Jeffrey S. Rosenthal, M.D.
Diplomate, American Board of Plastic Surgery
Private Practice: Fairfield, CT
Chief, Section Plastic Surgery at Bridgeport
Foggy Brain (or Fuzzy-Brain) following
Is It Real or Imagined?
only discussed behind closed doors;
chemotherapy’s aftermath of memory problems,
fatigue, anger and despair are now out in the
open. While chemotherapy affects each and
everyone differently, by understanding what is
happening during this crucial time in your life,
you can establish a sense of control. With the
knowledge of the physiological and psychological
effects of chemotherapy treatment, you can have
more confidence in your self-perceptions and can
assist in your recovery. You can call upon your
inner resources (and power) during and after
your treatments to help heal yourself. Rest
assured that this strength is at your
fingertips. So, let us explore some of the
explanations for what is happening to your body
that will enable you to better deal with these
confounding alterations in your life and very
First and foremost, realize that the stress that
your body is under is enormous. In response to
this added stress, your body produces cortisol,
which is made by small walnut-sized organs above
both kidneys called the adrenal glands. Imagine
that you are an athlete about to compete in an
event. Your heart rate increases, your muscle
tone becomes exaggerated, your pupils dilate to
let in light as your brain prepares to control
all these events and those to come. Well, your
adrenal glands are in a race. They are
overworked with the stress of worrying, fears of
cancer, along with your efforts to control these
fears and unknown future events. You may have
gone through surgery or are about to have your
cancer removed. Constant stress causes your body
to be in a heightened state of tension. This
heightened state of arousal (tension)
exacerbates your existing feelings of discomfort
and vulnerability. The extra cortisol also
adversely affects insulin utilization, fat, and
sugar processing. You may find that getting up
in the morning is difficult. You may have no
energy to lift your head off the pillow and find
that fatigue sets in faster and lasts longer.
The adrenal glands’ production of cortisol due
to stress is eventually altered. This will
further add to your state of depression and
create abnormal responses within your brain.
The chemotherapy drugs that you presently take
to control any remnants of your breast cancer
drastically affect estrogen production. If you
are not already menopausal, your body’s hormonal
balance will be thrust into a rapid state of
change. Normally, the onset of menopause is a
measured process that allows your body to
gradually adjust to the decrease in estrogen (peri-menopausal).
However, breast cancer cells are often dependent
upon estrogen and, thus, part of the cure is to
diminish this source of supply. With the
decrease in ovarian and fat production or
blockage of estrogen, comes the onset of a
menopause-like state. You may find that your
skin has a different texture, your sexual organs
are drier, your mood has changed and there are
rapid oscillations in the way you feel.
Things that normally were taken in stride now
become much greater events in your life, which
can, in turn, lead to a state of depression.
Likewise, your body naturally produces
testosterone that helps to maintain muscle and
bone strength and works in conjunction with
estrogen for sexual arousal. Prior to this
instantaneous menopause, your testosterone
levels were balanced by estrogen. Now, however,
unopposed testosterone may contribute to your
feelings of tension and anxiety, or it can cause
you to yield to aggressive tendencies that in
the past were more easily suppressed.
The brain has message transmitter hormones that
are also in a state of turmoil. Your life has
suddenly been altered by the discovery of breast
cancer. Of course, you contemplate the worst.
Surgery and chemotherapy add additional insults
to your body. Your sense of worth, empowerment,
and control over your life and destiny have been
altered by the simple words that you have
cancer. The daily pressures of life, raising and
caring for a family, spousal obligations, and
work activities have put you in a pressure
cooker mode. Pressures, which you normally take
in stride, become burdensome. This only
compounds your anger, episodic mood swings and
anxiety or depression. Coupled with the
psychological changes are the physical
manifestations that may occur due to the
chemotherapy and surgery. Your personal identity
is now undergoing a transformation. This is not
who you are or who you have been.
Added to this is the insult of memory and
learning disruption; i.e., where are my keys? ,
did I do that errand today? This interference in
memory and learning are called cognitive loss.
Studies confirm that these alterations in your
thinking may indeed be real. It is likely that
the burden of having breast cancer and the
additional strain of going through treatments
compounded by your hormonal imbalance and
altered cortisol levels, may contribute to the
loss of memory and learning difficulties.
Not only do cognitive alterations exist and
impact upon your daily activities, but they have
far-reaching effects on your family members,
friends and business relationships. Some of the
losses in memory and cognitive thought may even
last years beyond the end of your treatment. You
will be undeniably disturbed by these cognitive
losses and may not know how to deal with them.
