“Chemo Brain” is for Real, and There is Real Help - A Discussion on Chemotherapy-Induced Cognitive Impairment

Today, Jill is joined by Doreen Bridgman and Marilyn Abrahamson, the brilliant and compassionate minds behind Brain Thrive—Brain Health Coaching. These experienced speech-language pathologists dive into the realities of "Chemo Brain," a common yet often misunderstood side effect of chemotherapy. If you find mind fatigue, fogginess, and forgetfulness frustrating and disruptive of life, you're not alone. 

Join us as Doreen and Marilyn share their expert strategies to help cancer survivors navigate and overcome these cognitive challenges.

Key Discussion Points:

1. Role of Speech-Language Pathologists (SLPs):

   - SLPs address language and processing, attention skills, memory, and communication, These are crucial for managing cognitive impairments.

   - SLPs are vital in helping individuals with cognitive impairment caused by chemotherapy.

2. Chemotherapy-Induced Cognitive Impairment:

   - Affects attention, memory, word finding, organization, decision-making, and problem-solving.

   - Research shows MRI-detectable changes in brain gray and white matter, validating this condition.

3. Long Live Your Brain Program:

   - A six-week online course focused on lifestyle choices, reducing information overload, cognitive energy management, and environmental organization.

   - Emphasizes shared experiences through group coaching, fostering support, and building coping strategies.

- Support from group activities helps individuals feel less isolated and more supported.

4. Strategies for Coping:

   - Stop, Breathe, and Restart: A technique to reset focus and manage information overload.

   - Say it and Make it So: Vocalizing actions to make routine tasks mindful and memorable

   - Journal symptoms and use patient portals to communicate with healthcare providers.

   - Encouragement to re-engage socially, choosing quieter, less crowded environments for better cognitive processing.

 - Support from group activities helps individuals feel less isolated and more supported.

Contact Information:

