Danger! Exploding Melon! Or A Day With Transient Global Amnesia

  • Saturday / March 19, 2011
Danger! Exploding Melon! Or A Day With Transient Global Amnesia 1

Danger! Exploding Melon! Or A Day With Transient Global Amnesia

Just when I thought my life might be falling back into place … my melon exploded! It’s difficult to explain, it’s harder to accept … Transient Global Amnesia.

The Investigation

It seems I lost a day of my life. Not figuratively. Literally. It’s difficult for me to frame the story, because most of it has been pieced together through investigation and other people’s first hand accounts of the events. Watching all those episodes of “NYPD Blue”, “Law & Order”, and “Homicide: Life On The Street” may have paid off in some odd way … helping me cull information and try to make sense of what happened to me through an investigation of the facts.

Transient Global … WTF???

Transient Global Amnesia (TGA).  It’s the medical term for what I experienced Friday March 11, 2011. At some point after 3:00 PM my ability to create new memories ceased. Though I was able to walk, talk and see I was not able to remember that entire day. It was as if I was sleepwalking for a good part of the day. Even though I was conscious in the eyes of others, from my perspective there was nothingness. Quiet, painless, darkness. Nothing more. My brain just said “TMI” and flipped a switch and my brain turned off. Radio silence.

TGA Info:
Definition Of Transient Global Amnesia

Definition Of Transient Global Amnesia

Transient global amnesia is a sudden, temporary episode of memory loss that can’t be attributed to a more common neurological condition, such as epilepsy or stroke. During an episode of transient global amnesia, your recall of recent events simply vanishes, so you can’t remember where you are or how you got there. You may also draw a blank when asked to remember things that happened a day, a month or even a year ago. With transient global amnesia, you do remember who you are, and recognize the people you know well, but that doesn’t make your memory loss any less disturbing. Fortunately, transient global amnesia is rare, seemingly harmless and unlikely to happen again. Episodes are usually short-lived, and afterward your memory is fine.

Symptoms Of Transient Global Amnesia

Symptoms Of Transient Global Amnesia

Transient global amnesia is identified by its main symptom, which is the inability to lay down new memories and to recall the recent past. Once that symptom is confirmed, ruling out other possible causes of amnesia is important.

Necessary symptoms for diagnosis

Doctors base a diagnosis of transient global amnesia on the following signs and symptoms:

  • Sudden onset of memory loss, verified by a witness
  • Retention of personal identity despite memory loss
  • Normal cognition (ability to recognize and name familiar objects and follow simple directions, for example)
  • Absence of signs indicating damage to a particular area of the brain (limb paralysis, involuntary movement or impaired word recognition, for example)
  • Duration of no more than 24 hours
  • Gradual return of memory
  • No evidence of seizures during the period of amnesia
  • No history of active epilepsy or recent head injury

Additional signs and symptoms

These signs and symptoms sometimes accompany memory loss in transient global amnesia:

  • Headache
  • Nausea
  • Vomiting
  • Dizziness
  • Chills or flushing
  • Fear of dying
  • Pins-and-needles sensation
  • Cold hands and feet
  • Powerful expression of emotion
  • Trembling
  • Sweating
  • Chest or neck pain
  • Visual disturbance
  • Racing heartbeat

Episodes of transient global amnesia last only six hours, on average, and there is no lasting damage. When an episode is over, you remember nothing that happened while your memory was impaired, and you might not recall several hours beforehand. Otherwise, though, your memory is fine.

When to see a doctor

Anyone who quickly goes from normal awareness of unfolding reality to confusion about what just happened requires immediate medical attention. If the person experiencing memory loss is too disoriented to call an ambulance, call one yourself.

Although transient global amnesia isn’t harmful, there’s no easy way to distinguish the condition from the life-threatening illnesses that can also cause sudden memory loss. In fact, sudden amnesia is much more likely to be caused by a stroke or a seizure than by transient global amnesia. A medical evaluation is the only way to determine the cause of sudden memory loss.

