To Your Health

Dear Dr. Roach: I am dealing with normal pressure hydrocephalus (NPH) and had a spinal tap a few months ago. It improved my brain fog, but my neurosurgeon opts against putting in a shunt. I’m 96 years old. Could repeated taps assist me further?

— M.G.

Dear M.G.: NPH involves elevated fluid pressure in the brain. The exact reason for this condition remains unclear, but it typically shows symptoms like an atypical gait, incontinence, and, of course, the brain fog you pointed out.

A spinal tap can be an effective diagnostic tool when NPH is suspected. By removing a substantial amount of spinal fluid, the compression on the brain and spinal cord is temporarily alleviated. If symptoms, particularly walking difficulties, improve noticeably, that’s a strong indicator of NPH. However, the pressure tends to rise again after just a few days, and needing frequent taps could make the situation worse than the condition itself. Plus, there are no proven medications to help.

This makes me curious about why your neurosurgeon dismissed the idea of a shunt, which is the standard treatment for NPH. A shunt redirects spinal fluid into the abdomen, maintaining lower pressure and is the only method that can genuinely enhance functionality.

I understand that undergoing brain surgery at the age of 96 carries risks, but NPH often progresses over time. It may be worth considering a second opinion.

Dear Dr. Roach: In a recent article, you discussed the risks associated with microplastic polymer particles. Could you explain which health issues might arise from this and how they show up in the body?

— C.C.

Dear C.C.: Currently, there aren’t thorough studies that quantify the risks linked to microplastics. While they are suspected to impact various organs, the extent of that damage in humans isn’t well-defined. The digestive system could suffer from persistent inflammation and alterations in gut bacteria. The lungs might experience diminished gas exchange. Male reproductive health may also be affected, and although there is concern about a potential rise in cancer risk, nothing is confirmed.

It’s somewhat frustrating that we have discussions about the risks of microplastics, yet lack solid evidence to gauge their harm. For the time being, here are some practical steps to minimize exposure:

• Opt for glass or steel instead of plastic water bottles, as tap water generally contains fewer microplastics than bottled.
• Avoid microwaving food in plastic containers.
• Utilize glass or ceramic for food storage.
• Steer clear of heavily processed foods.
• Use a vacuum with a high-efficiency particulate air (HEPA) filter in your living spaces.
• Consider home-filtration devices equipped with fine filters (around 0.2 micrometers).

Most of these recommendations benefit not just your health, but also the environment. Implementing them won’t be a wasted effort. On a broader scale, addressing the microplastics crisis requires systematic changes, such as tackling oceanic plastic waste, which is beyond my immediate influence.

Readers may email questions to ToYourGoodHealth@med.cornell.edu.