‘It’s Like Being on a Boat’: Billy Joel Opens Up About His Life With a Rare Brain Disorder
The singer says his 'balance sucks' but 'I feel good'—what to know about NPH
Legendary musician Billy Joel, 76, has given fans an update on his health, opening up about living with normal pressure hydrocephalus (NPH) after revealing the diagnosis in a Facebook post in May. The “Piano Man” performer canceled all of his scheduled shows after being diagnosed with the condition, which can lead to permanent brain damage if left untreated. Here we explain what NPH is, early warning signs you shouldn’t ignore and how the iconic singer is doing today.
Billy Joel’s symptoms and diagnosis journey
On a recent episode of Bill Maher’s podcast Club Random with Bill Maher, Joel opened up about being diagnosed with NPH, saying, “It’s not fixed, it’s still being worked on.” The star of the HBO Max documentary Billy Joel: And So It Goes continued, “My balance sucks. It’s like being on a boat.”
When Maher asked for more details, Joel explained, “It used to be called ‘water on the brain’. Now it’s called normal pressure hydrocephalus.” Still, Joel said, “I feel good. They keep referring to what I have as a brain disorder, so it sounds a lot worse than what I’m feeling.”
Woman's World Answers
After his diagnosis began affecting his health, Joel had to cancel his upcoming performances. “Under his doctor’s instructions, Billy is undergoing specific physical therapy and has been advised to refrain from performing during this recovery period,” a statement posted on his Instagram read. “Billy is thankful for the excellent care he is receiving and is fully committed to prioritizing his health.”
What is normal pressure hydrocephalus (NPH)?
Normal pressure hydrocephalus occurs when cerebrospinal fluid builds up in the skull and puts too much pressure on the brain, explains Warren Boling, MD, Chair of Neurosurgery at Loma Linda University Health.
“Spinal fluid is produced in the center of the brain in fluid spaces called the ventricles,” Dr. Boling explains. “It circulates through the ventricular spaces, over the brain’s surface and around the spine before being reabsorbed into the bloodstream.”
In a healthy body, the amount of spinal fluid in the skull and brain remains constant. But with NPH, excess fluid builds up over time, increasing the risk of compression and damage to the brain.
“Early and rapid treatment is critical, and is usually curative.” —Warren Boling, MD
“When the reabsorption process is impaired, it causes fluid to accumulate in the brain and the ventricles to enlarge,” says Dr. Boling. “As the ventricles expand, they compress nearby brain tissue, disrupting brain signaling and causing the symptoms of NPH.”
What causes NPH and who is at risk?
About half of NPH cases are idiopathic, meaning they happen for unknown reasons. The other half of cases develop as a secondary condition to other problems, such as a brain aneurysm or stroke. According to Joel, his NPH falls in the first category.
“They don’t really know what caused it,” Joel explained to Maher on the podcast. “I thought it must be from drinking. I used to drink like a fish.” While researchers have identified a connection between alcohol consumption and NPH, the extent of the connection is unclear.
Early warning signs of NPH to watch for
Some of the most common symptoms of NPH include:
- Gait issues, such as trouble lifting your feet or walking normally
- Urinary incontinence
- Cognitive decline, which can lead to dementia.
Joel hasn’t publicly shared his exact experience with the health condition, but according to the statement he released in May, his symptoms were “exacerbated by recent concert performances, leading to problems with hearing, vision and balance.”
“NPH is often first identified by CT scan or MRI, where the very enlarged ventricles are apparent,” says Lynn Schaefer, PhD, director of neuropsychology at Nassau University Medical Center. “Even your primary care physician can send you for a scan if you are exhibiting symptoms, although ultimately you’d be sent to see a neurosurgeon.”
How NPH is treated
NPH is rare, but becomes more common with age. It affects 0.2 percent of people ages 70 to 80, and 6 percent of adults over 80, according to the Cleveland Clinic. This is at least partly due to the increased likelihood of a stroke or other traumatic brain event as we get older. Luckily, when caught early, NPH is treatable and even reversible.
“When the first signs of NPH become apparent—urinary incontinence and gait disturbance—the goal is to treat the condition before cognitive symptoms develop,” says Dr. Boling. “The most common treatment for NPH is the insertion of a ventriculoperitoneal shunt. This small, mechanical tube reroutes excess spinal fluid from the brain to the abdomen, where the body can safely absorb it.”
Why early diagnosis matters
If you find yourself losing control of your bladder or having difficulty walking, see a doctor right away. Early surgical intervention can improve and even reverse this condition. “The best results of treatment occur when it is diagnosed and treated early,” Dr. Boling says. “Early and rapid treatment is critical, and is usually curative.”
So while Joel may not be able to perform again soon, the fact that he’s making appearances and not struggling with any cognitive problems bodes well for the musical superstar’s health. With any luck, he’ll make a full recovery.
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