Saturday, November 22, 2008

Chemo brain... how I loathe thee....

For some survivors who have had chemo, we know it is real. I know it is real. I can read pages in books and suddenly find myself staring at the whitespace in the margins. Where did my concentration go and what did I just read?? I can have a whole conversation with a person and walk away knowing I got information, but shortly after, I can only remember vaguely what that information is. It feels as if I can't locate information in my brain. Luckily, my onco didn't discount my complaints and prescribed Provigil for me.... but somedays, not even that is enough.

I am increasingly frustrated that this side effect was never mentioned to me. I had to read about it in some pamphlets that were thrown my way. It seems that the medical community is starting to take it seriously since so many people complain of cognitive impairment. The new research shows that chemo may change your brain. Good to know.

Below is part of an article I found on symptoms and new research on chemo-related cognitive impairment. Read entire article here.

Recognizing the Condition

“It’s a definite medical condition,” says Dr. Christina Meyers, PhD, ABPP, professor of neuropsychology in the Department of Neuro-Oncology at M. D. Anderson Cancer Center in Houston, describing what has come to be known as “chemo brain,” a lesser-known side effect of chemotherapy, which can be just as serious as nausea, fatigue, and hair loss. Thankfully, the condition—marked by a reduction in verbal or visual memory, problems with attention and concentration, a reduction in the speed of processing information, and visual or spatial abnormalities—is the subject of several recent studies, as researchers seek clues to the cause and the cure of this foggy mental condition.

Doctors used to think that impaired cognitive ability was related to other side effects of chemotherapy. Anemia, fatigue, depression, and hormonal shifts can all cause memory lapses and concentration difficulties. But treating these conditions didn’t solve the problem for many patients. And assessing the severity was difficult because there was no baseline data of mental function before chemotherapy.

Several types of cognitive impairment that fall under the “chemo brain” label:

Reduced memory capability, both verbal and visual (“What’s your name again?”)
Lack of focused attention or ability to process information (must read a paragraph several times to get the meaning)
Learning new things takes longer (even though you’re still as smart as before)
Multitasking is overwhelming (can’t talk on the phone and cook dinner at the same time)
Easily distracted (“Why did I come in this room?”)
Missing key points in discussion (“Please repeat what you just said”)
Inability to find right word in conversations (You can’t just say “duh”)
More effort required for usual tasks (daily activities leave you very fatigued)

Help from the Pharmacy

At this point no drugs have proved successful for combating the effects of brain tissue damage. A small study conducted by Sadhna Kohli, research assistant professor at University of Rochester, showed improvement in memory, concentration, and learning for people taking Provigil® (modafinil), a drug that stimulates the brain only as required and lasts about 12 hours. Unlike Ritalin® (methylphenidate), which some patients have tried, Provigil is nonaddictive.

It’s also important that doctors assess and treat possible contributing factors such as thyroid dysfunction, hormonal imbalance, or anemia. As researchers come to better understand the mechanisms of chemo brain, genetic factors may play a larger part in treatment plans.

Thursday, November 20, 2008

Uh, I'm getting high blood pressure

Ugh. Since my diagnosis, I have tried to remain positive, and for the most part I have. Sure, I cried a ton in the beginning and I would wake up every morning and say, "Shit, this is still my life." As soon as I started chemo and I knew my treatment plan, I started to feel like I had some sort of control over what was happening to me. Well, I finished chemo and went in for a follow-up and to plan for radiation today, and I pretty much lost it in my oncologist's office.

I had a ton of questions about follow-up care and how to make sure I can catch a recurrence early, blah, blah, blah.... and my oncologist didn't phrase his answers like I needed to hear them and then he gave me too much statistical information. When he said the words "metastatic breast cancer" I started tuning him out and then I looked at him and said "I am going to cry now." And that was it...

Major waterworks in his office, major waterworks in the blood draw room. I cried while I was in the CT machine. The crying continued while I was getting my Herceptin infusion and all the 70-year-olds looked at me like what I was doing in public was unacceptable. I seriously couldn't help it. Today was just one of those days... if my brain wasn't occupied with a conversation, I was thinking horrific shit.

Beat down. I am emotionally beat down. I am 6 months into this thing and my oncologist reminded me that I have only just begun. He was just full of warm fuzzy words for me.