Chemofog

Today a year ago I started chemotherapy. Although I've written a little more about the long term effects of radiotherapy, I've been realising that I don't think I have entirely recovered from chemo yet either.

In particular, I recently read a little about 'chemobrain' also known as 'chemofog', or more technically, post-chemotherapy cognitive impairment. In particular, as I read this article, I found it described my experience in ways that were surprisingly familiar.

It's not that I can't function, but complex things just seem more difficult, I get tired and confused more easily and have occasional memory lapses. It was much worse during chemo at the start of the year. I had frequent short-term memory lapses, had great difficulty concentrating on a task (and could not multitask) and found my empathy was considerably dampened. I could figure out what someone might be thinking/feeling if I put my mind to it, but it didn't come naturally and intuitively. Instead, my grasp of the emotional experience of others remained a kind of head knowledge without feeling much myself. This wasn't particularly helpful when it was a very emotional time for others! These effects all remain in a muted way (especially getting tired easily).

The research into this phenomenon is all quite recent (the few papers I could find were published in '06 or '07), but one study study that (at least some forms of) chemotherapy had medium-term effects on the physical size of the brain, causing a measurable reduction in size for a few years.

Complicating matters, the whole experience of getting so dramatically sick and then feeling physically (and mentally) weak for months has dented my confidence. Sometimes it is difficult to tell whether I am experiencing loss of competence or simply confidence.

This is another area in which I am learning to trust God, and thank him for the abilities and opportunities with which he has blessed me. I am learning to be human, finite, a creature.

This is the day that the LORD has made. Let us rejoice and be glad in it. - Psalm 118.24

A weighty issue

When my oncologist first told me I would be having radiotherapy of my oesophagus, one of the pieces of advice he gave me was to eat as much as possible in the weeks beforehand. My dietician said I ought to maximise my intake of protein, carbohydrates and fat (when was the last time your doctor told you to do that?). They were concerned that the damage to my oesophagus would make it difficult for me to eat and so I might lose a lot of weight. Since it was December when I was diagnosed, it was not difficult to follow their advice (especially with two very concerned families who liked to express their love by supplying us with lots of food, not the mention the many friends and members of our church family who also cooked us meals). As a result, I gained 5-10 kilos on top of my usual weight, putting me into the 'overweight' range, according to my BMI (Body Mass Index).

Radiotherapy did leave me on a liquids-only diet for a few weeks (and a water-only diet for a couple of days at one point. Even milk or very thin soup was too painful), but being tired and feeling unwell also greatly reduced my physical activity, so I never lost much of the weight I'd so rapidly gained.

Today, I remain a little above the 'normal' BMI, yet my oncologist has always been far more worried that I will start losing weight rapidly than he is concerned at my being slightly overweight. An article in today's Sydney Morning Herald might help explain his reaction: a US study has found that "being up to nearly 14 kilograms overweight reduces by 40 per cent your chance of dying from a range of common diseases and risks, not least because it improves your chances of recovering from surgery, injury and infections."

Yum.

One year on

On this day last year (at about this time), I was diagnosed with cancer. I thank God for many things: that I'm still alive (it really wasn't looking good for the first few weeks); for the love and support (and generosity) of so many people over the last year, particularly my wife Jessica; for a wonderful (basically) free public medical system in Australia; for the chance to reflect with a little more depth and urgency upon death, fear and hope (amongst other things); and for "new birth into a living hope" (1 Peter 1.3), which gives us so much to live for now.

Voice update
Yesterday, I saw my speech pathologist for the first time in a few months. She was very pleased with my progress and said at the end of my appointment that I am the miracle case that she tells stories about. After our first few meetings, she had expected I would need surgery to give me back anything like an acceptable level of function, but my vocal strength, endurance and range have all slowly grown each month as I've (usually) practised the exercises she has suggested. I can now hold a conversation without needing to explain that I don't have a cold. I can now sing again, at least a little and within a certain narrow range. Best of all, I can once more pray and praise God amidst his congregation, raising my voice to join in worship, which is, after all, what voices were made for.

The next step will be another nasal endoscopy in late January to determine whether any function has returned to my paralysed left vocal chord. This is unlikely, but my speech pathologist is curious, given my continued and unexpected improvement. If there is any movement, I will continue to see her to strengthen it. If not, I will simply sing as best as I am able in praise of the God who raises the dead.

[With] this poor lisping stammering tongue... I'll sing thy power to save.

- William Cowper (amended)