What Is Zenker’s Diverticulum?

The Zenker’s diverticulum is also known as pharyngoesophageal diverticulum. Diverticulum is an out pouching of a part of a body. This out pouching can be fluid-filled in characteristic. The condition is not to be taken lightly as this present severe complication. It has been reported that this condition was described thoroughly by Dr. Friedrich Zenker in 1877 and was sought to be acceptable rather than the previous descriptions of the disease. Ever since, his name was coined with the disease condition.

This condition is said to be common or quite a number were noted in the northern Europe. This is a rare condition in Asian heritages. The prevalence rate is said to be in the case-population ratio 2:100,000 people. It is also reported that men are more affected than women and that the elders are also much affected than the young ones.

Zenker’s Diverticulum Location

Zenker’s diverticulum is said to be located at the pharyngeal mucosa or simply in our pharynx but specifically above the cricopharyngeal muscle. To be more exact and clear, it is above the sphincter of our esophagus. There are reports that the muscle may have some spasm problems in order for it to develop to such.

Picture 1 : A. Zenker’s Diverticulum Location; B: Barium X-Ray of Zenker’s Diverticulum

Image source : drugster.info

Picture 2 : Zenker’s Diverticulum (pharyngoesophageal diverticulum)

Image source : nature.com

Symptoms

The Zenker’s Diverticulum has a number of symptoms and it is nearly disabling to the affected. It has been noted that the sufferers are to experience such symptoms for months and even years. The following are the said manifestations of this condition:

1. Food usually comes back up from to the mouth after hours of eating.
2. Difficulty of swallowing the food is a common manifestation. This is medically termed as dysphagia.
3. There is a sensation that food is seemed to be stuck in the throat. There is a choking feeling.
4. Tendency of the client is coughing up after eating.
5. He client may suffer from weight loss.
6. Bad breath or halitosis is noted.
7. Some note distinct noises in the neck.

Zenker’s Diverticulum Causes

The cause of Zenker’s diverticulum is said idiopathic or from an unknown cause. The out pouching of the affected area is not believed to be non-hereditary. There are some pointers that the condition has started from an underlying esophageal problem. There have been uncertain beliefs from the root cause of Zenker’s diverticulum. Nothing has been helpful in supporting such diagnosis. But others noted that factors such as these influence the development of Zenker’s diverticulum:

1. Abnormality of the cricopharyngeal muscle and upper esophageal sphincter.
2. The elastic capability of the cricopharyngeal muscle has been altered or lost.
3. There has been an injury rendered at the central nervous system.

Radiology

The condition is said to be diagnosed through this confirmatory test, such as barium swallow with the procedure videofluoroscopy. This test shall involve viewing of the throat area with the use of this contrast medium, x-ray films are to be obtained in order to see any out pouching of the affected area. This could also be done with the use of videofluoroscopy which shall record or a form of motion x-ray to capture images of the affected area.

Zenker’s Diverticulum Treatment

Treatment for Zenker’s Diverticulum is aimed in alleviating the presenting symptoms of the client. It has been known that the best option for this condition is to do nothing. This shall only warrant for an intervention when it has come to a point of disability to the client. Alternative treatments are provided such as managing the manifestations:

1. Take or eat foods that are easy to swallow. Soft foods are recommended so that it shall not be blocked in the throat. Maintain a rich diet so to avoid weight loss.
2. Follow strict oral hygiene.

Diet for Zenker’s Diverticulum

Diet for Zenker’s diverticulum is important as this is usually altered when one is suffering from such condition. As the person has difficulty swallowing food and even has a tendency to choke, the following are recommended for them after a surgical procedure:

1. Intake of soft foods.
2. It is recommended that the person shall eat or chew ice chips in order to relieve swelling and avoid the bleeding tendency of the patient.
3. Provide high protein foods such as fish, meat and chicken.
4. One should avoid high carbonated drinks or any form of drink that can damage the incision on the surgical intervention. Thick liquids are example of such. Chewing of gums is also prohibited.
5. Remember that introduction of food to client post surgery should be gradual.