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Transcript

1:46

Hello everybody, welcome to the Everything Cancer podcast. We are so happy to have you here with us. We have two knowledgeable and helpful guests with us, Doreen Bridgman and Marilyn Abramsen. And they are both speech language pathologists that have been doing incredible work with patients for several years. They have many years of experience between the two of them and have recently kicked off a service called Long Live Your Brain, which they're going to introduce us tonight. But we're here to talk about chemotherapy-induced cognitive impairment, which if you feel like you're experiencing it, you probably are. And they're here to validate that for you and give you some strategies on how to deal with that and then how to seek out help. Doreen and Marilyn, thank you so much for being here. Thank you for having us. Thank you for having us. Sure, sure. So can you tell us about your credentials, Doreen, if you'd like to go first, and then Marilyn, if you can introduce us to your credentials and then tell us what is a speech language pathologist? So I'm Doreen Bridgman. I've been a speech pathologist for about 33 years and I'm also a certified brain health coach. Most of my experience early in my career was in the field of traumatic brain injury, which is how I got so interested in cognitive rehabilitation. And in my later career, I've been working more with concussion, ADHD, and any areas where people are noticing any mild cognitive changes. So whether that be as a result of an injury or an illness, and now with the chemo therapy. So Marilyn, if you could introduce us to yourself and then let us know what a speech language pathologist is, and Doreen, I'd like to go back to you then and explain how a speech language pathologist, what in their specialty, what in your specialty really places you with a person who is experiencing cognitive impairment. My name is Marilyn Abramson. I've been a speech language pathologist for, I don't know, since 1987, so about 35 years. And I've spent most of my career as a hospital based speech language pathologist working with adults with stroke, brain injury, neurodegenerative conditions like Parkinson's disease and multiple sclerosis. I would say the last 10 years of my career, I've been focusing more on cognition and helping people improve their cognition so that they can get back to their lives, get back to their families, doing the things that they love. In 2016, I started working very closely with brain health coaching, became a certified brain health coach. Oh, that's amazing. So what is a speech language pathologist? What do you study in school? Speech language pathologists can do lots of different things depending on the demographic that they're working with. They can work in theatrics, working with babies, feeding, most people know about children with R's and S's that they can't pronounce like that. But when you work with adults, you're doing speech as well, doing a lot of swallowing disorders and working with communication skills, certainly, and cognition. And for a very long time, it was really only occupational therapists that were doing that. And then speech language pathologists sort of got on the bandwagon maybe 15 years ago. And now I think speech language pathologists are primarily doing. So Doreen, what sets up a speech language pathologist to work with someone who's experiencing cognitive impairment? So because we focus so much on language and processing of information, we address everything from the moment that there's the stimuli presented, so helping somebody to focus their attention. And then we get into higher level attention skills, being able to shift back and forth between two people in a conversation, to then really being able to break down the language, understand it, remember it, and then give your response back. So you're on the receiving end and you're also on the expressive end. And we work on everything from, again, that initial stimuli to being able to organize a lengthy response, using the correct grammar, using the word choice that you're looking for using inflection. So I always laugh because many people say to me, I don't need to see a speech therapist, I speak fine. Because many people really don't understand that we do a lot more than just helping somebody to speak. Mm-hmm. Well, I'm really glad that we're here tonight to learn a little bit more about that. So thank you, both of you, for being here. And for the number of years that you've been working on this, you've certainly seen a lot of fashion changes. Over that time, I think when you both are talking about the 80s, I think of everything in the 80s and then the 90s. And now we're coming back to a lot of those things again. What is chemotherapy-induced cognitive impairment? It's funny because when we talk about this, they're not exactly sure what it is. It's different for everyone that experiences it. Generally, it's a cognitive impairment that could include anything from attention, problems with memory, difficulty finding words, problems with organization, decision-making, problem-solving, all of those things. And I think that every person that has it struggles with something different. So it's very, it's unique to the individual, but you're seeing consistent issues with cognition. You're seeing consistent issues with either memory or working through organizational issues, strategical issues. Doreen, is there research that's validating the existence of this now? So there is now more research coming out that does identify this. It has not yet been, there's no ICD-10 code for it. It gets characterized more under mild cognitive impairment. And I think what's really important for people to understand is that if you think there is a change, there likely is a change. And so people, I think very often the most frustrating thing for people is when they say, you know, I'm just not remembering or I just can't focus and somebody goes, oh, you're fine or oh, you just