Memory Loss and Pulmonary Hypertension

By Armond Aserinsky


 

Memory Loss and Pulmonary Hypertension

By Armond Aserinsky
 

There's an old medical saying, pertaining to diagnosis: "When you hear hoofbeats, think first of HORSES rather than ZEBRAS." In the case of the syndrome from which so many PH patients suffer, "CRS" (Can't Remember S**T), I think we have a cause that is staring us in the face while we're busy trying to figure out whether Zoloft or Zantac or Xanax, or Zocor is the culprit.
 

PH Patients are dealing with three classes of problems, any one of which is sufficient to disturb memory for both recent and old information. Recent, or "short-term" memory is out of whack when you can't remember what someone told you five minutes ago, or when you walk all the way from the bedroom to the kitchen and when you arrive you don't know why you're there. And of course, Old, or "long-term", memory is giving you a problem when you go to dial a phone number that you've used a million times and you can't remember whether it's "3-2" or "2-3".
 

So, It's both kinds of memory, and any one of the three following problems will disturb those very delicate processes of recall.
 

1. Anxiety AND Depression are both enemies of memory. They affect "Attention", "Concentration", "Mental Energy" and "Mental Stamina". Both Depression and Anxiety are words used in everyday speech, but their meaning is actually too narrow in their common usage. Since the words describe a feeling-state, we tend to think that we ought to know whether or not we're depressed or anxious. If you FEEL Depressed, then you ARE Depressed, right? (And ditto for anxiety?)
 

Right. AND WRONG. If you FEEL Depressed and/or Anxious then you are. By general concensus within the field of Mental Medicine, the term Depression is not used for very brief, transitory, feelings of being "Blue". If the feeling hangs on you for weeks, feeling as heavy as the drapes Scarlett O'Hara used for her dress, then you are indeed depressed.

Anxiety can be either brief or protracted. You get to use the term regardless of the duration of the feeling. However, we ought to distinguish between Anxiety and Fear. For example, when one of you says that you're feeling "Anxious" about your upcoming Cardiac Cath, the experience might more accurately be called fear, because we all Fear being subjected to something painful, especially when there's no "escape" once the situation has begun. Self-medication with drugs or alcohol is common.
 

Okay, the point is that for the most part you'll be correct to say that you are depressed or anxious when you Feel that way. Where the problem comes in is in cases when you don't "feel" bad, but you are in reality suffering from depression or anxiety. This can be determined by the presence of all the other symptoms of Anxiety and Depression, many of which are physiological and quite measurable. For instance, Anxiety is quite notorious for its effects on heart rate, blood pressure, respiration, conductivity of the skin, disturbed sleep, and a host of other parameters. Self-medication with drugs and alcohol is common.
 

Depression is known for its effects on general demeanor, facial appearance, irritability, pessimism, ideas of worthlessness, occasional paranoia, complaints about the body, hypochondriasis, obsessive and obsessive-compulsive thought and behavior patterns, and disturbed sleep.
 

*And rising above all the rest of these complaints is... "I can't remember things".*

I'd be curious to know how many people on this list are receiving ANY kind of treatment for either anxiety or depression. Of those who are getting such treatment, how many are working with a mental health professional. And of those, how many are seeing someone who can prescribe psychotropic meds or who consults with a physician regarding management of your psych meds.
 

I know that most of you are suffering from Depression or anxiety, so most of you will have some trouble with memory. The effects on the mind of having a serious, often disabling, frequently fatal, disease that can require strenuous, uncomfortable, and inconvenient treatment are well-documented.
 

One of the non-medical treatments for very sick patients is participation in helping others with the same disorder. This listserve, and indeed all PHCentral activities present every owner with a chance to put hard-earned life experience to work on behalf of others who are in the same boat--The QE2, not the Titanic, or the Lusitania, or the Andrea Doria. Every one of you who participates in this virtual support group is decreasing anxiety and depression. But even the most energetic of us, those devoted night and day to this worthwhile project, can still suffer from some emotional turmoil that requires professional intervention.
 