Zenker’s Diverticulum Surgery

There are a number of surgical interventions for Zenker’s diverticulum. The following are the presented options for the medical condition:

1. Cricopharyngeal myotomy. This is known in the 70s as the first surgical intervention for Zenker’s diverticulum.
2. Transcervical surgery. There shall be resection of the diverticulum. This is said to prevent the recurrence of the condition. A general anesthesia is required from this procedure.
3. Dohlman procedure. This is aimed to correct the diverticulum. The pouch is to be removed.
4. Endoscopic staple diverticulotomy. This is believed as the procedure of choice for Zenker’s diverticulum. There is a use of an endoscope which shall aid in placing a blade on the affected area. A stapler is then used to cut the pouch from the esophagus.
5. Surgery Complications
6. Complications are somehow cannot be avoided. The following are the proposed complications of Zenker’s diverticulum:
7. Hematoma. Also known as blood clot formation.
8. Esophageal perforation. Injury is prompted during an operative procedure. There is said to be formation of a hole from where to food passes.
9. Esophageal stenosis. There is narrowing of the esophagus. This shall tend to be a more problem to the affected for it can result to swallowing difficulties.

Pain on top of the foot can be disabling even though it sounds to be manageable and not much of a stress. This is basically localized in the 3rd and 4th metatarsal of the foot, the two most common areas affected of top foot pain. The athletes are the favored victims of such condition. There are also other parts of the foot that are much gravely affected, rather than the top of our foot. Because of this, activities become restricted and one becomes unable to perform activities of daily living.

Symptoms

The manifestations of pain on the top of the foot are basically almost similar with the symptoms of other foot problems. The following are the said common complaints of clients suffering from pain on the top of foot:

1. Foot movement restriction. There seemed to be a feeling of disability as the pain masks the sensation of the foot. This then becomes a difficulty for the affected.
2. Foot weakness. Since there is pain sensation, the affected tends to become weakened from the foot pain.
3. Limping. This is more common to those suffering from heel pain, but this does not exclude those suffering from pain on top of the foot.
4. Walking in tiptoes is a hard task. This is due to the restriction that is accompanied by the problem.
5. Running and walking become a hard task.

Causes

There are a number of causes for top of foot pain. The following are the said causes of foot pain (top of foot):

1. Tendonitis. This is a condition that is defined as inflammation of the tendons. This is believed as the common cause of pain on top of the foot among the active people and athletes. This is mainly caused by the overt tightness of the shoe or the tying of shoelaces. After a marathon, this condition may also develop. The factors behind this cause are basically the footwear, activity and training activities.
2. Fracture. A fracture is a rare cause of foot pain but is considered as a serious form of cause. This can result to a more difficult problem. Tarsal fractures are the most common cause of pain on top of foot.
3. Arthritis. This is an autoimmune disorder affecting the nerves and bones of the feet causing pain and discomfort. There shall be decrease in bone density that makes a person have a weaker bone and prone to fractures. The joints are affected that makes discomfort more debilitating.

Diagnosis

Diagnosis for this condition shall start with gathering the client’s medical history. This shall assist the client from knowing the root cause of the condition and that treatment would be easily managed. Physical examination shall also proceed. The following are instructed of the patient in order to assess his or her current state:

1. Examination at rest. The client is placed in a non-weight bearing exercise in order to assess the movement of the foot. Restriction of the area would suggest problems of the tendons.
2. Identification of deformities is also suitable for this may be the root of the pain.
3. Foot muscles are to be tested through activities such as walking, standing and running.
4. Injury is checked. When injury is suspected, an X-ray is to be done in order to check the extent of the problem. An MRI may also be necessary.
5. A bone scan can be done in order to determine the patient’s bone and soft tissues’ integrity.

Treatment

Medical treatment for pain on top of the foot is directly aimed to reduce the discomfort and avoid worsening of the problem. The following are said to be the medical interventions for foot pain:

1. Corrective shoes. These are provided in order to relieve the problem of the foot. This is not a long-term replacement for the current shoes but is temporary in order to treat the problem. Proper footwear is also recommended.
2. Provide anti-inflammatory agents to relieve the discomfort. NSAIDs are commonly prescribed.
3. In cases of fracture, corrective surgery is required.
4. Led light therapy is done in order to reduce pain. This is an expensive form of treatment but can indeed assist the patient to comfort.

