Survivorship / Survivorsh!t: Chemo Brain

Leah 0:00

Speaking of vegetables, there is a there's a mushroom, is a mushroom a vegetable? I think I'm just trying to think of a segue there. Okay. What is a mushroom?

Tina 0:15

In the, in the kitchen, sure, sure. Call what you want in the kitchen, but no, technically it's has nothing to do with...

Leah 0:21

what the heck? It's a fungus. Who wants to be like, speaking of fungus?

Tina 0:25

I know.

Leah 0:37

Hey, Tina.

Tina 0:38

Hey Leah, how's it going today?

Leah 0:39

It's going pretty well. We've got a really interesting subject that we're going to talk about. We're going to talk today about chemo brain, which isn't just for chemo. It's, it's actually known as cancer related, cognitive impairment.

Tina 0:55

Or commonly known as brain fog.

Leah 0:58

Brain fog, chemo fog, brain farts. I think chemo farts is a completely different thing, but it could be chemo, brain farts, but, um, yeah, it's, it's one of those symptoms and you, I think a lot of people do experience it during chemotherapy and then once it's done, you kind of expect it to kind of clear. And for many people it does not, and it's completely distressing. And I think it's a really important subject. important also because for a really long time it wasn't acknowledged.

Tina 1:37

Yeah. Like so many things that are without a criteria for so long. If there's no criteria and it's not written down in black and white, then it's actual existence is questioned by the establishment. I think we've come a long way, but yeah, certainly 20 years ago, this was not as commonly talked about or recognized.

Leah 1:56

Right. I think it was dismissed as, oh, you need to get more sleep. Oh, you're depressed. You know, that kind of thing. And what's really cool is I sat in on a webinar yesterday. It was with the University of Texas at Austin. The presenter was Dr. Ashley Henneghan. She is a nurse and a PhD, and this is kind of her focus. She's not, she said, she's not a cancer survivor. This is just her area of interest. So I sat in on the webinar, and it was so cool because it validated everything that I feel like I've been doing. And I learned more, which is like the whole point of like sitting in on a webinar. You want to learn stuff. But the validation of all of the things that I kind of compiled, you know, over the years, because I guess my interest in chemobrain started in about 2013 when I started working at the cancer center in Arizona. And I'm going to tell a story.

Tina 2:50

All right, let's do it.

Leah 2:51

OKay.

Tina 2:52

I want to hear it.

Leah 2:53

Once upon a time, I worked at a cancer center in Arizona, for those of you who have never joined in and heard me say that before. I was relatively new and spoke with the speech and language pathologist one day and she said, Are you aware of, the services that we do here? And I was not. And so I sat in with her, like I made an appointment with her and went through her evaluation of patients And so, I did the MOCA test, which is a cognitive screening test, like to check people for cognitive impairment or Alzheimer's, and then she guided me through different things that she would do, you know, to, help patients. And one of the things was to there, there are apps available. And so it's, it's cool. Cause it's more than crosswords, you know. It's more than Soduko. so

Tina 3:47

this was this. I never know. I always say it differently than it's spelled, so think I always say it wrong.

Leah 3:53

I think I just did.

Tina 3:54

Sudoku, but I don't think it's proper. Um, so this is a speech therapist that does the cognitive assessment.

Leah 4:03

Yes. The speech and language therapist and occupational therapy did it as well. So for people who are at a facility, where they have occupational therapy, they most likely are familiar with this sort of assessment.

Tina 4:17

And so you got this assessment done just to find out what it was about?

Leah 4:20

Just to find out what it was about. And so that if I recognized that a patient needed to be evaluated, then I could refer them on. And it's interesting because I believe I did this in September of 2013 and that would have been pretty much a year before my diagnosis.

Tina 4:39

OKay. So you had a baseline assessment, that's something, most people don't get.

Leah 4:42

I know I did. I had a baseline assessment and it's funny because at the time I thought like, oh, I'm really forgetful. And I think it was just probably stress-related coming off of residency and all of that sort of thing. But, yeah, I remember the test was normal, which is like one of those things where you're like, really, can we do this again? Cause I don't think it is normal, but it was normal. And I did the apps. I just played on the apps. Cause it's just kinda like you're sitting in an airport, you got an app. Why not?

Tina 5:05

Now, let me ask you this. Did you get retested at any point post-treatment?

Leah 5:10

You know, I don't remember. I don't think I did. I think no. You know, treatment and then after my surgery, especially after surgery, my big concern was I lost my voice from from the surgery. And so I saw her for speech.

Tina 5:27

Okay.

Leah 5:28

And I think that the memory thing, it just wasn't, it wasn't as big of a concern then. Honestly, I think it's cause I was working. I never really stopped working except for the time when I was recovering from surgery. And so I think just using my brain, like I knew what I needed to know at work. I mean, at home I was a different, I was different, but you know, at work I think I was still sharp. And so, um,

Tina 5:50

So, wait, so now this is interesting. So you're saying you worked through the treatment, took the time off you had to for physical recovery, but mentally you were capable of continuing, and I know what we do, so I know it's rigorous mentally, and you were able to do that, but then you'd go home and crash?

