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New York Times, 2/10/04 A MIND EMERGES JOYFULLY AFTER YEARS LOST IN A CLOUD by Beverely Jablons Late one night in August 1994, I tumbled down the stone steps outside the United Nations headquarters as I was leaving a wedding party in the delegates' dining room. As I rolled down the steps, people seemed to step aside politely, the better to clear a path. The back of my head struck the last step with a resonating crack. I can still hear it almost 10 years later like a malevolent echo. The next morning, a lump on the back of my head was the size and shape of a computer mouse. I cupped it in my palm. After two days of rest, I arose from my bed. But when I stood up or sat down, when I walked or when I placed my head on a pillow or held it a certain way, I was overcome with nauseating vertigo. I was a Frankenstein monster, lurching, rocking from side to side for balance. I touched door frames, walls and furniture to stay upright. Outdoors, I felt safe only when hugging the sides of buildings. My life disintegrated in increments. I avoided crowds, and evenings out had to be orchestrated. The sidewalk traffic of bicycles, baby carriages and skateboards became my obstacles. Once agile, a "gotta dance" woman, an aerobic exercise aficionada and a mediocre tennis player, I began using a cane and asking people to help me cross the street. My doctor, Mark S. Pecker, a dedicated man at New York-Presbyterian Hospital, guided me through the maze of the medical world. After extensive tests, a neurologist diagnosed a vestibular disorder, caused by the blow on the head, of the inner-ear system that affects gait and balance. With physical therapy, I improved somewhat. But there was a nagging sense that there was more. In the following years, I had seven MRIs and saw seven neurologists, two orthopedists, one rheumatologist, one otologist, two physiatrists and one psychiatrist. In the occasional moment of epiphany, I tried an acupuncturist, a chiropractor, a personal trainer, and yoga and tai chi instructors. I convinced myself that I was reliving the trauma of that night. But a psychiatrist said my condition was neither mental nor emotional, but physical. By 1997, I had other symptoms, though MRIs showed nothing. Doctors were baffled, ruling out Parkinson's and Alzheimer's diseases. One physician suspected that I had suffered three ministrokes. "Like buckshots," he said. "Pow! Pow! Pow!" I became incontinent, humiliating for a fastidious, romantic and, yes, vain woman. I went from a cane to a walker to a wheelchair. I lost cognizance, concentration and focus. My flamboyant signature was pinched and crablike. My intellect was failing. I had been an author, a Scrabble player and an intense reader. A talker. Now I couldn't retrieve words or finish sentences. I lost my sense of humor, and my imagination evaporated. I lived in a veiled landscape. I gave my heartbroken son and daughter power of attorney. Five young grandchildren loved me from afar, with misgivings. The doctors insisted that I have 24-hour live-in care. People spoke about me in the third person, like asking, "Does she want a sandwich?" Friends stopped visiting, frightened by the stranger I presented, they said. Did I know this? Yes and no. I can say now that there often lurked a clandestine awareness. I felt lost forever. But my daughter-in-law, Dr. Cynthia Green, a clinical psychologist associated with Mount Sinai Hospital, urged me to try one more neurologist. A friend said the same. Unknown to each other, each recommended Dr. Seymour Gendelman at Mount Sinai. It was a coincidence we couldn't refuse. I saw him in July 2000. He suspected normal pressure hydrocephalus, but it still did not show up on the MRI. He monitored my condition until he could make a positive diagnosis. He suspected, in lay terms, water on the brain that could be caused by a blow to the head. Simply put, spinal fluid has detoured from its normal course, causing pressure on the brain. A procedure to relieve the pressure involves placing a shunt in the brain to permit the fluid to return to its natural movement. It is not an uncommon procedure, but it is delicate and carries the risk of possible infection or hemorrhaging. The neurosurgeon, Dr. Wesley A. King, recommended placing the shunt in the lumbar region. Though that is a more