need a good night's sleep. If this is an ongoing, persistent kind of problem, it's something that needs to be addressed. And so even though nobody may be validating it for you, it's definitely worth exploring. It sounds like you're validating it for listeners right now. So for our listeners, if you are experiencing, which happens to me all the time, but if you are experiencing not finding the words that you want to use or difficulty organizing things, remembering tasks, remembering how to follow through on tasks or what you need to do. And I'm sure you can give many more examples, Marilyn and Doreen, you are validated. This is a real phenomenon and there is help for you. And Marilyn and Doreen are here to tell us about that. What were you gonna say, Marilyn? I was just gonna say, you know, the problem with it is it's one of those sort of invisible kind of things. When someone looks at you, they don't see it. But, you know, going back to your question about the research, I think one of the most important pieces of research, because it is so validating, is a recent study that showed that they actually see changes in the brain on MRI with people who are experiencing chemotherapy-induced cognitive impairment. And what they're seeing is they're seeing changes both in the gray matter of the brain, which is actually like if you're holding a brain in your hand, the gray, you know, that's the gray matter. In terms of shrinkage of the brain, the brain actually gets smaller. And they're also seeing changes in the white matter of the brain, which is damage to the neural pathways that travel throughout the brain. And those pathways are so important because that's how the brain cells communicate with each other. Like if you're going to pick up a pen, obviously there's a lot that goes on in your brain. And all of those electrical impulses have to travel on these pathways. And if those pathways are damaged, then they're not going to be able to communicate with each other. And that's going to translate to cognitive impairment. And so, you know, we're not happy that these changes are being seen, but it is validating because, you know, you can't deny it. Right? So if someone has radiation, say for head and nut cancer or for brain cancer, oftentimes they talk about a similar phenomenon. Is that similar to what we're talking about here with chemotherapy-induced cognitive impairment? I think it can be, right? Jordan, I mean, it's a different mechanism, certainly still neurotoxic, particularly if it's being, you know, aimed right at the brain. And even if it's being, you know, I mean, it's good, you know, now they can pinpoint it much better than they used to. But there can be scatter. But also, you know, just like with chemofog, I call it chemofog because I think that's the term that people relate with. But with that, you know, there are so many other factors that are going on, right? Like it could be menopause. Sometimes even young women are kind of thrown into menopause very quickly. And so we know that that causes, you know, cognitive impairment and pain and nausea and depression and all of the other things that go along with it are just contributing factors. So tell us about your joint venture of Long Live Your Brain. So we've put together a six-week online course and it consists of talking about the lifestyle choices that people make. Let's face it, if you're recovering from any kind of an injury or an illness, those lifestyle choices become even more important than, you know, the healthy, when we're healthy and we're just continuing those. So they can't be ignored. And then we also spend time talking about different strategies. So we really, our initial goal for everyone is to help them reduce what we call information overload. Our days are overwhelming. And if you are experiencing brain fog, trying to organize from morning to night and, you know, do your 27 things on your to-do list, trying to figure out what's the most important, what can I, you know, I don't have time for everything, what is it that I don't have to do that's not gonna be earth shattering and setting those expectations, as well as, you know, how do you set up your house so that it's the easiest to navigate? You know, how do you get rid of all the extras that you don't need, that your brain has to rifle through to get to what is relevant? So we spend time talking about that. We spend time talking about cognitive energy and how do you use your cognitive energy and what things impact, how you use your cognitive energy. You know, one day I might make breakfast and it's like, you know, hey, that was easy. And then the next day I get up and I'm wiped out after I do it. So, you know, helping people to just understand why those changes occur and why things can be different from one day to the next and how do you do them? You know, how do you manage that? That's very frustrating. So Marilyn, can you share with us the benefit of the shared experience with the group coaching session? You know, there's a lot of options when it comes to doing a course. You can record it, put it on a membership site and let people just watch it, you know, when they are gonna watch it, you know, whenever they want to. But we felt when we were putting this together that, I mean, first of all, we love coaching. I mean, that's what we wanna do. We don't just wanna record it and throw it on the membership site. But when people get together, a lot of things happen. You know, they form relationships, they form bonds. Very, very important is they feel like they're not alone. If you're gonna watch a recording, you're doing it alone. But this is kind of in a group. People learn to, rather than, you know, in my experience, I think in situations like this, rather than getting upset when you make a mistake, people learn to sort of laugh at it and sort of have like that, like, remember that I should have had a V8. Instead of getting upset, you kinda just do that, you know. Oh, I can't believe I did that. And everybody kind of laughs along