Since I was at University I can remember having strange pains inside my head when I turned it suddenly. As the years progressed, I began to get agonising pains in my head if I coughed, laughed, or sneezed. The pain would last for up to about a minute, but was excruciating while it lasted. The best description I can give is as if there was a strap about 3 inches wide connected from the top of my forehead to the bottom of the back of my neck and it was being tightened.

For the duration of the attack, nothing I could do would relieve the pain. Holding my head up was almost impossible, and dropping it forwards seemed to make the pain worse. The main pain would go off quite quickly, but a lingering after-effect would be left for some hours. Sometimes I would wake up in the morning with a pain in my head that felt like the after-effect, making it very difficult to get up and get on with the day.

These pain attacks went on for over 10 years, and I adjusted my life to try to avoid anything that triggered them. To avoid coughing I always made sure I had a drink readily available, or kept my mouth closed to try to force myself not to cough out loud. Avoiding laughing was difficult, because I quite like laughing! Avoiding sneezing was almost impossible. I used to dread it when I could feel a sneeze "brewing up", and I avoided watching some films at the cinema because I knew they would make me laugh. Sometimes the dull after-effect pain was there all the time, not always after I'd triggered the sudden pains first.

I visited doctors, hospitals, and osteopaths, and the general opinion was that my neck was going into muscle spasm, and that there was pressure on an inter-vertebrae disc, probably caused by a minor car accident I had had many years before. X-rays revealed nothing, and stretching the neck, pulling the vertebrae back to their proper positions, and sleeping with my head over a rolled up pillow to extend the muscles, none of these cured the problem. The only thing that gave any relief was massaging the back of my neck and the top of my back, releasing the very tight muscles, but this did not get to the root cause - it did reduce the dull pain, however.

Just before Christmas 1999 I had to visit Malaysia for work for a couple of weeks, and when I returned to England I found I had a permanent headache, all day, every day. Over Christmas, my left eye swelled up, and the neck and head pain became much worse. My blood pressure was very high, and I was put on medication to control this. The eye returned to normal, but the headache remained. The sudden cough/laugh/sneeze pains continued, but the after-effect pain was there nearly all the time. Some mornings I just could not get out of bed because of the unbearable pain in my head. I visited my own doctor (I had by now moved to Brixton), and neither of the doctors in the practice could identify what was wrong. They did many tests and could see that I clearly was not well, but could not identify the cause.

One day the pain was so bad that they sent me for observation at King's College Hospital in Dulwich. Even their tests did not diagnose anything. I give my doctor(s) all credit, however, as they did not give up on me and referred me to a neurological specialist. He sent me for a CT scan, which did not show anything wrong, but he had a suspicion that I may have a condition called "Arnold Chiari Malformation" and suggested I have an MRI scan. Unfortunately my consultant retired in between the time of these two scans, and my records and scan requests were somewhat delayed in the system. Eventually I was allocated a new consultant surgeon who was an expert in this field, and the MRI scan showed that I did indeed have the condition.

He arranged for my operation (a Foramen Magnum Decompression) to be carried out on 20th August, 2001. This fitted conveniently in between shows I was doing that year, but I made sure that everyone knew I would be missing for what I imagined would be quite a few weeks. I had a revue show coming up about a month after the operation, for which I recorded backing tracks - in fact, I was still recording them on the day before I went into hospital! The operation was on a Monday, and on the Sunday before I did my final rehearsal in the morning, then went to the hospital in the afternoon.

The surgeon had not told me a great deal about the condition, nor did he go into any great deatil about what would happen to me, but I had investigated all I could on the Internet. Many of the useful sites I found are listed on the Links page. The lists of symptoms confirmed that I was not going mad!! There are a few other people out there who had the same problem. A quick summary of the condition is as follows:

Your brain is protected and cushioned by a liquid which also flows inside your spine, protecting the spinal cord. If the pressure inside your head increases for any reason, or if it is knocked, or you sneeze, cough, or laugh, the fluid moves around inside your head and can escape into the spine if necessary. If you are suffering from Arnold Chiari Malformation, the two Cerebellar Tonsils (tonsil-shaped lobes at the base of the brain) restrict the flow of the fluid because they are inside the top vertebrae along with the spinal cord, blocking the gap which should allow the fluid to flow freely. This means that the increased pressure inside the skull does not get released in the proper way, and causes various pains and other symptoms.

According to my surgeon, my problem was diagnosed before the increased pressure in my brain had done any permanent damage, and because there did not seem to be any complications with my specific case, he was very confident that the operation would be successful. It is quite risky, as the correction process involves the base of the brain and the top of the spinal cord, but I knew I had loads of people praying for me, and I was sure I would be OK. I had no time to get nervous, anyway, as I was so busy preparing backing tapes for shows, and rehearsal tapes for while I was incapacitated.

