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“In a radical fashion, Jesus, by example and word, establishes servanthood as the way in which his people are to lead others.  He expressly repudiates every secular model of leadership in favor of servanthood.”  -Philip Greensalde

]]> http://mmcneuro.wordpress.com/2012/12/15/nph-often-a-diagnostic-dilema/ Sat, 15 Dec 2012 23:06:26 +0000 Dr Holland http://mmcneuro.wordpress.com/2012/12/15/nph-often-a-diagnostic-dilema/ Normal pressure hydrocephalus (NPH) is caused by excessive accumulation of cerebrospinal fluid (CSF) and enlargement of the brain’s ventricular system, putting increased pressure on the surrounding brain tissue, and leading to a distinctive gait disturbance, urinary incontinence and mental decline.

NPH can be effectively treated by a surgical procedure to divert the CSF from the ventricles into the peritoneal cavity via a ventriculoperitoneal shunt. Early diagnosis and treatment are important for this surgical treatment to be effective.

However, many patients with dementia or gait problems and large ventricles on a brain imaging study will not improve after shunting.  Performing surgery on all such patients, without further selection, can result in ineffective surgery, and more importantly other potential complications like bleeding around the brain (a subdural hematoma).

Therefore selecting the patients with suspected NPH who are most likely to benefit from surgery is of the utmost importance.  Most patients with suspected NPH will first undergo a lumbar puncture to measure the CSF pressure, and then drain off excess fluid, temporarily lowering the pressure.  If they improve after this procedure they will usually be referred for placement of a permanent ventriculoperitoneal shunt.

However, “improvement” after lumbar puncture is generally assessed subjectively, and can be very transient.  Some NPH patients who do not improve after lumbar puncture do still benefit from a shunting procedure.  Studies have shown that careful evaluation of patients using objective measures during prolonged CSF drainage via a lumbar drain is the most sensitive and specific way to predict which patients will improve with surgery.

The Monmouth Neuroscience Center  has developed a multidisciplinary hydrocephalus assessment program to evaluate patients with suspected NPH and determine who is most likely to benefit from a shunting procedure.  Patients are admitted to the intensive care unit, where a sterile lumbar drain can be placed to continuously drain CSF over 1-3 days, while they are carefully evaluated by our multidisciplinary team of neurologists, neurosurgeons and physical therapists for improvement in memory and gait using objective measures including videotaped gait analysis.

At the conclusion of the procedure, the drain is removed, and patients can review this data with their doctors to decide whether they might benefit from elective re-admission for placement of a permanent ventriculoperitoneal shunt.  Our surgeons implant  shunts with magnetically programmable valves allowing easy access to fine tune shunt function over time.  Patients are regularly followed by our team of neurologists and neurosurgeons, with ongoing adjustment of the valve in the shunt using an external programming device to ensure the correct rate of CSF drainage, to maximize neurologic improvement and minimize complications.

Click here for more examples of neurogenic gait disorders. For more information about the NPH program at Monmouth Neuroscience Institute, please visit our website, or call us at (732) 923-5576

Pseudocast IV – Watch Along: Dr. Horrible 

Anyway, this is our attempt at commentary! So get out your copy of Dr. Horrible’s Sing-along-blog and get ready to Watch Along with Mitch n Chelsea (what a good name for these huh?). You don’t have to follow the movie, but then you’ll just be listening to us kinda sing for 40 minutes.

So let us know if this is something you folks enjoyed, or if you ripped out your ears after the first 2.7 minutes; we appreciate constructive criticism.

*we don’t own the rights to Dr. Horrible’s Sing-A-Long Blog, of course; we’re just massive massive fans of everyone involved in its creation*

Vulture named Jennifer Lawrence their Celebrity BFF of the Year, an accolade my friends and I bestow on her every time we read an article, see a picture, watch an interview, or go to any movie in which she graces her presence. The foul mouthed, down to earth, bow wielding super star would be #1 to attend my fantasy celebrity brunch. Here’s who else rounds out the list:

• Mindy Kaling- Have you seen the Mindy Project? I want her in my life.
• Tina Fey and Amy Poehler- My idols, my heroines, my favorites.
• Jason Segal- He could bring his muppet friends too.
• Neil Patrick Harris- His family is just so adorable. Brunch with him would be legen-wait for it- dary.
• Emma Stone- Self-deprecating, adorable, and unassuming, and she has the in with Ryan Gosling. Speaking of…
• Ryan Gosling- I mean, yeah.