This is especially true if you are told that
these memory changes, physical disruptions, and
social breakdowns are unique to you and not
commonly shared by many women in these
But as we know now - this is far from the truth.
We do not have all the answers, nor do we know
the exact cause of these alterations. Common
sense would tell us that they are attributable
to many coexisting factors affecting you.
The first step towards helping yourself is to
recognize that there is a problem. An honest and
open discussion between you and your physicians
(oncologist & surgeon) and counselor regarding
your experiences and fears, needs to be brought
out into the open so that you can better manage
your altered lifestyle. Controlling, minimizing,
or mitigating the hormonal, physical, and
emotional side effects of chemotherapy is a
challenge that should be embraced and understood
rather than ignored or denied.
One has to realize that the art of medicine is a
healing continuum that embodies learning about
the disease process, formulating specific
treatment options, and then redirecting these
parameters to meet your personal and
ever-changing needs. Treatments are far from
perfect, but strides made within the past decade
for curing breast cancer have been tremendous
and are responsible for the continued health of
countless women and men.
Treatment options are multidimensional, relying
on the control of breast cancer through surgery,
chemotherapy gene identification, and radiation
therapy. Someday we hope to identify and isolate
the genetic causes of cancer. Until such time
current treatments reflect the present day state
of medical research and are still the most
effective that humanity has ever yet known.
The healing of the body through the mind-body
connection, given the appropriate environment,
is legendary. This restorative process can only
occur if attended to with the awareness of the
problem and the desire to help oneself. Cancer
is the Gordian Knot of our era. How do we cure
cancer while maintaining the stability and
health of the human body?
Multitasking, or simultaneously performing many
tasks at once, may be disruptive to the
thoughtful understanding of each task that your
brain needs to analyze and formulate answers.
Try riding five trains at the same time that are
going in different directions. Which destination
will you reach when traveling in such a chaotic
pattern, and do you really save time? Or is it
just a huge expenditure of your brain’s energy?
The brain may process these tasks but there is a
toll that must be paid. Multiple centers of the
brain light up at once when you try to do
simultaneous tasks. Remember that the brain is
constantly working to maintain your life
functions of breathing, circulation, fighting
infection, controlling muscle movement,
thoughts, vision, hearing and speech to name but
a few tasks. Asking your brain to jump through
hoops to satisfy your multiple comes at a cost.
Multi-tasking boosts stress hormones, which are
already zooming upward; wearing down your finely
balanced internal system resulting in fatigue,
loss of focus, and chaos. How often have you
forgotten where you were driving when on the
phone? A famous actress noted that she likes to
save time by reading a book or watching a movie
while having sex.
Emotional imbalance &
Emotional upheaval and physical distress will
affect your family. Surgery upon the breast may
leave you with feelings of sexual inadequacy. It
is important that you realize that you are still
the same woman within and that your family and
friends love you.
Anger, when directed for a reason, is healthy;
however, when it is free-floating and unbridled
it will eat away at you and increase your
overall stress level. Reach into your inner core
and find a comfortable place where you can allow
your mind to be calm - the place where loved
ones exist and where smiles and laughter and
good times are in abundance. Extend your hand
and its warmth will be met by those that care
about and for you.
Your mind has an amazing ability to heal you, if
you let it. No one denies that you have the
right to feel badly, but wallowing in self-pity
does not help your body to heal. What can be
done with the feelings of isolation, frustration
and anger? Confiding your feelings with a friend
or counselor helps. Writing your worries down in
a private journal to get them off your mind will
often soften the tension and distress. Centers
such as the Norma F. Pfriem Breast Care Center
will be your advocate; friends await you there
to direct you or just lend a hand on a bad day.
Likewise, excluding your spouse, significant
other, family or friends in the attempt to
shelter them, often works in the reverse.
Openness allows for greater understanding and
compassion. They, too, want to help and may also
be feeling frustrated and alone. If you isolate
yourself within an impenetrable barrier, those
that care about you cannot share their loving
warmth. You are counseled to let them into your
life to calm the energy imbalances within you.
Jump-start your body with daily exercise.
Feelings of well being, due to increased blood
and oxygen flowing through your body, are
essential and add to your peace of mind.
Likewise, exercising daily produces pleasing
substances called endorphins, which assist in
the regulation of your happiness. The stress
created by your body is translated into
accelerating levels of cortisol similar to that
found in the runner about to start a race.
Exercise is a way in which the body can reduce
these levels and calm down once again.
Smoking steals much-needed oxygen from your
muscles and brain. The 40-plus toxins and
nicotine present in cigarette smoke only serve
to diminish the oxygen needed to heal you.