Leah 6:05

Yeah, yeah. All the word-finding and all of that sort of thing. So let's kind of talk about like it's not just like memory, like we think about chemo brain, you know, memory issues. Um, whether it's long or short term memory. There are more layers to this, you know, it's the ability to multitask, like paying attention to things, especially breast cancer patients. I hear a lot of them talking about like, "Do you find that you have ADHD after treatment?" So yeah, there are definitely more, more levels. yeah, the word finding the, the verbal fluency, which, you know, I, I, I struggle with sometimes just trying to find that right word, um, how fast you process things. So, yeah, it's kind of like, it's more than memory. And so I think when people think. Well, maybe, you know, I've got this memory issue, but I seem a lot less organized.

Tina 6:57

Yeah. Yeah. I think it's interesting that you say that. Cause I think from what I've read for the perception of this fogginess, post-treatment most people do not bring it up too much during treatment because you know, you're dealing with other things during treatment and maybeY

Leah 7:14

You're just trying to get through treatment.

Tina 7:15

Yeah, exactly. and afterwards people are able to even perform on the gross testing decently, like the kind of gross cognitive function testing that looks at whether you are going to have a quality of life that's so impaired that your activities of daily living ,as they call them, you're not capable of doing. And most people, that's not the issue. They can still get up and take care of themselves, but everything's a little different. fog is a good word. Don't you think that kind of reflects

Leah 7:44

it? Yeah. I mean fog is that sluggishness, that slowness. I always think about, you know, I don't know if you've ever had one of these dreams where like, you're stuck in mud and you're trying to run?

Tina 7:56

Nope.

Leah 7:56

never had one of these dreams? Wow. Hmm. Well, there are these dreams that some people can have. Have you ever been in the deep South when it's really humid?

Tina 8:05

Yes. Now that I have experienced.

Leah 8:07

So, you know, you feel like you could just move that like humidity aside with that slowness that comes over you. Yeah. That's kind of, I guess you would say, the brain fog thing,

Tina 8:17

And just technically that's all executive function. Like if you, if this were a pyramid, that's the tippy top of the pyramid of, cognitive function is like being able to, well, we call it multitasking, but being able to even filter out distractions while you're doing one thing. Or, you know, keeping your calendar, hearing your kid, making your grocery list and kind of doing this all at the same time is executive function. I think that's what is the highest functioning of our brain actually. And so it is a lot of times I think. Yeah, that's the last thing to come back as the brain heals from treatment.

Leah 8:52

from treatment. Yeah. So I think that people have established that yes, this is real, this chemobrain as it's called and it's not just chemobrain is not just for chemo, right. It's not just for chemo anymore. It can be caused by a variety of treatments and other conditions. Right.

Tina 9:09

Yeah. So of course, as we have said before on this podcast, one of the risk factors for cancer is aging. And so there is more cancer, cancer treatments and cancer survivors with an aging population. So aging is also a risk factor for cognitive difficulties and cognitive impairment. So there's two parallel tracks here. We're talking about the treatment but you know, we're talking about a person and with every passing year and decade of life, generally speaking the brain ages and interestingly, some of the changes that happen during chemotherapy specifically, mimic an aging brain. So in some ways you kind of fast forwarding the aging process, and I'm talking about structurally like on imaging and actual tests that look at the anatomy of the brain. That's not to say it can't be reversed. You can still do something. So I don't want to be a total Debbie Downer here.

Leah 10:00

No, cause that's my job.But yeah, I mean that, and you know, those of us who have been through treatment, I don't want to say everybody, but you know, many people that I talk to definitely feel like we've aged. Inside you feel like you're, you know, you're 90 or something. And so, yeah, that's interesting. That's, that's actually, you're able to see that on imaging. So our favorite friend or foe inflammation plays a huge part in this.

Tina 10:28

Yeah, it's interesting that you phrase it that way. Cause I think they've actually used that in some scientific articles that summarize inflammation in our body and you know, often they'll put, "Friend or foe

Leah 10:37

And it's both right. I mean, a certain level of inflammation is actually helpful. It nhelps your body to heal. It signals to the rest of your body. Like, okay, let's send in all of the things that we need to heal, but the levels of inflammation that we experience when going through treatment, whether it's surgery, radiation, chemotherapy, hormone therapy, targeted therapy, all of that can definitely contribute to this. Because I've seen it. I think that the greatest population of patients that I've heard speak of this has been with breast cancer patients, but I've had other patients also, talk about this.

Tina 11:17

Yeah. And, I think because we do have a growing population of survivors of cancer, the breast cancer survivorship population is probably got more data going all the way back to the 1950s than any other type of cancer, to be perfectly honest. So I think this becomes a bigger issue because it's affecting more people.

Leah 11:36

For sure, and a really interesting thing is I remember reading that there is a pretty big percentage of at least breast cancer patients who complained of memory issues prior to being diagnosed. So like they verbalized that was their baseline. And that's funny because, you know, "Hello? That's me."

Tina 12:00

Well, yeah, I think there was a study a couple years ago or so that came out and talked about memory issues before treatment, and I think it was breast and colorectal cancer in that particular study. And they showed that they had cognitive impairment prior to their treatment, as well as afterwards. So that is interesting. Like. Then does cancer itself become something that we should think about causing some of the problems that have to do with cognition? You know, is it, is it the inflammatory state because cancers themselves create some inflammatory cells.