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I have learned many things while living here in Seattle. One area in particular is as a leader for my NPH family. I want to give my best effort while I study English at Seattle Central Community College. Also, I want to share my dreams and experiences from NPH. My dream is to help my NPH family because so many people have helped me. I feel happy to know so many people that want to help all the children of NPH. In the future, I want to study economics or finances. Why? Because it is a way that I can help my country and NPH. A phrase that has helped me grow as a future leader: If you want to change the world, you need to start with yourself.

Thank you for being part of my family and for reading my post, because I am NPH.

Rodolfo

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Photo: NBC

While Blake Shelton is elving crazy, 90210 celebrates it’s 100th episode. Find out what else is on tonight.

I just love this so much. People singing this song is a surefire way to make me fall in love with them. It doesn’t help that my new unemployed weakness is watching How I Met Your Mother (yep, I have become everything that I detest).

Image: Screenshot via YouTube

Neil Patrick Harris + Singing Puppets + The Nerdist = araghgrahwhaaaaaaOURDREAMSCOMETRUE!

Check out the Premiere of the series below, via The Nerdist’s YouTube Channel.

It’s called Neil’s Puppet Dreams. It has Neil Patrick Harris. And David Burka. And Jim Henson puppets. AND IT’S AWESOME.

Pay me indeed.

Muppets plus Neil Patrick Harris. There is no way this could go wrong. Watch it. WATCH THE SNOT OUT OF IT! Now! You won’t be disappointed:

It’s clear that, like ‘toons, puppets have no regard for the laws of physics, sense-making, or human life. But damn, they’re funny. The ep starts a bit slow as we’re introducing the concept but it ends with a bang (or whatever sound  bodies make when they hit the ground. Something between a thunk and a splat, I guess). Watch it, and also subscribe, because that’s a real button, that NPH is really holding.

Neil’s Puppet Dreams is the Best. Thing. Ever.

Casper Van Dien

The hot Denise Richards

Aliens who are mean

Acting’s an option

When your out to kill Bugs

Just CGI mayhem

And gratuitous jugs

#

Verhoeven at his finest

With blood and guts galore

Though more bugs get blown up

If you want to keep score

With cruel basic training

Who can tell who’s more dangerous

When Zim’s throwing knives

The body count’ s tremendous

#

The big baddie is the brain-bug

It just fills you with awe

Until it kills you

Sucks your brain through a straw

And  let’s not forget

Neil Patrick Harris

In faux nazi dress

Not one to embarrass

#

Leave your brain at the entrance

Your bound to enjoy

With all you would need

As a twelve-year-old boy

Filled with propaganda

Would you like to know more?

The great Starship Troopers

A film I adore

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Father Rick, on behalf of the St. Luke Foundation which helps fund the St. Luke Hospital as well as many other programs, received the prestigious Opus prize in recognition of the phenomenal impact the Hospital and the many other programs have had in the lives of thousands of Haitians. The Opus prize is a faith-based humanitarian award that gives one $1 millon award each year to a deserving organization. Here is a beautiful video put together by the Opus Prize in recognition of Fr. Rick and the St. Luke Foundation’s work:

Ted and Victoria’s break up story felt like a rip-off of the Ross and Emily breakup from Friends (and people say that the shows aren’t similar). Victoria can’t be with Ted because she can never be comfortable how close he is with Robin and for their marriage to work out, Ted can never see Robin again. When the writers brought Victoria back in such a dramatic way, I assumed they have some big plans for her. Alas, I was very disappointed. They reduced her into a minor character making you wonder what that last finale was all about. I could only find two upsides to the entire Ted-and-Victoria-version 2.0 storyline. Firstly, Bays and Thomas using The Swell Season’s Low Rising as Ted and Victoria’s break-up song. And secondly, – and this was the most impressive moment of the episode – was Ashley Williams’ (Victoria) more than commendable acting skills during the breakup. With her mixture of frustration at Ted’s decision and the heart-wrenching sorrow of knowing it’s over, she far surpassed the performances of all her co-actors this season.

