How Google saved my life

White Storks used to be a common sight in the little village in Germany where I grew up. Their return to their old nests each year heralded the true onset of spring - and a new beginning since for us kids any sighting meant a new life was about to be born somewhere in the neighborhood. Gradually over the years sightings of storks became less and less common as the moors and wetlands were being drained to make room for agriculture.

There's only one pair now, and to be sure they stayed, the villager erected a stable platform for their nest.

On a trip to Spain though I discovered where our storks had stopped and stayed on their return from their wintering grounds in North Africa. Almost every high building or church spire in the city of  Caceres on the river Tajo had one or more of their massive nests and in the surroundings were plenty of ponds and wetlands to supply their favorite prey, frogs.

Storks near Caceres, Spain

A new beginning was what I was looking for too. I am apologizing that for the past several months I have neglected visiting and leaving comments on my favorite birding blogs. I have been dealing with a critical health issue, and so, in this post, I am not going to write about birds, but about how a Google search saved my life.

I had become aware of some problems with my memory, such as blocking on names and words, and had started feeling insecure on walks. I was falling frequently without clear cause, falling on trails, on side walks, into a pond, and in an airport.There was no rhyme or reason to these falls, no stumbling or tripping that I was aware of, and fortunately no serious injuries other than bruises. My walking had turned into a choppy gait when tired and hurrying. My husband remarked on it and demonstrated to me what looked like a Parkinsonian gait.  But I knew it wasn't Parkinson's, since there was no rigidity or joint stiffness. It was also puzzling that these problems appeared only intermittently, days or weeks at a time.

The pattern didn't fit any of the common neurological diseases. My memory problems made me worry, of course, about Alzheimer's disease (AD). My dad had died of it, and I was afraid I was heading in the same direction. As a physician I had taken care of plenty of patients with advanced AD and was horrified of facing that same future, an existence devoid of any joy: the patients never smiled, laughed or showed any pleasure, only occasionally displayed anxiety or anger. It was as if a cataract was blocking their mental access to the world and finally obscured it totally, like this:

I saw a neurologist who however couldn't find anything abnormal and referred me for baseline neuropsychological testing. But it turned out to be more than a baseline. The tests looked like child's play with colorful disks, pictures, cards, photos...but the report, after several hours of testing, and the test results being abstracted into numbers and the scores compared to standard data, showed I was no longer as smart as I once was. The neuropsychologist reassured me however that the test results did not point to AD.

I had done extensive reading on neurological diseases such as Parkinson's, AD and multiple sclerosis and had found none that matched what I was experiencing. So I finally entered my symptoms into Google search and I think putting "frequent falls" first was the tip-off in that a new disease popped up: Adult Onset Hydrocephalus and specifically Normal Pressure Hydrocephalus (NPH).  Everything fit: my many falls, my instability when traversing rough terrain, my memory problems and lastly, which I actually hadn't considered a problem yet, urinary urgency (or the sprint to the BR when observing my dogs relieving themselves before bed time).

The tragedy is that the disease, although rare, is treatable but most of the time is not diagnosed. Many patients, bed-ridden or wheelchair-bound in nursing homes because of inability to walk, dementia and bladder incontinence, may actually be suffering from NPH. Dr. Harold O Conn, a former Yale hepatologist (liver specialist), eloquently recounts his own many-years-long journey as a misdiagnosed Parkinson's patient until a new neurologist came up with the correct diagnosis. He was cured with the placement of a shunt to drain off excess fluid from his brain, and since then has been devoting his remaining years to NPH research.

The CBS program 60 Minutes devoted a segment to this disease which then served as a wake-up call to many patients, their families and to physicians.

Along with the triad of symptoms - problems with gait, memory, and bladder control - diagnosis depends on showing enlarged fluid-filled lateral ventricles on CT scan or MRI. An MRI of my brain was initially read as normal. However I also happened to have had an MRI in 2003 for an unrelated problem, and a comparison between the two showed that in the current one the ventricles were significantly larger. I was so lucky to have come up with a diagnosis so early in the course of this  disease, which so infrequent, is often missed.

