The Memory Biz

Cancer Bitch is concerned with memory and its lack, and subscribes to Johns Hopkins' weekly health alerts about that and other subjects. Hopkins presented a Q and A (just one Q, one A) about memory workouts with Peter Rabins, M.D., M.P.H., Richman Family Professor for Alzheimer's and Related Disease'
Co-Director, Division of Geriatric Psychiatry and Neuropsychiatry at Johns Hopkins Hospital. He says, basically, we don't know for sure what will save your brain, but do what you like to stimulate your brain--after all, it couldn't hoit.

I just saw a TV special about a local "memory gym" where people go to work on improving their memories. Are these memory businesses just a fad or is there some real science behind them?

Dr. Rabins replies: Both. Emerging research suggests that remaining active -- cognitively, physically, and socially -- might lessen the risk of developing dementia or at least delay its onset. Doing the definitive scientific study would be very difficult and prohibitively expensive, though, so a clear-cut answer might never be available.

However, I believe the evidence is strong enough that people who want to do what they can to lower their risk of memory loss should consider some type of regular cognitive stimulation. Unfortunately, we have no real information and almost no scientific evidence to provide guidance on specific activities to improve memory. That is, we cannot say whether sudoku is better than group political discussions or trips to interesting and stimulating places such as museums, historical sights or the movies. And -- even more challenging -- we have no idea whether the activities that would benefit one person might not be helpful to another.

Given this lack of information, I recommend (with no scientific evidence!), that people who want to stave off memory loss use common sense. For example, the likelihood seems low that a person who never liked crossword puzzles will do them regularly and over time, so I recommend that people think about what they like doing and try to come up with activities that fit their interests and skills.

For some, the structure, peer interaction, and competition (with one's self or others) of a memory gym, computer program, or regular bridge game would increase the likelihood that they would continue with the activity. For others, the more solitary and less scheduled nature of the crossword or sudoku puzzle would work better. However, to insist that a person do any of these "for their own good" when they do not want to seems inappropriate to me.

Yes, we don't want people to feel guilty for not doing the day's crossword puzzle. It would be too ironic, anyway; there are people who do the crossword as a guilty pleasure.

Are you positive it's negative?

I've always thought that the challenge of the pathology report was understanding it. I'm talking about my challenge as a patient. Now the front page of the New York Times tells us that the tests are shaky that determine whether a tumor is HER2 negative or positive, meaning whether it has extra copies of a protein called HER2. If it's positive, the tumor should respond to Herceptin. The problem is that tests are not uniform. The patient profiled in the times is a doctor, and her tumor was tested four different times with four different HER2 tests. The first test was positive, the second negative, the third positive, the fourth negative.

My tumor was fed by estrogen--or was it? Tests for estrogen sensitivity are wrong 10 percent of the time. I will have to think about this and figure out if there's anything I can or should do about this. Get the tumor tested again? I did send it to a pathologist at Vanderbilt who came to the same conclusions that the doctor at Fancy Hospital did: that the whole breast needed to be removed. But I don't think he re-tested the tumor.

Just because a tumor hasn't been inside you for three years doesn't mean it can't still cause trouble.

[The photo above is of a low grade fibromatosis-like metaplastic breast carcinoma chosen only for the color of the dye.]

Son of Meltdown

One thing about cancer is if 10 days after surgery you are weepy and feeling sorry for yourself, everyone says, Yes, of course, you just had a mastectomy; you're having a meltdown, it's only natural. And if you feel that way when you're going through treatment, people say, Oh yes, of course, you're going through treatment. But if you have a few days of terrible headaches and crying, more than weepy but less than jags, and feel ever so sorry for yourself, you can't say to people, I'm having a meltdown, of course, because I had breast cancer, OK, chemo ended in July 2007, and I do have cancer still, that darn polycythemia vera, blood cancer. Because the timing is wrong. Really, haven't you gotten over cancer yet?

