Welcome back! Yesterday, I wrote about how chemo fog can affect day-to-day cognitive functioning for those receiving cancer treatments. Now on to the fog you see when you look out a window and can’t see a darn thing except fog. It’s as if the world comes to a halt, only extending as far as your range of vision.
Literary images of fog usually contain some lurking figure in the distance that’s barely discernible, but is there waiting. A lone figure limps across the isolated barren moor in a horror tale. Fog fills uninviting alleys. Fog mysteriously envelops a person and he or she disappears forever.
Most of us are more familiar with this type of fog. You can’t see your mailbox from an inside window looking out. An outstretched arm in front of your face is invisible. Driving in fog is frightening when you can’t see anything in front of you, and you inch along using the white line at the side of the road as a guide. Too much hope is placed on that white painted line.
Planes are grounded. Ships don’t sail. People are cautioned to stay off the road.
Fog limits visibility.
Or does it?
For planes, ships, and cars, the answer is yes. Fog forces us to slow down. People get so busy running from one thing to the next that they scarcely know what their thoughts even are. They live race car lives going at break neck speed around the same track over and over. These cars go nowhere. You can get off the racetrack. Slowing down gives time for thoughts and ideas to change, develop, and strengthen. It may be a subtle shift from not knowing to knowing.
Foggy days have their advantages. I like them. For me personally, fog has reflective benefits. Fog offers introspection and time to think. When fog settles in around the house and changes plans, I just take a step back and wonder what it is I’m being given the opportunity to figure out. Then I proceed to hunker down and figure it out.
Fog leads us to knowing.
In many ways I found myself in foggy territory while I was on leave from teaching. Eventually, it became clear to me that there were more reasons, better reasons, to retire than to return. I have not known what would unfold at oncology appointments or what choices would be best for me. Eventually, I would get information or a feeling that would sway me in a particular direction. There have been relationships I have been unsure about, but when I looked at repetitive patterns, my choices suddenly seemed obvious. It takes time. I need to sit in the fog for that subtle shift to happen.
Last winter brought my part of Wisconsin several foggy days. Plans changed again, and I just planned an indoor day. There was nowhere to hurry, no “have tos” that day, and more of a relaxed pace. When you know you don’t have to go anywhere, there is no worry and anxiety. You are safe in your slippers inside drinking some green tea with pomegranate with you feet propped up. Maybe the world needs more foggy days.
Fog leads to clarity.
Some years I identify a word as a theme for the year. My word for 2019 is FOCUS. At the end of 2018, I was walking in the arboretum imagining thoughts of the year ahead materializing just a few steps ahead of me on the path. Nature really reveals a lot. I heard words of warmth, feeling, and finally focus. I am not sure what big feelings I will have. Maybe it’s a reminder to rely on my intuition and trust my feelings. I am also not sure of what exactly is the significance of the word focus. I waited for more, but nothing came.
It was a cloudy day, but not foggy.
I decided something would happen to let me know where my focus needed to be.
My focus continues to be on my health and happiness. Both are continued works in progress.
It can’t always be sunshine and blue skies. Rain clears away what a person no longer needs. Winds carry new and old away. Winter gives the earth a chance to rest and eventually renew.
And the fog, whereas it first seems like it closes in and confines someone, it redefines. Fog offers a moment in time that is a respite from reality. When it lifts, it has the potential to offer clarity, freedom, and direction. Let it roll in and sit with it for a while. When it’s ready and you’ve had time to sort through confusion, it will roll out, leaving you behind with clarity on what needs to happen.
Sometimes fog just happens and it isn’t safe to be out.
You can’t find clarity wandering around aimlessly on a foggy moor or driving down a road you can’t see. They are lonely and scary places.
Wait until you can see.
The fog will lift.
Today I feel rather foggy on the inside. I don’t have much “ummph.” I think it’s a good day to get super comfy and listen to what messages I may be trying to send myself. Maybe I’ll take a nap and awaken back in a world of sunshine and warmth. Maybe it’s less foggy in my dreams.
