“I need this like I need a hole in my head,” I was tempted to say to my neurosurgeon, Michael G. Kaplitt, M.D., Ph.D., FACS, of the Weill Cornell Medical College of New York-Presbyterian Hospital. Soon he would be making that hole in my head. I wanted all his good will I could muster, which ruled out a typically wise-guy comment from me. I would not want to induce a “Freudian slip” in the vicinity of my brain.
In late spring of 2008, my neurologist, Dr. Baradaran, had listened to my symptoms, sent me for some tests, evaluated them, and had given me, gently, the bad news: I had hydrocephalus, “water on the brain.” If not treated, I would likely experience dementia, depression and death. Outside of that, I joked, nothing to worry about. I saw more neurologists and also neurosurgeons, getting the same message: I needed a hole in my head to relieve the internal pressure from the improper flow of my cerebral-spinal fluid.
My investigations led me to choose Dr. Kaplitt and his group at New York - Presbyterian.
The operation was September 4, 2008. Dr. Kaplitt and team drilled a hole, perhaps a quarter of an inch in diameter, into the upper right-hand region of my forehead, penetrated the dura matter protecting my brain, made a passage through my gray matter to a cavity, the right lateral ventricle, and put one end of a tube there. Several inches from that end, a pressure-regulator valve was attached to the tube, followed by more tubing that was run under my skin, “tunnelized,” back behind my ear, along my neck and chest, finally into my abdominal area.
Recuperation took a month or two. Bedridden and doped up with painkillers, I had a drowsy first few weeks. Your body does not want to have a couple of feet of “tunneling” under the skin to get a hose from hither to yon. I was instructed to take it easy, a command I obeyed, leaving dog walking and other strenuous activities to hired help.
I endured some complications that were not direct results of the operation, and I will not describe them here. You do not really want to know.
The pressure regulating valve is a work of genius. A tiny stopper on an adjustable spring controls the flow through a small orifice to give a selected pressure difference from one side of the valve to the other. The pressure adjustment is made by an external magnetic wand, which signals the valve the degree of tension desired on the spring. Amazing. My initial setting was average for an adult, but subsequent computerized tomography (CT) scans of my brain showed that the setting needed to be higher or my brain would contract and put me at risk for a “subdural hematoma,” the leaking of blood into the space created between the gray matter of the brain and the dura brain casing. My brain had gotten so used to the higher pressure it had for so long, that the valve setting needed to be at or near the maximum pressure. Subsequent CT scans and visits led to a pressure about 10% lower than the valve’s maximum setting. This somewhat high pressure is what I attribute my frequent mild morning hangover symptoms to, but I have been medically advised that putting up with this is better than risking too low a setting.
From this, I emerged the Bionic Doug. No longer was I experiencing three classic symptoms of hydrocephalus, a.k.a. “water on the brain”: trouble walking, urinary incontinence, short-term memory deficits. I had a fourth symptom that was fixed, also, a narrowing of my emotions, less cheerfulness, less gloom, a dull, mellow emotional middle ground. Upon recovering, I preferred my ups and downs to this emotional numbness, but it had not been all that bad.
Three years later, I feel fine. I can walk our dog and get some other exercise. Still profoundly retired, I’ve written a book about my wife and me, Ting and I: a Memoir of Love, Courage and Devotion. I’ve become a freelance writer, or so it says on my business card. I thank Dr. Kaplitt and staff and my own neurologist, Dr. Baradaran of Middletown, NY, for this successful outcome.
It turned out that I did need a hole in my head.