Tuesday, October 14, 2008

Newspaper, Telephone, Flower

I found myself walking through the front door of my house at 5:30pm yesterday, not remembering where I'd been. In actuality, I'd just walked two blocks from the new circuit-training fitness center when I had done a trial workout. The thing is, I only remembered the first two-thirds of the circuit. I didn't remember walking home and a lot of other recent details were pretty fuzzy. A trip to the ER was clearly in order and my wife drove while I slowly downed a couple of liters of electrolyte. I felt light-headed and dopey, but slowly began to feel better.

I felt well enough to be dropped off at the entrance, to walk through the security screening by myself, and to tell the triage nurse my complaint: There were 15 minutes of the last hour of which I had no recollection. Even as the words were coming out of my mouth I couldn't believe I was saying them.

No offense to anyone out there who works in the health care profession, but I hate hospitals. I've watched my mom and two sisters slowly waste away in hospitals while the world shimmered just outside the window. Just being in a hospital gives me the creeps. Nevertheless, the ER staff was friendly, courteous, and on top of their game.

Within minutes I was hooked up to an EKG, breathing oxygen, and unsure what was going to happen next. A CT scan of my brain, a chest x-ray, an EKG, and preliminary blood tests revealed ... nothing. And I was feeling better and better as my sensorium became clearer. Within an hour, I felt like my old self, with one, new, sinking realization: The FAA medical certificate in my wallet was toast. It was like a switch had been thrown and I was no longer fit to be pilot-in-command. And it was clear that the ramifications of this event were lost on the doctor and staff.

After three hours, all subsequent tests had come back as "normal" and I went home with a diagnosis that really didn't seem like a diagnosis: Transient Global Amnesia. A rare syndrome that usually occurs in adults over age 56, TGA is idiopathic - the underlying cause is not known. The vast majority of people who experience a TGA episode have no recurrence in their lifetime. There are no long-term adverse effects, no course of treatment, no medications, nothing to do, no action to take. Understandably, the FAA doesn't like events for which there is no clear cause and getting a new medical certificate will require up to 2 years.

Yet for being so benign, experiencing a TGA is decidedly unsettling. It's odd to not remember part of your day and it's oh so easy to imagine that you must have some sort of serious disease - a brain tumor, vascular problem, the nightmare list goes on and on. You just have to trust that the EKG, CT scan, xray, blood tests all attest to your health. Of course, there are more tests.

Today I visit the neurologist after the appointment desk calls me at 8am, an amazingly prompt response since I was just in the ER last night. My wife drives me to the doctor's office, I register at the desk and have my blood pressure taken. The doctor arrives and she's friendly, but no-nonsense. She asks me, among other things, to repeat three words - newspaper, telephone, flower. She has me repeat them three times and says she'll ask me to repeat them again in a few minutes.

I count backward from 100 by 7. I spell "world" backwards and duplicate her drawing of two simple hexagons. I draw the face of a clock, including all the numbers and draw the hands showing 10 minutes to 8. I tell her where I am, the name of the building, the city, county, state and country. I tell her the date and day of the week, who's president and the past presidents going back three-plus decades, carefully distinguishing between George W. Bush and George H. W. Bush.

I touch my right thumb to my left ear. I follow her moving finger with my eyes. I stand with my eyes closed and my feet close together. I walk heel-to-toe. With my eyes closed, she draws the outline of numbers on my upturned palms and I tell her what the numbers are. She examines my retinae, tests my pupillary response to light, tests the strength of my muscles and all of my reflexes. I say "ahh," then squint, then smile on command. I'm anxious, but after several minutes, I still remember "newspaper, telephone, flower."

A few more tests need to be done, but two things are clear: I'm apparently healthy and my day-to-day life has dramatically changed. How will I earn a living? With whom will my students train now that they can't train with me? Three days ago I demonstrated flying an ILS approach down to minima to ATP standards in turbulence and 25 knot, gusting winds. Today, and for the immediate future, I'm grounded with many questions left unanswered.

Once again, the shimmering, fleeting quality of life comes clearly into focus.

14 comments:

Anonymous said...

Are you on a cholesterol reducing Statin medication like Lipitor?

Dave Starr said...

Wow. Glad that you are apprently all in working order but I sympathize deeply with the medical loss. Here's hoping it's possible to get back on the horse in the future.

I think you are an Avitrix reader, you'll no doubt recall it looked nearly impossible at one time for her to return to PIC status, but thankfully the pendulum of fate swings both ways.

Once again my homespun belief that exercise for the sake of exercise is bad for the health comes through ... I know, it's a joke, but I hate to be right none the less.

I wish you the best and although it seems like empty words, ... easy for me to say since it isn't happening to me ... please don't dwell too intensely on the 'how will I earn a living' aspect. For a man with your breadth of knowledge, your ability to make complex subjects understandable and your writing ability I am sure there are many future paths that will make themselves apparent. God speed.

John said...

