethan!
Go on, Ethan!
She's very, very busy, and...
Yeah, I'm just wondering how much of a role that's playing here.
Back at home, Rangan is looking for more clues in Gemma's
The only time when it was a definitive period that was
linked to any change in you was when you fell pregnant with Ethan,
and it just stopped.
And then we found out she was pregnant.
And for that whole nine months,
and the six months she was breast-feeding, nothing.
Well, that's really interesting to me, because pregnancy...
Your body's immune system has to sort of change gear a little bit
so that it doesn't reject the baby.
Got a poorly head?
(Hey, how you doing? All right?)
Come on out, Sienna. Move over.
All right, baby.
See in here.
Sometimes she wants me to press on there.
Sometimes she can't bear me to touch it.
Sometimes I've got to massage her here.
Is it tense on one side? I'm really interested, is it...?
-No, feel. Just feel.
-Will she mind?
Gemma, do you mind if I just feel your neck?
You feel here?
-I know, Sienna. Where my finger is, there, now?
You'll feel there's a lump there.
Like a...like a pea.
Can you feel it?
That comes up when she has these attacks. Sometimes.
It hasn't done it for a while.
You helping Mummy?
Hold Mummy's hand. Good girl.
Hold Mummy's hand. Good girl.
This attack lasts six minutes,
but they can last up to three quarters of an hour.
You want some cheese?
You want cheese?
-How you doing, Gemma?
-Completely back to normal?
-Is it just, like, quite black and white?
-It's either on or it's off?
-Pretty much, yeah.
When my head's starting, my head goes on one side like that.
I noticed that there when you were lying there.
-Yeah, I stretch it out that way.
-Like, to put it back that way when I'm actually having an
attack is just...
just wouldn't do it.
-Can I just press on your...
-..trapezius muscles at the back.
I just want to...
-Sorry, can you just pop your hair...
That's sitting higher on that side.
-I know you've... Is that tender on that side?
I constantly feel like my back's in... Like, all my shoulder's in knots.
Just over an hour later, another attack.
-Oh, is she having an attack?
-Where is she?
Come on, let's go and have a look.
I think this is her fourth one today.
I've literally never seen anything like this.
I actually think it's a superhuman effort to actually have got used to this.
She probably walk out in a minute and just be absolutely fine.
You seem really matter of fact about it, just getting on with it. "Oh, it's just one of these things.
"I've got these really bad headaches."
I have bad days and I have days where I'll say to Simon,
"I just can't do this anymore. I just can't..."
-See that's what, that makes more sense to me.
-I do, I have loads,
you know, I do have that a lot, but then I kind of...
I have that, "I can't do this anymore" and then
the other side of my brain kicks in and goes, "Well, you don't have any choice!
"You've got limited options here, you kind of..."
You either deal with it or, well, there's only one alternative, isn't there, really?
-And what's that?
-Well, they call them suicide headaches for a reason, don't they?
And they're like my two options, and obviously that isn't...
That's not an option for me, but,
two kids and a husband and a...
They're quite extreme options.
In fact, I was actually reading about a man who suffers
with this and he was talking about everything
and it's exactly the same as me.
And he'd gone down the Dignitas route.
-The what route?
Legal euthanasia. That's where... He'd gone down that route.
That's where he was going with it, because he just couldn't do it anymore.
I tell you what's amazing, it's so...
matter of fact, the way you're talking about this.
It's so... "I've got two options, I either live with it or, um...
"there's only one other option."
That is, that is the options.
But these are extreme options, and you're talking about someone who's had legal euthanasia,
because he can't put up with these anymore.
-And I don't know yet if you're, um...
..genuinely as OK with it as you say you are
-or whether it's...
-Most of the time I am.
-Are you, really?
-I am. Most of the time I am.
Because I can't... Because I have to be.
With Simon working night shifts
and Gemma suffering headaches up to 16 times a day
the stress on the family is enormous.
I'm not exactly sure how much longer they can keep going.
On some level...
..they probably know that.
I need to...get some tests done.
I need to go away and do a bit of research.
But at the moment, I don't know how far I can get in the next few weeks.
Rangan is keen to look at the whole family.
He orders blood samples from Gemma and Simon,
plus saliva samples to measure the stress hormone cortisol.
I've just got the cortisol results back, and that's given me an idea
of actually her stress levels throughout the day, and they're much too high.
He consults expert neurologists.
Have you ever seen stress contributing to these at all?
-Stress is a very important contributing factor.
I think it's fairly likely that stress will be
playing a role in her headaches as well, that's interesting,
and would, I think, be fairly likely.
Certainly, she does seem to have
some A-symmetries on her left... The base of her neck,
and I was talking about either a chiropractor or an osteopath.
-Um, we've, sort of, at Oxford, we've got
a specialist neck physiotherapist and she certainly helps some people
who've got a clear mechanical headache.