Remedies

Home remedies are indeed of help as this is also accessible and not expensive. The following are the proposed remedies for pain on top of the foot:

1. Provide rest. This can facilitate healing. Restriction of movement on the affected foot is necessary to attain wellness.
2. Provide exercise. The exercise should not include strenuous activities for it can only worsen the problem. It is suggested that the client would follow easy range of motion exercises. Stretching exercises should be monitored and that a physical therapist should be assisting the client.
3. Massage. This is not entirely suggested to patients but is quite helpful too. This can only relieve the discomfort but cannot correct the problem.
4. Follow the RICE treatment. This is done through providing REST, ICE application on the affected area, COMPRESSION and ELEVATION.

What is Failure to Thrive?

Failure to thrive is identified in infants and young children rather than in teenagers or adults. This places a concern to the affected as this not to be taken lightly for this condition is associated the developmental process of the young and also the emotional aspect of the child. This condition is described as the deceleration of the growth of the affected infant and child. This is commonly found in babies who were born premature. This can be corrected as the baby has continued follow-ups and proper nutrition provided for.

The condition is easily discoverable, especially when the infant or child is frequently sent to the doctor or pediatrician for monitoring its weight and built. But the infants shall be measured for its weight and size with accordance to the normal or ideal chart of growth and development. This is a form of evaluation that comes along with attesting the child’s development and normal functioning. A delay to such will indicate the presence of the condition, failure to thrive.

Comparison of Failure to thrive baby (left) and normal child (right)

Symptoms

Infants and children suffering from failure to thrive manifest the following symptoms:

1. Appropriate weight gain not attained by the infant and child, in the basis provided for from a chart for the child’s G & D (Growth and Development).
2. The child is easily irritated and easy fatigability is noted. Increased sleepiness is also observed from the child.
3. Some developmental milestones are not ideally attained according to age.
4. The child seems to avoid eye contact.
5. Motor development is also delayed.
6. Basically, the infant or child has lost about 10 % to 20 % of his/her normal body weight.

Failure to Thrive Causes

There are a number of causes for failure to thrive. It may be rooted from the mother’s inability to provide the nutrition or care for the child or it can be classified as from an organic cause, meaning from a medical disorder. The causes of failure to thrive can be classified according to organic and non-organic causes:

a) Organic Causes of Failure to Thrive

Organic or endogenous cause of failure to thrive can be derived from a medical disorder or from an underlying condition. There are certain medical disorders that trigger such condition. This can be pointed out from a chromosomal problem, which is a common cause. A thyroid gland deficiency is also likely to cause failure to thrive. When the problem involves the GI system, this can result to FTT as the child or infant becomes unable to take in and digest the supplements from food. When absorption is also involved, there should be difficulty in digestion and sufficient nutrition to the child. Other conditions related to organic FTT are liver problems and celiac disease.

b) Non Organic Causes of Failure to Thrive

Non-organic causes of FTT or also known as exogenous FTT are primarily from external stimuli. There are no medical issues constituted with this condition. The development of FTT is rooted from the caregiver’s lack of attention or can be due to the socioeconomic status of the family. This type of cause is very common in third world countries, who are striving for food and health. This can also be due to the maladaptive behavior that a parent or guardian possess. There are conditions related to FTT due to the primary caregiver’s suffering from deep depression, alcohol abuse, and lack of affection toward the infant or child.

Failure to Thrive Diagnosis

In order to diagnose such condition, one is set to assess for signs of failure to thrive. One should have a list of the possible signs of the medical condition. Vital changes in the child’s physical appearance, seemingly the child presents malnourishment, and then this can assist in the possibility of failure to thrive. The infants can be assessed thoroughly and in a monthly basis. The child’s weight and head circumference are measured monthly to check for vital changes and growth. There developmental growth can also be assessed through checking for the child’s attained milestones and also through consulting a developmental chart accordingly.

Assessing the caregiver’s ability to provide care and nutrition to the child and infant shall also provide sufficient information on the status of the child. There role is much significant in the development of the condition, as this interview is much obliged during the child’s examination.

Treatment

Treatment for FTT is aimed to provide comfort and proper growth and development of the child. It is essential that the underlying condition is identified so corresponding treatment shall be provided. The following are proposed therapies for FTT:

1. Underlying conditions should be managed accordingly. This can avoid further causing harm to the child or infant.
2. Provide high caloric foods to the child. Avoid foods that can induce diarrhea which is another form for worsening the condition. Proper food supplementation is necessary to be provided to the child.
3. Guidance is much obliged to the coping parents or caregivers. When it has been assessed that the condition is caused by a non-organic stimuli, then this should be taken care of by assisting the caregivers.
4. There are many unavoidable causes, such as poverty or abandonment. This cannot be easily altered but suggesting that the child is to be treated for good foster care may be necessary as to help the child withstand the ailment.