Chemo fog is also commonly referred to as chemo brain. It is like weather related fog in that a person just can’t see clearly or get much done. You go through the motions, but life lacks luster. You can’t shake being tired when you wake up. Fatigue of the mind stays with you all day. Other symptoms include difficulty concentrating, trouble remembering conversations or the right word, and taking longer to complete projects or tasks. A serious illness can also bring on extra stress, depression, anxiety, and insomnia. All of these can affect a person’s cognition. Although I never really felt confused or had trouble remembering anything, I just had a general mental fogginess that I couldn’t quite identify. I was slower. You get used to it and just figure it’s part of the collateral damage of treatments.
Then one day, the chemo fog lifted. I remember the morning about six months out from what I thought was my final chemo back in 2012. I woke up and my mind was completely clear. It felt like information traveled faster on neural pathways. It happened again the next morning. By the third morning, I was convinced that I had met one more benchmark that life was returning to my normal.
It hadn’t, but the chemo fog was gone. Even with continual treatments over the past three plus years, I never had that sense of slower processing return. I am grateful that my thinking is as clear as ever.
Many people deal with chemo fog every day. What can a person do to help minimize chemo brain?
Make lists and follow routines. Writing important ideas down will ease any pressure to remember so much on your own. Try to keep all your notes in one place so what you’re trying to remember isn’t scattered about in several different places. Use a daily planner, your phone, or an ongoing notebook of lists. A notebook or health journal is also a good place to track chemo brain symptoms since you may discover patterns when it seems better or worse. Medications or specific situations may also affect your memory. Following a routine will help you with day-to-day schedules. Do you always pay bills on a certain weekday? Is pizza night every Tuesday? Do you have a grocery list of staple foods that you always buy? Are there specific days that you use for specific appointments? I always set up acupuncture appointments on Mondays. I spaced an appointment that I made on a Wednesday (even though it was written down) because I just didn’t go there on Wednesdays. I do well with routines, not so much with changes in those routines.
It’s said that driving when you’re tired is as dangerous (or more dangerous) as drunk driving. I know people who haven’t had any cancer treatments who are unable to remember much because they simply do not get enough sleep. Lack of sleep slows your brain in processing information. Sleep is important all the time, but it’s especially an important part of healing and recovery during and after cancer treatments. Appointments, errands, and work may go more smoothly if you complete some activities in the morning when you are fresher and have more energy. I wanted to walk the other evening with a friend and was simply too tired to go. I was grateful she cancelled and now I know to schedule those activities earlier in the day.
Focus on one activity at a time. Ask for help from family and friends so you can conserve mental energy for more enjoyable endeavors or your work if you’re working. Multi-tasking doesn’t work well for someone experiencing confusion with an unreliable memory. If you know you need a whole day or two after a treatment to focus on the basics of the basics, that’s fine. There is no need to push yourself.
I like word games and brain teasers. I did a lot of word puzzles and critical thinking exercises with my students. My mom and I would do jigsaw puzzles together. A few years ago, I bought the memory game Simon more out of nostalgia than any other reason, but it’s a great way to work short-term memory skills. Reading is another way I continue to work my gray matter.
Veggies are better for brain health than sugar. Moving around is good for both mind and body. It can help decrease fatigue brought on from treatments. This may be a good time to put the word out to friends who have offered to help that a casserole or dinner with fruit and salad would be appreciated.
Stay tuned for a special Monday post where I continue with a few thoughts about the atmospheric fog that limits visibility. It’s a bit shorter, yet, metaphorical and worth pondering.
Tags: fog, clarity, focus, chemo fog,
A quote from the 2014 documentary Fed Up concisely sums up how diet and exercise must be thought of as partners in health: “You can’t diet your way out of a sedentary lifestyle. You can’t exercise your way out of a bad diet.”
It seems likely that someone who watches what they eat probably also has an active lifestyle. Eating right and moving around just helps you feel better and fuels your fun. Raw or steamed broccoli is better than a bag of chemical chips. Taking a walk around the pond is better than sitting on my duff watching TV or even, ahem, blogging.
I am not athletic. Attempts at running were always short-lived and caused me minor injury in the past. But I love to walk outdoors. Going to the UW-Arboretum or Pheasant Branch Conservancy takes care of my heart, lets me decompress, and promotes creativity. Once I build up a little endurance, I also enjoy biking. Gardening, yard work, mowing the lawn, shoveling snow, and anything functional in the line of caring for my home all count and provide that undeniable feeling of self-satisfaction.
