When my son was small we were shopping at a hardware store. In the rear of the store, a buck’s head was mounted on the wall. My horrified four-year old asked, “Mommy, what’s that?”

Always one to believe simple truths are less confusing, I replied, “It’s an elk.”

“How did it get there?”

“Someone shot it, sweetie.”

“Oh,” he said.

Later, as we returned to our car, he asked if we could walk around to the back of the building.

“Why?” I asked.

“To see the back end of it.”

I have told that story many times. But once, at a dinner party, I couldn’t retrieve the name of the store. I don’t mean a specific name. I couldn’t remember what those types of stores are called!

This was years ago. Forgetting words was a new experience. After a long embarrassing pause, I began a description. “You know, those stores with hammers and screwdrivers…”

“Hardware store?” someone offered. 

“Yes.” Relieved I resumed my story.

Since my chemo, I forget words regularly. When I can’t pull up a word, hardware store is my default utterance.

My oncologist seems unconcerned about my brain glitches. He says they are common after chemo, as is the fogginess and fatigue that make it impossible to resume my energizer bunny persona.

Friends, who have never had chemo, confide that their memory isn’t what it used to be. As we age, memory lapses are normal – forgetting names or where you left your glasses, missing an appointment or having trouble remembering the details of a conversation. But, in my cancer support group, this memory thing has a name - chemo brain. Before treatment, I’d never heard of it.

I had heard of the hippocampus, the region of the brain involved in the formation and retrieval of memories. I was curious how normal brain aging differs from chemo brain. So I attended a presentation by speech pathologists Carol Superfine, M.A., C.C.C. and Jeannette Nagai, M.A., C.C.C.

They described these frequently experienced post-chemo experiences:

·      Being unusually disorganized

·      Difficulty: concentrating, finding the right word, learning new      skills and multitasking

·      Fatigue, Mental fogginess

·      Short attention span

·      Short-term memory problems

·      Taking longer than usual to complete routine tasks

·      Trouble with verbal memory, such as remembering a conversation

·      Trouble with visual memory, such as recalling an image or list of words

They termed these symptoms "mild cognitive impairment."

Usually the changes are very subtle, and others around us may not even notice. But we’re aware differences in our thinking.

Doctors have known for a long time that radiation therapy to the brain can cause trouble with thinking and memory. But now, they are learning that chemotherapy is linked to some of the same problems. Though the brain usually recovers over time, it’s important to know that the vague, distressing mental changes are not imagined. Chemo brain is real!

Two major studies are being conducted in Australia by oncologist Janette Vardy, MD. Her studies include people with breast cancer and colorectal cancer. The researcher has found that those with cancer who never received chemotherapy didn’t experience any brain changes. Those who had received chemotherapy did.

To try to understand better what is happening, the researchers tested the central nervous systems of experimental animals, Dr. Noble’s team found that  chemotherapy interferes with the cell division in the hippocampus. (Remember what that is?) The cells needed for memory don’t reproduce normally. They also learned that the myelin, the nerve’s insulation can be damaged, causing cognitive problems.

Early research by Jame Abraham, MD, director of the Comprehensive Breast Cancer Program at West Virginia University’s Mary Babb Randolph Cancer Center shows differences in the white matter in the front part of the brain in women who had received chemotherapy—differences that correlate with their slower speed in processing information. These changes do not appear to be caused by depression or anxiety.

The last time I walked purposefully into my office and stood wondering what I was doing there, I thought, “Wow! This chemo brain is really annoying.” But then I remembered, so was my cancer.

So how do we deal with the inconvenient and sometimes aggravating aftermath of our changed bodies and minds? How do we cope with the new normal? Here’s another story I just remembered.

I think it’s easier to put things away – right away, rather than leave them lying around until later. The other day, I needed to tell my son to put something back where it belonged. “Could you put this away?” I pointed at the offending object.

I guess I was sounding a little bossy, because he shot back, “What’s this?”