Leah 12:32

Right? Because a year prior I had my cancer, I just didn't know I had my cancer. So...

Tina 12:38

Right. now, when there's an association like this, when you see there's cognitive difficulties before the cancer is diagnosed, but we know the cancer was present, we have what's by definition and association, but we don't know it's a chicken and egg thing. We don't know what's causing what.

Leah 12:53

Yeah. And so, you know, just knowing that, oh, if somebody is complaining of, memory issues or adult onset ADD, which I think I used to always say, then think inflammation. I mean, I wouldn't be like, oh, think cancer, but definitely think like, oh, maybe there's a lot of inflammation. Maybe there's a lot of stress, stress plays a big part of it. There's another chicken and egg thing is the sleep depression kind of cause. You know, is it because sleep is impaired oftentimes during treatment as well as after treatment? there is, you know, depression, anxiety, these sorts of things also may contribute. I'm not going to say that they actually cause it, but there are definitely, you know, contributors. An d then, lack of activity, being sedentary.

Tina 13:40

sleep and exercise, I think have the most data on them. As far as cognitive function directly affecting it, nearly immediately.

Leah 13:46

The webinar mentioned cytokines and memory, and I thought that was really cool. And I was going to look at it this morning. I had found a study, but I can, I can put up this little chart that I found and it talked about the different cytokines, the different signaling

Tina 14:03

networks.

Leah 14:03

Yeah. that are correlated to different parts of, executive function.

Tina 14:07

Yeah. And cytokines are interesting because in just like inflammation, you need the right amount at the right place for a short duration sometimes to create and consolidate memory and to learn something new sometimes. I mean, the more you study biology, the more you realize nothing is inherently good or inherently bad, it has to do with time, place, dose duration. So the brain is one of the most complex organs in the body to understand, because we're talking about physical, but we're also talking about transmission of basically electrical signals. So we get into physics pretty quick. So we're not going there today, but I'm just saying that this is a, it's an inherently complex,

Leah 14:46

Another sort of, I would say complex aspect of a possible cause would be a genetic link.

Tina 14:53

Yeah. So you're talking about some of the genes that are associated with cognitive function over time.

Leah 14:59

Yeah. I mean, the one that I mostly think of, I know in the webinar, I learned that there were two other, potential genes that were related, but they did mention the APOE gene, which was something that I have been doing a lot of reading about as well. and that's. Uh, gene that is linked to Alzheimer's.

Tina 15:16

Yeah. So you can inherit one or two of those genes and that will raise the risk of Alzheimer's and that is not disconnected from inflammation. So it raises your risk of Alzheimer's and inflammation exacerbates that risk. in and of itself, it's a risk factor and then you add inflammation to it. And you've got a recipe for speeding that up considerably. So that reminds me there was a study. I think it was actually this year that talked about machine learning and taking images of the brain with MRI and other high tech brain imaging devices and using machine learning. Seeing patterns of communication, what they called connectedness in the brain and using that to predict who was going to have cognitive difficulties from treatment. So what they're trying to do is, put this into the hopper and use this as, one of the possible risks that one is taking with treatment is to come out the other side with some cognitive difficulties. If that's the case, can we predict who that's going to be and put that in the pros and cons of getting that treatment. So this machine learning that looks at the images and, um, parses out that information and says these particular people will have more difficulty in these people over here who have a better connectedness or a different pattern, whatever it is, um, won't have as much trouble. I thought that was cool.

Leah 16:36

That is cool. Another thing that they mentioned in the webinar that I thought was fascinating was that there's this whole like emotional aspect, becoming more emotional about things. And I do recall, speaking with one of the surgical PAs at work and telling her everything that I was experiencing, and she was not a cancer survivor, you know, she had never been on any of these therapies. And she looked at me and goes, "Oh honey, that's menopause." And I was like, whoa, that's crazy. Of course, like, what did I think of that? But, you know, it's, it's all of those kinds of mood swings you know, one minute you're crying and you're, you know, this emotionally label situation, is going on. And so that's also probably why a lot of breast cancer patients. I mean, I've also heard this from patients with prostate cancer and. You know, from other people who, treatment just, pre-med just shut down their hormones,

Tina 17:35

Yeah. It's amazing how the hormones influence emotions in particular, right?

Leah 17:40

EMotions and memory. I mean, right? Isn't estrogen protective? Yeah. You once you lose estrogen, you find out how, again, friend or foe? It's your friend until it tries to kill you. But, I guess maybe we should move on. Let's let's talk about, is there anything we can do to prevent it? are there things that we can do to address it? Like the, of course there are things that we can do. We'll talk about that next.

Tina 18:24

Yeah. So when it comes to prevention and to treatment the NCCN guidelines for patients mentioned some treatable causes. And I think you've already mentioned some of these, sleep, and depression And and the fatigue that can add to the fogginess, some medications too.

Leah 18:44

Right. Medications, and pain for which people take these medications. So, yeah, that would be the first step is to find something that is treatable. You know, potentially treatable.