Nicotine accelerates your heart rate and shrinks
down blood vessels throughout your body. This
crutch will, in the long run, be more harmful
than helpful. Besides robbing your body of blood
flow to your internal organs, it permanently
alters the quality of your skin and adds
additional risks of poor health.
Your body needs healthy nutritional foods that
can sustain it during these added days of
stress. There is nothing wrong with the
occasional splurge; however, eating a balanced
healthy diet will nourish your body and mind.
The human body and mind are amazing; however,
they need nourishment. The tendency may be to
eat out of frustration. And who could blame you.
But in the long run eating a diet low in
saturated fats and sugars with moderated
consumption of alcohol (which is a depressant),
will afford you a greater opportunity to heal.
Common sense tells us that water (which
comprises most of our body), grains, fresh
vegetables, unsaturated fats and proteins will
replenish the energy source for your brain and
motivate your body.
Omega 3 fatty acids are important for the nerves
and brain. Fat is a large component of the cells
that comprise the nervous system. Take
supplements of good quality.
Vitamins such as Zinc and B complex will soothe
your mind. Calcium and magnesium will nourish
your bones and allow muscles to function
properly. Other vitamins should be discussed
with your physician prior to starting. During
your treatments it is important to ask your
oncologist and surgeon which vitamins are
acceptable. Likewise, a consultation with a
nutritionist knowledgeable about various effects
of food and supplements on your treatment will
be beneficial. There are numerous books that
will augment your understanding of your added
nutritional needs, found in bookstores or on the
Is chemo-brain real or
The crux is that normal patterns of
forgetfulness occur with the natural aging
process. When the emotional intent of the
thought and reality of breast cancer is added to
the mass of swirling thoughts that the brain has
to master minute by minute, it is no wonder that
you become overwrought. Family, business and
personal obligations, fears of the unknown, and
the potential ramifications, estrogen and
hormonal imbalance, physical discomfort from
surgery or chemotherapy, all contribute to the
feeling of having a foggy brain.
feel fragile, confounded by the thoughts of illness. The unknown is
always worse than actually knowing. Overwhelmed and distraught, your
mind has no peace. Constant turmoil precludes clear thoughts. Cancer is
a bummer to have. It threatens your very existence. You can overcome
these dreaded events that you are going through and come out a stronger
and healthier woman. It may be no solace to know that many have traveled
the same path, but it does help to understand that your happiness is
dependent on your outlook. Living your life, as best as you can, during
this difficult time, will help your body and mind. Our cells are renewed
each day, giving us the opportunity to grow and become stronger. Healing
requires time, positive energy, patience and love of self. Like a paper
cut upon your finger, which is initially sore, your healing will require
time and soon be a part of your past.
Try meditating. This can take various forms.
Thinking and repeating to yourself that you are
healthy and happy is a self-fulfilling prophecy.
Visualize yourself being well, strong and
healthy. Visual imagery has been shown to affect
the body in a very positive manner.
Surround yourself with friends who are calm and
generally optimistic. Negative individuals give
off negative energy. Positive energy buoys us up
and recharges us. Would you not be more pleased
to be around a person who smiles rather than a
Laugher is contagious and in all likelihood
calms the brain down or relieves it of tension.
Focus on what really matters to you. If you find
that you are forgetful, make a list of the
things that you need to remember. Busy people
have a lot on their minds and need reminders.
Daily stresses of living exaggerate everyone’s
Take a health break when you can. Stop and
breathe, take a brief walk, read an enjoyable
book or magazine to clear your mind.
Start a log of your journey. Record the good and
the not-so-good. Not as a reminder of these
events but to alleviate your mind from having to
remember them. Air your thoughts in private and
with your family, friends and a counselor or
therapist who will guide you through this
Some days may be bluer than others but beautiful
golden mornings and stunning sunsets await you.
With your loving family and friends on your side
you will be able to reach deep within yourself
to find a center of calm within what must seem
like an endless storm. Take the time you need
for your well being. Peace and tranquility
emanates from within our central core.
Difficult as it may seem during these life
altering times, having a positive approach and
surrounding yourself with the warmth of your
family and friends will help to overcome the
hurdles faced with having breast cancer. Your
mind is an amazing organ of growth and healing.
Your mind and body are one. Together they have
been known to accomplish unparalleled and only
dreamt of deeds.
Congratulations! By endeavoring to understand
yourself, you have just realized one of these
amazing goals. No one will say that what you
endure is easy; but with guidance and balance to
your life you can and will flourish.