Again I pointed, this time laughing, “I’m trying to think of the word. Would you put it away, anyway? Please.”

Here are a few suggestions on how to cope with day to day living:

·      Share these changes in you with the people you love. They’ll be much more accommodating

·      Talk with your cancer team. Write down your questions and bring them to your visit

·      Relax. It helps you remember

·      Have routines

·      Write it down

·      Move. Exercise increases the circulation to your brain

·      Wait. Sometimes, your mind needs time to reboot

·      Get enough rest and sleep. Naps can bring back alertness

·      Eat healthfully, especially vegetables

·      Give yourself permission to focus on one thing at a time

·      Consider some time for meditation or yoga

·      Don’t rush. Give yourself enough time

·      Look for patterns that may help you figure out what affects your memory. Then, don't plan important tasks or events when your memory problems are worse

·      Exercise your brain. Do or learn something new

·      Don’t be hard on yourself. Acceptance will help you put your new thinking into perspective

·      Describe it. If you lose a word, a name, ask for help.

·      Don’t forget to laugh at yourself

·      Don’t forget the Hardware Store

Helpful information and materials may be obtained from the American Cancer Society at 1-800-227-2345 or check out their Web site, www.cancer.org.           

   

BACK TO THE DOCTOR

We all need feedback, an accountability partner. You might have felt inspired as you read about Bob, who lost over 50 pounds and is still at it. Bob moved his BMI from 35 to 25. In other words from obese to normal. Bob was motivated. 

His doctor warned him that he was going to get diabetes. How did the doctor know? Numbers – Bob’s weight and his blood sugar’s upward creep.

Fear is a short-term motivator. For success we need intention. When Bob left the doctor’s office, he was determined to try, though he wasn’t convinced that his weight wasn’t just his inherited body type.

To recap, in case you haven’t read his interview in earlier blogs, Bob’s a therapist, and because he understands behavior, he knew he needed feedback – some reality check outside himself. Change needs a plan. His was to go to Weight Watchers.

He was willing, but he wasn’t drawn to it. He’s a busy guy, and he’d rather spend his free time golfing than going to meetings. Then, he happened upon a product, a Nike Band, which gave him feedback on how much he was taking in and how much he was burning. It was as if he was wearing his accountability partner on his wrist.

Another thing in Bob’s favor is that he’s computer savvy, so he utilized the Nike site to compare his progress to others his age. He could have succeeded by using other means, but the fact is he found something that worked, and he’s still doing it. He’s still on course more than six months later.

I’m not someone who pushes products or programs. You can burn calories dancing alone in your kitchen or walking your dogs, just as you can at a gym. But, if you find something that motivates you, helps you stick with your goal and the principles behind it are legitimate, embrace it.

Don’t misunderstand. I am not endorsing the latest miracle product. Ads for coffee beans, berries, grapefruit, WHATEVER, put me in a bad mood. I hate seeing people shell out hard-earned money for quick fixes. Anything that strains your budget while offering to turn your life around in 28 days is suspect in my penny-wise world. Losing weight is like getting out of debt. Just as you can’t borrow your way out of debt, you can’t buy your way out of excess inches.

One part of Bob’s journey, not covered in the interview, involved his 6-month follow-up visit with his doctor – the one who threatened him with diabetes. Here’s what happened.

His doctor looked at Bob’s lab results and read the numbers, which were now normal. His doc didn’t jump up and congratulate him. He didn’t seem amazed. He didn’t even ask Bob how he did it. Strange! Bob looks like a different person. Maybe the doctor needs glasses.

Or here’s another possible explanation – Physicians are numbers people. Just like a financial planner, they watch figures go up and down. Doctors aren’t behavioral change specialists. What most of them want to know is where you are in terms of your  numbers.

Bob has another theory. “My doctor’s seen this before in other patients. He doesn’t believe it’s going to last.”

Could be. And Bob thinks it will be fun to prove him wrong.