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July 2007:
Around 1985 I began falling during my morning runs when I was a 54-year-old kid. Embarrassing, but nothing serious. I adapted by changing my route from the streets of town to the sandy beaches.

Around 2000 my arms began tingling and my fingertips were going numb. Nobody was quite sure what was happening. In 2003 I got out of bed in the morning and couldn't walk. My properly alarmed GP sent me to the neurologist who sent me to the neurosurgeon. MRI showed spinal stenosis. C3 through T2 were gummed up. Nerve signals couldn't get through. After laminoplasty I was much, much better. My fingers worked, I could run again ... but not as well. In 2007 I was again encountering difficulty in ambulation. MRI showed the stenosis problems in L4 and L5. After a laminotomy, matters again improved, but problems remained. I requested another MRI. The report said "ventriculomegaly admits the possibility of NPH."

NPH? What's NPH? A web check took me to Pat Sabin's site and my education began. I invested two solid weeks in self education, performed a self diagnosis (I exhibited ALL the listed symptoms!), contacted the office of Dr. Bergsneider at UCLA, met with him and scheduled a week in the hospital for drainage tests and evaluation. Subjectively I found the change dramatic. My wife was amazed at the new me. I walked straight, thought more lucidly and, most dramatically, the incontinence was gone. When I returned home, the symptoms returned almost exactly on the predicted schedule. I met again with Dr. Bergsneider and we discussed options. I requested a Codman-Hakim vertriculoatrial shunt ASAP. I went into UCLA for surgery on Monday morning, was wolfing down everything edible in the hospital that PM, explored all the hospital corridors on Tuesday and was released on Wednesday AM. That was just last week. This week I'm anxiously awaiting the doctor's release to resume my exercising and driving. I feel great, except for an occasional headache. (That's why Tylenol exists.) I had thought my mentation was previously unaffected ... until I saw a truly dumb entry that I had made in the checkbook. My speed of response to "Jeopardy" questions is now nearly normal again (although my wife is still the unquestioned household champ in all but science questions) and I again follow complex arguments with my old analytical fervour. I walk well, there is no remaining balance problem and I am feeling great!

Observations: This was like peeling an onion. Stenosis plus stenosis plus NPH. Fortunately for me, the alert MRI reader saw the possibility of NPH and Pat Sabin's website educated me. My GP, neurologist and neurosurgeon all missed the diagnosis. My neurologist tried to talk me out of it. My old neurosurgeon didn't believe in the careful UCLA approach. He said, "Sure, I can do it. Tell me what you want!" The UCLA crew was superb in every conceivable way.

My advice: Educate yourself, talk with the best experts that you can find, make your decision carefully, then move out! You'll never do it younger. I'm sure glad that I did!

Updated 1/30/2008:

Followup CAT scans following the previous shunt procedure showed considerable bleeding on my brain. Why? Well, It seems that under 3% of the population (hey, that's me!) tend to run very high peaks in CFS pressure. Those peaks just overwhelmed my shunt valve, excessively large amounts of CSF fluid squirted out, my brain began to deflate like a balloon, pulled away from the interior of my skull, tore blood vessels in the process, and the bleeding resulted in a nice big subdural hematoma. It scared the daylights out of the CAT-scan readers and report writers. From the user's viewpoint, it was completely asymptomatic; throughout the whole ordeal I felt zero discomfort. Fortunately, the UCLA gang recognized the problem, added a new 70mm fixed-pressure valve in series with my old 0-200 mm variable-pressure one (I was in the hospital for only one day), essentially shut off the valve by resetting the pressure to max so my brain would trap the CSF, "reinflate" ... and absorb the bloody mass. Biweekly CAT scans showed the hematoma disappearing as my NPH symptoms reappeared (right on schedule). After a month or so, the reabsorption was complete. I traveled up to UCLA biweekly for a couple more months as the valve-pressure setting was gradually reduced a few mm at a time, with everybody in SoCal monitoring my CAT scans for any indication of bleeding. No problems ... and I got to know and educate lots of very nice folks about NPH.

Here's a shocker: some time back, my neurologist had sent me to a speech therapist because I was experiencing difficulty in pronouncing some words. My handwriting also had deteriorated badly. The conclusion was "effects of age." Well, whaddayaknow; it ain't. After my CSF pressure was properly stabilized, both my handwriting and speaking skills were completely restored!

NPH had been responsible for my impared memory, thinking, speech, handwriting, walking and balance, impotence and incontinence ... and I'm sure that with adequate reflection there are more items that I could add to the list. I had really needed both the stenosis surgeries as well as the shunt procedures ... and a new knee to fix me properly. I now feel incredibly fortunate and again robustly healthy ... so much so that I'm taking my bride of 52 years to Paris.