Of course it always feels a little rough criticising NPH’s acting simply because it’s more likely to be a bad script than his flaw – yes, he is that good. Personally, the Brover storyline made me think Bays and/or Thomas had a nasty head injury during all that Sandy fiasco. It was being stupid and the only thing that made it look good was Marshall and Lily’s storyline. I think we are way past decent Lily-and-Marshall plots and everything from now is going to go downhill. So that’s one out of three storylines. And Ted’s storyline is starting to look quite poorly planned. So the only story that has anything going for itself is Barney and Robin’s. Not surprisingly, this episode (much like the rest of the season) laid the groundwork for a return to a Barney and Robin world. And I am looking forward to that because that would effectively end the Ted-Robin rumours. So how are Bays and Thomas going to write themselves out of this one? I’m probably biased on this one but how many times do we have to go back to the Ted and Robin story? It’s frustrating because we know that they aren’t going to end up together so now that storyline feels like a drag. This is a sad time in my life. I ‘m running out of reasons to keep watching How I Met Your Mother. I almost decided to stop but Squirrlock Homles was funny enough to make up for the lack of laughs in the episode.

What did everybody else think? 

Let’s hope my facebook friends prove helpful :p 

As far as the day…it was actually pretty terrible. Well it started that way, and increasingly got better. I’ve been struggling a lot with feeling lonely, dealing with insecurities with the job, and trying to fund raise with little improvement. On top of that, only my sister, an aunt, and a cousin told me happy birthday on my birthday….actually at all even (minus friends. I have a lot of awesome friends who love me ^_^) After a conversation last night poking sarcastic jabs at the folks for forgetting, I realized they spent all our time defending themselves and still never actually said happy birthday! Maybe I’m being a baby about it, but that got me a little pissed. I have a big family, so the fact that only 3 of them shared my day with me (none of them live in the house), that hurt, and set the stage for the rest of the day.

Later on, my awesome friend/coworker took me out for some delicious burgers for my b-day. She let me spew on her about life (thanks much my friend), and really helped to begin lifting me out of my deep dark hole. And was it deep and dark!

As I went on my way to an meeting, I began listening to Psalm 91 (great one for encouragement!) and praying into it. For the rest of the day, meeting after meeting, God showed faithfulness in bringing new donors to the ministry, good relational conversations with people, and not to mention 2 counts of free food! By the end of the night, I was leaps and bounds on a better emotional ground. You’d think after so many years on staff I would learn that when I am feeling my darkest, something is good/encouraging/powerful is going to happen.

Yep. It sure did!

Dr. Horrible’s Sing-Along Blog.

I believe there will be a second season, and I’ve heard rumors of a certain Mr. Barrowman maybe lending his vocals…

Nonetheless, not to start out with a 10-day deficit, I decided to go ahead and write in the mornings before work Thursday and Friday and to start my weekend of costume-making frenzy off with some morning pages.

I thought I’d see if something different could get me back in the writing groove, since I’ve been lost in the Fire Swamp battling lightning sand and R.O.U.S.’s (they totally exist) otherwise known as the end of my novel. Thus I started the Christmas novella.

You guys…oh, my God, you guys. I have banged out close to 10,000 words so far.

My daily average is 2355 words right now.

I can’t stop thinking about these characters. I can’t stop finding things to write. I am abandoning my cosplay to write, and I never abandon costumes at crunch-time for anything (seriously…ask my husband how much attention he gets in the last week before a big masked event).

I think my muse is on X right now. Or speed. He took some kind of ridiculous upper and is going monkeyballs crazy dryhumping my imagination, NPH in Harold and Kumar Go to White Castle style.

This development has caught me utterly by surprise. I expected to get a little work done this week, enough that I didn’t feel too terribly behind on the 11th when it’s finally time for me to focus on writing, but this…this is a godsend.

I can’t even care that what I’m behind on now is my costume, because it just feels so frakking good to be writing again, and to be loving the act of writing again, and to be making myself giddy and shrieking with laughter at my own cleverness again. It’s…been a while since I felt this feeling, the feeling that reminds me why I love to do this in the first place, that I don’t just love the product but also the process.

I can’t wait to see what tomorrow brings.