Failure to Thrive Prevention

This condition can be avoided as this shall start with the caregiver. Parenting classes are provided so knowledge of the condition shall be made aware of and that possibility of the medical condition to arise is far from happening. Assisting the caregivers to be responsible enough to the care of the infant or child can help prevent such condition.

Detecting the problems ahead of time is also a preventive measure. This can help in, if not preventing the condition, avoiding the worsening of FTT. Avoidance in illicit drugs is necessary as this can precipitate premature babies. Alcohol abuse in much prohibited to expecting mothers.

What is Medullary Sponge Kidney?

The medullary sponge kidney is also known as the Cacchi Ricci disease or simply the sponge kidney. This is considered as a rare condition that involves cystic malformations in the urinary system, specifically in the collecting ducts of our kidneys. There is a possibility that both of the kidneys are affected. The term sponge should not be taken literally, as this has been found misleading in the medical sense. This does not conclude that the kidneys have developed into a sponge-like form. It has been used but shouldn’t be considered as such.

The prevalence rate of medullary sponge disorder in the United States of America is noted to be 1:5000 people. Women are more affected than men. Basically, the condition is caused by formation of calcium stones that about fifteen percent of medullary sponge kidney cases are caused by such. The condition is said to be affecting those in their thirties.

Medullary Sponge Kidney Symptoms

The manifestations of medullary sponge kidney are sometimes masked or seemingly become asymptomatic to others. Usually, the condition is noted to start from a urinary tract infection or from a kidney stone. Because of that, the affected are suffering from these symptoms:

1. Burning sensation during urination. This is usually accompanied by difficulty in urination.
2. Pain in the flank area or the lower abdomen
3. Urine discoloration is noted. It may become dark, cloudy and tinges of blood may also be observed.
4. Changes of the urine smell are sense.
5. The patient shall suffer from fever and chills

Causes

Medullary sponge kidney is basically from an unknown cause. There are some known factors being related to the disease condition and it involves genetics.

There are also cases where the condition is believed to be a complication or a worsened state of a urinary tract infection or any form of stone formation in the urinary system.

There are no cases where it has been found linked to any environmental factor or some sort of drug intake/abuse.

Diagnosis

It is essential that for the diagnosis of this condition, collecting pertinent data regarding the person’s complaints should be done. The present medical history is essential in order to point out the root of the disease process. Urograhy is ordered, which is usually a confirmatory examination for medullary sponge kidney. This shall reveal abnormalities in the kidney.

Radiology is suggested mostly for this condition. This can help in viewing the kidneys and find the distinct changes – such as grapelike calcifications development. The CT scan is very much essential for it can be specific and can provide concrete visual pictures of the affected organ.

An Ultrasound is also used as a tool for the diagnosis of medullay sponge kidney. This indeed can help in viewing presence of calcifications of the kidney which is highly suggestive of medullary sponge kidney.

Medullary Sponge Kidney Treatment

The direct treatment for medullary sponge kidney is yet not identified. The treatment provided for patient with such condition is only aimed in managing the presenting symptoms and relieving the discomfort of the affected client. The following are done in managing medullary sponge kidney:

1. Infection is treated with antibiotics. This can relieve the presenting symptoms such as pain, urinary difficulties and the like. As this can also be recurrent, the longer the drugs are provided but are prescribed with low dosages.
2. As kidney stones are identified, it is highly suggested that they are to be removed. A procedure is done which can break down the stones easily with the use of sound waves, known as lithotripsy. As the stones are already broken down, they can be readily removed from our system through urination.
3. Clients are provided with diuretics so to decrease hypercalciuria – that causes stone formations. Urine alkalinizing agents are also provided to reduce stone formations.

Diet

There are indeed diet changes when one is suffering from medullary sponge kidney. A cleansing diet is much recommended as this can reduce the presenting symptoms and shall help restore the normal functioning of the urinary system. As recommended, the client should reduce intake of high sodium foods. Increasing once intake of potassium shall improve excretion of excess calcium salts. It is also advised that the patient shall increase his or her water intake as to assist in the proper excretion of wastes from the body.