And so when your personal trainer (Personal trainer! What privilege!) is sarcastic; when she is once again incredulous that you can't line up your toes by looking in the mirror and have to look down at your feet; when you can't remember which way to move after that squat in which you must keep your head up, you must keep your back straight, your hips back and what is the purpose of this anyway; isn't there something less complicated you can do in order to stretch whatever muscle you're supposed to be stretching because no muscle is aching yet as it should be becuase you aren't angling the squat right and because even though a second grader would have learned this by now--large side step, squat up, squeeze, step to the other side--it all stymies you. You can't let the trainer see you cry. She's upset herself because the lock in her apartment malfunctioned and she had to wait for the repair guy. It does not do to be an adult in this world and cry in the gym for no reason.

But there is never no reason. There are many reasons: You did not sleep enough, you returned to sea level from the mile-high city--why not blame it on altitude, why not on the stars instead of ourselves, Brutus?--where you had headaches and hay fever and terrible heartburn and had to throw up just a little bit. B thought it was because of your oral chemo, throwing up was normal, but that wasn't it. It had to have been the dark chocolate you bought to lure buyers to your table where you were signing books, or would have been signing books had they not sold out. You took orders then.

But that was all the day before yesterday and closer in time, Y has written imperious emails and during the squats and leg movements (not jerky, smooth, squeeze at the end) you think of retorts: You must be so unhappy. You must really feel powerless or else you wouldn't try to control me. Why don't you at least pretend that you believe everyone is equal? But you must not engage. And haven't you been imperious with Y? But yeah, he started it, really Mom really.

You think if, if only you had a brain tumor there would be a reason for this--this head pain, this heart pain. Horrified. You don't want brain cancer but you want a reason--a socially-acceptable reason--and yeah, it could be medically related: you are sick, you are disordered, you have general anxiety disorder, a basket overlarge diagnosis, everyone's got it.

You were weepy and you were running out of potion, red-capsuled Effexor, in that mile-high city. You took half a dose yesterday, your last pill and none this morning. You were out, flat out.
And then you get more Effexor and you sleep eleven hours and the next day you are Good As New. You are yourself again. Though anyone could argue that the unmedicated you is the unmediated you, the real you. Without chemical additives.

{Effexor, hero of the day}
To read about Meltdown I, click here.

More on Sick Humor

An audience report on our Sick Humor panel: here.

Just Like Europe

Read Gina Barreca's report on the AWP confererence, starting with our panel on Sick Humor.
I'm back at The Market and on my way to the public library for the Living Library event.
Alas, the Living Library event was a huge disappointment. More than a tinge of the do-gooder to it. There was a room in the basement of the public library with tables across it. Each table had two people you could "check out" for an interval to talk to you about bee keeping or urban bicycling and the like. The bee-keeper was checked out and wasn't back when she was supposed to be. And it was all theoretical for me, because I don't plan to keep bees. But that looked like the most interesting topic. The Westward weekly newspaper listing about the event said that such things are done in Europe. The whole thing seemed very Fahrenheit 451-ish.
Tonight B and I walked around Denver and saw a bookstore advertising a contest to see who could write best about what book s/he would be if s/he had to be one, a la Fahrenheit 451, the premise of which is that booked are banned.

Internationally, there is the Human Library, also a do-gooder project. The notion is that you can choose among an array of people to "check out" and the interaction reduces prejudice and stereotypes. It was started in Denmark by some kids who sought to eliminated violence after their friend was stabbed in the back. (He survived.)

Cancer Bitch in Denver

Cancer Bitch is in The Market in Denver, sitting at a round wooden table by the window. She was on two panels yesterday at the AWP conference. One was on Sick Humor, about funny writing about illness. Another was about persona, during which she spoke about using different points of view in this blog and the subsequent book.

Denver is very sunny. C Bitch has noticed that its inhabitants are very very still. Often already she has seen people on the street from afar, and has thought they were statues. She's noticed three people gesturing at the sidewalk tables outside The Market. Two have AWP name tags on. The third looked Ethnic--Latina. Ethnics--such as Latinas, Mediterranean types and Jews--are big gesturers, if she can be afforded the use of stereotypes.