With Gemma living in such extreme pain,
Rangan investigates every possibility for her headaches.
There are all these potential culprits...
..and I want to tackle them all,
I want to try and find out what's the cause of her headaches.
There will be a cause, the body's not going to just have these headaches.
A lack of certain nutrients, poor diet, or even a change in hormones during pregnancy
could play a role, too.
All these things here, by addressing them,
we're going to do no harm at all,
but at best
we're going to start making an impact.
Rangan's next patient also battles pain every day of his life,
but it takes a very different form.
Gary's 32 years old
and a successful paralympic athlete
who competes for Team GB in the high-octane physical sport of ice-sledge hockey.
Played for Great Britain for 15 years.
And when you're in there, I absolutely love it.
I love the violence of it, I love the physicality.
Extreme sport and daily use of crutches
puts Gary's shoulders under immense strain.
He could soon be confined to a wheelchair, with his sporting career cut short.
That is scary. My shoulders are the gateway for me to do everything.
So if that stops then a lot of things stop.
Rangan is visiting him for the first time in Mansfield,
where Gary lives with his mum and dad.
-Nice to meet you. How are you?
-Nice to meet you. Fine.
-Hi, Gary, nice to meet you.
Dr Chatterjee. How are you?
Gary needs crutches because his amputation is so high
he can't use a prosthetic limb.
I rely on my shoulders a lot to get myself around.
I can see how, just watching you come up these stairs,
if your shoulders go...
-You can't actually do that yourself.
-No, exactly. That's...
Don't get me wrong, there's lots that people can do with wheelchairs now.
It's this, the simple little things.
Gary has never let his disability get in his way.
He's climbed Machu Picchu and backpacked around the world,
all on crutches.
I lost my leg when I was very young, so...
Um, I had a car accident when I was five,
so I've been told multiple times where,
if you continue to use crutches, you will be in a wheelchair.
-So if you continue to use crutches,
-you'll wear your shoulders out and you will be in a wheelchair.
You've been told that is going to happen to you.
That is going to happen to me, I've been told that from a very, very early age.
Gary wants Rangan's help to keep him on crutches and in Team GB.
Gary's worried about his shoulders, yet he seems to...
..not even consider that he might have to compete less.
I think he probably knows that there is an end date to it.
That he can't continually
punish his shoulders
with no retribution.
Though it's not really worth saying to Gary, "You can't do it."
He's jumped off the high cliff in South Africa on a bungee.
-He's swung across the gorge, hasn't he?
Don't say, "Don't do it."
He'll push himself to the limit.
And that's Gary all over.
And how bad are your shoulders?
-They hurt most days...
-..that your shoulders hurt.
So there's always that niggling ache, niggling ache, all the time.
And every now and again I'll have a bad day where
it's so sore I can't lift my arms up.
If it's not just a niggling shoulder, it's actually
really quite problematic.
Usually my left that goes first.
I'll get to about there and I won't be able to go any higher.
So I won't be able to lift my arm any higher than that.
And that's my range.
Rangan wants to see for himself the strain Gary's shoulders are under.
First, an ice-sledge hockey practice session.
Probably the roughest disabled sport you can get.
He's underneath all that, Gary is.
He's right at the bottom of that. That's him with his leg in the air.
You really get a sense of how brutal, how physical this game is.
Gary's right in front again, nobody can touch him. He is the fastest player!
Nobody's got his arm strength, no-one has got any acceleration.
Look at him.
He's absolutely killing it.
-How you doing?
-How was it?
-It was all right, yeah.
Quite a gentle session tonight, there was a couple of hits but
nothing too heavy, so it was quite nice, actually, yeah.
-Are you the fastest player here?
I'm probably the fastest player in the country at the moment, so...
The acceleration you had was just phenomenal to watch,
I saw some of the other guys when they were trying to accelerate.
Now I see why you train so hard in the gym.
Rangan wants to assess how Gary's training is impacting his shoulders.
Can you hold it up there?
-It's probably slightly heavy for that.
That's why I'm going up and back down.
-I know my range of motion backwards is terrible.
-Observing you, there is quite a rounded posture.
-I know from my own experience as well...
-Trying to get that..
Yeah, but that also then puts a strain on your shoulders.
Yeah, I'm just thinking as I'm watching you.
-Yeah. OK, so you would...
-Shoulder press, nice and easy.
-Does that feel easy.
-That's very easy.
So once it's there it's all right.
-Once it's there it's all right.
-Once it's there it's all right.
Man, that is so heavy!
-Yeah, just about done with that.
One more, push, push, push, come on.
That's all you.
Thank you. That's super heavy.
I'm guessing for you that not working out hard and not competing
-is not an option.
There's no... I think... If anybody says, "No, you've got to stop"
I'd keep doing it anyway and accept that
all right, at 40 I'm going to be in a chair.
