After simple dental surgery, William lost his ability to form new memories
bbc.com
bbc.com
It would be very interesting to see exactly what type of imaging they performed on him. Bear in mind, an abnormality in the hippocampus or other memory related structures could be sub-mm in size and result in a significant impairment.
If, for example, he did not have an MRI with diffusion weighted imaging with a sufficiently high B value (gradient value) they may be missing/have missed a very small stroke (this test is also time sensitive -only positive within the first few days of insult).
If they did not perform susceptibility weighted imaging, they may have missed a tiny micro-haemorrhage. Both of these scenarios can result in memory loss if critical structures are involved.
There are also several technical issues that may have resulted in a sub-optimal scan, precluding finding a tiny abnormality. There's also the question of whether the person reading the scan got it right or whether the strength of the magnet/technical parameters of the study were sufficient to resolve a tiny abnormality.
Either of these scenarios could have been a consequence of reduced blood flow (hypoperfusion), a small clot (embolus) or a tiny blood vessel injury (dissection) that could have occurred during the procedure - possibly related to the anaesthetic but not definitively so.
I suspect there is a definitive abnormality that the clinicians that saw him were unable to pick up. This seams a lot more likely than the idea that we need to revise our entire conceptualisation of memory formation to suit a psychological theory.
Scouring the medical literature, he found five similar cases of mysterious memory loss without brain damage. Although none occurred during a trip to the dentist, they do seem to follow other periods of physiological stress during a medical emergency.
That doesn't prove that the anaesthetic isn't the root cause. The article title sounds link-baity.
1. http://www.forbes.com/sites/leahbinder/2013/09/23/stunning-n...
"With these latest revelations, medical errors now claim the spot as the third leading cause of death in the United States, dwarfing auto accidents, diabetes and everything else besides Cancer and heart disease."
Based on the findings of http://journals.lww.com/journalpatientsafety/Fulltext/2013/0...
It counts every death that could have been prevented by perfect care, not only harm caused by treatment in otherwise safe individuals.
For example, if someone with heart disease visits hospital and the hospital does not administer best known treatment protocol and the patient dies, that's a "medical error". But at root it is a heart-disease death. Same for cancer.
Some of the highlighted examples from the abstracts are extreme:
>>>
One example of a lethal error of communication between provider and patient occurred when cardiologists failed to warn their 19-year-old patient not to run. The patient had experienced syncope [fainting] while running, and 5 days of inpatient, diagnostic testing were inconclusive; however, his cardiologists knew he was not ready to return to running but failed to warn him against this risk. Having not been warned against running, he resumed running and died 3 weeks later while running.
<<<
The proper analysis is "what are your odds of survival when you choose to seek vs not seek care?"
For instance a family friend was told she had uterine cancer and was all set to start her doctor's protocol. But at the last minute wanted a second opinion from MD Anderson, the best cancer hospital in the world. After their team looked at her doctor's tests, they ordered their own test, and told her she had bladder cancer instead. They were dumbfounded how her doctor could have missed it, and that protocol would have certainly of led to her death, as bladder cancer treatment must be aggressive and fast.
Yet the only consequence her doctor faced was being told by her that two of MD Anderson's teams thought he was a dumbshit. Other than that, he'll keep on doing what he was doing.
1. https://en.wikipedia.org/wiki/Preventable_causes_of_death#Ac...
2. http://journals.lww.com/journalpatientsafety/Fulltext/2013/0...
And, sure enough, my memory was pretty much wiped for the hour or so after the event. Later that evening I had a conversation with my wife that went like this:
"Um, did you help me with putting my clothes back on?"
"Um, no. You did that."
"Did I talk to you and the doctor?"
"Sure. Normal conversation."
I have no recollection of these events at all. It gave me an uneasy feeling for a day or so. Nothing traumatic but every time I tried to reach back and think about that post-op period I drew and continue to draw a complete blank.
"Hey, I'm awake! That was easy."
"You've been awake for two hours."
"...Oh. Huh."
As I was being prepped for my third knee surgery, my doctor asked if I had any problems with anesthesia. I told him about the memory loss after my first surgery. My friends who were accompanying me, and had been at my second knee surgery, started mumbling "um, huh, well, oh, actually". It turns out that after my second knee surgery, when the surgeon was giving me a summary of how the surgery went, he told me he botched up my knee, and I proceeded to make very coherent and precisely detailed threats against his life. (The threats were bad enough that the surgeon considered bringing security into the recovery area and restraining me. In the end, my friends, including a combat vet, convinced the doctor that I'm not actually a violent person and agreed to restrain me if I actually became violent.) Again, I have absolutely no memory of this!
It seems to me like the internal, autobiographic self being disabled, and then upon awakening this self immediately says "wait, discontinuity in the recording ... where was I?" and this feeds back into the rest of the brain creating the confusion.