The operation was done on the NHS at King's College Hospital. Basically, they shaved the back of my head, cut a 5-inch incision from the base of the neck up to halfway up my head, and removed the back of the top two vertebrae, then sewed me back up. I have a couple of photos of the completed job taken when I was back at home (nothing gory, and they are luckily slightly out of focus, but you don't have to look!) here. In my case they left the brain intact - so I've got no excuses! - but another option is to remove the cerebellar tonsils instead.

The surgeon and nurses had definitely under-played the seriousness of the operation, and certainly gave me no indication of how painful it would be after it had been done. I remember one nurse telling me that operations to the abdomen are much more painful, but it definitely felt like someone had been beating the back of my head with a cricket bat when I came round from the anaesthetic!

The operation apparently took quite a few hours, but I was blissfully unaware of it all. My first memories when I woke up are of being wired up to loads of monitoring equipment and realising how painful the back of my head was. The natural position to lie in on these occasions is on your back, but when there's a recently stitched-up wound right where your head makes contact with the pillow, this is not very convenient. Trying to lie on your side is also a bit tricky, as this stretches the scar as well. Each time I turned over I seemed to detach one of the monitor wires, and the frantic beeping from the machines kept bringing me visits from the nurses!

I can remember the first thing I did when fully conscious - apart from thanking God that I was still alive - was to check that my hands and fingers were still working. I was very pleased at this point as I knew I would be able to carry on with my music playing. That had been my only real worry, as music brings me such enjoyment. Before the operation I had had to remove my metal jewellery, but I had left my WWJD (What Would Jesus Do) bracelet on as it was embroidered. The nurse who had looked after me overnight had noticed it, and said she had been praying for me as well, as it was nice to have a Christian patient. I was in the intensive care section for quite some time, as I know my parents had been trying to find out how I was and kept being told that I hadn't "come up" yet.

I was transferred to a double room for the rest of my recovery, sharing with a lovely man who had pressure on part of his brain making it difficult to remember words and who was finding it very frustrating to speak. By the end of our time together, I could often work out what he wanted to say and could help him in his conversations with the nurses, cleaners, and catering staff. We had a really joyful cleaner who sang hymns and choruses all day long - a nice way to start each day.

My family and friends, especially my best friend Lester, visited me every day while I was in hospital, and I really appreciated this. In the early stages it was not always easy to talk to them for long periods, as even though you are lying there doing nothing, you are still very tired. I had loads of cards and some lovely gifts to wish me well, and I still treasure them all.

To while away the time I did lots of word puzzles, listened to music and comedy programmes (I was still very careful when laughing!), and hired a television, but the signal was so poor there that it was a bit difficult to watch. Lester read most of Harry Potter and the Chamber of Secrets to me while I relaxed over the time I was in hospital. I loved the hospital bed, with electric control of height and reclining - every home should have one! The hospital food was pretty good as well, even though I didn't feel very much like eating a great deal for the first few days. Once I got my appetite back, I really enjoyed it.

In fact, there were only two things I didn't like while I was there. One was the fact that our room was next to the kitchen and washing up area, so we heard loads of cutlery being thrown into the sink, but that was only for a short periods. The only other problem was nothing really to do with the hospital, but the garden centre just next door had two guard dogs which would bark all night long, and when you're desperately trying to sleep, this was very irritating - but earplugs soon sorted that out!

It was only three days after the operation that they got me back on my feet, which was quite a challenge, but within another day I was walking myself to the toilet! This was a great relief :) I have since found out that I am not the only man who can't use a bottle in the bed. It must be something to do with your potty training that prevents you, but it really is difficult, especially when you're getting desperate!!

The operation had been done on a Monday, and I made a really rapid recovery. By the end of the week I was walking up and down stairs, and walked round the hospital regularly, including visits to the hospital shop. It was still painful, but the pain killers were very effective. I had been on three drugs to keep my blood pressure down, as it was very high before the operation, but afterwards it dropped significantly back to near normal, and has remained much more stable since even without the aid of medication.

The following Monday was a Bank Holiday so I was not discharged until the Tuesday, and my Mum and Lester came to fetch me by car. I had my own place in Brixton, but as I would have been on my own there during the day when my flatmates went to work, I went back to my parents' home to convalesce.

So I was back at home (my parents') 10 days after going into hospital, and was told to rest - something I find very hard to do! The pain was well under control with the prescription pain killers and some standard paracetomol, but I was still very tired. Unusually for me, I was in bed by 9 o'clock each night, as that was when my energy had run out. At least here I had my laptop and could keep up to date with e-mails from friends and work. I did not know until this point that Lester had been sending e-mail updates on my progress to friends and my work colleagues while I was in King's College.