Causes Of Transient Global Amnesia

Causes Of Transient Global Amnesia

In many cases, an episode of transient global amnesia can be traced to a physically or emotionally stressful incident shortly before symptoms began.
Among the triggering events commonly reported are:

  • Sudden immersion in cold or hot water
  • Strenuous physical activity
  • Sexual intercourse
  • Medical procedures, such as angiography or endoscopy
  • Acute emotional distress, as might be provoked by bad news, conflict or overwork

The underlying cause of transient global amnesia is unknown. There appears to be a link between transient global amnesia and a history of migraines, though the underlying factors that contribute to both conditions aren’t fully understood.

Risk Factors Of Transient Global Amnesia

Risk Factors Of Transient Global Amnesia

Interestingly, high blood pressure and high cholesterol — which are closely linked to strokes — are not risk factors for transient global amnesia. Your sex doesn’t seem to affect your risk, either.
The clearest risk factors are:

  • Age. People age 50 and older have a higher risk of transient global amnesia than do younger people.
  • History of migraines. If you have migraines, your risk of transient global amnesia is significantly higher than that of someone without migraines.
Complications Of Transient Global Amnesia

Complications Of Transient Global Amnesia

Transient global amnesia has no direct complications, but it can cause emotional distress. If you have an episode, the gap in your memory can be unsettling, and you’re likely to worry about a recurrence. Also, a symptom as dramatic as memory loss often heralds a serious underlying disease. Transient global amnesia is an exception, but it can be hard to let go of the fear that you have a tumor or had a stroke.If you need reassurance, ask your doctor to go over the results of your neurological exam and diagnostic tests with you. A counselor or psychotherapist can help you deal with persistent anxiety. Importantly, transient global amnesia is not a risk factor for stroke.

Preparing For Your Appointment

Preparing For Your Appointment

Anyone who experiences sudden loss of memory for all events leading up to the present needs emergency medical care. Call 911 or your local emergency number, or go to an emergency room. If a friend or family member develops these symptoms in your presence, go with him or her to the hospital.If you have time before you leave home or on the way to the hospital, use the information below to get ready for the appointment. Because your loved one doesn’t remember recent events, you’ll need to provide critical information to the doctor.

What you can do:

  • Note any physically or emotionally stressful events leading up to the memory loss. Important details include conflict or anxiety at work or at home, strenuous physical activity, sudden immersion in hot or cold water — anything that may have caused your loved one alarm or strain.
  • Note any accompanying signs or symptoms, such as numbness, weakness or trembling.
  • Write down key medical information, including any other conditions with which your loved one has been diagnosed. Also write down all medications he or she is taking.
  • Stick with your loved one through the full medical evaluation. Sudden memory loss may indicate a serious health problem. Take an active role in soaking up all the information the doctor provides and making decisions about next steps.
  • Write down questions to ask the doctor.

Prepare a list of questions to ask the doctor on your loved one’s behalf. Although people experiencing transient global amnesia can think and speak, it’s likely that they will be feeling severe distress.

For transient global amnesia, some basic questions include:

  • What is most likely causing my loved one’s symptoms?
  • What are the other possible causes for these symptoms?
  • What kinds of tests do you recommend?
  • Is any treatment needed now?
  • What signs or symptoms should I be watching for at home?
  • What signs or symptoms should prompt me to call 911 or emergency medical help?
  • How soon do you expect my loved one’s symptoms to improve?
  • Do you expect a full recovery?
  • Are there any steps my loved one can take to prevent a recurrence of this problem?
  • What is the risk of long-term complications from this condition?

In addition to the questions that you’ve prepared to ask your doctor, don’t hesitate to ask questions during your appointment at any time that you don’t understand something.

What to expect from your doctor

The doctor is likely to ask both of you a number of questions about your loved one’s symptoms and about the period leading up to the memory loss.