No statins in my medicine cabinet, though I have seen claims of a relationship between statins and TGA episodes.

John said...

John,

Sorry to hear of your medical issue. I am sure you have already discussed this with the FAA, but if not, Dr Silverman will be at the AOPA thingee in San Jose and would be a great time for you to discuss directly with him.

You also know that you can instruct without a medical, but can not act as pilot in command. Your student must be able to be PIC. A part 142 instructor should not need a medical, nor a ground instructor.

Your writing style is professional and demonstrates real talent. Aero News Network is always looking for people.

I wish you the best and will include you in my prayers.

Best regards,

John Collins

Greybeard said...

I've blogged before about the dilemma we face with health issues and our livelihood.
A fellow pilot had tightness in his chest and his wife insisted on taking him to the ER where it was found he was not having a heart attack, but had experienced some sort of "incident" in the past.
Next physical, his medical disappeared.
You've done the right thing.
You've done the safe thing.
I'm glad to know you have other skills to fall back on, but man, this sucks, doesn't it?!

Fran├žois said...

I hope you'll be able to fly again soon, and I'm sure you will find a way to keep on fulfilling your passion of flying.
Best wishes !

Anonymous said...

I'm very sorry to hear about your medical problems - i hope it will be solved as soon as possible.

Next, thank you for an excellent blog. I'm convinced you'll be able to put your writing talent to good use during the downtime.

Ron said...

Are you sure your current medical is "toast"? As I understand it, you self-grounded until such time as you meet the medical certification requirements again.

You've undergone medical testing and they find nothing wrong with you. As far as anyone can tell, your electrolytes got out of whack after a new and unfamiliar workout. Why must you remain medically disqualified? It's entirely possible no cause may ever be definitively found for your episode. Does that mean you cannot act as PIC ever again?

I'm sure there will be paperwork and questions from the aeromedical folks at your next renewal, but if all you have is a 3rd class (and that's all you need to instruct), that could be good for as long as... five years?

An AME once told me that nearly everyone who wants a medical certificate can eventually get one. Some just have to jump through a lot more hoops than others.

Keep your head up. And keep on instructing! You can do a lot of teaching and flying without a medical certificate. Your experience, knowledge, and skills are sorely needed in a world of sub-par CFIs!!

John said...

Ron,

Thanks for you words of encouragement. I appreciate it.

RE the medical, I do believe my medical is no longer valid based on my conversations with AOPA and this.

I won't ignore the fact that I've been given a diagnosis of TGA and that the FAA explicitly say this requires review. The 2 year waiting period of no recurrence that I've been told to expect seems pretty reasonable from a safety of flight perspective, even if it causes financial hardship to me personally. The big picture for which I've always advocated is general aviation safety, not personal convenience. Perhaps that's un-american?

I've had some folks suggest to me that I could just hide this event, but I can't do that. Some people have argued that there are plenty of pilots out there who are flying with undisclosed medical deficiencies. But I just won't do that.

I agree that there is still a considerable amount of teaching I can still do without a medical. That's what I plan to do, assuming no last minute abnormal test results come in.

If I don't take this course of action, I'd set a horrible example to other pilots. Just like those sub-par pilots and CFIs out there.

So break out the hoops through which I need to jump. It's go time!

phil said...

Wow, that is strange. I'm sorry to hear that. Sounds like a strenuous workout combined with any: empty stomach, dehydration, cold/flu ...

Tangozulu said...

Are you sure it wasn't simply exercise-induced? Fatigue and low blood sugar can do a number of a person's mind. Our responses to exercise can also change as we age too. So the "it has never happened before" comment on the tip of your tongue may not be relevant.

I hope you have a successful conclusion to this.

K said...

My three words were 'Apple', 'Bear', and 'Circus'. That was nearly 25 years ago, but I can still remember the terror I was feeling, wondering if I done myself permanent neurological damage due to a bike wreck. I turned out to be just fine (or, at least, unchanged from my original state) -- I hope it turns out well for you, too!

I can understand why the FAA is so anal, but it just doesn't seem fair when you consider the damage you could do blacking out in a car on a downtown freeway at 75 mph. It hardly seems possible that you could do more damage in an aircraft. Good luck.

jog said...

John:

Have you ruled out Transient Global Amnesia caused by shellfish poisoning? Apparently consuming some types of shellfish can result in TGA.

John said...

Jog,

I assiduously avoid shellfish, but I am wondering if something I ate may have contributed or even caused the event. For a week before the event, I had been drinking a yogurt drink that contains plant sterols.

I consumed one of these drinks right before I went to workout and the TGA event occurred about 30 minutes later.

Like statins, plant sterols reduce cholesterol and there have been numerous reports of TGA and memory loss from people on statin therapy.

Unlike statins, the approval process for food additives is not as rigorous as it is for drugs. But there are no studies that I know of that are investigating the safety of plant sterol food additives.

Without a "smoking gun," all of this will probably have little or no effect on my medical issues.