Tina 18:56

Right. And that's contributing to your brain fog, right? What's contributing to your particular scenario. Is it sleep? Is it more dietary? Is it fatigue adding to it? Is it stress? And if it is stress, can you either jettison that stress or maybe find other ways that we're going to talk about to deal with that?

Leah 19:14

Yeah. Finding other ways of coping. So, the evidence that is out there, there is a bit of evidence about cognitive training. And so that would involve doing, the apps and, you know, mind, the mind games, playing mind games. Even doing things like putting reminders on your phone and all of those, those types of hints that I think many of us sort of found on our own, finding little tips and tricks to help you remember things that you need to do throughout the day is part of cognitive training. Um, meditation has been shown to be helpful. And again, something I learned with this, presentation that I watched and I'll put, I'll put a link in, to the presentation because it is, it's pretty, it's pretty darn cool. They looked at meditation and classical music, and so they had one group of people doing this. I believe it was a 12 minute meditation that involved repeating words and using hand movements known as mudras. And then they had other people listen to classical music for that period of time. And then they checked over a period of time, they checked their cognitive function and meditation showed improvement on, certain. Aspects of cognitive function, certain categories and music showed an improvement on other areas in some people. So it was just, it was this really cool study. And I thought that was awesome.

Tina 20:44

That is awesome.

Leah 20:45

So music therapy, listening to classical music and what's cool is I do remember when I was doing pre-med learning that listening to classical music while you study is supposed to help you with

Tina 20:55

Um,

Leah 20:56

So I just thought that was kind of neat.

Tina 20:58

that's awesome. Yeah. And you know, they reminds me of the studies that show. You know, learning new things in a dance class, because now you're using active memory and learning something, you're doing it in a social setting and then you're moving your body. That that's really good for cognition as well. So they've done that in some studies and I thought that's a great way to like combine a lot of, non-drug therapies into one and make it fun.

Leah 21:23

Yes. And that was one thing before I ever went through treatment, I used to recommend to my patients, something like Zumba, right? Because you're getting exercise. Zumba is cool because you kind of learn a movement, and then you learn another movement. Like you slowly learn, you build on the choreography when doing Zumba. And so I found that to be helpful for myself prior to treatment, in terms of like remembering things, increasing that blood flow and, you know, memorizing the steps. And learning a new instrument is the other thing that I used to recommend. So ukulele, I am pointing to my ukulele across the room.

Tina 22:00

uh-huh

Leah 22:00

Teaching yourself an instrument, teaching yourself a new skill There was a study that was done on looking at yoga and quality of life in I believe breast cancer patients. And what they found surprisingly was that it actually helped with cognition.

Tina 22:17

Interesting.

Leah 22:18

And I don't, I don't have the information off hand, but I do recall it wasn't like doing a lot of yoga. It was just like this short period of time, a week, you know, kind of dedicating like a little bit of doing yoga. And I think Qi Gong has also been shown to be helpful. And part of me thinks, because I did, Qi Gong in school and part of me is thinking like, is it that choreography? Right? Because in yoga, I always found it frustrating that, they would kind of go through this flow of movements from one posture to another posture, and then they'd say, find your own flow. And I was like, okay. Yeah. Like what are you talking about? Find my own flow. I need you to show me. and I think doing that repeated movement. With your body and then trying to remember what your body did, you know, previously that I think that's huge.

Tina 23:08

Wait. So do you have a flow now?

Leah 23:10

Um, well now I do my own yoga, so I've got my own flow. I

Tina 23:15

That's that's my question.

Leah 23:17

I got my, I got my own

Tina 23:18

Are you going with your own flow? That is the question.

Leah 23:21

I haven't taken a public yoga class in a long time. So.

Tina 23:24

So I want to say, like, we're talking about learning all these things and, learning new skill sets or, challenging your brain with cognitive training and one. Remind everyone, because if you're old enough, what you learned in school was that your brain doesn't have the ability to create new synapses. And it does, it's called neural or neuro plasticity. And we now know the brain can create new synapses. And I want to just add to this, like you have to also sleep well in addition to creating the new synapses and the new connectedness in the brain, your sleep is when you consolidate that

Leah 24:00

It's your repair state. That's when your brain, you know, that's when your body repairs

Tina 24:05

Yeah. Yeah. So sleep is essential. So there there's two things that I want to mention going on when you sleep, because they're so essential to bringing your cognition back. One is you have a lymphatic system in the brain and it's called glymphatics. It starts with a G your glymphatics works like the lymph in your body. It's part of your immune system. And one of its roles is to clear out the brain. And we know that even those amyloid plaques in like Alzheimer's disease, those are cleared when you're sleeping by the glymphatic system, to an extent. So these protein aggregates, amyloid beta is the one people know about, maybe because it's talked about with Alzheimer's, but there's other protein aggregates and that it has to all be cleared out. And the other piece that's happening while you sleep that fascinating is called pruning like a tree.

Leah 24:54

I don't know if I like that term.

Tina 24:55

No, it's, it's, it's so fascinating. you create. Sprouting branches in your brain of, neurons during the day. Cause you're taking in all this information and then when you sleep, they consolidate. And what that means is non-essential neurons get trimmed off what that does is it strengthens the remaining ones, just like when you prune a tree.