with you. It just changes the whole perspective. And, you know, we feel that this is very important. You know, the positive attitude that comes along with that is really important. One of the things that, you know, we really love about the course is something called a virtual toolbox. And, you know, Doreen, you know, went through the lifestyle choices, you know, the sleep. All of these things are really important. Eating, writing, and physical activity and things like that. And they're so, so important. But most of them, except for sleep, the rest of them are kind of like playing the long game. You know, you do them and eventually you're gonna feel better if you stick with it. Although sleep, sleep's the one where if you don't do it right the next day, you feel it. But the virtual toolbox is, you know, where we sort of talk to people about what they're struggling with specifically. And we say, okay, if you're struggling with, you know, you leave the stove on or you can't remember if you've taken your medication or, you know, whatever it is, you know, you identify the problem and here's the solution. Here's how you're gonna compensate. Here's how you're gonna work around that impairment. And that is sort of like instant gratification. And so people say, wow, I can't believe I didn't always do it that way. And it's simple, but, you know, people need to be shown, you know, you need to kind of work it out. Here's a problem, what do I do about it? And it's very liberating because like, well, I can't do that. And now you say, wow, I can do this now. And, you know, I think that people need that. The saying that comes to mind with what you're describing is you don't see the forest with trees. Because you are immersed in the situation and it's really hard to think your way out of it and to apply common sense because you're panicking at the things that you're forgetting or you're frustrated. And so it's really hard to be objective. So what you're doing is allowing for the objectivity to step in and say, this is happening. And here are some strategies. Step back, think about them and help people understand how to start employing those strategies and baby steps bit by bit as they're working to resolve their problems. I facilitate a cancer support group and I can say that the shared experience is invaluable. And it does really help having, we do laugh. I mean, we, it may seem odd, but we oftentimes do laugh about things together. And that helps to relieve a lot of tension and give a sense of normality to what is happening and not feel so, like you were saying, Doreen and Marilyn, not feel so alone with the experience. And that's invaluable. You don't feel isolated anymore. And I think it's a little bit easier than to tackle and less overwhelming. So in addition to maybe engaging with your coaching course, what are some other resources that people can find that maybe are local to their cancer center or local to them to help them with this situation? So I think a lot of the local hospitals are starting to recognize this as a need and they're putting programs into place. So I think that would be the first place to start as well as with your doctor. I know Marilyn and I will, one of the things that we're going to be making ourselves available for is if somebody would like to create a program similar to ours, we will be more than happy to help any of the local cancer centers develop their program. That's really great to hear. I'm going to be sure that we have a link to your organization that you have put together Long Live Your Brain so that people can reach out. And if you'd like, I'm also happy to add your email addresses to the, or you have, you actually have an info at Long Live Your Brain, I believe, that we can add to the show notes here for everyone to use. Thank you. I agree. Talking with your doctor. And one of the things that we had talked about before that we started the interview is that wellness coaching may be covered under your flexible spending account or your healthcare spending account, as long as it's not a high deductible limited use healthcare spending account. But going with, you need a letter of medical necessity and I'm not guaranteeing that's going to work, but it's certainly worth trying. So communicating with your doctor about these symptoms is huge towards working towards helping to get something like this covered. But from what you've described and what I've seen, the cost for the short term will have many, many long term benefits, plus those long term friendships that your members will develop, which is great. So I really, I'm so appreciative of what you're doing here and the resources you're making available to people and also talking here about whatever the resources they can find. One, I had, I have a book on Amazon, Cancer Journey, Guide in Journals, Empowerment in Treatment Diagnosis and Beyond. And a big thing apart in talking with your doctor is symptom tracking. And on the daily symptom tracking sheet, the two minute check in, it talks about fogginess. And so if you, whether you use that book or use a composition book or a notebook to track what you have happening every day, if you notice something's not quite right, start doing that because then you'll notice a definitive pattern. And you can talk with your doctor about it. You can talk with someone like Doreen or Marilyn and say, this is what I have happening. They can help you be more strategic in your approach then to these issues. And so that, that symptom management journaling or symptom journaling is huge to help you be able to better manage what you observe happening. Plus you'll be validating for yourself what is going on if you journal it. And you bring up a really important point because without journaling, you know, a foggy brain does not have the best memory. And so you may be questioning, well, did that happen or how often is that happening? You know, and as far as people say, well, why can't I come up with solutions? Well, because you're experiencing brain fog and