Moving needs to become second nature. My Fitbit has helped me monitor how much I move (or don’t move) on a daily basis. Before that, I wrote down how many miles I walked in a journal. It’s important to find a way to be accountable. A while back I read that making goals wasn’t enough, but a person needed to take goals a step further and make plans. Wanting to walk more is all very nice. Scheduling to walk in the arboretum helps turn the very nice into a reality. Saying I’m going to bike more means nothing if I don’t make sure my bike is ready to go and I make the effort to do it.
Hiking is one of my favorite activities. Hiking gets me out in nature with fresh air, blue sky, and lots of trees. Getting lost in my thoughts and really giving myself time to think away from other distractions always provides me with new insight. There is something amazing that happens in my brain when I pair physical and mental work together. My brain works better and thoughts are clearer. Physically, hiking has a long list of health benefits including improved cardio and muscular fitness, lowering risks of high blood pressure, type 2 diabetes, high cholesterol and triglycerides, and also lowering risks of cancers like colon and breast cancer. It’s a great aerobic workout. Hiking also can provide better sleep quality, reduce depression, and lower your risk of an early death. Being active in general tends to lower the risk of death. Honestly. How not surprising. Psychologically, hiking can provide feelings of relaxation and well-being. Sunshine, fresh air, trees, and feelings of accomplishment all feed into better mental health.
Exercise is important for everyone, but keeping it as part of a daily routine is one of my priorities as someone trying to live well with cancer. There definitely are times I would rather sit through a dental cleaning or a foreign film without subtitles than exercise. When I’m already feeling fatigued as a side effect from treatment, it seems crazy to purposely choose to do something that will make me feel more tired. Strangely though, this is not the case. Exercise combats fatigue. I feel tired after exercising, but it’s a different kind of tired than fatigue. I have more energy after I recover from however I’ve chosen to exercise. The energy sticks around a while. Regular exercise has also been connected to increasing survival rates for women with breast cancer. I want to stay alive, hence I exercise every day.
What about when fatigue isn’t the problem? What if it’s physical pain that’s preventing movement? I experienced this the other weekend with aggravated inflammation and muscle soreness from an injection that caused deep hurt with every step. I fought through most of that day trying to find a way to keep fun plans I had that night to go to a concert. I missed my daily workout because I couldn’t exercise through the pain. I could barely walk. I don’t think exercising when you hurt is a safe idea. Pain is a solid stop sign. The up side to my story is I was prescribed some strong medication to help make my evening of fun possible. I still hurt but there were moments I forgot. The down side is the meds made me puke profusely by the next evening. It took days before I moved well again. I’m not pushing activity and I’m definitely not taking any more of those pills. My body will let me know what I can do.
How much exercise does a person need daily? The current guidelines from the Department of Health and Human Services recommend that healthy adults get at least 150 minutes a week of moderate aerobic exercise (activity that produces a sweat). That’s a mere twenty-two minutes a day when broken down daily. Strength training is suggested at least two times a week. Click here for a short article provided by Mayo Clinic on these recommendations.
After getting through six months of initial chemotherapy in 2012, I needed to make changes in my diet. It’s still hard because of my love affair with sugar. Ideally, I should probably also be a vegetarian, but I love cheeseburgers too much. I try to keep these in check and enjoy them when I eat them. For me, a healthy diet consists of less meat, less processed foods, no alcohol, less sugar, more plant-based proteins, and more fish. More of a plant-based diet in general is a healthy winner. I order a steak about once a year on vacation, but even that is waning because of how I feel after eating it. I eat a lot of fish. My breakfast used to be a fairly tasty blend of five fruits and vegetables in my Nutri-bullet. What I thought was extremely healthy was also providing far too many natural sugars and unknowingly raising my A1C. Now I’ve switched to breakfasts that usually consist of eggs, half an avocado, and one fruit. The avocado cuts the natural sugar from the fruit.