Leah 25:14

Oh, wow.

Tina 25:15

Yeah. So that's what memory consolidation is about

Leah 25:18

So that leads me to say all of these things in terms of preventing this from happening. I don't know if you can actually be prevented, but we can reduce the risk by making sure that throughout treatment we're addressing sleep. We're addressing stress. We're addressing depression you know, we're moving. I think the key to, and you know, how I feel about the word prevention when it comes to cancer. But the key to reducing the risk of, cognitive impairment from treatment is just get on top of it you know, while, while you're going through treatment, because it's gonna help with so many other things too.

Tina 25:55

Yeah. And know that no matter where you're at, whether it's two months, two years or 12 years out from treatment, there is still potential for new. Neural synapsis to develop neuroplasticity is ever present.

Leah 26:08

Yeah, you know, some of the other things I will share that, that I do for myself. Well, I think, you know, working on this podcast definitely helps with, my having to look things up as we prepare for each episode, I've been reteaching myself Spanish. I learned Spanish when I was a little kid and then quickly forgot it when I returned to the United States. And so I watch TV shows in Spanish. English subtitles. And I try not to look at the subtitles. And so, you know, just by learning a new, not really a new language, but relearning a language. I mentioned by ukulele and then one thing I did was, um, when I lived in Arizona is I took flamenco lessons. And you know, I have a slight dance background and I have to say, that's one of the hardest things I've ever done. I don't advise it if you have neuropathy because it was really difficult. But, um, flamenco is unlike other dance that I've learned where it's a different, I can't remember how many beats it is. I think it's just, it was just such an unusual count. I mean, that was a real challenge because you're moving your feet, you're moving your head and you're moving your hands. It's kind of like that rub your tummy and pat your head type of a thing, but you got, but then bring in your feet.

Tina 27:17

Yeah.

Leah 27:18

yeah. So yeah, there's something for everyone, you know?

Tina 27:22

you know, we get so busy and life takes us away from what we used to do and what we might have enjoyed in our earlier years. So I often will sit there and help people reflect back or give them the assignment of saying, you know, what really truly brought you joy, you know, when you had time to do whatever you wanted, what did you do? And maybe revisiting some of that. I mean, did you play an instrument? Did you go out, did you dance? you know, what was your creative outlet?

Leah 27:45

Yeah. And then, you know, those were conversations I had with patients too, especially because, in a way it's a good distraction from everything that's going on. You know, finding something that brings you joy. I love that. We need to mention something that I can't believe. I think we forgot to mention in our cancer fatigue episode, which is hydration, making sure that you're hydrated. I like, you know, what's so funny is I was so tired when we were taping that.

Tina 28:16

you were fatigued and I was dehydrated. I'm sure.

Leah 28:18

Yeah, no, but I think, you know, there were a couple of days where I wasn't drinking as much water as I typically do. And then I remembered like, oh, we didn't even mention hydration during that episode. So I wanted to make sure that we did mention hydration is really important when it comes to memory. Diet is important as well.

Tina 28:36

Yeah, I guess we didn't mention that, but sure. The brain is, is substance. I mean, it's mostly made of fat. It's about three pounds, total there's also neurotransmitters, which are made from amino acids, which you get from protein. So you need healthy fats, healthy proteins, and then you need some carbohydrates your brain prefers to run on glucose. It really does. It's it's almost exclusively runs on glucose. It is capable of running on ketones as well. yeah, the components the brain structure and its energy processes, require a healthy diet and that's back to the same diet, we kind of always keep revisiting, which is a plant-based anti-inflammatory diet.

Leah 29:15

In addition to diet, there are supplements that have been looked at. I don't believe that the NCCN handbook acknowledges this in any way, but there are certain supplements. Like I said, that I've, that have been investigated, that can help to support cognition.

Tina 29:35

Yeah. and we've talked a little bit about inflammation, or at least we've mentioned how inflammation can contribute. so top of the list is often things that quell inflammation, including in the brain.

Leah 29:45

One thing that I saw that was a recommendation, was for certain prescriptions but when I looked it up and then also, you know, from what they were saying in the webinar, there is no conclusive evidence that medications, medications for ADHD or medications for Alzheimer's that, that those are actually helpful. So at this time there is not evidence, I guess, those are being used off label,

Tina 30:10

okay.

Leah 30:10

I thought that was interesting too. This is something that, that we can do to support our patients. And for me, myself, you know, lifestyle modification, and lifestyle, but there were also supplements that that might be helpful. And so let's, let's talk about them.

Tina 30:30

supplements are going to come up next.

Leah 30:53

So supplements, I mean, they're, they're constantly being studied these different products, in terms of memory, you know, with Alzheimer's, and more recently looking at it for. cancer related cognitive impairment. you know, do you start these during treatment? Maybe? Do you do these after treatment? Maybe, you know, like, so, what is, what's the evidence out there for, these supplements?