a foggy brain isn't really efficient with problem solving either. So it's not anything you're not doing that you should be doing. It's really that your brain is not able to do it. Or it hasn't been retrained. Right. The goal of our class is that when you, at the time you leave our class, you then have the tools that you need to move forward. And so whether that's, you know, potentially using them at work or at home. Yeah, our goal is to get people reengaged. We certainly don't want people on the sideline. What are some of the success stories you have witnessed through working from your specialty with people with the treatment induced cognitive impairment? So I actually worked with a teacher who had, she was in charge of things like the school yearbook. And she had multiple, she did tech classes or she had, I don't know, like 120 students a day. And by the time she was ready for discharge, she had not only put the systems in place to be able to manage the yearbook, but she also opened up her own swimming lessons school. So she went, that was a dream of hers and she was able to take it one step further. So, you know, the strategies definitely work. Yes. Marilyn, how about you? I have a story of a nurse that I worked with who worked actually at the hospital with me and I actually noticed the difference in her and I, you know, asked her what was going on and she told me she was experiencing brain fog and it was just, she was actually thinking of retiring. She was 41. Well, that's so young. I know I encouraged her to just kind of do a sabbatical. And we worked together for about two months. She learned the strategies and not only she just, that was several years ago, about five years ago and I kind of lost contact with her and she actually called me about two weeks ago and told me that not only did she return to work, but she's now a nurse practitioner. Oh my gosh. Back to school. And she told me that, you know, she still has symptoms, but it was because she's able to now compensate for those symptoms. They never went away for her. They sometimes do for her. They didn't, but she was able to get her degree as a nurse practitioner with her symptoms using the strategies that she learned. Those are both amazing success stories, Dorina and Marilyn. That must be so rewarding to be part of that. Yeah, I do. Could you share with us some of the simple strategies that people can start with while they're trying to wade their way through this and feel some measure of success? You want to start? Sure. So my favorite strategy is actually stop, breathe and restart. Information overload is one of the big issues for people with brain fog. And overload basically happens when your brain's taken in as much information as it can in that moment and it can't process anything else. So you just stop, take 3D breath and reengage. And while you're doing the breathing, you're not focusing on anything but the breathing. And that in that short period of time, it allows you to reset. Your attention is better focused and then you can continue the task. I love that. I need to do that. Marilyn, how about everybody? Yeah, really. Marilyn, what are a couple of simple strategies that come to mind for you that someone can try? My favorite strategy is actually called say it and make it so. And this is for people who do things sort of mindlessly and then they don't register up here that you've done it. Like, did I take my pills or did I close my garage door? Did I turn off the stove? You know, things like that that you just do automatically and then you don't know if you've done them. And so what I tell people to do is as they're doing it, as you're closing the garage door and you're before you drive away, you watch it go down and you say to yourself, even if you're alone in the car, you say, all right, the garage is closed. Because what you're doing is you are taking a mindless activity and making it mindful. It's not so much forgetfulness as it is just mindlessness because these are for things that are sort of routine. You do that every day, every day. I am sure that for many people who are listening who are say relatives of someone who's gone through treatment, they're having a light bulb go on above their head and saying, I need to start doing that too. I often think of like such as having my glasses on top of my head and not knowing where they are. If I put them there, I can say my glasses are on top of my head. Exactly. That's a great thing. Right, right. So that is, that's so helpful. I mean, turning off the stove before you leave the house and then saying it. So you're kind of imprinting it that you did that. Because you know every day the things that you say, did I do this? Did I do that? You know the things and you just make a rule that for those I'm going to say it out loud when it's done. So it sounds like other strategies which are common sense, but we get lost in at times or we change our priorities are good sleep, good sleep hygiene going to bed at around the same time every night and waking up about the same time every day and having a chance to relax before you go to bed. So your brain can truly rest. And I imagine that subconscious rest helps a lot to good diet and nutrition. I should say not diet, but good nutrition and also just a break like both of you were talking about. So taking sitting out in your yard and listening to the birds for a little while or going on a hike. That is so refreshing and can help and physical activity to and these are all things that really contribute towards our wellness but I am sure contributes greatly towards brain health. In addition to the specific strategies that you teach people and go over with them. Right and socialization is a big part of brain health, as well as, you know, keeping your brain active and learning new things. So I've talked to a lot of people that have had cancer that have a really difficult time after treatment with socializing again. What are some strategies that you can offer to help with that. So one of the strategies