Chemofog II

I've just arrived back from my CT scan. I won't get the results until later this afternoon. While I'm waiting, I thought I'd post about another appointment I recently had.

Back here I talked a little about post-chemotherapy cognitive impairment, often called "chemofog" or "chemobrain". A week or two ago, I had a chance to see one of Australia's leading specialists into the field. Formal study of the phenomenon is quite new (only in the last couple of years has it been recognised as a condition) and has focussed almost entirely on breast cancer patients (this is now being expanded to bowel cancers). Nonetheless, it seems that there is a consistent experience reported across many cancer patients of finding short-term memory and concentration more difficult during and after chemotherapy treatment. As I described my difficulties, I was told that I was a classic case. These complaints seem to be particularly common amongst more educated patients who rely on higher cognitive skills more often in their employment and it is usually upon returning to work that it becomes most noticeable. Although not nearly as pronounced as it was during treatment, my own frustrations surfaced again when I returned to trying to do some more "serious" reading, writing and lecturing in the second half of last year.

Although I am outside the scope of present research (having had the "wrong" kind of cancer), I was offered some follow-up with a neuropsychologist to more formally test for any cognitive impairment. The specialist I saw told me that my results are likely to still be within the "normal" range, since I probably began ahead of the game. Much more interesting would be to test how I go now compared with my function prior to treatment, which is, of course, impossible.

As I said, research into this phenomenon is still new, but the latest results seem to indicate that chemotherapy, while contributing to the problem, is not the only cause, as similar symptoms and testable impairment can be seen in cancer patients prior to their chemotherapy. Whether this is the result of stress or a function of the cancer itself (or even the body's reaction to it) remains to be determined. Interestingly, there are some similar cognitive problems encountered by sufferers of a few other chronic conditions (such as the early stages of HIV). Thus, calling this condition "chemofog" is probably a misnomer.

I'll post again once I have today's CT result.

Oncology consultation

After my fourth good scan last week, I saw my oncologist this morning, who was also happy with the result. He didn't think a PET scan was necessary and said my next CT scan could be in three months, rather than two. This is all good news.

As for ongoing side-effects of the treatment, we discussed two things. First, I mentioned chemofog and he referred me to one of his colleagues, whom he said is a leading researcher into the phenomenon. She is away at the moment, but will contact me soon to discuss it.

Second, he pointed out the visible scarring of my lungs from radiotherapy. The damaged region comprises less than 10% of the total volume, but is still a significant amount. He said I will probably not win the Tour de France now.

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