El: Retired Merchant Marine Faced Choppy Waters

As a merchant marine and industrial electrician for more than 50 years, Eleftherios "El", 74, was used to living through hard and unpredictable conditions at sea transporting manufactured goods all over the world. But, when he retired and moved from Florida to Chicago in 2006 after his houseboat was damaged in a hurricane, he began to face bigger problems on land than he ever faced at sea and for five years, his family, friends and doctors could not figure out exactly why.

El had heart surgery and suffered a stroke the year he came to Chicago and later developed vascular dementia, a condition that causes cognitive problems as a result of impaired blood flow to the brain. Yet, his daughter, Demetria, 49, and some doctors didn't think those conditions were fully to blame for his difficulty walking, increasing confusion and memory problems and incontinence.

"We looked for solutions from a variety of family doctors and specialists," said Demetria, a business consultant who also was the primary caregiver for her father. "Because the symptoms could be attributed to other conditions, it was hard to find out what was really causing his health problems."

The cause was normal pressure hydrocephalus or NPH, a little-known neurological condition characterized by three primary symptoms: cognitive decline and confusion, walking and balance problems and incontinence -- symptoms similar to those associated with Alzheimer's, Parkinson's, dementia or "old age." Experts estimate about 375,000 people in the U.S., or five percent of all those with some form of dementia may have NPH.1

Over five years, El suffered frequent falls. He walked with a cane and then a walker and eventually he needed a wheelchair. His mind started to suffer. He couldn't remember the names of some his family members and had trouble distinguishing his sister from his aunt.

El was diagnosed with NPH when a CT scan revealed enlarged ventricles in his brain due to an excess buildup of cerebrospinal fluid (CSF). Additional tests revealed he could benefit from treatment. In 2011, El had shunt surgery, the standard treatment for NPH. In the procedure, he had a CODMAN® HAKIM® Programmable Shunt, implanted under his scalp. This thin, tube-like device drains excess fluid from the brain and moves it to the abdomen where it is absorbed. After implantation, the shunt may need to be adjusted because removing too much or too little fluid can be problematic. Programmable shunts allow doctors to painlessly adjust settings quickly using a magnetic device held over are the area where the shunt was implanted. In the past changing the setting required further surgery.

Since surgery, El is out of the wheelchair and walking on his own and his thinking has improved. He participates in activities at the local senior center and visits his two grandchildren in Florida. The former merchant marine is also working out at the gym with hopes of getting in good enough shape to go sailing again on the boat he keeps at a Chicago marina.

1 Hydrocephalus Association

While most experts say that approximately 375,000 people have NPH, estimates have ranged from about 200,000 to 750,000 cases of NPH. Hospital discharge data shows that only about 11,500 cases a year are currently diagnosed and treated with surgical implantation of a shunt. Since NPH is often mistaken for other conditions, most cases of NPH go unreported and many are left untreated. Only a specialist can properly diagnose NPH. Surgery is not for everyone. There are potential risks and complications; recovery may take time.

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