I think my greatest fear is for someone to say,
"He's just another guy."
I don't want to be just another guy, I don't want to be average.
I'm as good and a little bit more.
And be able to push that little bit further.
Do you think your disability makes you want to push even harder to prove yourself?
Without a doubt. I don't want anybody to kind of,
not so much take pity,
but give me that excuse.
Give me that out, give me that, "You don't have to do that, cos you've only got one leg."
"You don't need to go as hard as everybody else, cos you've only got one leg."
I don't want anybody to ever say that to me.
Cos instantly I'll go out and do it anyway.
I hear him loud and clear, but there is a slight dilemma for me,
because, to me, and I appreciate I'm not Gary,
but to me I'm thinking, "Hold on a minute,
"you need your shoulders to walk, to literally be active and get around...
"..but you're also damaging your shoulders every time you train."
Yeah, so, a small part, maybe a slightly bigger part of me is thinking...
"Hey, let's have a conversation here, Gary, maybe you don't need to train that hard anymore.
"You've achieved phenomenal things, you have reached the pinnacle. You have competed in the Paralympics."
I don't know, is it... It's...
Very challenging. Very, very challenging.
That's two in the morning when on days, two before work when you're on nights, that's that one.
Rangan is tackling Gemma's painful and frequent cluster headaches.
To treat them, he's beginning a multi-pronged attack,
changing her diet and giving her supplements.
-Right, and you've taken how many?
Three, so it'd do me 50 days.
He also sends Gemma to see musculoskeletal specialists,
to explore whether a problem in her spine or neck
could be connected to her headaches.
There's no convincing scientific evidence saying
that actually treating her neck
is going to get rid of her cluster headaches.
I have seen it in some patients, it helps tremendously.
Rangan's first plan is to send Gemma to an osteopath.
-Gemma, is it?
-It is, yes.
They use physical manipulation, stretching and massage,
to increase the mobility of joints and relieve muscle tension.
I'm going to be looking for areas of tension that I can feel with my hands
-that wouldn't be picked up on x-rays.
So what I'm feeling here is quite a blockage in this little joint here
in the bottom of the spine. And if this joint's blocked it'll send muscle tightness all the way up.
There you go. Can you hear that?
OK. Straight away, as I put my hands under here, I can feel
a tightness on the left side.
Can you feel that?
There was a point where I thought, "My head's going to start hurting here."
And it was just before you put your hands there. And when you had your hand there
I was like, "That's brilliant", because that's where I press to try and stop it.
That's exactly the spot, yes. It's always very, um,
encouraging when I can actually feel the bit
-that you can feel.
-I suggest we meet in a week's time and we'll have a re-appraisal of that and see how it's going.
The investigation into the cause of Emma's headaches is underway.
Don't brush her!
Back at home, Rangan turns his attention to husband Simon.
Good to see you.
You've worked shifts for years, and it sounds like you're more tired now
-than you've ever been.
-It feels like it's all catching up.
I can feel it.
I could just lie in bed all day.
Simon is Gemma's main support, but her condition, combined with his long hours at work,
is taking its toll on him.
So that's 14 stone 12.
Nearly 15 stone.
Do you know what you should be?
According to the charts at the GPs, about 12 and a half.
Do you feel dizzy at all?
But I just put it down to being tired.
I think, from what I've seen, fair to say you've got high blood pressure.
I've got this machine that does what's called your metabolic age,
so it tells me how old your body is
-compared to actually how old you are.
So you're 45 years old. This is telling me that your metabolic age, the age of your body...
Does that surprise you?
-I feel like I'm 55.
Really, we want our waist to be smaller than our hips,
and so a waist-hip ratio, we really want to see around 0.8, something like that.
-Yours is about one, so...
Yeah, much too big.
Certainly implies that you are at increased risk of getting...
all manner of things.
If Simon is to offer Gemma the support she needs
he needs to make significant changes.
I think Simon's walking heart attack.
overweight, he's got high blood pressure, his job's killing him.
I'm worried about both of them.
They're both knackered, they don't sleep,
they're running around.
Rangan's first step is to try and understand where Simon's going wrong.
I'm just outside Simon's house at 6.30 in the morning.
I think Simon's shift pattern is really playing havoc with his body clock,
what we call the circadian rhythm.
And I think that it's putting him at increased risk
of all kinds of problems, such as heart attacks, strokes.
And I need to talk to Simon about steps he can take
to actually mitigate that.
Yeah, this is Simon, I think, returning from his night shift.
'Simon's just coming off his four day run four days and then two nights.
'This is the last of his nights. He's got a few days off now,
'so what I really need to do with Simon is help
'his body clock get back on sync
'to days as quickly as possible.
'The sooner we can get his body clock back in sync, the sooner he can start enjoying his days off
'and recuperating, and that's what he's missing out on at the moment.'