He wasn't confused the moment before, because his autobiographical self wasn't recording.
Maybe we're just the tape recorder?
Clearly though, this guy is still "conscious" - it seems like a situation we don't have quite the correct terminology to describe.
The trick, seemingly is manipulating the focus of awareness to convince the subconscious decision-making apparatus to make different decisions, even though all we really have control of is our awareness.
After a while I decided that I dont have month long seizures rather I have brief seizures in which I lose a month of memory.
For this and other reasons I am concerned I have a brain tumour. That would totally suck.
- You should definitely have imaging done to see if you can identify a cause.
- If you have seizures, you should definitely NOT be driving a car, for your safety and the safety of everyone around you
Please get this checked out immediately...
Instead, he should tell a family member or close friend right away. Then they can help him make the proper medical appointments, etc.
She had put it with my stuff then never mentioned it.
Mom is actually quite an intelligent woman but sometimes she can be a little daft.
Meanwhile, driving a car seam to be potentially dangerous.
Also sounds like he could have had a fugue state episode https://en.wikipedia.org/wiki/Fugue_state
It's a very odd feeling for sure. Nothing serious and I doubt it caused any damage, but it was the first time I'd ever just had a blank set of time that I just couldn't answer for. I did have family nearby though.
This is important because the psychological trauma of a surgical procedure will often cause people to avoid future procedures even when procedures are medically advisable. These drugs temporarily prevent strongly negative experiences from becoming a part of who you are mentally, subconscious or otherwise.
[1] (let's just say this was moving a camera in a....direction...against traffic)
But that's actually something different than what I'm asking. I have no trouble understanding why I wouldn't want to remember a pain "similar to that of surgical incision". Similarly: I wouldn't want to remember an unanesthetized incision!
But before learning that surgical patients were routinely given midazolam to zap their memory, my impression was that surgical patients were completely zonked out by general anesthesia, and so there'd be no need to zap their memory, because they weren't going to consciously experience the incision in the first place.
Now I'm like, is all of general anesthesia a scam, and we're all enduring horrible pain, and we just don't remember it? J/K ONLY SERIOUS.
I'm medicine, not anesthesia, so I don't use these agents all day and therefore referred to cardioversion which is more in my domain. Cheers!
It seems unlikely that would be the case if the time inbetween was spent thinking 'oh my god this hurts so much' rather than just blacked out.
(Let me clear, I'm being deliberately silly about all this. I do not think there is a huge anesthesia conspiracy. I am, at the same time, seriously skeeved out by having my memory deliberately tampered with.)
I don't remember! :P
The answer to your question in is no, you aren't suffering enduring horrible pain while under general anesthesia. That doesn't mean you won't experience things you would rather not remember. Some examples: 1) patient may experience burning sensation from propofol (induction agent) entering the body 2) patient may see something disturbing before general has kicked in (e.g. a big saw before an orthopedic procedure) 3) in certain cases (e.g. emergencies) or due to human error, patient may not be fully under pre-surgery, e.g. patient may remember breathing tube being inserted.
The high level answer for why you are given midazolam (at least in the US) is because anesthesia is a "patient satisfaction" service and giving it increases patient satisfaction.
The only time I experienced it was for an endoscopy. Because I was a heavy drinker at the time (probably the reason for the symptoms that lead the the endoscopy, ironically) the intravenous sedation had little effect, so I was awake through the whole thing. I didn't find it traumatic, merely unpleasant, but I think other people might have. The local anesthetic at the back of my throat wore off after some time, so I was dry retching every few minutes. At one point they pumped air into my stomach so they could take a sample with a needle (which was in itself painless), and that sensation was also unpleasant.
So while I doubt people undergoing intravenous sedation during routine surgery are in extreme pain, they may be in very uncomfortable situations that most people would rather forget. Also if it had been effective, it would alter your state of mind as well, so that the immediate experience was less bad.
OTOH I regularly have a colonoscopy under heavy sedation, and never remember a thing.I know there are risks with any kind of sedation or anaesthetic, however anecdotally they've saved me a lot of trauma.
It varies by person but - Yes, it certainly can be.
My grandma had to undergo hip surgery awake with only local anesthetic. She was too frail and had all these health conditions so she couldn't be put under or given much medication. At the same time they couldn't just leave her hip broken. It was an extremely traumatic event for her.
Of course others would think it wasn't such a big deal.
For the procedure on midazolam, I have virtually no recollection of the procedure except for about a minute in the middle where it apparently wore off. It was a completely neutral experience.