Prognosis

The condition is said not to be fatal in terms of its effects. There are no reported cases of mortality among the affected. The condition only poses a hard time onto the affected as it takes great effect on the renal system. It places a nonprogressive disease but should not be taken lightly. There is no significant damage rendered on the renal system but can be impaling as it also places worsening of the condition.

What is Genioplasty?

Genioplasty is a known cosmetic surgery and is famously identified as the cosmetic surgical intervention of the chin. This type of surgery is aimed to improve a person’s chin. There are a number of reasons why people undergo such procedure. This can either be for aesthetic purposes or to correct a deformity or positioning of the chin. The reshaping of the chin is still a person’s choice as this is also to attain balance of their facial structure.

Genioplasty before & after picture

Image source – mcleandentalimplant.com

Those who are a candidate of such procedure are the following people:

1. It should be made sure that the candidate is in good health.
2. The patient should not have any serious ailment or disease that can only risk his or her immune system.
3. Patients with a small chin are indicated to undergo such procedure. This is due to the fact that the facial features should be in proportion. A receding chin is also to be corrected.
4. Patients with an enlarged chin are possible candidates of genioplasty. This is to make the largeness of the chin more proportionate to the client’s face. Because of the large chin, this can be very destruction to the part of the patient.

Genioplasty Terminology

A. Sliding Genioplasty

The sliding genioplasty is also known as the chin advancement. This procedure is another form of chin enlargement. This plastic surgery is said to correct the form of one’s chin making a “new chin” with the use of own skin. The said procedure can result to a very natural effect as there are fewer incisions done because it can be done intra-orally. However, the procedure can be result to nerve damage because of either an implant or the augmentation itself affected a nearby nerve.

B. Jumping Genioplasty

The jumping genioplasty is said to be the ideal when one wants a reduction of the chin. This is mostly done to patients who have an enlarged chin.

C. Osseous Genioplasty

The osseous genioplasty is said to be a reliable form of genioplasty. This can correct the problems affected the sagittal area that it can change the chin projection. This is a more corrective form of genioplasty. There is correction of the contour and height of the facial muscles. It can either move the chin forward or in backward position. This can be done through grafting and would mostly require a longer recovery period because of bone healing.

Genioplasty Procedure

The procedure is done in order to reshape the chin or to reposition the bone that has been supporting the chin. If an implant is involved, it shall include the use of silicone that can be placed on the chin. During the procedure, there shall be an incision done inside the lower lip of the client in order to correct the area. It can also be that the area of incision is located under the chin. Once the chin bone is to be repositioned, an implant may be placed to correct the area.

Genioplasty Recovery Time

Those who have undergone genioplasty shall have a different recovery time from each type of procedure. The osseous genioplasty is reported to have a recovery time of 12 to 18 months, while the other two procedures are to have about 2 weeks as a recovery time. The procedure shall take that long to recover for to allow the skin and possible implants to adjust in the area. After recovery has been attained, the patient shall resume to normal activity. When sutures were involved with the procedure, one week is the time for the sutures to be removed.

Genioplasty Cost

The average cost of genioplasty is reported to be 4000 USD. Some institutions have a range of 3000 to 10,000 USD that comes along with the doctors’ professional fees and the amount of the surgical procedure. The procedure is might costly as this is considered as a plastic surgery.

Complications

Complications are somehow inevitable and can provide a delicate situation to the client. There are untoward effects, not just complications of genioplasty. It can be that the client shall suffer from bruising after the procedure. These are also a tendency the client shall have overt stretching of the skin. The known complications of genioplasty are the following:

1. Bleeding tendency.
2. Infection is a common complication from the surgical procedure.
3. Nerve damage.
4. Damage to the nearby tissues or structures of the face may be likely.
5. Repeated surgeries of the face can truly affect the muscles. This can either weaken them that the muscles and tissues make it difficult for the client to masticate or simply chew food.
6. Teeth damage is said to be a complication. The jaw can also be affected.

What are Night Terrors?

Night terrors are quite common to children, ages three to twelve years. It is noted that the condition peaks at the age of 3 and a half. These are activities that cannot be avoided as a child may constantly dream, as adults also do. These night terrors are quite effective in making a significant change to the child. This places also alarm among the affected parents, as the children. The night terrors are not directly classified as a dream, instead is a reaction of fear during sleep. This condition is indeed unpleasant and usually occurs during the REM sleep, most likely in the earlier stages.