-It was, actually, yeah.
Now the other side of it starts.
Time for a hot shower and a...
..early morning beer.
-Bad advert, really, isn't it?
-It's a bad advert, isn't it, quarter past seven in the morning?
Quarter past seven!
How does it feel?
Yeah. That's good.
That is good.
I understand why you have a beer in the morning.
Don't have one.
Well, today is, it's not really your night anymore,
-because it's the start of your four days off.
So that beer, you're having that beer now, it's still going to affect you at lunchtime.
And it's not going to help you get back on a
day rhythm. So I get it when you're on night shift,
and you're working tonight,
and you want to chill out when you get home, have a drink and then go to sleep.
I mean, as long as you can. I can kind of understand that, but I think
when you're trying to get on... We don't really have time to waste with you,
you've only got a few days off before you're back on shift pattern again.
Do you think we could start now? Should we, uh,
Should we get rid of the beer now, or...
-One more sip!
-I'm not poring it away, that's waste. I don't like waste.
-I'll start me next shift.
-Can you put it in the fridge?
-No, it'd go flat then, won't it? I will on the next shift though.
-On the next shift. Fine.
Let's go and see if, uh...
I think, um...
I think... I think Simon is very much stuck in routines. He...
It's a tricky one, he's been doing this for so long,
he obviously knows how to manage his night shifts.
Or he thinks he knows how to manage them, but I think there's a few
things he's not doing well that are going to really, really help him.
Yeah, it's very frustrating, actually. Did you have a good sleep?
-Where's your mummy?
-There she is.
It's now 8:30 AM, and Rangan wants Simon to get to sleep quickly.
But Gemma's attacks don't run on a timetable.
-Where is she?
-In my bedroom.
She's gone again.
I was moving your hand away because you stink of Marmite.
It's making me feel sick.
-I'll see you later, I'll have a good sleep.
-All right, cheers.
By nine o'clock, Simon eventually gets to bed,
but it's only for two hours. When he wakes up, Rangan's waiting for him.
You do need the light, actually.
Because this is really good to train your body that it's daytime now.
You can stay out there, if you want, Simon. Get you a little hut.
When it's sunny, obviously it's quite appealing in the summer,
not so appealing in the winter,
but it is really good for you to...
To sort of train your body clock, "Hey, it's daytime now." Yeah.
It feels good, actually, breathing clean, you know, fresh air.
Rangan has decided to put both of them on
a diet to help remove possible triggers for Gemma's
headaches and to improve Simon's general wellbeing.
-You pay attention.
-No, because you've got to cook this.
I want to remove foods that could simulate your immune system in
a bad way, that I think may be contributing to your headaches.
And instead of doing any testing, I'd prefer to do
a four-week elimination diet where you completely cut them out.
I'll take the yes column, he can have the no column.
-Is that not how this works?
-Not how this works, no.
In terms of the no column, the foods I would like you to avoid, OK.
Wheat is one of them.
The second most commonest food sensitivity that I see in my
practice is dairy.
But it's... The focus is going to have to be 100% on here,
because if, for example, IF dairy is a trigger for your headaches,
if you have a little bit, that can then trigger the immune system,
even if it's just, "Oh, I'll just have a little bit now."
I'm going to put added sugar here.
And, to be very clear, this is not about calories either.
I almost guarantee you can eat as much as you want on this and
you'll probably still lose weight.
-I'm reluctantly going to put chocolate on the no list.
Wait until he tells you you can't drink.
For Gemma, for you, alcohol can give you histamine reactions in the body.
Do you both think, here and now today, you can commit to four weeks on this?
-My palms are sweating now.
-You can't. I know I can.
I have to do, don't I?
You don't have to, nothing's compulsory.
But in my experience, 15 years of seeing patients,
-I think this would be a great start.
-If I can give up chocolate...
-I'll do it.
-See, I know I can, because I've done it before.
Rangan has now implemented all of his treatment plan and
he has just one final issue to tackle - stress.
It does seem, from what I've observed, pretty full-on a lot of the time.
And you've got so much that you are doing all the time.
And I don't know how you do it when you don't seem to be sleeping
very well, because these headaches seem to be affecting your sleep.
There must be a quick way where, at least once a week,
you guys can do something together that you both want to do, for
an hour or two, given that you get four days off in a row.
I do feel like I'm in a bit of a Catch-22 situation, because I
will say to you, "Shall we go and do this, shall we go and do that?"
And he'll be like, "Why can't we just stop? Why do we have to keep doing something?"
Yeah, but that's because as soon as I finish work, like we said,
you've got to come down and you've got to switchover.
As soon as I'm out of work, "Right, let's go."
That's got to stop, period.
Don't forget, you're still younger than when we met.
If Simon was to do more in the kitchen,
would that help you at all, or would that...?