For the other procedure, it was extremely unpleasant for two reasons but I got through it like a stoic. First, they had trouble keeping up with the local anesthetic, too many nerves involved, so there was quite a bit of transient pain and it got sloppier over the length of the procedure as the doc got tired. Second, even when you can't feel pain, you can still feel them tearing up your tissues and rearranging your parts, which is disconcerting if nothing else. Overall, I strongly recollect just how unpleasant and painful (even under anesthetic) that procedure was. I probably would not be able to tell you any of this if I was on amnesiacs because I would not remember.
It is really about where your thresholds are. Like you, I find the loss of memory on the amnesiacs disturbing and the alternative, anecdotally, was far more unpleasant than I think some people imagine. The experience that I remember doesn't bother me that much because that is my nature but I can't deny that I have vivid memories of it. I can easily imagine that many people would prefer to not have those memories. That said, I would likely elect to forego an amnesiac again if I thought it would inconvenience me (i.e. by making you useless for several hours). I can deal with the experience.
As I understand it there's an increased risk of PTSD if people are chemically restrained, which is why some ITUs (but not in England) use physical restraints when needed.
This is a different use case from surgery, where these meds are useful.
To me, that (and experiments of Gazanigga etc) indicate that Jaynes was onto something with the "bicameral mind" theory, as crazy as it sounds.
It does. We replaced it with the subtitle, which is more neutral.
Agreed, and psychogenic causation seems more likely (see my comment at the previous discussion https://news.ycombinator.com/item?id=9810025).
This seems to be yet another case of HN users upvoting dubious link-bait scientific press-releases. This particular one has been posted 3 times this week.
(P.S. I will be using that word from now on.)
Another well-known case of retrograde amnesia is Clive Wearing, a British pianist who was the subject of a BBC documentary, "Man Without a Memory" [2]. I recommend watching the clip. He describes his "resets" rather terrifyingly as slowly emerging from a sleepless coma. Whenever he sees his wife after such a reset, he leaps up to greet her as if they have been apart for a long time, and his evident happiness and inability to recognize his situation is heartbreaking. (His wife, unbeknownst to him, of course, has since divorced him, which only adds to the poignancy of the scene.)
[1] https://en.wikipedia.org/wiki/The_Man_Who_Mistook_His_Wife_f...
...including the fact that you can't remember anything? That would certainly be scary.
From wiki:
"Wozniak sustained severe face and head injuries, including losing a tooth, and also suffered for five weeks after the crash from anterograde amnesia, the inability to create new memories. He had no memory of the crash, and did not remember his name in the hospital or the things he did after he was released from the hospital."
I understand he didnt set the trim, which adjusts the balance of the plane for the distribution of passenger weight.
http://www.cultofmac.com/275742/wonderful-rides-steve-woznia...
I used to love flying into Scotts Valley back in the '70s and '80s. It had a great picnic spot next to the field, and a scary approach when the landing direction was toward the southeast: The base leg (last turn before final approach) took you right toward a big tree-covered hill and you had to scoot around it a bit to avoid the trees.
Most of the runway is long gone, with houses at the north end and a park in the middle. There is a bit of the old strip left at the south end - but it would have to be a real emergency to even consider trying to land on it.
You can see the old airport in Google Earth if you use View/Historical Imagery and go all the way back to 10/1991. The south end of the runway is near Mt Hermon Road and Kings Village Road in Scotts Valley.
Your chance of dying from anaesthesia is around 1 in 100,000 - 185,000. While it may seem like a safe number, it's orders of magnitude higher than winning a major lottery.
That number also doesn't include medical fuckups during anaesthesia, like overdose, airway obstruction. In that case the number shoots up to 1:2500 - 1:5000.
http://bja.oxfordjournals.org/content/95/1/95.long
1.5 people in 1000 wake up, so the pain shock alone can kill you.
Dental anaesthesia is known to kill, around 2 children per year.
http://www.huffingtonpost.com/2012/07/13/dental-sedation-chi...
From the second op, I had a huge black bruise on my thigh in the shape of a hand print. I couldn't imagine the pain if I'd have woken during the cause of that.
Literally 50 First Dates...
https://www.psychologytoday.com/blog/psychologist-the-movies...
"His ability to form long-term procedural memories was intact; thus he could, for example, learn new motor skills, despite not being able to remember learning them."
Doctors tried to push me into accepting the general anesthesia, saying that it's the only option(and that we lose brain cells every day really, so who cares). I went to a different clinic where a doctor agreed to do the surgery under local anesthetics and without sedation without any problems. Said someting along the lines "don't worry, man, your brain is gonna be fine."
He failed to mention that local anesthesia can also lead to neurotoxicity, and I was too ignorant to know about it(for some reason I assumed that local anesthetics are harmless, and didn't do my research).
During the surgery I felt the symptomps(dizziness, difficulty speaking), consistent with neurotoxicity caused by local anesthetics.