One area in nutrition I’ve been more successful in is eliminating dairy. I miss milk. I love milk. However, it contains casein, a protein that promotes cancer growth in any stage. I know some who have read widely on this and disagree on whether that is true or not. My current feeling is I really don’t have much wiggle room to disagree. It is potentially more beneficial to me to avoid milk than to drink it. There is no dietary reason to consume milk produced by another animal. Calcium can come from plant-based proteins such as quinoa, brown rice, oatmeal, white beans, kale, and collard greens. With all that said, I still will enjoy ice cream now and again, maybe a little more than I should. I like string cheese. I slip every so often and have cereal with milk. It tastes awesome, but it can’t become regular diet. I grew up and live in Wisconsin, also known as The Dairy State. Clearly, there is room for improvement in cutting out more foods made with milk. Did I mention I really love ice cream?
I have also added an Omega low-speed, masticating juicer to extract all the vitamins, enzymes, and minerals in their purest and rawest form to provide the highest juice yield. Kale, spinach, celery, cucumber, and green apples make the most gorgeous green juice I’ve ever seen, and it’s also very refreshing. The color green is both a healing and energizing color. Green juice is a great way to send oxygen and needed nutrition to unhealthy cells. Unhealthy cells don’t like oxygen. Too bad, I’m very fond of oxygen. I get to choose, not the other way around.
Both exercise and nutrition need to work in tandem together to get the best results. I am a firm believer that everyone can do something. One person’s exercise or nutritional needs are different from what someone else needs. For example, most people are supposed to get what vitamins and minerals they need from eating a healthy diet and not need these in supplement form. I take a lot of supplements because treatments make it harder for my body to absorb some things. I also still feel a bit down when I look at people hitting the pavement or trails on their bike who look like they are practically flying. I have to work hard to achieve even a slow speed. It takes time for me to build any true endurance. I do the best I can.
Click here to read the 2015-2020 Dietary Guidelines provided by Mayo Clinic. I don’t agree with all the recommendations, but it does force me to justify my choices. As I mentioned in an earlier post, sometimes I feel like there is so much conflicting information on what healthy nutrition means that it’s hard not to drive myself nuts. I look for overlapping ideas from multiple sources.
I try to make the right choices for me in how I move and what I put into my body. I can’t just do one or the other to be healthy. I can’t compare my needs to anyone else’s either. Everyone has individual preferences, routines, and needs. I do learn a lot from others who share what they know when I ask for their wisdom.
My hope is that we all find a way to eat well and move well.
There is wisdom in the old adage to trust your gut. It tells us when something is off – be it a person, situation, or our bodies. It has been quipped as our second brain and more and more people believe the gut plays a role in our emotional health. I think it’s wise to listen to your gut. I dealt with IBS symptoms for years prior to a cancer diagnosis. Forgive me if I share too much. True, there were trigger foods and emotional triggers that caused issues. I saw many specialists that only ruled things out and never could explain why my stomach and digestion were such a mess. Other than a colonoscopy to rule out colon cancer, no one ever thought cancer was truly at the root. And it may not have been, but my gut was certainly working hard to tell me something was wrong. I made minor changes to my diet, but wound up just trying to control symptoms since I never got a real explanation.
Interestingly, after the diagnosis, the IBS symptoms all but disappeared. Sure, my diet is much different now, but I find it a very interesting correlation. Trust your gut. Perhaps it’s bringing your attention to something physical or emotional. Listen.
I am not a dietician, a nutritionist, or a health coach. I just want to share a few things I’ve learned over the past few years. Please follow-up with research of your own and consulting health professionals before making changes to your diet.
Eating a plant-based diet is one of the easiest ways to naturally change your gut environment. Many fruits, vegetables, and whole grains contain prebiotics that keep the large intestine happy. Plants that are higher in fiber content help the gut. It has something to do with the fructans found in fiber rich foods. Fructans are a type of prebiotic. The higher the fructan level, the happier your gut biome. Fresh, whole foods are the recipe for a healthy gut biome. If you choose fresh fruits, veggies, legumes, beans (pinto, kidney, white), and whole grains, you’ll have it covered. Artichokes, raspberries, and asparagus are also good sources.
Legumes typically are low in fat, have no cholesterol, and contain insoluble and soluble fiber. They are high in potassium, iron, magnesium, and folate. General foods in the legume family are lentils, chickpeas, beans, soybeans, and peanuts. Your gut likes legumes. I personally steer clear of soybeans and therefore any soy products due to associations with estrogen production, but I leave it to individuals to research and make their own decisions regarding soy, beans, and any of the suggestions I may make. What’s right for me may not be right for you. It’s always possible I have misread a fact even though I’ve made every effort to double and triple check.