for people when you go out to dinner right is always try and go either before or after the crowd, because many times what they're having difficulty with is processing and processing and noise is even more difficult. So you want to choose a quieter restaurant one that doesn't have a lot of loud background noise and then choose a table that's off to the side. So again, you're just not in the midst of all of the activity and then you choose your seat to be at one end of the table and if you can choose a seat that is with your back to the wall. So you have no noise coming in behind you. You only have the people that are right in front of you at your table and that helps you stay focused. That's a great strategy. I would not have thought of that. How about you Marilyn as far as socialization and getting out. Well, one of the things I've noticed with my clients is that a lot of times they just want to say no. There's no reason except that they just want to say no and you know, sometimes it has to do with depression and withdrawal and fear and you know, just all of the feelings that come up. And you know, I always encourage them if you're feeling well if it's not because you're not feeling well, but if it's just because you're just closing yourself off. I always encourage my clients just to do it just do it and then they come back and they say, I'm glad I did it. I had a good time. So, you know, just a different perspective. Right. Yeah. And they have a sense of success too, which they previously did not and that can be so uplifting and maybe have a little fun. Absolutely. New friends are great. And another strategy is it seems simple, but it can be really difficult to think of in the heat of the moment is when you have a question for your doctor, such as including brain fog or chemo fog, write it down. Keep it in a consistent place in your journal, your questions for your doctor, keep space after that question so you can write their answer in. And if you're noticing chemo fog, make sure you write a question in about that and then make sure you remind yourself you've been journaling about it. And that helps to reinforce that too. And it seems like common sense, but a lot of people don't write their questions or concerns down to address during their visit, their next visit. And if you have a long time between visits, by all means call or contact them and let them know what's happening. I think the use of the patient portals now is helpful too. So you don't have to wait until your next appointment. And my experience has been that you do get a response pretty quickly. And it's in writing. So it's easy to follow through and it becomes part of your electronic record. So that's an excellent point, Doreen, is it's more easily followed through on to so you can call if you actually if you have something that's journaled say over a week or two weeks time of a pattern, you can put in your patient portal. This is what I've noticed happening and let them know and kind of see what the response is. And they may are listeners to this episode may also say I would really like to go see a speech language pathologist to talk about this. Can you give me a referral or an occupational therapist someone that deals with this professionally. And it's so generous of you to offer that Cancer Institute's health care systems can reach out to you to see how to set up this program. That's, that's phenomenal. I love that idea. So is there something that we haven't covered here yet that you really want to that you think is important to bring up. I think that the most important thing honestly is for people to not feel like it doesn't, it can't change. There may not be structural changes seen on your MRI. I over time, but you can make a functional change in your day to day living. And there's no reason I don't think either Marilyn or I have ever worked with somebody who did not end in a better place than they started. I've never seen, never. That's, that's wonderful to hear that's that is very hope giving to hear. How about you Marilyn. I, you know, I'm just going to reiterate what Doreen said I, I, the gratitude, you know, is, is just amazing. You know, even in the beginning of the program or when they find a strategy that, you know, works for them. It's, it's, you know, the gratitude that comes back to us is incredible. You probably see light come back into their face and their shoulders lifted a little bit more, which is. Yeah. And I contact and maintain more. That's got to be a real gift to see that metaphor, metamorphosis transition. Yeah. I really appreciate your time here today. I think that this is going to be, I know it's going to be an invaluable. Well, all of our episodes are invaluable, but this is validating and offers true help in real direction. And I really appreciate both of you taking time to be here today. I wanted to mention that we're actually offering a free webinar. It's a an on court presentation of the one that we did, that we did before. The nice thing about podcasts is they live in perpetuity. So if they go to your website, if people go to your website, will they see webinars that are being offered? Yes, it's under the events tab. Perfect under the events tab. Okay. So we'll make sure we have that listed and that way that anytime they listen to this podcast and go to the show notes, they can go to the events tab on the on your website. Long live your brain and I'll have a link to that in our show notes and see when a free webinar is. You're welcome. Do you have any good resources in addition to your website for people to go to that or experiencing this? Nancy's list is a great resource. Nancy's list is great. I'm also thinking maybe American Cancer Society too. They have great information that covers a lot of this. So Nancy's list is wonderful. You'll be able to find a provider that can help you on Nancy's list too. So many, so many providers. Yes, yes, Nancy's list is great. Thank you for bringing that up. Again, thank you so much for being here. Thank you, too.