-No, it would send my stress levels through the roof.
Because he costs... He spends a fortune when he cooks.
Oh, give it a rest.
You give me earache, woman. You make my ears bleed.
Guys, look, a lot has come up, OK, I'm going to leave it with you.
We are going to see if you can maybe spend a bit of time together,
at a time that suits you both.
Cook with me.
-I'll teach you.
-You're joking, aren't you? Cook with you?
Guys, I'm going to leave you guys to work out what it is, OK.
He's like Gordon flaming Ramsay in the kitchen.
Guys, I think you'll be able to figure something out. Is that a deal?
-Yeah, deal, you've got it.
Sure? All right.
-I think you need to get the kids, don't you?
'I honestly don't know if I can help them.'
I think it depends, really, how willing they both are to change.
If they're both willing to change, and they give me a little,
I think I can help them a lot.
Rangan is trying to help Paralympic athlete Gary Farmer continue
the active lifestyle he loves.
He must find a way to save Gary's shoulders.
If he doesn't, Gary will end up in a wheelchair for the rest of his life.
-Nice to meet you, Paul.
Rangan has organised for Gary's shoulders to be assessed by Paul Martin,
lead physiotherapist for Paralympians at the
English Institute of Sport.
The question is,
can he still train at a high level without damaging his shoulders?
So that he can stay on crutches for longer.
Just sit it a normal posture for you.
Foot on the floor there. Good.
So, I mean, certainly you're quite rounded in the shoulders,
you're tilted a long way forward.
It looks like this has dropped a little bit further on that side,
which is, again, for a right-hand dominant person, that's not
unusual, you often find, because people are using a mouse or writing,
that sort of thing, people tend to be a little bit dropped through here.
Paul immediately spots that years of training and using crutches
have pushed Gary's shoulders forward, out of position.
So, are you basically saying that there is a larger distance there,
-which is basically because his shoulders are rounded like that?
-So you've got more of a distance.
-Everything is pulled forward, so the...
This part of the shoulder joint is a long way off the bed.
-And you want it a lot lower?
-Yeah. 15 centimetres off the floor.
I make it 14. So they are both a fair way up off the ground.
What would you like to see?
I think I'd like to see something way below ten.
So, if you... Just stop for a second, Gary.
If you have a look around this area here.
It's going low, so as he puts his weight through...
through the crutches, at that point where he needs these
shoulder blades to be in a good position, that's where it's tilting up.
So if you can bring those guys back, this is going to feel really,
really weird, OK? This is going to feel...
It's the best position I've ever seen his...
In some ways, we might actually have to shorten these crutches for you.
In that position, they might be a little bit long.
What Gary's got going on is not actually that dissimilar to
what so many people around the country have got going on.
Back pain, neck pain, all kinds of aches and pains around the
body that are actually linked to how we are spending our days.
And instead of just popping a painkiller because you've got
some pain, why not get to the root cause and try to figure out that
actually, maybe if I do a bit of work on my posture,
and these back muscles, if I start strengthening them,
-maybe, actually, everything's going to be a lot better.
Paul gives Gary a new set of exercises.
To start with, it's just going to be a lot of hard work and it's going to
feel really tiring, and sitting at your desk is going to feel like
much more of a challenge when you're starting to do this for the next few weeks.
If you can start getting that right at your desk,
it's going to be less of a problem going forward.
Rangan's next step is to try an alternative treatment for Gary's
shoulders and posture.
-Hi, this is Gary.
-Nice to meet you.
-Nice to meet you. In you come.
It's called the Alexander Technique.
I've got a weight of a head.
-That's what's up on top.
-That's how much...
That's how much a head weighs, yes.
So that's like 4.5 to 5 kilograms, the weight of your head.
It's scary heavy, isn't it?
It is, isn't it? So, if you've got that weight of the head and
your head juts forward, the weight of the head is then putting
pressure on my neck and shoulders and back.
I now have to do two or three times the amount of work in my back
than I should be doing if I balanced it.
If I balance it, weightless,
takes the stress off the neck and the shoulders.
What percent of patients, do you think, that you see
have got this problem where their skull is jutting out?
-I'd say something like 95%.
Alexander Technique is often used by dancers and athletes.
Clinical trials have shown positive results in reducing back pain.
Rangan hopes it may work for Gary's shoulders and posture as well.
I'm also interested in how you come to stand from the chair and sit.
If I was normally getting up from the chair at work,
I'd normally have my crutches, so I'd end up leaning
down to pick those up and then standing from there.
-Oh, would you?
-That's even worse.
Let me see you stand up as normal, then.
So we see what the habit pattern is that you have now.
I'm on a chair, obviously with wheels on it, so I'd push that back.
-And from there, it's just from there.
-Yes, OK, great.
And what you see is the classic pulling of the head back, which
puts more strain on the back, and the lower back as well, to come up.