Tina 31:20

So this is a growing topic in the research, as far as what helps the brain, what helps with mild cognitive impairment, and that's brain fog from treatment, or it's just the aging brain as well. But in any case, there's, there's decent evidence in some natural agents or what are natural agents here in the United States and might even be a prescriptive drug, in Europe. And the first thing I'm thinking of when I say prescriptive drug in Europe, and it's a supplement here, it's, Citicoline. It's also called CDP choline Citicoline is a molecule that probably has the best evidence

Leah 31:53

I have a friend who has a traumatic brain injury, and I know that that he's taking that and it was recommended by his neurologist. So I mean it, and you know, if you think about, I, I think of chemo, brain is traumatic brain injury.

Tina 32:06

yeah, yeah. And traumatic brain injury is definitely being researched more. Now that we know what happens with repeated brain injuries and how that leads to neurodegeneration, but there was a Cochrane review on Citicoline and I'm going to read their conclusion because a Cochrane review, if you're looking at evidence-based medicine, this will influence how neurology is practiced if neurologist's know about this review. So their conclusion was "some evidence that CDP Choline provides modest, but consistent, positive effect on memory and behavior. in at least the short medium term in elderly people with cognitive deficits associated with chronic cerebral disorders of the brain." So they have evidence for at least short medium term in elderly people. Translation is there's not enough data on the long-term. it doesn't mean it was disproven, but Citicoline potentiates or improves that neuroplasticity I was talking about and another one, I guess, right behind that, I would put some things that are anti-inflammatory and top of the list might be curcumin. And boswellia those two are top of mind for me when it comes to brain inflammation.

Leah 33:08

And I think omega 3's. food and and as the supplement and what I love when I used to sit in with the team dietician, and we would talk to patients about, foods with omega threes, we would talk about walnuts as being a source and how they look like a little brain. They do, they have little like hemispheres and everything. So, you know, it doesn't have to be the big honking fish pills. So basically anything, you know, in your diet that reduces inflammation, like a diet rich in whole grains, fruits, vegetables. I know this is the supplement part, but you got to throw in the diet, right.

Tina 33:47

It's true. Yeah. Yeah. anything and everything that can be anti-inflammatory from a lifestyle and diet perspective is a good thing.

Leah 33:53

Just think of food as a supplement, right? I mean, it's, it's basically these individual nutrients all packaged up into something delicious.

Tina 34:03

It is true. We can eat a pro-inflammatory or an anti-inflammatory diet and a pro-inflammatory diet is the standard Western diet, high in processed food and sugar and all that stuff. And anti-inflammatory diet is whole foods.

Leah 34:17

Uh, what about Gingko? Right? Gingko is one of those things. Oh, I got to tell my Gingko joke, you know, I brought it up just so I could tell my gingko joke. And it's not my joke. It's an Ellen Degeneres joke.

Tina 34:27

right.,

Leah 34:28

you know, you don't need Gingko biloba, if you remembered to take it, I guess I didn't tell it. Right. I'm not very good at telling jokes. Anyways. What about Gingko?

Tina 34:39

um, yeah, Gingko has been traditionally used, I think it has to do with the extraction process and whether it's extracted properly and has the right components, whether it has been shown to work or not for memory and recall.

Leah 34:52

It hasn't been investigated for the cancer related.

Tina 34:57

I have not seen it. I

Leah 34:58

I haven't either. And I would would've thought that there would've been some stuff, but I just, yeah, it just. It just popped up in my brain. So I thought I would, I would ask,

Tina 35:06

Run with it. So in addition to Gingko, which has been traditionally used for memory, there are other traditional plants like Bacopa and Gota Kola.

Leah 35:17

Oh, for sure. Yes, I Ayurvedic herbs. Yeah.

Tina 35:20

I do include those in my formulas for people when we're trying to support brain health and recover cognition and improve neuroplasticity. Gota Kola is also used for connective tissue in general. So it's good for the brain and it is good for healing

Leah 35:33

I think that it's also known as the longevity herb. So, you know, that's not a bad thing. Um, I do believe that there are potentially interactions with medications and like all of the supplements that we are mentioning do not start taking these on your own because we are not your doctor. We don't know what's going on with you.

Tina 35:50

yes. And there's, you know, there's a couple of other natural agents that I use that you have to take in larger doses. So I use them selectively when people are capable of taking the proper dose. These are not ones that I think people should take in a small amount if they want to get an actual effect from them. One of that comes to mind is one of the mushrooms lion's mane.

Leah 36:08

Right. Oh, you know, I actually see people cooking with it too. I think that's pretty cool.

Tina 36:12

Yeah. It's delicious.

Leah 36:13

but yeah, I D that was one supplement that I never saw any huge results with, but I, think it was just because you have to take a lot.

Tina 36:23

Yeah. Yeah. I think that some people may not be taking enough of it and the proper extraction, as far as mushrooms go, in my opinion, proper extraction means you're doing it the way that it's been traditionally done. Mostly in Asian countries, we have the information on how mushrooms were taken for medicine. And they used, what's called the fruiting body. You know, the fruiting bodies, what we see when we call it a mushroom. When we look at it, we buy it in a store. We're buying the fruiting body underneath the ground or in the substrate, wherever they grew it. If they cultivated it is what's called the mycelium and that's equivalent to the roots of a tree. Right? So this is my. The underground aspect but you want the fruiting body to be hot water extracted. So normally in traditional medicine, you'd take that mushroom. You'd cut it. You would dry it. Maybe if you want to preserve it, but then you would ultimately boil it.