The next steps went pretty fast. I was referred to neurosurgery, had some more testing, and a couple of weeks later was admitted for placement of a shunt which drains the excess fluid from my brain through a thin tube under my skin to my abdominal cavity where it is being reabsorbed into the blood stream.  The symptoms related to my walking resolved within a couple of days; my memory may take a little longer. I am sure of one thing though: a Google search averted a catastrophe and gave me my normal life back!

I am looking forward to go birding again this spring, venture off trail without fear of falling. At 6 AM a couple of mornings ago I heard a Woodcock's twittering wing beats overhead and another one peenting from the wetland across the road. Shortly after, as the sky lightened, a Robin started singing. All day a Tufted Titmouse has been calling loudly advertising his availability as a mate. Last night we heard the first spring peepers in the swamp next to our house. The snow has melted and spring is here!

Cheers and happy birding!

Birds in Winter

The other day I was surprised to see a flock of about 20 American Robins feeding on the hairy red fruits of  the Staghorn Sumac that was growing behind our shopping center. Because the fruits are dry, have little flesh, no fat or sugar they are usually left untouched until late winter. In spring and summer we are used to seeing them foraging on the ground, running, then suddenly stopping to listen and pouncing to extract an earthworm. In the winter when the ground is frozen they switch to fruit on the ground or still hanging in the trees. 

The Robins we see here in the winter probably probably started their fall  in Canada and found the Northeast temperate enough to stay through the winter, whereas those that summer with us have shifted southward. So these are probably the same Robins we see in early spring when the snow is receding,  in transient large flocks foraging among the old grasses and leaves in our backyards and fields.

Many birds that are solitary during the breeding season often flock together in winter, when food sources are rare and much more sporadic. Even through the bounty must be shared with a larger number it still pays off to have more eyes scouting for them.

Snow Buntings are highly territorial in the summer, jealously defending their nesting sites in the tundra, but during the winter they often travel in mixed flocks with Horned Larks. They are most easily found along plowed roadsides where they forage for grass seeds and grains.

Snow Buntings crossing a paved road

Flock of foraging Snow Buntings and Horned Larks

Male Horned Larks

Both the Horned Larks and Snow Buntings roost in scrapes in the ground or burrow into the snow for extra protection against the cold. During a storm they may let themselves be snowed in. 

In the winter Northern Shrikes, like this first year juvenile, migrate south from their home in the tiga/tundra to southern Canada and the northern United States where prey may be more available.  Sitting high in a tall tree they look innocuous, watching and scouting for any small movement in the trees or on the ground, when they are down in a flash to grab a bird or small mammal, revealing their true nature and justifying their Latin name Lanius excubitor "Butcher Bird".

House Sparrow puffed up against the cold trying to keep warm.

Bohemian Waxwings are true  nomads, roaming in flocks  and descending when finding berry or fruit bearing trees. They are voracious eaters and only leave when all the fruits have been consumed. They are so unpredictable that It's always a special thrill to see them. 

They cheer me up with their jaunty masks and feathered caps, the red wax tips on their wings and the red untertail coverts. Here they are feeding on fruit fallen off a crap apple tree. 

Their rakish looks make me smile.

Homely looking Wild Turkeys foraging on a manure pile in a snowy field.

I first saw this Common Raven on the flat roof of parking garage. It then flew across the parking lot and landed on a  mound of snow at the edge of the lot where I followed it in my car. I was able to take a couple more photos before it flew off heading east into the morning sky.

Happy Birding in 2013!

Birds of Summer....

It's the time for tending, feeding and rearing the young.

I photographed these Bobolinks last year. Haven't seen any yet this year, but then their meadow was cut much earlier this year, leaving no time to rear the young. Bobolinks are threatened with loss of high grass habitat.  Farmers are faced with a quandary: cutting late allows these birds to flourish but it diminishes the nutrient and monetary value of the hay.

Lastly here are a couple of juvenile Barn Swallows

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