-And then if you sit down again.
-And now you're thinking, "How am I going to do it?"
So, what I propose is that you could come up into standing, you know,
you're strong, you're an athlete,
you can come up and just use one leg, but without pulling the
head back, and we'll see if things work a bit better.
So we tip, we flow, well done. Into standing.
-It's all right. Still a challenge to balance because it's new.
So, in a way, we're just trying to eliminate anything unnecessary.
Any unnecessary action of the shoulders, we just eliminate that,
so we take the support down through the arms,
down through the crutches.
And you can just see how there will be less tension,
there'll be less strain.
And it means that when you go to the gym and you are pushing
yourself hard to stay at that competitive level,
your muscles and your body is just in a different state to work on.
Because my biggest fear is that I end up in a wheelchair
a lot sooner than really I want to.
I don't think that you should think like that, I really don't.
That you should... I don't think you should think that.
There's no reason why you should.
And it may be that you'll choose in a few years'
time that you'll reduce the amount of work that you might do in
the gym in order to preserve the long-term effect of being
able to use the crutches, but I don't think you should think like that.
That's fair enough.
Gary will have eight more sessions before the state of his
shoulders is reassessed.
Two weeks after Rangan's treatment plan has begun,
Gemma's headaches have become alarmingly frequent.
They're now happening almost every hour during the day and night.
-Gemma, hello, it's Rangan here.
-How are you getting on?
Er, yeah, it's not been the best week of my life.
Is it really bad at the moment?
It has been bad, yeah.
At the moment, I've been having up to...
16 a day.
Is this as bad as you remember ever having it?
And so it goes on.
Rangan makes an emergency visit.
There is the possibility that things can get worse first before
they get better.
Now, it's easy for me to sit here and say, "Oh, they get worse,"
but I'm not the one having to live with that.
I need to find out from Gemma actually how bad it really is.
Hey, how are you doing? Hello. Hi.
-How are you?
-Hey, how are you? Are you all right?
-I got player of the week.
Player of the week? Put it there.
Gemma has been keeping a diary of her headaches.
So, how many headaches have you had?
15. 15 x 5...
is 60, 75, 76.
-76. Since when?
-Since last Thursday.
So, in one week, you've had 76.
I mean, Gemma, I sort of had no idea it was going to be...
..this bad. How does that...?
-I mean, how do you feel about that, that's it got this bad?
5:30, 7:50, 11:45, 3:20,
6:10 in the night.
-I've got text messages in the middle of the night, desperate.
Every time the phone's ringing, there's screaming down the phone.
Because sometimes, Gemma, I think when I come sometimes, you,
to me in many ways, this tells me a different story from the
brave face you're putting on to me. I mean, this looks... I mean,
I wouldn't be surprised if at some point you've been sort of cursing me.
Not cursing you, no. The reality of it sometimes...
When there's just the four of us,
the screaming that goes on under this roof, it's... It's bloodcurdling.
The more frequent they are, the more I have to just get up and get on with it,
because if I've had one, if I've had one in the middle of the day,
I can sit there for 20 minutes and feel a bit sorry for myself because, you know,
that's just one. But if I did it every time I had one, then by the time I've had
a chat with myself and sorted myself out, I'd be going again.
This is very typical Gemma, you hit the nail on the head,
that she puts a brave face on. This is not the case.
This is tearing, tearing Gemma apart.
And it's tearing all of us apart,
because this last week has been a living hell.
As well as the frequency, the nature of the attacks
has changed since Rangan began his treatment plan.
For the past sort of, I would say, four or five days, it's been here,
-coming into here.
-So, it was here, here and here, three places.
So, from three places, it went down to two. OK.
There's something happening, we don't know good or bad yet.
I said that to you, didn't I? Obviously something's happened.
-Am I all right to sit down, my head...?
-Is your head going?
-Is that all right?
-Yeah, yeah, yeah. Is it going?
I don't know, it's just...saying hi.
Just in case I'd forgotten about it.
SHE SOBS LOUDLY
-All right, all right.
SHE SOBS LOUDLY
-That was a big one.
-Big, bad one.
-I've not seen her that bad.
-That's how it's been.
-Is there a point at which we...
-We say that this isn't working?
It's been extremely hard this week, but I think you've got to give it a go,
but it's got to be Gemma's call ultimately, I think, because she's the one suffering with this.
-Are you OK?
-Are you sure?
-Yes, Princess? Come on, then.
Gemma, I'm sorry, I'm sorry things do appear to be deteriorating.
But as long as you're...
As long as you're OK with it, I think we should continue.
-It's still very, very early days.
-Can I have a biscuit?
-No, you're not having a biscuit.
Gemma is experiencing one of the worst bouts of headache she's
ever had. But Rangan has identified a potential way forward.
Something is changing in Gemma's symptoms, and that's a clue for me,
that's a real clue, and frankly, that's the only clue I've got at the moment.