The doctor may ask your loved one:

  • What is the last thing you remember?
  • Do you know who you are?
  • Do you know the person who came with you to the hospital?
  • Do you have any symptoms other than memory loss?
  • Are you dizzy?
  • Are you having problems with balance or coordination?
  • Do you feel weakness or numbness on either side of your body?
  • Are you having any vision problems?
  • Do your symptoms include headache?

To determine the extent of memory loss, the doctor may check your loved one’s knowledge of general information — such as the name of the current president — and assess his or her ability to recall a random list of words.

The doctor may ask you:

  • When did your loved one’s memory loss begin?
  • Did the memory loss come on gradually or suddenly?
  • Has anything like this ever happened before?
  • What happened just before the memory loss?
  • Did your loved one experience an accident that may have injured his or her head?
  • Has your loved one recently experienced significant stress, conflict or loss?
  • Has he or she had a seizure since symptoms began?
  • Has your loved one been diagnosed with any other medical conditions?
  • Does he or she have a history of migraines?
  • Has your loved one recently undergone any medical procedures or surgery?
  • What medications is your loved one taking, including prescription drugs, over-the-counter medications, herbs and supplements?
Tests And Diagnosis

Tests And Diagnosis

Diagnosis of transient global amnesia rests on excluding more-serious conditions — stroke, seizure or head injury, for example — that can cause the same type of memory loss.

Physical exam

  • The process begins with a neurological exam, checking reflexes, muscle tone, muscle strength, sensory function, gait, posture, coordination and balance. The doctor may also ask questions to test thinking, judgment and memory.

Brain and imaging tests

The next step is to conduct tests that detect abnormalities in the brain’s electrical activity and circulation. The most common of these tests are painless and take less than two hours each:

  • Electroencephalogram (EEG). An EEG records the brain’s electrical activity via electrodes affixed to the scalp. People with epilepsy often have changes in their brain waves, even when they’re not having a seizure.
  • Computerized tomography (CT) scan. Using special X-ray equipment, CT machines obtain images from many different angles and join them together to show cross-sectional images of the brain and skull. CT scans can reveal abnormalities in brain structure, including narrowed, overstretched or broken blood vessels and past strokes.
  • Magnetic resonance imaging (MRI). This technique uses a magnetic field and radio waves to create detailed, cross-sectional images of the brain. The MRI machine can combine these slices to produce 3-D images that may be viewed from many different angles.
Complications Of Transient Global Amnesia

Complications Of Transient Global Amnesia

Transient global amnesia has no direct complications, but it can cause emotional distress. If you have an episode, the gap in your memory can be unsettling, and you’re likely to worry about a recurrence. Also, a symptom as dramatic as memory loss often heralds a serious underlying disease. Transient global amnesia is an exception, but it can be hard to let go of the fear that you have a tumor or had a stroke.If you need reassurance, ask your doctor to go over the results of your neurological exam and diagnostic tests with you. A counselor or psychotherapist can help you deal with persistent anxiety. Importantly, transient global amnesia is not a risk factor for stroke.

Treatments And Drugs

Treatments And Drugs

No treatment is needed for transient global amnesia. It’s resolves on its own and has no confirmed aftereffects.

Prevention

Prevention

Because the cause of transient global amnesia is unknown and the rate of recurrence is low, no standard approaches for preventing the condition exist. Some doctors recommend daily aspirin to improve circulation, on the theory that reduced blood flow may be the cause.If your episode of transient global amnesia followed a particular activity, such as a strenuous workout or a vigorous swim in a chilly lake, talk with your doctor about what’s safe going forward. He or she may recommend that you limit or avoid the activity that seemed to trigger your memory loss.

If you read all that … wow! Is your head ready to explode? Lot to take in? Lot to parse? More information than any one human should have to know? Sort of how I felt, probably before the “episode”, and most certainly after.

Meanwhile … back to my story …

If  not for eMails I sent out that day, my cellphone call log, or text messages in and out, I’d have no record of ANY events that took place on Friday March 11, 2011. I think I woke up. I think I had breakfast. There were dishes in the sink … but who knows.