I don't notice any permanent damage, though I doubt that I'd be able to tell. 6 months after the surgery I have developed tinnitus, but I can't tell if it's connected to it or not.
Anyway, my point is that no way in hell would I agree to the surgery if I'd have known the risks.
Also, before that, doctors pushed me into unnecessarily taking general anesthesia for a routine procedure. They convinced me that it can't be harmful, and I was too young and socially awkward to ask more questions or argue.
I also fear dental anesthetics. There is research indicating that they can cause neurotoxocity. I can easily sit through filling regular cavities(with a dental laser it really isn't that painful), but I'm not sure what I would do if I have to get root canal. I would take any option over anesthesia, but I don't know of any alternative.
Some doctors say that it's just an irrational fear. But given that there's some research saying that even dental anesthesia can cause neurotixicity, I'm not sure what's so irrational about not wanting my brain cells to die. My brain is what matters to me the most in the world, far more than anything else, it has infinite value, because that's literally "me", so even small chance of small damage is worth avoiding at all cost(in my value system).
It's infuriating how casual doctors are about such risks, especially in cases when they can be avoided. I understand taking necessary risks when it's a life-saving surgery, but when you have alternatives, I think patient should be able to make an informed choice.
How likely is it that you're going to suffer brain injury in your day to day life versus from anaesthetic?
[1] irrational is probably a not useful word here. You have real fear of real things.
> while not appearing to assign much risk to how you get there.
If you are saying that I'm not putting enough weight on the risks of avoiding the procedure - let me be clear, I'm talking about cases where anesthesia is optional, and is a matter of pain vs comfort.
I know that avoiding root canal puts me at risk of dying from infection, so of course I wouldn't avoid doing it, and it makes sense to prefer "treating tooth with anesthesia" over "not trating a tooth." But I could have avoided that surgery(it was about quality of life, not survival), and I could've avoided anesthesia if I was willing to suffer some pain/discomfort. And that should be my choice to make.
I think that it is rational to take short term pain over (even small) probability of long term brain damage. If I could take some reasonable amount of pain over brain damage risk, I would take it any time, and it would be the right choice. My problem with root canal is that I don't think I could handle the pain without anesthetics. So I fear that when faced with choice "a lot of pain" vs "safety for my brain" I will fear the pain, take anesthetics, and betray my values.
Do you see my problem here? If brain has literally "infinite" value, then no matter how infinitesimal risks are, it is rational to minimize them at all cost. If doing the procedure minimizes them, it is rational to do it, if it doesn't - the right thing is to avoid it.
Correct me if I misunderstood what you're saying.
> How likely is it that you're going to suffer brain injury
> in your day to day life versus from anaesthetic?
Now compare that to the risk of day to day life. How much has the risk increased?
There's a bunch of stuff you do that you don't need to do that carries more risk than anaesthetic.
It's fine for you to chose your medical care. You might want to investigate an "advance health care directive". Having one should persuade doctors that you have spent time thinking about this and it is your sincere and considered desire to ignore their advice to have anasthesia.
I don't have any evidence for this but I suspect that the majority of brain injuries in otherwise healthy people come from trauma due to accidents. If my suspicion is true then wearing a helmet all the time might be the most effective way to avoid brain injury.
You get that "neurotoxicity" in this case is almost exclusively referring to deleterious effects that local anesthetics can have on nerves at the site of injection, right? Subcutaneous injection of local anesthetics will have very little, if any, involvement with your brain.
You did the right thing finding a surgeon that would work with a block instead of GA if you were concerned about the (potentially real, if not that bad, effects of GA) but I think your fears of local anesthetics causing CNS damage are overblown and I wouldn't want others to refuse the use of them in themselves or their children based on your post.
For now try not to freak out or get depressed about it, turn on air conditioner or running water to mask the noise.
Try taking ginko, try taking melatonin for sleep.
Listen to music or audiobooks when it's too annoying(not too loud to not cause any more damage).
Visit a doctor and get some advice from him. Go to a support forum or subreddit if it gets bad.
If you are lucky enough to be living in US - check out what trials you can enroll in. Some of them can probably help. People are workong on a cure and making some progress.
Local anesthetic is pretty much just a pain killer... it's not supposed to knock you out like GA (general anesthetic). I wonder if the article got the term right.
I highly recommend it, especially if you are a mathematician.
Certainly one could understand why the dental industry would avoid the meme "root canal = bad!", but in this case the patient has little to lose, his future being lost already.
http://www.quackwatch.com/01QuackeryRelatedTopics/mercury.ht...
Furthermore, root canals require different training and are (usually) done by endodontists. Dentists usually handle the more mundane and more tested procedure of dental fillings.
My point is, root canals are much more invasive and have their own problems(not associated with dental fillings).