Her friend B, who has lived here three years, suggests that the still people may be stoned.

There is less cell phone usage here on the street than in Chicago, and restaurant workers are slower and mellower and friendlier than in Chicago. People are more trusting, leaving their purses on the floor behind them. There is the slowness here that you would think you'd find in Berkeley or SF, but you don't.

CB is going to set up a blog with lists of humorous illness memoirs. Click here.

O where o where has my memory gone?

[Black hole in my brain that sucks out memories of writers whose named begin with E; image from LSC/NASA]

I spoke at KAM Isaiah Israel Congregation not long ago. It's right across from the Obama residence, and while I was on the way there, I felt a little lump of pride/excitement that Our President lives (more like lived) right there. That he is from our city. That I know people who know him. That I heard him speak about three years ago or more, about 10 feet away from me. That I almost asked for his autograph then, though he might not have even been a senator yet. This is the difference between therapy and no therapy. I started therapy again in fall 2008 because I was at Grant Park on Election Night and didn't feel anything.

But back to the Jews. I spoke to about a dozen people or more. It started out as more then went down to a dozen. I read from my book about Passover and one title had Elvin Hayes in it. One guy said, irritated: I don't know who Elvin Hayes is!! As if he thought I wouldn't have explained it in the piece. He got up and walked out in a hurry, if not a huff. But maybe he was on his way somewhere.

After I spoke a woman came up to me and said we'd met before and mentioned Effie Mihopoulos. I said that I knew of Effie but she hadn't known me, and that I knew she had recently died. Then the woman said that Effie knew who I was and that Effie had introduced us, at a gallery in Wicker Park, and that I had spoken to Effie for about an hour then.

I did not remember. She said that Effie had had cancer but had decided not to get chemo. There is a hole in my brain, through which Effie fell through, as well as the meeting of this other woman, R., though her name sounded familiar. I felt very bad because I knew that Effie was dying but didn't send her a card or email because I figured she didn't know who I was.

Chemo brain, I explained apologetically.

At home I looked Effie up and she looked familiar in her photograph and I thought it was plausible that we'd conversed. But when? Where, exactly? What galleries have I been to in Wicker Park?

[Effie Mihopoulos, Chicago Examiner]

Spring Quarter started this week at Smart University and I told the class I knew everyone but E. Then E said she had met me, and reminded me when, and then slowly it came back to me. She also fell through the hole. Maybe it is reserved for women writers whose names begin with E.

My memory started fading when I was 30. That's almost a quarter of a century ago. Now I'm age-appropriately forgetful. Johns Hopkins tells me in a health alert about what is normal for a brain that's been around for fifty years:
Processing speed slows further. It takes more time to recall names and words.
Learning something new takes longer. Once learned, however, the information is usually retained.
Multi-tasking (doing several things at once) becomes more difficult.
Attention to detail wanes. You probably will remember fewer details of a novel, movie, or painting than a younger person would.
Placing an event in time and place becomes more difficult. You may remember the event but not exactly when or where it occurred.
Visuospatial processing is more difficult. This might translate into more trouble in copying three-dimensional designs or in reassembling an appliance.

I went to the gyne this week for a Pap smear and asked about suggestions for memory and also for relief for hot flashes. The nurse practitioner called back and suggested I take Cymbalta, Zoloft or Prozac for hot flashes. I am already taking the max amount of Effexor. I've tried Cymbalta. I used to be on Zoloft and Prozac; both interfere with the estrogen-blocking mechanism of tamoxifen. I've tried Strattera and Adderall for ADHD.I got my shrink to prescribe meditation for memory and focus. The nurse said I should ask my oncologist about improving memory. The onc spoke at the cancer Town Hall last year and all she recommended for memory-helpers was lists.

I used to be offended when people didn't recognize me. Now it seems that I'm the offender. Everyone looks familiar and everyone looks unfamiliar. Depends on how long I look at the face. I must brace myself; I'm going to a conference next week, where I will see people I know, people I don't know, and people I've forgotten. Please forgive me if I don't recognize you.