"Try or Die"

Ken Tuggle
February 15, 2006

At age 66, going on 67, I have two chronic physical conditions. The first, normal pressure hydrocephalus (NPH), is a neurological condition of uncertain origin, diagnosed, at least in part, by its symptom complex: impaired balance, gait, and short-term memory, and incontinence. I understand the only treatment to be surgical placement of a shunt - a pressure sensitive "brain drain" that opens to release cerebral spinal fluid (CSF) when the intracranial pressure exceeds a preset limit - to maintain the pressure at a level that does not provoke symptoms. Shunt placement yields results varying from complete recovery (my case) to moderate change to continued decline.

The second, low testosterone (LT) occurs in men in varying degrees as they age. LT is diagnosed by blood work showing low serum testosterone levels. Its symptoms include reduced vitality and reduced sex drive. Treatment is providing the body with externally supplied testosterone, in my case by a daily topical application of Androgel to my upper torso. It works remarkably well to abate both symptoms.

I want to tell you about my recovery from surgery to implant a second shunt when my first failed after about three years of service. For me, it was a try or die situation. I chose to try. Complete recovery and major personal gifts resulted.

Putting the gifts before the gore, 20 months post surgery, I see that major personal events such as an illness provide us an opportunity to crack open the cocoon of complacency and convention that we allow to bind and blind us to creative, alternative ways of acting, being and caring. So seen, the tragedy lies, not in the event, but in our failure to avail ourselves of the opportunity for personal metamorphosis the event presents or our failure to become open and aware, even seek, both prospectively and retrospectively, more such opportunities to revise and reform our lives. Indeed, I believe our lives are filled with such opportunities. May you recognize and embrace yours.

Now for the gore. In the first week of January 2004, I skidded our pickup truck off a rain slicked curve, totaling it. I received no wounds, but low back strain halted my usual mild fitness routine. Concurrent onset of low testosterone robbed me of vitality needed to pursue recovery. And recurrence of Normal Pressure Hydrocephalus symptoms led me to contact my original neurosurgeon to discuss how my shunt was functioning - on the day he retired from practice. On that day, my balance was becoming erratic, and I was resuming the wide placed stance typical of NPH. My gait was sliding from a stride to a shuffle, again. As my memory faltered, I was moving from long dictation from few notes to short dictation from many notes. And to stay dry during my 45-minute morning commute, I gave up my morning tea until I reached work, relocated all public toilets on my route, and put the wide mouth pickle jar back in the car. Having been here before, I despised returning. I thought of myself as a pitiful wreck but was determined to do something about it.

At my request, my original neurosurgeon wrote my internist summarizing his placement of my first shunt and the relevant medical history. My internist recommended Dr. Clark Bernard, a neurosurgeon, in a well-known Louisville neurosurgery group. Dr. Bernard and I soon established our doctor-patient relationship. After reviewing my medical history and radiographic films, and obtaining his own data, Dr. Bernard concluded my first, fixed range shunt had failed and recommended a new externally, programmable one. Because my brain had grown around my first shunt, he recommended abandoning it in place, but removing and replacing the existing internal drain tubing.

I agreed with Dr. Bernard's proposed conclusion and treatment, but sought a second opinion from a well qualified local neurologist to rule out other neurological diseases that might cause or contribute to my symptoms or be masked by them. Finding none, my neurologist concurred with Dr. Bernard's recommendations, and I agreed to a second surgery.

On the morning of June 2, 2004, in a three-hour operation, Dr. Bernard placed a right frontal ventriculoperitoneal shunt using a Hakin programmable valve. I went home at noon the next day to recover from three significant incisions, closed with surgical staples, a severely sprained neck and the past six months of minimal physical activity. Recovery provided the most significant challenge of my first 65 years.

Once home, I had much to do to become functional again. I was unable to drive, stand or walk for more than a few minutes before my neck pain struck. Sitting on hard chairs was agonizing, but I could do an hour or more on soft ones. I could not lift more than a few pounds. Obviously, I needed an exit strategy and patience. In the days and weeks that followed, I developed both. I was beginning a new phase of my life and had time to spare.

Spiritually, I resumed my daily morning meditation and prayer, asked my spiritual family to send healing energy and my more conventional friends for their supporting prayer. Both responded. So did I.

Physically, I determined to improve my condition short-term and long. Short term, on my first post-surgical visit to remove my surgical staples, I asked Dr. Bernard to order physical therapy at a hospital near our farm and commenced three visits a week. Guided by my therapist, I also resumed as much exercise and walks on our farm as I could tolerate. At every opportunity, I pushed my physical envelope - gently, but persistently. When insurance limits ended my therapy visits, I used the last visit to get exercise routines and Therabands to continue therapy at home, and have increased repetitions, weights and resistances, and added other exercises. Long term, realizing the folly of my pre-surgery lassitude, I exercise and walk daily, work around the farm and hike with old woods buddies.

Personally, I asked my wife of 30 years for spiritual, emotional and physical support. Thankfully, she provided it with tolerance of my limitations and self-centric focus. She also helped me realign my lifestyle in more balanced, healthier and sustainable ways. And she accepted my offer to rebalance our partnership by me assuming greater responsibility for many routine activities. We have a stronger, more loving and balanced relationship, despite the agony of my home recovery. I am, we are, happier.

In early July 2004, I returned to work part-time, and in November 2004, full-time. By then, my physical recovery was well along but not complete. Dr. Bernard rated my recovery in the top 10% of persons receiving a shunt placement for NPH. Although delighted with the result, I was aware my mental functions still lagged. To address this lingering issue, I decided that continuing legal practice provided the best therapy available, and it has been. It was hard work and took determination, but I had a goal and also still enjoyed the practice of law. By mid-2005, my colleagues and friends agreed I was as good mentally as I ever had been. That's good enough for me.

Today, I have much to be grateful for and much to look forward to. I am alive and well, enjoying life and going on. Major illness indeed can be a catalyst to personal change.

(Ken's e-mail address is ktuggle@fbtlaw.com)