cognivie abilities
My current state of matter is a high-grade DCIS with comedo necrosis that was not removed after two lumpectomies. I'm considering either unilateral, or bilateral mastectomy now. MO was talking tamoxifen and/or aromatase inhibitors if I do a total hysterectomy for my big fibroids (8 cm max). I research the side effects of hormonal treatment, and a temporary and/or permanent loss of cognitive abilities is a documented side effect.
I had an episode three years ago when I temporarily lost my abilities to solve complex problems: I was able to solve college-level low-division math and physics problems, but could not do problems for my upper-division classes for majors and graduate students. I need to be able to solve differential equations, take integrals, understand advanced topics, do original publishable research, etc. A loss of these abilities means a loss of employment for me and erase who I am. As I see it now, I may choose to life and sacrifice who I am, or risk metastatic cancer. Although these are not mutually exclusive outcomes.
Would you be willing to share your thoughts and experiences with me, please?
Comments
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I’ve been on Letrozole for almost 6 mos. now. My “CRS* Disease” (*Can’t Remember Squat) is limited mostly to an occasional temporary (as in a minute or two) inability to remember the names of certain minor celebrities, certain lyric fragments (so I rehearse more often and bring lyric sheets to gigs--or make up new ones on the fly), and a need to make shopping lists and immediate calendar entries. I stink at math--always have--so no way to compare my situation in that regard to yours; but if it’s any encouragement, I still can easily do the toughest crosswords & double-acrostics in ink (when my cataracts allow me to see the tiny clue numbers) and kick butt while watching Jeopardy! (Would that I did that well when I was actually a contestant 20 years ago). I can still ad-lib easily, much to the consternation of those with no tolerance for puns. I got into the habit of entering deadlines and due dates into a calendar with a “tickler” system decades ago in my first law-practice job (retired now), so I haven’t screwed up there yet. I lay out my pills for the next day at the same time I take the evening ones (in a pair of shot glasses) and only use a multi-day pillbox for travel. Of course, I am 65 years old, and some of the minor memory issues predate my diagnosis, much less the start of my AI therapy.
No guarantee, therefore, that forgoing AI therapy would keep you sharp but bring on mets--nor that taking an AI would guarantee mets but harm your intellect. (As you may have deduced, that for me regular mental exercise and memory-aids go a long way to preserving it). Estrogen deprivation is part of the aging process, so it’s hard to separate “AI-brain” from age-related cognitive differences. But it’s definitely milder than what I’ve read about “chemo-brain,” and it isn’t inevitable.
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Dragonsnake,
I also went through an episode where I was taking classes while on medication, and at the time I felt it had something to do with my difficulty in comprehending. I can't state that it was 100% caused by it but I've been looking at the forum "Complimentary & Holistic Medicine Treatment " and they were mentioning something called DIM. I'm taking a closer look at this because not just the cognitive effects but other SE's that have made me rethink about the anti hormone medication that I was prescribed. Everyone is different and I don't want to sway you in any way; but this is what happened to me, and I'm sure that there will be others that will chime in that they haven't had any problems.
Good Luck
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Some months ago I read on the internet a news item suggesting that cognitive decline might be the first symptom of cancer. I cannot find that particular item, but I have found this one. You might find it worth a read through.
https://www.mdanderson.org/transcripts/POE-Cognitive-Function-Meyers.htm
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I have no cognitive problems as of now. Still sharper than most of my colleagues with the exception of one professor who recently died of pancreatic cancer. He was a world-renowned theoretician who pioneered a new area of research. I think doctors want you to believe that you had problems before cancer treatment to downplay side effects. It is established that tamoxifen binds to receptors not only in the breasts but also in the brain. I just would like to figure out the extend and the severity of the problem.
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I definitely notice a difference when I was working my last year. It sort of forced my retirement. Doctors don't agree, I should know I was doing my job over 30 years.
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I am a civil engineer on letrozole. No problems with the math stuff, haven't lost that, but occasionally I forget words I've known forever. I always remember them later, but in the moment I can't quite access them. I play bridge and haven't notice any effect there either which requires counting and keeping track of cards played, but I did have trouble spelling letrozole until I looked at Chi's post..... Old age maybe. I did have "chemo brain", but it went away in a year or so.
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I think fatigue got me more it affected my cognitive abilities extremely fatigued
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Dragonsnake, as long as you don't do anything permanent, i.e. have your ovaries out, you can test drive the hormonal therapy and quit or change if you need to. So tamoxifen, or ovarian suppression using Lupron or Zoladex combined with either tamoxifen or an aromatase inhibitor would be options. The last option might shrink the fibroids. In my personal experience, some trouble with word recall, especially names, has been the most obvious cognitive side effect of both tamoxifen and letrozole.
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You can always try anti hormone therapy and see how you do. There can be some permanent SE but I don't believe cognitive issues is one of them. As far as DIM goes, I take it in leu of anti hormone therapy. Please feel free to private message me if you want to talk in more detail. Good luck to all...
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Hi Dragonsnake, I am an IT manager working in a high pace and high stress environment. I don't do differential equations but I need to be focused, able to multi-task and generally speaking be sharp when I am at work.
I have been on an AI for almost 2.5 years now - all while working - and btw I worked through chemo and radiation too. I think hormonal treatments do not decrease your mental abilities but rather accelerate the aging process that in turn impacts all of your abilities - both physical and mental. My brain works better now than when I was on chemo or in radiation treatment and I believe that is because I am physically stronger and less stressed than when I was in active treatment. That being said, I cannot work as much without losing sharpness as I used to in the past: my job sometimes requires late night phone meetings or weekend work and I feel tired sooner than in the past. I used to be able to function quite well on very little sleep but not anymore. I need to rest in the evening in order to be sharp the next morning, I can't do a business meeting till 10PM at night and feel refreshed and productive at 9AM the next morning.
So in my opinion, it's a combination of factors that produce stress and accelerate aging, I wouldn't blame it all on tamox or AIs.
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muska - right on!
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One word: GABA. I was getting so bad, I had all 10 warning signs of Alzheimers. Didn't recognize people's faces, getting disoriented in restaurants, coudln't finish a sentence, on and on. I discovered a half of an Ativan let me get some sleep, no hot flashes, but I was still pretty spaced out during the day. So I researched Ativan and learned that it works by keeping the GABA in your brain... so I bought a GABA supplement and literally overnight I think I'm cured! I can think straight again... sleeping pretty good! Let me know if anyone knows anything about it... for now, I'm a fan.
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I'm an academic administrator with a very complex and stressful job. I have trouble remembering words and names, but do fine otherwise if I get good regular sleep and don't work a several of 60 hour weeks in a row or have multiple late night events. Regular exercise is also important. I'm well past menopause, so attribute this to both aging and the AI.
Estrogen is a wonderful hormone. My 60+ sister still takes supplements to keep her mind sharp. She is a systems engineer programing sometimes 18 hr/day and through the weekend. I miss the little bit of estrogen my body produced after menopause.
I too suggest that you try Tamoxifen and an AI with ovarian suppression to see how it goes. You may be fine, and if not, you can stop.
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