Leah 37:13

So you're making a tea like or a decoction...

Tina 37:16

or a soup. Yeah.

Leah 37:19

soup.

Tina 37:20

So in any case mushrooms have a, have a cell wall that you and I can't break through. Right? So we can't, we have to break it open with heat, get the goodies inside into the solution. And some companies go through all that trouble of growing it, cutting it, extracting it and hot water, taking that hot water and dehydrating it down into a powder. Not surprisingly when it's done properly, they're rather expensive and you have to take them in a pretty good amount, like two to three grams a day. So we're talking gram doses of these powders. That's a lot different than taking, you know, 250 or 500 milligrams of Citicoline, which is one or two capsules a day. So I put the lion's mane down on my list just because it's not practical for a lot of people. Not because I don't think it works. Um, And the other one that you'd take the higher doses to get some results is a acetyl-L-carnitine. The evidence for acetylcarnitine is in not in chemo brain in general, but for elderly brains for the aging brain, but it is also two grams a day. And you know, when you have to take two grams a day, you it's either a lot of capsules or you have to resort to a powder in that powder does not taste great.

Leah 38:22

No, it smells like vinegar. I don't mind the taste. but it smells when I open up the container, it would smell like vinegar. And then the taste is very... tart?,

Tina 38:34

tart bitter, right? Like it's like, it makes me make a face

Leah 38:37

Yes, it does. It does. Um, and there are some contraindications for taking a acetyl-L-carnitine during some treatments. And so that's, that's one to use caution if you're in active treatment, just make sure there's no interaction. so yeah, I think that's a, that's a pretty good, that's a pretty good summary. Did we leave anything off?

Tina 39:18

Maybe just the one, you know, you mentioned earlier about how maybe there was a little bit of like attention deficit aspect for you where it's hard to filter out inputs.

Leah 39:28

focus. Oh, Theanine! Oh, and you know, I love my theanine. it. It's like my best friend. My dog takes a supplement with theanine. Oh my gosh, she does.

Tina 39:42

It sounds like you put Theanine in your salt shaker, just put theanine on everything.

Leah 39:45

I put it... I should put it in my water filter. I love theanine. Yes. And, um, and my experience using theanine was, before I worked at the cancer center, was using it in people, children with attention deficit disorder. So for sure. Oh yeah. I love it.

Tina 40:02

Yeah. And it's a really nice substance because you can get away with a very small amount, 200 to 400 milligrams, a capsular two, and even taking it earlier in the day has been shown to be helpful, to help people sleep that night. So not only does it help you with focus during the day and specifically with filtering out those distractions, you know, being able to watch one thing and not have that little effect where it's like squirrel, you know,

Leah 40:28

Corgi.

Tina 40:31

so there's that, and it also helps the brain relax.

Leah 40:35

you have mentioned, we mentioned it before, and you talked about that it creates the same waves as if you're in a meditative state. I love that. I love that meditation and a pill.

Tina 40:46

Exactly. Yeah.

Leah 40:47

So much easier.

Tina 40:48

I know, really. I know, that's as close as we get to, uh-yeah, putting a lifestyle into a pill.

Leah 40:55

And then a fun fact with theanine for people who take in caffeine, there are studies showing that the caffeine plus the theanine cause thinning is derived from green tea, but itself, there is no caffeine in it. But if you take theanine and you have a cup of coffee or a cup of green tea, you know, maybe some macha that has a higher amount of caffeine that that actually has shown to help with, focus. We did that in school to try. And when we studied.

Tina 41:22

yeah, and the last thing I want to mention is essential oils. A lot of essential oils can be used in inhalation capacity, so you can get a diffuser and use things like frankincense, even clove, Aspect. That gives a lot of our spices that we use in the kitchen they're distinctive scent are molecules that will lower inflammation. And when you inhale them through your nose, that is a direct link to the brain. I mean, you're very close to the brain and it's not surprising that you can take what goes into the nose and it has a direct access to the brain and it goes, it goes immediately through the mucus membranes and into your system very quickly. when people cannot or don't want to take pills or powders or whatever, this is an easy thing you can do is add essential oils to a diffuser have that handy nearby.

Leah 42:19

And, you know, again, that was something that we used to do during studying was to have these essential oils. And then before an exam, you know, just kind of waft the bottle to try to remember, but... And in my office, I had a diffuser and I. I had Rosemary and, you know, in my own little blend essential oils. So maybe that was helping me ultimately, who knows, who knows, it just felt good. And it was relaxing moment. I stepped into my office and so anything to reduce stress.

Tina 42:45

Yeah. There's very little downside risk. I mean, have a nice clean diffuser and, uh, use the purest essential oils. And then there's very little risk.

Leah 42:54

Yeah. And so we've covered the, you know, the possible causes and things that can be done as risk reduction, or to actually address the, um, The chemo, fog, the words escaped me and then supplements that that might be helpful as well. I don't know if I'm the best ad for this.

Tina 43:22

You're doing great.

Leah 43:23

No, it's because we always do it like right before lunch. And so,

Tina 43:26

I know, I know this is when we fade

Leah 43:28

is when we fade.

