Healthcare is often in the news as part of political schemes, awareness campaigns, and public commentary related to the expenses surrounding the industry (especially in the United States). This story is different. This is the story of my mid-80s grandmother who is otherwise in good health experiencing a life altering event that we never would have predicted. Does she enjoy sugar a little more than she should? Sure, don’t we all. Does she check her blood sugar daily by stabbing her finger? No, she finds it inconvenient and undesirable, but she’s barely Type II diabetic, so we aren’t too hung up on that at this point. Did she change her a-fib meds without telling any of us? Yes, because she’s a spicy little Irish potato.
She had a low grade fever one night, 99 degree F. In senior citizens, this is a bigger deal than a healthy midlife adult. She was chatty, a little feisty, took two Tylenol to pull her temperature down and went to sleep. The next morning she was not speaking in fully cohesive thoughts, still had a fever after two additional Tylenol, and physically had minimal control over her body. She lacked the ability to sit up in her bed on her own. She recognized me when I arrived to her house. I lifted her out of bed and was able to get her to her husband’s walker with a seat and roll her out to my car. I then lifted her into my SUV and drove her to the hospital. She had some drooping on the left side of her mouth, so I figured it may be a stroke. I turned on Elvis Radio on SiriusXM and she sang along on our 10 minute voyage. I asked an ER nurse to help me with a wheelchair and safely retrieving her. I told the doctors I thought she had a stroke, she wasn’t speaking coherently, her fever wasn’t responding to Tylenol, and she was a retired executive so her baseline is much higher than her similarly-aged peers.
After multiple behavior tests, a CT scan, an MRI, and a voluminous collection of bloodwork, they came back with a three-part diagnosis: 1) the ‘rona; 2) a possible ischemic stroke, but not in the last 24 hours; and 3) NPH.
What’s NPH you ask? So did I. Normal Pressure Hydrocephalus is a brain disorder that occurs when excess cerebral spinal fluid accumulates in the brain’s ventricles. This dementia precursor places abnormal pressure on the brain due to the overflow of fluid in the ventricles. The impacted brain tissues are specifically the ones that impact balance and gait, thinking and reasoning, and bladder control. The cause is often unknown. It is believed to not be genetic. It can be misdiagnosed as Alzheimer’s or Parkinson’s.
Why screening for brain atrophy or NPH isn’t a part of standard aging preventative care, I don’t understand. The only way to truly see it is using imaging via CT or MRI scans. You may see dementia symptoms or a change in ability to balance or in gait when walking. So little is known about NPH, it became a research mission to find an adequate amount of information.
My goal in writing about this is specifically to encourage you to pay attention to the aging population in your life. Look for changes in ability to reason, frequency in bathroom use or incidences of incontinence, and watch for changes in balance or gait. One statement from patients that was commonly cited in the material I read is that their “feet feel like they’re in cement and won’t move” or “I feel like I’m walking on a boat.” My grandmother has all of her own teeth, used no assistive devices, and drove herself to breakfast 4 days before we landed in the emergency room. I had no idea.
We are so grateful that she has made a full recovery. Fourteen days in the hospital, six weeks in a residential skilled nursing facility with occupational and physical therapy daily, and then in-home therapy have her back to normal. But we have made conscious changes for her safety. Glass tables and furniture with sharp edges have been removed in case she gets wobbly. We continue to encourage protein consumption and cutting sugar. We encourage walking around the house since someone is always with her now. We are also confronting and preparing for the incontinence issue because it is critical to keep her dignity in tact.
I hope that this post goes viral specifically for the purpose of drawing awareness to this brain disorder. We never would have known if she wouldn’t have spiked a fever landing us in a hospital with a fantastic physician who sent her for imaging. We now have time to plan, adapt, and teach her about what to expect so that she can make decisions for how she wants any symptoms to be managed going forward. If you have seniors in your life, I hope this shed some light on a disorder that may be overlooked. Wishing you and your loved ones much health and happiness.
Additional Resources:
Hydrocephalus Association: https://www.hydroassoc.org/about-normal-pressure-hydrocephalus/
Alzheimer’s Association: https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/normal-pressure-hydrocephalus