Symptoms

The night terrors are quite similar with the presentation of nightmares. But the two are distinct from each other and should not be compared or mistaken as the same. Here are the common manifestations of night terrors in children:

1. Sudden waking up from sleep, usually in the middle of the night. The child may seem awake but is truly asleep. The child may awaken screaming or catching his or her own breath.
2. The child manifests intense fear and even may panic. The content of their dream may be threatening but shall have no recollection of it or some sort of the cause.
3. The child has increased vital signs such as the heart rate and breathing.
4. There are times that the child is difficult to arouse from sleep.
5. The very next morning, the child may have a difficult time recollect with the night terror.

Causes

This has been quite a debate in the medical science for nothing can truly decipher the tricks of the mind. But accordingly, this condition has been quite linked to sleep deprivation of the children. This is basically triggered when the usual sleep routine of the child has been disrupted or abruptly changed. It is important that the children are very sensitive that breaking their usual routine places a great effect on them.

Stress is also linked to such phenomenon. This can either be stress from school or at home. Lack of sleep is also a stressor.

A trauma or recent accident is also likely rooted for causing night terrors in children.

What Happens During The Night Terror?

Night terrors are quite different from nightmares, for the fact that the child entirely forgets or cannot recollect a memory from the dream. Usually the episode would begin an hour and a half right after falling asleep. Most episodes are noted to last for a minute or two but could come and go for thirty minutes. This phenomenon truly confuses the child that disorientation and confusion is usually noted from them.

Diagnosis

A night terror is usually can be easily diagnosed through taking the child’s history. Gathering vital data as the sleeping pattern and its abrupt changes to it can assist in the diagnosis of the condition. As this condition is commonly confused with the known nightmares, taking note of its difference is important. This can play support in diagnosing this condition is through the history of the child and collecting the manifestations of the child.

In order to rule other other possible conditions, it is essential that the child undergo such examinations:

1. EEG or electroencephalogram. This test shall see what the brain activity of the child is. This can rule out the possibility of a seizure disorder.
2. Polysomnography. This is a test, basically a combination of tests, which shall check the child’s breathing cycles during sleep. This is done in order to test for any form of breathing problems.

How To Stop Night Terrors (Treatment)

Direct treatment for night terrors is not yet known to medical science. Treatment for night terrors nowadays is only aimed in assisting the child who suffers from them. This is to manage and make the child feel less discomforted from the night terrors. The following are presented are the medical remedies for night terrors:

1. Once the condition has been known, make sure that the child has a safe sleeping quarter. As night terrors cannot be avoided, making the child safe would help manage the condition.
2. The parents’ responsibility is not to alter the child’s sleeping routine or pattern. This shall maintain consistency and shall avoid the trigger of night terrors. It shall also be helped with removing any form that shall facilitate sleep disturbance.
3. Some medications are recommended, such as those that can temporarily resolve the night terrors. Tricyclic antidepressants are prescribed, most especially when the night terrors are at its worst.

Prevention

Prevention is a good form treatment for night terrors. The following are forms of preventive measures for night terrors:

1. Interrupting the child’s sleep “before” an episode can avoid further episodes. As the parent has noted the time where the child usually suffers from a night terror, 15 minutes prior to the episode is the right time for to interrupt his/her sleep. This should be done in a routine in order to assist the child in relieving the condition.
2. Do not abruptly change or alter the child’s sleeping pattern.

Difference Between Nightmare and a Night Terror

The difference between nightmares from night terrors is truly minute or not that recognizable that most of the time both are being compared as the same. The differences between the two are to be presented through this table:

Nightmares

The child seems to be in an unpleasant dream and shall be awakened from it. Complete recognition and recall of the dream shall be noted or partial remembrance is noted. The child shall then seek for a parent or parents’ comfort after the nightmare. Waking up the child from the nightmare is necessary for comfort is much obliged to them.

Night terrors

The child experiencing night terrors shall be in deep slumber. He or she shall be truly restless in an episode of a night terror. One should not wake the child during an episode instead make the vicinity safe for him or her. As the child wakes up in the morning, he or she has no total recall of the episode that had happened.