Tina 43:28

We're right on time.

Leah 43:30

Yay. I think this brings us to the song. you know what? I didn't forge you the song.

Tina 43:36

No.

Leah 43:36

It's actually kind of awesome. I played it for my husband and he was like really down with it. Um, it is a song called Brain Cloudy Blues and it's by Merle Haggard.

Tina 43:47

oh God, I wish we could do a little excerpt right now.

Leah 43:50

I know, and we can't because, um, even though these are our unofficial theme songs, we are not paying any royalties for them. So head on over to Spotify and you can hear this on our unofficial theme song, Spotify playlist, or mixed tape as we call it,

Tina 44:07

and you added that to our homepage too. So if people go to our website, they can see it on the bottom of the homepage.

Leah 44:14

I edit there too? Oh, I don't remember. I will be adding it if I didn't.

Tina 44:19

You did. You did.

Leah 44:20

Okay. Um, and then, you know, what's cool is that, somebody on Instagram sent me two more songs for survivorship. So I'll talk, I'm going to keep adding things. If you've got songs that you think, represent survivorship, we're going to keep this going

Tina 44:33

Oh, nice. So we have two. We have our unofficial theme songs for each pod

Leah 44:39

right for each series, each series of episodes, which is a pod.

Tina 44:43

and then we'll have an ongoing, so far it's 10 songs?

Leah 44:46

No, it's more than that because I just added more

Tina 44:49

All right.

Leah 44:49

yeah, I, yeah,

Tina 44:51

The survivorship album, mixed tape.

Leah 44:53

it's a mixed tape.

Tina 44:54

I love a mixtape.

Leah 44:55

I don't know if some people don't get mixed tape., please, please Google it because

Tina 44:59

you have to be over a certain age.

Leah 45:01

I know, but it's such an awesome thing. I even like make mixed CDs and call them mixed tapes.

Tina 45:06

I think I think it's fitting.

Leah 45:08

Okay. And you know what? I completely flailed on the moment of Woo. I'm sorry. I came up with an idea and I didn't do my research behind it. So I know that you have a moment of woo.

Tina 45:20

Yes, because I held my tongue when you talked about that Walnut looking like a brain thing.

Leah 45:25

Oh,

Tina 45:26

the moment of what we have right now, because that is 1- that sounds woo woo in and of itself.

Leah 45:32

It does, but it was a way to like have patients remember.. So, uh,

Tina 45:38

but it's an official woo woo thing called the Doctrine of Signatures.

Leah 45:42

yes. This is something that we learn in herbs class.

Tina 45:45

Yeah. So when a plant looks like the organ that it is indicated for.

Leah 45:52

That is that that's the doctrine of signatures right there. Yeah. It's yeah. It's like the color or the shape.

Tina 45:59

so classic is Walnut because the raw Walnut looks so much like a brain and it does, the walnuts are good for the brain health. And then Gingko comes to mind. It looks like two lobes of a brain. You know, it's a two lobed leaf, which is pretty unusual. And then the other one that comes to mind and we have lots of it here in the Northwest is the Hawthorne tree.

Leah 46:17

sure. Well, and know, the Hawthorn berries right there, red,

Tina 46:22

And there for the cardiovascular system. So the berries are red, usually No. Well, we have a garden here, a botanical garden that has different hybrids that they go to yellow, to red. But the one that we use classical use for medicine is a red Hawthorne. And the trunk itself looks like a vascular bundle.

Leah 46:42

so that's an excellent moment of woo.

Tina 46:44

It's really a good moment of woo. Cause it's fun to, it's fun to play around with the idea of it

Leah 46:48

Right. So the next time you look at your food, you're going to see it in a whole different way.

Tina 46:53

that's right.

Leah 46:54

Maybe you should do more moments. I'll save the one that I was going to do for this one. I'll find a place to put it in another, in another pod. Cause it was a good one. But for now, thanks for listening. Hope you learned something. Um, if you can't remember what we talked about, we're going to have show notes and we're going to have links to various topics that were mentioned in the show. And we've been putting up transcripts on our website. And so you can go back and see what we, what we had to say about this, the subject of chemo brain.

Tina 47:30

Yeah, so like us subscribe check out our website. We're going to start up a newsletter in the new year sometime

Leah 47:37

yeah, if you, if you are interested in, in getting notices on our newsletter, which will probably be monthly, sign up on the website and you can sign up through the link tree. And then I also added to our Instagram link where you can email us directly. If you want to give us a shout out or ask us questions, do not ask us questions about your medical health, because we're not your doctor.

Tina 48:02

I love link tree. I think link tree is cool.

Leah 48:05

It is cool.

Tina 48:05

Cause then you can, you know, go wherever you go. Like you look at LinkedIn, you're like, oh, that's, that's a place. I go, whatever that is. I Heart radio or Spotify or whatever.

Leah 48:14

Or our website.

Tina 48:16

Or our website. Hint, hint.

Leah 48:20

Hint, hint. On that note. I'm Dr. Leah Sherman,

Tina 48:25

And I'm Dr. Tina Kaczor.

Leah 48:27

And this is thee Cancer Pod.

Tina 48:29

until next time.