I really want to delve a bit deeper.
To investigate why Gemma's headaches are changing, Rangan sends her to
Dr Hume, a chiropractor who specialises in neurology.
She looks for issues in Gemma's neck joints and muscles that could
be affecting her nervous system and causing her pain.
You can have some bread.
Over the next two weeks, Gemma sticks to Rangan's treatment plan,
and he helps her de-stress.
We really want you to start breathing in through the nose and out
-through the mouth, OK?
-And now forwards.
Hold the elbow straight and push outwards.
Then Dr Hume has a breakthrough.
-Come on in.
I wonder if you could talk me through a little bit about
-what you found and some of the treatment you've been doing.
I'll show you the X-rays first, and then we'll move on from there.
So these are each of the vertebra down into the neck.
Now, normally we have a curve that comes through like that.
So, you can see with Gemma, instead of coming forwards
like that, it actually is a reverse curve, it comes round this way.
So she's got the opposite curve than what you would expect?
-Yeah, she's got what's called a cervical kyphosis.
This abnormality in Gemma's neck has affected nerves connected to
the areas of the head where Gemma feels pain.
The nerves that cut that exit through here, through the top area,
which is what we were talking about through in here, that nerve pierces
muscle and then comes up over the head, right over to this area here.
And very often, they get pain at the front, pain at the back,
pain at the front, sometimes over the whole area.
Interesting, that's where Gemma...
It starts there and it goes to there.
That's where you're experiencing a lot of your pain.
The furthest it comes is sort of here, but it's there.
What could cause an abnormality like that, that you've found on the X-ray?
Well, I'm absolutely convinced it was injury related, an accident.
-What was that accident?
-It was a car accident when I was 15.
I was in the car with my boyfriend at the time, brakes locked, car span,
went over a barrier.
Didn't flip, the car didn't flip over. Went over a barrier.
-And the car was a write-off.
-I would think that would be, you know, a candidate.
The prime suspect.
Everybody is familiar with the whiplash, where the head goes back
and so on, but these side impacts or rotational strains actually are,
you know, the neck really doesn't like that kind of thing.
You have been treating her for a few weeks now.
Would you say that her neck area and those nerves are actually
functioning better than when you first started to see her?
Yeah, I mean, the upper part of the neck is generally a lot less tender.
When we push down in there, you're not sort of leaping.
You just touched sometimes and it was like, "Oh, that really hurt."
By making the changes and getting it working properly, you have
less neck pain and, you know, hopefully less issues later on.
That was amazing, that abnormality on her X-ray, which may hold the
clue to all of Gemma's headaches, may have been caused by a car crash.
Could it be that Gemma's suffering has all stemmed from that?
I don't know, but it's a big, big clue.
Now, everything hangs on the success, or failure,
of Gemma's musculoskeletal treatment.
Release the knees forward as the hips go back.
Six weeks ago,
Gary Farmer feared his shoulders would soon wear out, confining
him to a wheelchair and ending his life as an elite sportsmen.
Now he's completed a course of Alexander Technique and
has a new set of exercises designed for shoulder health.
Rangan is meeting up with Gary to see what difference it's made.
I'd love to see something tangible. Like, the physiotherapist,
he made measurements.
Has that measurement gone down, you know, are we making a significant
difference in his shoulder, in his upper back, in his posture?
Because, actually, that's what's going to make a difference long-term for Gary.
Physiotherapist Paul Martin has been tracking Gary's progress.
-How's Gary getting on?
-He looks OK, doesn't he?
-He looks much more upright.
-Yeah, definitely. Much more upright.
-I can see automatically how that would actually generate more power.
And again, if you're looking at small margins, just a little
bit of extra force in a couple of early push-offs can be quite useful.
Yeah, should we go sit in one of the rooms and let Paul take
-a look at you?
-Yeah? All right.
Five weeks ago, when the position of Gary's shoulders were first measured,
they were bent too far forward, 14 and 15 centimetres off the table.
The last time we met, we were aiming for a target of between five
and eight centimetres for the AC joint off the bed. Let's see where we are.
There you go. So, nine centimetres there.
-So, left side, down to seven.
Long-term, that would translate, surely, to better shoulder health and less
-likelihood of straining the shoulders.
There's every possibility that with the right sort of work, we can get well on top of this.
So, some of these issues should be much less of a problem.
-Does the future look sort of good now?
-It really does look good,
it doesn't look as scary as it was before,
saying, "At some point I'm going to be in a wheelchair."
But now, it's like,
"No, I don't need to have that worry over having to go into a wheelchair,
"I can still compete, I can still push myself to those levels.
"But just make sure that my shoulders are in the right place when
-"I'm doing it."
-Keep it up.
-Thank you very much, I really appreciate it.
-'I feel good.