2. Physiological Processes becoming Conscious. It has long been said that the unconscious activities of our brain should remain out of our awareness. There's an awful lot of bodily activity that is regulated by the brain which passes entirely unnoticed. Imagine what life would be like if we had to listen to the instructions to our vital organs. With a heart beat close to one hundred cycles per minute for many patients, it would be pretty hard for one's mind to work on any other tasks.
 

With the PH patient, the most primitive "mechanical" processes shove themselves on to the theater stage. Patients are aware of their heart beating, they're aware of their breathing, they're aware of the amount of oxygen being pumped into arteries. They may have aches and pains associated with Flolan, their temperature control may be peculiar so that they're either too hot or too cold, Remodulin use may be associated with a continuous bee-sting cutaneous reaction, calcium channel blockers may induce odd sensations in the chest, food may not taste right, external O2 supplies blow air up your nose causing it to dry out and become stuffy, feet get swollen, hands shake, mid-life hormonal changes announce themselves and hormone replacement therapy may be disallowed, etc., etc.
 

Most patients do a great job of growing accustomed to these things, and they complain only when one or another of them becomes unusually troublesome. To think, however, that all this body "noise" has no effect unless something "spikes" would be wrong. Experiments have shown that certain low-level background sounds have a considerable effect on people's "nerves". An interesting example is found in the very small sound emitted from those little earphones that kids wear when their listening to their portable cd or mp3 player.
 

So reason number two for memory/concentration/attention problems is the high "volume" level of numerous body systems affected by PH.
 

3. Lastly, we have to consider the direct effects of dyspnea, apnea, and hypopnea. At its core PH is a disorder of oxygenation of the blood. The heightened resistance of the constricted lung arterioles leads to decreased blood flow through the lungs, and thus to a decrease in the supply of oxygen to the rest of the body. Various mechanisms attempt to compensate for this deficiency so that the output of blood from the lungs per unit of time is maintained (to the extent that the pump can push hard enough and fast enough) along with the amount of oxygen available for use by the body. This latter feat is sometimes accomplished by the overdevelopment of hemoglobin, which allows more oxygen molecules to travel in a unit of blood than would normally be possible.
 

Despite all of this, many PH patients remain slightly or mildly underoxygenated. The number used by some insurers to determine whether they will pay for supplemental O2 is awfully low in terms of mental functioning. I can tell you, I wouldn't want to be conducting business at an O2 Sat of 90%. Furthermore, this Sao2 parameter which is used to describe one's "oxygenation" for certain purposes is not the whole story. There's a lot more to it--more to it for some folks than others.
 

That is the third "cause" of memory trouble in the PH patient: low grade hypoxia, not serious enough to cause alarming symptoms, but enough to make you feel like you're not the sharpest pencil in the box.
 


I hope patients will take this as I mean it--as testimony to your will and determination to lead active, productive lives in the face of great odds. The dedicated family members and medical caregivers do their best to get you up and running at the best possible speed, but let's face it, Captain, with those Di-Lithium Crystals gone, "We canno' use Warp Draayve; Shi'll ne'er take it,"
 

Captain, I fail to understand why Chief Engineer Scott speaks in an Earth Dialect of the early 19th century, called Scottish Brogue, which hasn't been heard in that form since Sir Walter Scott wrote the Waverly Novels.

Shut up, Spock, before I come over there and Van Gogh your ears.

Ah shore hates it when dem big bosses gits to fightin and fussin'.

Shut up Binks. You're not even in this series. This is Star Trek, moron, not Star Wars.

[The universe isn't what it used to be.]


Armond

December 1, 2002

 

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We would like your feedback. Please comment above about this article and your suggestions for future articles. We ask that all articles are relevant, that common decency prevail, and that any factual statements be verified for accuracy. If you are sending comments on a feature, please reference the title in the subject line. Our goal is to bring useful and interesting features to you in future months.

PHCentral is committed to the expression of diverse opinions from members of the PH Community.

We feel strongly that free and open discussion regarding PH will assist in the generation and the refinement of new and existing ideas. To that end, we provide the opportunity for anyone from the medical and patient communities to submit editorials, letters to the editor or short articles on a PH-related topic. We will be encouraging opposing points of view. Areas may include treatments, causes, advocacy, disability, etc.

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