I had warned work that I would probably be off for about 10-12 weeks, as this was the estimate from the consultant. I had to see my local doctor to have the stitches removed (in fact, it was just one long stitch), and to check on my progress. The stitch could not be removed at the first appointment because it was still a little "moist" at the bottom, but came out a week later. The nurse and the doctor commented on how neat the scar was.

On the Sunday after I left hospital, I went to a rehearsal for the revue show for which I had been recording backing tracks on the day before I went in. I could not play the piano at this point, and I was not driving myself, because even when my neck was not in a soft support collar, I still could not turn my head a great deal, nor look down, and doing up my shoes was a bit tricky. However, I was fully mobile, and had actually only missed one rehearsal for this show - amazing. Everyone remarked how well I looked, and that I seemed to have lost 10 years in my face: it is surprising how much I had been frowning from the permanent headache.

During the following week, I made my first trip alone and went to work for a half day, travelling by train. This was quite an exhausting experience, and most of my colleagues could not believe that I was up and about so quickly. I was trying to take things steadily, but felt so much better than I had done for over 18 months that I couldn't wait to get back to doing everything I normally did. I also went to another rehearsal, this time for the show I was conducting in October, and again, the cast were very surprised to see me looking so well. It was no "act" - I really did feel fantastic.

I was back to work part-time (mainly mornings) within a few more weeks, travelling by train to start with, and resumed driving as soon as I could comfortably hold my head upright and turn it fully without pain. As soon as I was comfortable driving, I moved back to my flat in Brixton, but did take things very easy for a while. My first attempt at playing the piano was at some auditions for another show when the pianist failed to arrive. It was a little difficult not being able to look down very easily, but it was another step towards full recovery. I was back at work full time about 10 weeks after leaving hospital, and restarted nearly all my normal activities. I was careful not to over-do things, and when I felt tired, I did make sure I rested.

The pain from the scar subsided within a couple of months, but there was the odd "twinge" from it for many months. The worst pain for me was an extreme sensitivity on the right hand side of the back of my scalp. Sometimes this felt like pins and needles, and often even the hair moving in the wind could really hurt if it touched the scalp. I was warned that this could last between 1 and 2 years after the operation, but it has pretty much gone now (18 months later, at the time of writing). It takes quite a long time for the multiple layers of sewn flesh, internal as well as external, to heal, and the nerves have to get back to normal as well.

I was warned not to go on long-haul flights for a while, and it took a while till I could easily look downwards without the scar feeling that it was stretching, but by the end of March 2002 I was allowed to fully resume all activities. The surgeon was very happy with how the operation had gone, and with my progress since. To date, I have had hardly any noticeable recurrence of the symptoms, although when someone (accidentally) fell off the stage and on top of me in the orchestra pit at a local theatre, it took a few weeks of physiotherapy to get my neck muscles back in shape! Luckily no permanent damage seems to have been done.

The obvious question - and the answer is a resounding YES. To awake each day without that headache is wonderful, and even when the scar was still painful, it was much easier to bear than the constant dull ache of the previous 18 months. I can now laugh, cough, and sneeze without having the prospect of unbearable pain in my head, and physical exertion no longer makes bits of my head hurt, rather than just the parts of my body that are being exerted!

The scar is now almost fully covered up by the hair on the back of my head (about the only place where the hair still grows!), and generally gives me no trouble at all. In very cold weather, I can sometimes feel the scar, and the scar tissue occasionally does get a bit tight, but gentle massage and moisturising lotion helps it return to its usual state. Apparently my type of skin and the scar type (keloid) means that the scar may never completely disappear, but it is not very visible - and besides, it is only other people who can see it, not me :))

By a remarkable coincidence, a lady at the church I go to in Cape Town, South Africa, when I am on holiday over there had exactly the same operation at almost the same time as I did, and her scar is almost invisible. However, it's the lack of pain that counts, and as long as there is still some hair on the back of my head as the baldness progresses, I'm not worried!

If I had not had the operation, there was a risk that I could have ended up partially paralysed, and the pains I was already experiencing would probably have got worse. There were risks associated with the operation, as the area that the surgeon has to work on is right where the main control system for most of the body enters the spine. However, I am really pleased that I had it done. My surgeon was very calm and reassuring, and did explain bits about the condition and the operation, but the Internet was by far the most useful resource.

Arnold Chiari Malformation is not an uncommon condition, but it is something that does not seem to be in most doctors' experience. If you are unlucky enough to suffer from this problem, I would very much recommend that you find out as much as possible in advance (see the Links page), partly to put your own mind at rest, and also so that you can ask your own doctor or surgeon more detailed questions.

Thanks for reading this far. I know that's almost a chapter from an autobiography, but if it encourages anyone who has the same problem as I had, I am very pleased to have written it. If you have any questions, please feel free to contact me. I am no medical expert, but can answer from my own experience and perhaps offer some support.

Very best wishes,

Andy.