What was the weather report usually in the spring of 2010 when I was undergoing stem cell transplantation?  It seemed to match my mental state: Snow showers (cold and lonely thoughts); freezing rain (tears unwilling to be shed); fog (brain fog, that is), often interspersed with bright sunshine (grateful to have survived the myeloma).  Typical foothills weather; if you don’t like it, wait 15 minutes, and it will probably change.  That is the way it is in the shadow of the Canadian Rockies.

The treatments that I went through involving chemotherapy drugs had a deleterious effect on my cognitive abilities at the time.  (I like to think that I have recovered now from all of that, although that is not really for me to decide.) 

After successful induction therapy, I plunged into the stem cell transplantation process in the spring of 2010.  I received strong doses of cyclophosphamide ^[1] (Cytoxan) before the stem cell harvest and then melphalan ^[2] (Alkeran) for the destruction of my bone marrow; a day later, my stem cells were used to ‘rescue’ me from that treatment. The entire process certainly did not help my brain powers.

I photocopied sheets of poems and took them to the cancer center in an effort to memorize them while I received treatment.   Robert Burns, Joni Mitchell, William Shakespeare…the muses kept me company there.  I couldn’t get the poems, songs, and sonnets memorized, though. Chemo brain was making inroads into my powers of concentration. If you are an older person and have tried to memorize song lyrics, piano pieces, and such, you probably know what I mean.  The young adults have us beat when it comes to memorization, even at the best of times.

According to the American Cancer Society, ‘brain fog’ or ‘chemo brain’ can be defined by the following symptoms:

• Short-term memory loss
• Trouble concentrating, such as having a short attention span
• Trouble with word finding, such as remembering names or being able to complete sentences
• Trouble with multi-tasking
• Slower thinking and processing times, i.e. taking longer to finish things

Some of the foggy effects I suffered were variations of the above. I couldn’t place people’s names even though I had known them for years (once I got the name back, even hours later, it seemed to stick, though). 

I felt quite lost sometimes, probably partially due to cognitive impairment, but also because I was still processing the whole myeloma diagnosis and treatments emotionally.  I couldn’t remember even the simplest things sometimes, let alone function as I had a year earlier.  I couldn’t do simple mechanical things, like open a combination lock, untwist a cap on a ‘childproof’ plastic bottle of pills, or change a cartridge of printer ink on the computer’s printer.  I was also worried about my driving skills and kept my driving to a minimum.  I think that my reaction times in driving were slowed down then.

I usually keep a journal, briefly noting the events of my days, but there is a gap in it right around the time of my stem cell transplant.   The journal entries gradually started again a month after the transplant. 

I wrote that we were invited to a friend’s house to watch the opening ceremonies of the Winter Olympics, which were held in Vancouver that year.  It was great to be included in a social event again after being so ill and tired.  By another month, I was back to doing bookkeeping for work and in a rush to meet the deadlines for tax returns.  Our accountant was really helpful in getting me through tax season that year.

I am sure most patients are aware of the phenomenon of chemo brain, and I am also sure everyone has their own unique way to try to get back to normal thinking processes. 

A few things helped me out a lot in dealing with chemo brain.

One was continuing to communicate with everyone in my life, be it by talking together in person, on the phone, or by e-mail.  It helped me to practice stringing my sentences together again in a meaningful way. 

Another help was the use of crossword puzzles and online scrabble.  My mom, both of my sisters, and I have been playing scrabble together online since 2006. We actually have played hundreds of games together.  It has helped us to stay in touch with each other since we live many hundreds of kilometers, a few mountain ranges, and an ocean apart.  Scrabble is my word game of choice…you can stretch your vocabulary and it keeps you mentally alert too.

As mentioned above, I keep a calendar to keep track of my events. I have found that it useful not to make too many lists or keep several calendars at a time, because that can cause confusion.  

I started tying brightly colored bows on my suitcases when travelling to help me recognize them and remember not to leave without them. More than once I have forgotten a suitcase in an airport and left the building without the case.  It is not just the luggage checked onto the plane I have trouble with, it is also the carry-on bags. 

I have a rolling backpack, charcoal in color, that I have repeatedly left behind in airport waiting areas.  I would have lost that case by now if it were not for my husband Dilip noticing its absence.  Once we had already boarded a shuttle bus and we had to jump off and run back into the terminal to the information booth where I had left it.   So now I tie bright flags on everything and hope that I don’t forget any luggage in the future.

Walking has also helped me in organizing my thoughts.  On many of my walks, I would be mulling over my to-do list, when suddenly the order of what to do when would simply fall into place…clunk!  I planned my day that way, since lists are usually too long and unrea-LIST-ic anyways. 

One of the best things I did to combat chemo brain was to take up writing that would be read by others. 

In the spring of 2010, I volunteered to be the secretary for our needlework guild, a local group about 60 ladies strong.  They really needed a volunteer but were surprised when, wearing my wig and still receiving chemotherapy, I put up my hand to offer help. At first, it was a struggle actually to do those minutes, but I got my name recognition skills mostly back in order and succeeded in following the flow of the meetings and get everything jotted down.  I only had to re-do the minutes a couple of times, and since it was a volunteer task, most people were fairly understanding of any ‘errors or omissions’, and pointed those out.   

Then, in the winter of this year, I started to write a column for the Beacon.  This has also helped me tremendously in sorting my thoughts in regards to the events of the last three years.  

I hope that some of my suggestions help those going through cognitive difficulties.  I can say that most of them sorted themselves out over time with a little effort and the help of others.  

One final note: It is mentioned on the Canadian Cancer Society’s website that a patient may notice problems with memory a year or longer after treatment. 

One should also realize that many people who have never had cancer may have the same memory problems.

Do any of you readers have any thoughts you would like to share on the phenomenon of brain fog, aka chemo brain?

The weather report for today calls for ‘mild temperatures, mostly sunny, no rain or fog, just a few scattered clouds.’

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The quotation for this month is from Oscar Wilde (1854-1900), an Irish playwright, poet and author of essays and novels, who wrote "Memory is the diary that we all carry about with us."