'This is a guy who actually thought he had two stark choices,'
and now he knows that the health of his shoulders is in his own hands.
That's all I could really ask for.
-I can have butter, can't I? Or can't I?
-No. Oh, you're joking.
What am I going to have on my corn on the cob?
For the last two months, Rangan has been trying to solve the mystery
of Gemma's suicide headaches.
A condition that's left doctors puzzled and unable to find a cure.
For years, Gemma and her family have been left to cope with the
stresses of her debilitating condition.
Now, Rangan has come back to see if his treatment plan has worked.
I've not seen Simon and Gemma now for a few weeks, but I'm just
hoping that I've managed to make a little bit of a difference.
-Hey, how are you doing?
-You all right?
-Yeah, nice to see you. Are you well?
Rangan's keen to know if there's been any change in the frequency of Gemma's attacks.
Obviously, 13 years is a long time to remember,
but I can't remember it being as good as this.
The only time it's been better than this
has been when I was pregnant and I didn't have them. At all.
And that's... And they did, they just went, and that was the only time.
Actually, maybe, maybe there is some hope insight,
maybe there is some sort of respite from this...
life sentence? Which is how it certainly seemed to me.
You were getting... I mean, we documented in one week, 76.
You're telling me 80, 90 in some weeks.
And we're now quite consistently getting under ten a week.
And that's probably been for four, five, six weeks?
We're getting 24-hour periods without any.
How is that in terms of going forward for you?
It's fine now, I can live with that.
-One or two at night, that's my happy place.
-You're in a happy place.
I like that place.
Hopefully, potentially less stress in terms of the house,
in terms of then, you know, your interactions with Simon.
The biggest thing was always how much it affected Ethan, because he's the one
that's old enough to know what's going on and to be able to help.
See, that's what's going to make me cry, thinking about him.
Just him, he's just...
It's all right.
-Gemma, it's all right. He has been amazing.
-He is amazing.
He really has been.
You know, maybe he doesn't have to be as amazing in that way any more.
-That's the best thing.
-I'm just saying how amazing Ethan is.
He is a special little boy.
Rangan will also check whether Simon's measurements have improved
-compared to three months ago.
-It's going to be your waist-hip ratio.
Can I just do one more on this arm? How are you, are you all right?
The family arrive to hear the news.
Blood pressure, 137/96 at the start, which was high.
It's come down to 122/83, which is pretty much normal.
His waist, which was 40 inches, has come down to 36.5.
-So he's lost 3.5 inches.
-After what he ate last night?
-In spite of what he ate last night.
-Yeah. Has he stopped drinking beer in the morning?
-There you go.
See, Ethan's noticed. Do you know how much weight he's lost?
About a stone and a half.
The machine does something called your metabolic age,
so it tells you how old is his body.
And the first time round, obviously he was 45 at the time,
-his metabolic age was 50.
He's now 46.
His metabolic age is 34.
That must be wrong, I want a recount.
That can't be right.
-You're married to a 34-year-old, basically.
-Well, there we are, see.
-So, I've got a toy boy.
-You don't know how lucky you are, what you've got here.
-Oh, here we go.
I told you he's sexy!
-There you go.
-That's my boy.
-That's my boy.
I do love you.
All right, keep it up. 'Wow, what an experience with these guys.'
Simon, there's no question, he is in a much better place.
Gemma, I have literally had to try everything I could possibly
think of, and seeing the kids' response, seeing her response,
you know, she is now getting about five, maybe less a week.
It almost feels like a miracle.
And I think if she keeps going,
it won't be long before she's completely cured of these.
It just feels fantastic.
Next time, Rangan travels to Liverpool to help a mother...
I'm going to cry again, I've been like this all week.
-I don't know what my issue is.
-..who's battling panic attacks.
I feel like I'm unfixable, I just feel like I'm a big mess.
Every single day of life for, for 20 years plus,
has felt just like wading through treacle.
And tries to help a father overcome a mystery illness.
Go to your doctor and you say, "I stop breathing when I'm asleep."
And they just basically say, "There's nothing wrong with you."
I'm worried about him, really worried,
that he is a walking time bomb.
For the last 15 years mum of two, Gemma, has battled cluster headaches up to ten times a day. Experts often refer to them to as 'suicide headaches' because the pain is said to be the worst that any human can experience. This crippling condition is destroying family life and particularly taking its toll on husband, Simon. It's a major challenge for Dr Chatterjee. So far, no one has been able to help Gemma overcome her condition and the family are desperate for a cure.
Gary Farmer lost his leg in a car crash when he was five years old, but he's overcome his disability and achieved success as a Paralympic ice hockey player. However, a lifetime on crutches and a punishing exercise regime has severely damaged his shoulders and he will soon be confined to a wheelchair. It's up to Dr Chattergee to come up with a solution to keep him on his feet and able to compete.