Beans confuse me. Mark Hyman is the author of Food – What the Heck Should I Eat. He believes beans have benefits, mainly as resistant starches. He says the fiber, minerals, proteins, and other nutrients found in beans can be gotten from other food sources. He also writes that beans are to be avoided if you have cancer. I’m left confused here. There are always conflicting statistics, studies, and recommendations about foods. As stated above, beans can help contribute to a healthy gut. There are times I feel that I’m doomed whatever I eat. I still don’t know what the heck I should eat. Then I slip and have a delicious bowl of ice cream.
Broccoli probably wins the prize for the most beneficial food ever grown. I can’t stand it, but I’ve eaten it diligently. Now, I’m on a bit of a broccoli break. It’s easy enough and you can’t beat all its benefits. It’s just one of the mighty cruciferous vegetables that decrease the risk of several types of cancers (breast, colon, melanoma, pancreatic, and liver) and improves bone health. Cauliflower, kale, turnips, and Brussels sprouts are other cruciferous winners.
I have a lot to learn about whole grains. For those in the gluten-free camp, grains aren’t for you. The great thing about whole grains is they are packed with fiber and carbs. When these make their way to the large intestine, they are broken down there and promote the growth of beneficial bacteria.
Plants rich in polyphenols are also helpful to the gut biome because they decrease inflammation in your gut. Polyphenols actually aren’t absorbed efficiently on their way to the colon, which in this case is a good thing, because it means there are more to be digested by bacteria in your gut. Good sources of polyphenols include blueberries, grape skins, broccoli, and onions. Almonds also are a good source, as well as cocoa and dark chocolate. Finally, no guilt for all the dark chocolate I eat! Red wine and green tea are liquid sources for polyphenols.
There are lots of diets out there claiming to achieve wellness for your body – low carb, no dairy, no gluten, no sugar, no meat, vegan, high protein, high fat, etc. The list goes on and on. Some have merit. I am waiting for the high chocolate diet since dark chocolate has already been established as a very good thing.
Bottom line: Eating a diverse diet that is mostly plants, limited in processed meats, and low in sugar is one that will keep your gut happy and that keeps YOU healthy.
I worked with a naturopath in the fall of 2016. It turns out my gut ecology wasn’t helping my body absorb nutrients even though I had made many diet changes and added supplements to my daily intake. This was less than thrilling news to hear that I’d been getting little if any positive effect from years of faithfully ingesting numerous pharmaceutical grade supplements, not to mention the financial investment involved with that commitment. Apparently, chemotherapy and some medications can drain your body of certain nutrients. The solution was better gut ecology, attained through a plant protein based drink that was dark yellow, thick, and awful tasting. I called it sludge. Strangely enough, I came to count on it as a support. It gave me needed nutrition and repaired my gut. I continue to drink it from time to time since my gut will likely be in need of extra support for a long time.
Gut ecology and health is a burgeoning field of science. No matter what the ailment, it seems improving your gut biome is a place to start recovering better health. Thousands of species of microorganisms make the gut home sweet home. These microbes help maximize nutrient absorption and support digestion. They even can contribute to a better immune system. Both these functions are vital to a stronger, healthier me, so if I need to drink sludge every day, I’ll do it happily, because a body that is functioning creates an environment where cancer cells are not welcome. Healthy bacteria in your gut actually form disease fighting armies. Foods like bananas, broccoli, blueberries, beans, and fermented plant-based foods are natural ways to create this bacteria. I give my gut a boost however I can and also take probiotics.
Michael Pollan is an author and food connoisseur who has taught me a lot about healthier eating. He has three simple rules: Eat Food. Not too much. Mostly plants. For further reading, I recommend In Defense of Food (or any book by him).
Trust keeps coming up over and over again as an underlying thread in many posts. It affects how you relate to yourself, to others, and how you function in the world. Trust affects what you eat and how much you eat. Establishing healthy boundaries has a lot to do with trust. I believe there is a direct cause and effect link between happiness, health, and trust. Examining each of these is a huge topic. For now, I’ll keep it simple with a basic guideline to listen to what your gut has to say. Trust yourself. Trust your gut.