8:00 AM: Woke up. Got out of bed. That’s just an assumption based on past history.
9:00 AM:I made and ate breakfast?
10:50 AM:Text message from my sister in NJ.
10:54 AM:Call from Dr Rosenfield to confirm my Monday appointment.
10:54 AM: Reply to my sister’s text message.
11:14 AM:Mom called me … 2 minute conversation.
12:59 PM:Chris eMails me his plans for the weekend.
1:05 PM:Sent myself a group of “notes” as a backup via eMail.
2:10 PM:Received an eMail from Seattle Short Sales asking for IRS 4506T form.
2:13 PM:Sent response to Seattle Short Sales asking for more info and the form.
2:14 PM:Googled for 1506T form, found it & downloaded it.
2:15 PM:Client called. I logged into her computer remotely and fixed some issue she was having.
3:10 PM: eMail Seattle Short Sales completed 4506T forms.
3:47 PM: eMail reply from Seattle Short Sales Re: My completed 4506T forms.
3:58 PM:Brenda posts a message to my Facebook wall. I get an eMail notification. I sort of remember that … but didn’t respond then because I was going to do it later.
4:58 PM:Text from Chris. (no response from me)
5:48 PM:Chris sent same text again. (no response from me)

Looking at the list of events, it seems I was “fully functional” between 8:00AM and 4:00 PM. But it’s the time between 4:00 PM and 9:00 PM that are a total mystery.

@9:00PM

At 9:00 PM I called my ex Chris who was two hours north in Bellingham, WA. From what I’ve been told by Chris, I called him and told him I didn’t know where I was, what day it was, that I was afraid, and that something was really really wrong. I sensed that much. He immediately called my best Friend Amy and conference called us together. Then Chris dropped off the line and called our friend and neighbor Harriet. Once Harriet was on her way to me, Chris left Bellingham to drive to the emergency room. Amy stayed on the line until Harriet showed up. At which time Amy left her home to come to my place. Harriet rang the condo doorbell and I walked down the stairs to answer the door. I opened the door, recognized Harriet and she came in.

Once upstairs she started asking me questions. I kept asking her over and over again, “How did you get here?” To which she answered, “Chris called me.” This is one of many questions that were asked and answered over and over again. It’s part of what told Harriet something was seriously wrong with me and to call 911. Harriet came down so quickly from her condo “up the hill” from us, that she was still in her pajamas.

Sorry Rock & Ro!!

Just as the medics were taking me out the door (on a stretcher?) Amy pulled up. Harriet stayed behind to feed the cats, seems I forgot to do their usual evening feeding, which I do around 5:00-6:00 PM every day. Oops! Sorry Rocky, Rosie, and Angel! Amy followed the ambulance to the UW Medical NW Hospital emergency room. Harriet then went home to change into her clothes, and soon after came to  the emergency room, which is only five minutes from the condo. Being Harriet has a medical background, it was a good thing she was there from the beginning to “document” what was “different” about me to the  med staff in the ER. She also knew a little about my history too.

What day is this?

Once at the ER the “fun” began. I’m told I asked the same questions over & over & over again. What day is this? How did I get here? I’m hungry! There were others but those were the big ones. At one point Harriet wrote “Friday” on a sheet of paper in BIG letters and put it on a clip board. So every time I asked what day it was they just held up the sign. As a patient no one in the ER had ever seen a case of Transient Global Amnesia (TGA) ever. Rather dubious honor indeed. So doctors, and staff marveled at me as I asked the same questions over & over, in the same tone, with the same delivery, every time. Again … all this recounting is culled from those who were there and has percolated through my still fuzzy brain all week. The ER staff also marveled at how tough my skin was. I was told that the staff bent needles trying to get IV’s in me. Nice! A physical manifestation of how I’ve had to live my life? It’s all one big mystery.

Do the math!

Harriet told me that every time they’d asked me my birthday, I’d tell them 1/20/57. And every time they asked me how old I was I’d say “Do the math!” Every time! When they asked me what day it was, I didn’t know, nor the month. But I did know who was president of the US … the Obaminator!

