One Month Down - 13 to GO

To clarify any confusion that I know the title has already caused, I plan on finishing work at the end of June and then traveling for 6-8 weeks. On that note, it has been brought to my attention that the very end of my last post can be misleading. What I meant was: it's too bad my Mom never taught me to eat with my mouth shut. And it's too bad that, despite Nate's best efforts, I never learned before I left.

So, not too much has happened since I last wrote. Yesterday I went to Cologne (Koeln), which is actually the place that cologne (the crap you put on yourself to smell nice_ was first made. I think it was for some religious purpose at first. It was pretty nice, I've been there before, but it was cool to just decide to leave Aachen at 5 pm, take a 1 hour train ride, and be in a totally different city. Plus, the train is free!!!!!!! Germany is great for students, you don't pay for shit. Went to Koeln, got some food, drank some beers, watched "The Wedding Singer" and came back to Aachen all for 8 Euros. Thanks again John.

Posted some more pics for y'all. They are from my rowing trip somewhere in Germany, my sailing trip from last weekend, and from today. I threw in a couple pics of my place here in Aachen so you can get a picture of my day-to-day. As usual the link to the pics is in my links section.

So I've also had a request to explain more about my work here in Aachen. I'm not exactly sure what would be of most interest, so I'll keep it broad. If you have any specific interests, let me know.

So, what is hydrocephalus? Basically, it is a persons inability to properly regulate the amount of cerebrospinal fluid (CSF) that is swimming around you brain and spinal column, right now, as you read this. You need this junk to cushion your brain from your hard skull, like when you get hit in the head from a friend (is that just me?), plus it helps transmit nutrients and chemicals, and stuff. I've read that is has the consistency of water.

So the proper way CSF is circulated is that it is produced in ventricles, which are at the center of your brain. From there, is flows through some canals, to your brain. Your brain and spine are saturated and surrounded by it. It then gets reabsorbed into your bloodstream by diffusing into certain blood vessels near your skull. Typically, the rate of production of the fluid matches the rate of reabsorbtion, and you are cool. However, people with hydrocephalus cannot reabsorb the CSF properly. Too much fluid gathers in the patient's head and spinal column, which creates a large amount of pressure in the skull. This high pressure (maybe 50 - 100 mmHg for the engineers) disrupts your mental and motor skills, and basically, if left untreated, will put you in a coma and kill you. If I am not mistaken, and I think I might be, that is what happened to my cousin Meghan. I think her cancer also grew so rapidly and large that it put pressure on her brain directly too.

Hydrocephalus can occur because of three main reasons: a congential defect where you body cannot reabsorb enough CSF; a brain tumor or lesion forms in your brain, which blocks the CSF and doesn't let it reach the reabsorption sites; too much CSF is produced, again congential. According to the Hydrocephalus Foundation, hydrocephalus is "one of the most common 'birth defects'" and affects more than 10,000 babies each year (in the US or world?).

Okay, so how is hydrocephalus treated? There are a few ways, but the most common and successful is to implant a valve under the patient's skin (typically behind one ear), which is connected by tubing to a ventricle in the brain and the stomach cavity. The valve then lets CSF drain from the ventricle to the stomach cavity, once a certain pressure has built up in the skull, where the CSF is reabsorbed into the blood. However, all existing valves are purely mechanical - that is, they don't measure the intrcranial pressure (ICP) and don't make sure that the proper pressure is in the patient's head. They just open at a specific pressure difference between the stomach and head, which is fixed and only adjustable by a doctor.

There are many complications and problems with these valves, but the biggest is that they tend to drain too much fluid out of your head. For example, if you are laying down, and the opening pressure of the valve is A, then the valve will work fine. Once the ICP reaches A, the CSF will be drained. However, if you stand up, now there is all this liquid pushing down on the valve which was not pushing down on the valve when you were lying down. The weight of the CSF pushing down on the valve is typically much larger than A, the opening pressure of the valve, and therefore, all (or most) of the CSF drains from your head. Besides not being very comfortable, or good for you, it also ends up pulling brain pieces into the valve tubing and breaking the valve. So often, hydrocephalus patients have to go get another surgery and another surgery.... I think the record is 86!!!

People have tried to fix this in a lot of good, smart ways, but the problem still exists. My prof and I are working on the FIRST mechanical-electronic (mechatronic) valve, that can measure a patient's ICP, make sure it is right, adjust the valve's pressure setting automatically and essentially ensure that everything is hunky dorey. At the moment I am in the process of deciding (with my prof of course) what the best way to go about this is, and what components to use to do this (type of valve, how to change the valve setting, what to change it with, etc.). Soon I should start building my first valve and testing to see how it works. If you are still curious, I've put a couple links to the clinical info and one of the better shunts (valve) on the market. I'll also let you know how things are going with my research as it progresses.

One last thing, I've recently learned that the english word school comes from the Greek word skhole. However, "comes from" is slightly misleading since it went through Latin, then Old English, Middle English and now modern English (and I am still pretty convinced through German along the way).