conservative approach, he thought that complications would be less likely. I underwent the procedure on Jan. 9, 2003. Five days later, I went home, weak but gloriously whole. A dear friend and my daughter held a triumphant luncheon in my honor where we laughed and cried and marveled at the return of my senses and intellect. "I have my mother back," my daughter wept. Someone said it was a miracle of biblical proportions. But it is really a miracle of medical proportions. Beverly Jablons, a freelance writer, is the author of "Dance Time." Copyright 2004 New York Times --------------------------------------------------------------- New York Times, 2/17/04 EASING A BLURRED MIND To the Editor: Re "A Mind Emerges Joyfully After Years Lost in a Cloud" (Feb. 10): Like the author of the article, Beverly Jablons, I too am thankfully wearing a shunt, which I initially thought was only for babies and young children. But I consider myself more fortunate than Ms. Jablons. A perceptive doctor at a nearby clinic diagnosed my problem after quickly seeing that I did not have Parkinson's or Alzheimer's disease. He then guided me to a hospital in Boston where the chief neurosurgeon inserted my shunt. Now my mind, too, has "emerged." I have just recently mailed off a novel to my publisher. SHERRY BUNIN Vinalhaven, Me. --------------------------------------------------------------- undated, 2004 WNBC-TV / wnbc.com TREATMENT RELIEVES SYMPTOMS OFTEN MISTAKEN FOR ALZHEIMER'S -- SOFT, FLEXIBLE TUBE DRAINS EXCESS FLUID FROM BRAIN It has become possibly the most feared epidemic of older Americans: an elderly person who's losing their memory perhaps becomes incontinent and is often told they have Alzheimer's, dementia or maybe Parkinson’s if they have trouble walking. That’s what doctors told Alan Spillner. "Right after I started taking medication my condition worsened markedly," said Alan Spillner, 56. "So, they upped the dose, and I got worse." Spillner got so bad that he would often fall even walking a small amount. Eventually, he couldn't walk at all. Plus, his memory was failing. "I’d read something and 10 minutes later I couldn't recall what I had just read," said Spillner. Dr. Gail Rosseau of the Chicago Institute of Neurosurgery and Neuroresearch says that nearly a million people who have been told they have Alzheimer’s, or some other dementia, or Parkinson’s, may actually have a reversible, even curable condition called Normal Pressure Hydrocephalus, or NPH. "The normal fluid-filled spaces in the brain called the ventricles," said Rosseau. "If spaces are too filled with fluid, the patient has symptoms. And the symptoms are gait problems: trouble with walking, trouble with urinary control, thinking problems." Mirza Naqi, an NPH patient, had all of those problems just four months ago. In fact, walking was so risky, he was in a wheelchair. "I was reporting to my daughters that something happened to me, I cannot control myself, then somebody said Alzheimer’s," said Naqi. "He had frequent falls,” said Noneek Khan, Naqi’s daughter. "He would forget that he couldn't walk anymore and he would try to stand up." The fix? Rosseau installed something called a shunt in Naqi's brain. It's a soft, flexible tube that drains excess cerebro-spinal fluid from the brain ventricles and runs it all the way down to the abdominal cavity, where it's reabsorbed. "It's all better," said Khan. "He's remembering, he has his short-term memory back. He doesn't wear diapers anymore, he had total control of his bladder, which makes life easier for us. And he's walking without a cane, at home he doesn't use a cane, only when he leaves the house." For Spillner, the effect of the shunt was nearly miraculous. Within hours he could walk again, without falling. And, the man with a failing memory is back working as a computer programmer. "I just couldn't imagine that I could go from such a degenerate state to fell the best I’ve felt in years” said Spillner. “My whole life back!" The signs of NPH are trouble walking, sometimes incontinence and memory or thinking problems. Those symptoms are reason for a CAT scan or MRI. If the ventricles are swollen, doctors will do a three-day spinal tap to drain off fluid. Only if you get better will doctors consider installing a shunt. Copyright 2004 by WNBC.com

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