Consciousness

The hardest thing for me to wrap my brain around since my episode of TGA is the concept of consciousness. During the time I could not form new memories, I saw nothing, heard nothing, felt nothing, though I walked, talked, heard and saw what was going on around me in everyone else’s eyes. So was I truly conscious? I still say that I didn’t “wake up” until somewhere around 11:30 PM or there about. Each time I would open my eyes I’d see myself in a hospital bed, with medical staff whirring around me and tubes and wires attached to various parts of my body. And as I looked over to the left of my bed I saw Chris, Harriet, and Amy. At that moment I was starting to form new memories again. I even remember one of the ER staff saying that. Of course as I was able to form new memories I asked fewer of the SAME questions. Though the last time I had to ask what day it was I finally remembered seeing the sign “Friday” that Harriet had made.

The Awakening

As I was now “awake” and forming new memories, I was told what was going on. That I had an episode of TGA, they explained what TGA was, and how I got to the hospital. I was also told that while there, I was stuck poked, prodded, questioned, had a CT scan of my mellon, blood tests, etc etc etc. None of which I remember … even now. So from 4:00-ish PM to 11:30-ish PM is a total mystery to me. What I did, where I went, what happened just a big question mark. A hole in my space time continuum. Once I did “wake up” and I was making new memories, both Harriet and Amy decided they could leave and Chris stayed with me until they released me at 3:00 AM or so.

MMM … PBJ

On the way home Chris stopped at Safeway and bought some peanut butter, jelly and bread, and made me a PBJ and a glass of milk so I could take care of the “I’m really hungry!” It felt strange and good to be back home. I hugged the cats an awful lot. Somewhere around 4:00-4:30 Am I went to bed. No sleeping pill needed. Head hits pillow and zzzzzzzzzzzzzzzzzzzzzzzzz. I’ve been sleeping on the couch since my left shoulder surgery months ago. But the cats didn’t let me sleep long. Around 7:00-ish they were stirring. I got up, fed them, then tried to go back to sleep, with not much success. So I got up at 8:00 AM. Fuck! Made breakfast for myself too. Around 9:00 or 10:00 AM the hospital called and wanted me back in for more tests. They didn’t like that my hemoglobin levels were so high, and the neurologist now wanted an MRI/MRA.

Day 2

Around 11:00-ish were back at the hospital emergency room. The short version … more blood drawn, a shunt for contrast dye put in my arm, and the MRI were all done. We were there another 7 hours … more or less. The end result. Nothing. No stroke, no blown blood vessels, nothing! On one level … that’s good. On another … WTF??!!??!! So back home it was. The only thing was my blood pressure was still high, so they gave me Benzapril for that. One tab, once a day for the next month, and see where we are.

A Week Later

It’s been a week and a day since it all happened. I’ve relived it every time I’ve talked to someone. I’M FUCKING TIRED! With reason I guess. Saw my primary and had him give me my testosterone shot so I wasn’t also “coming down” from not having received it on Monday. Also saw the neurologist (Dr Gordon) on Thursday. He was pissed that they let me go from the ER on Friday. He’s actually launching an investigation why they did. In talking to me he doesn’t see anything wrong with any of the tests that were done. Though he sent me for an EEG. Did that yesterday. Waiting on results now. He also want me to go for a spinal tap to be certain my Sarcoid hasn’t involved my nervous system. He’s consulting with my pulmonologist and Sarcoid specialist Dr Raghu before I get tapped. Yippee fucking Skippy! And the beat goes on!

The Wrap Up

Okay … I”m done. For now. Even writing this is draining. Maybe I’ll write more to keep folks informed in another post at a later date. But this was way too draining and took me a week to complete. But if you read to the last word … WOW! Thanks! You do care! : )

To wrap it up … Joe’s okay. Or as okay as I can be after having gone through something so traumatic. Thanks to all my friends and family for their love, kind words, and support … and especially to Chris, Harriet, and Amy for all they did. I love you all! Thank you.

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