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Donna Nammar of Cottonwood, California, doesn't let anything get in her way. She'd never been much for bike riding, but at age 43, she decided it was a good way to get fit. Soon she was pedaling 25, 35, 50 miles a day, keeping track of every mile. And on December 31, 2000, at age 58, Nammar logged her 100,000th bike-riding mile.
In a picture from that day, she's standing at the top of a small hill, her arms flung skyward in exhilaration.
She looks invincible, but the wheels soon started coming off her life. She took several falls on her bike. Then she began having "accidents." And she kept getting lost -- in the middle of a sentence, or at the end of a hall, clueless about where she was headed. Was her memory bad? "She didn't have any," says Nammar's husband, Ross.
Then her feet started sticking to the ground, almost literally. "I walked with a strange sort of shuffle," she says.
Nammar, who was in her 60s by then, saw specialist after specialist, with no success. But she doggedly kept going; she even tried an acupuncturist. He had nothing to offer, he told her, but he gave her a piece of cryptic advice: "Go home and look up normal pressure hydrocephalus."
Remarkably, Nammar had gone to the one acupuncture office in town -- in the universe, perhaps -- where the receptionist's father-in-law had a condition called normal pressure hydrocephalus, or NPH.
In NPH, for unknown reasons, excess spinal fluid collects in small pockets in the brain. Experts believe the enlarged pockets interfere with the brain's normal circuitry. Sitting in front of her computer, Nammar read about NPH's classic trio of symptoms: feet that will barely move, incontinence, and memory loss. "Oh my God," she said. "That's me!"
The most common treatment is to install a shunt in the brain to drain the excess fluid, usually into the abdomen. All Nammar needed was an official diagnosis, but when she went back to her doctor, he pooh-poohed her, saying the syndrome was so rare, she certainly didn't have it.
In fact, NPH is probably more common than many doctors think, experts say. "There's not a lot of awareness about NPH even in the medical community," says Laura Paré, MD, a professor of neurosurgery at the University of California, Irvine.
Nammar persisted, though, getting a referral to a neurologist, who quickly vindicated her self-diagnosis. She pushed again when the specialist suggested she delay treatment until her symptoms worsened; Nammar's own research indicated immediate surgery was a better approach.
"Good for her," says Marvin Bergsneider, MD, neurosurgery professor at the University of California, Los Angeles. "The longer you have symptoms, the less improvement you're likely to see."
In January 2008, Nammar got her shunt. She's back on her bike and ready to get going. "This summer, I plan to ride 25 miles a day," she says. And she's not a bit worried about getting lost along the way.
The Cures That Can Cause Big ProblemsWhen the doctor told Billy J. Reeves he had dementia, he felt like the bottom was falling out of his life. He'd lost his wife to Alzheimer's disease just a few years before, so he knew his future was grim.
Reeves, 78, had been forgetting the names of his customers at Reeves Cleaners in Griffin, Georgia -- customers he'd known for as long as 50 years. But his failing memory was only the latest in a long line of ailments. He was already being treated for high blood pressure, high cholesterol, sinus problems, stomach complaints, unexplained pains in his arms and legs, anxiety, insomnia, and depression. The drugs his doctor prescribed for dementia brought his total to 21.
Not that they were doing him much good. "I didn't feel right," he says. "I couldn't function."
Reeves doesn't sound like a particularly lucky guy, but he was very fortunate in this respect: A longtime customer of his, Armon Neel Jr., was a certified geriatric pharmacist. Dr. Neel offered to take a look at Reeves's medications. He had a strong hunch that he could help: Studies show that polypharmacy -- taking multiple drugs -- is particularly risky for older people, who often need treatment for a number of medical conditions but whose slowing systems are less efficient at processing drugs. The liver is crucially important in drug metabolism, for instance, but it shrinks by as much as 35 percent between young adulthood and old age, and its ability to clear some categories of drugs takes a proportional tumble.
Of the 37 million people 65 and older in this country, Dr. Neel says, "probably 80 percent have drugs on board that are causing side effects. And many of those are having memory problems."
Dr. Neel found that a number of Reeves's medications had been prescribed to treat side effects of other drugs that he was taking, a phenomenon known as a prescribing cascade. For instance, his stomach problems were probably caused by the pain relievers he took for the aches in his limbs; the limb pains had probably been caused by the drugs he was taking to lower his cholesterol. Most important, several of his medications were known to cause memory loss in some people.
So Dr. Neel wrote a report for Reeves's doctor, noting the drugs that were likely to be causing problems and suggesting safer substitutes. It was 29 pages long, and every page offended the physician. Reeves needed the drugs, he said.
Reeves found another doctor.
Today he takes just six medications, which keep his blood pressure and cholesterol under control. Some of his other complaints have simply vanished. He recently headed up a successful drive to raise $90,000 for a statue of his hometown's founding father. And he still runs his dry cleaning business, where he greets his customers by name.
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