DEAR DR. DONOHUE: My 83-year-old mother was told she has hydrocephalus. She has a hard time walking. Her doctor wants her to have fluid drained from her head. Will you please tell me your thoughts on hydrocephalus? — K.

ANSWER: The word hydrocephalus (water on the brain) turns people’s thoughts to the infant condition where too much cerebrospinal fluid overfills the brain’s ventricles (hollow caverns) and causes head enlargement. The adult equivalent of that problem is called normal pressure hydrocephalus, NPH.

NPH occurs at any age, but mostly happens to those older than 60. It has three fairly distinctive progressive signs: difficulty walking, loss of urine control and impaired memory and thinking. Typically, affected people walk with small steps and have a hard time lifting their feet off the ground; it looks like the feet are glued in place. Loss of bladder control is something that develops after the walking problem has been present. Mental changes include a loss of all interest in what’s going on, an inability to stay focused, difficulty in expressing thoughts and loss of memory. It can be mistaken for Alzheimer’s disease.

A CT scan or an MRI scan demonstrates the enlarged ventricles and a shrinkage of the brain.

Once doctors have evidence that a person suffers from NPH, they often drain an ounce or two of spinal fluid through a lumbar puncture. That temporarily corrects many of the above problems.

When the diagnosis is certain, permanently draining the excess fluid from the brain caverns brings about permanent improvement in to up to 60 percent of patients. A thin plastic tube called a shunt is placed into the fluid-filled brain ventricles, and the other end of the tube is maneuvered into the abdomen. This procedure keeps cerebrospinal fluid from overfilling the brain ventricles. Your mom might benefit from this.

TO READERS: I printed a letter from the grandmother of a teenage girl who had her tongue pierced and wanted to know the health consequences. I invited dentists to contribute their views. Dr. R.C. responded. I am grateful he did.

Here is his response: “Although infection would seem to be the obvious complication, I have not seen one. The more common risk is tooth breakage and, in extreme cases, tooth loss. The tongue ‘jewelry’ is dumbbell-shaped, with one ball sitting on top of the tongue, the shaft through the body of the tongue, and the other ball under the tongue.

“Some develop the habits of biting the ball or rubbing the bottom ball against the inside of the lower front teeth. I had one patient who broke six teeth before he decided that tongue jewelry was not a good idea. One patient did enough damage to require extraction of the two central incisors. She needed bone grafting and implants. Functionally she’s fine, but the aesthetic result is very poor.” — R.C., D.D.S.

DR. DONOHUE’S COMMENT: The idea of doing such a thing creeps me out.

DEAR DR. DONOHUE: You wrote about chronic diarrhea. I had the problem and found out that sorbitol was the cause. It is in some foods of different varieties, like sugar-free candy, salad dressings, mayonnaise, cookies and others. Once I cut out the sorbitol, my problem disappeared. — M.M.

ANSWER: Sorbitol is a sugar alcohol — an unfortunate name, since it’s neither a sugar nor an alcohol. Sugar alcohols are used as sweeteners in place of sugar itself. They have fewer calories. Sorbitol is not the only sugar alcohol. Xylitol, maltitol, lactitol, mannitol, erythritol and isomalt are others. Many sugarless gums and candies contain one of these products.

Excessive amounts do bring on diarrhea. Some people are sensitive to them and develop diarrhea with lesser amounts. Thanks for sharing your experience.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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