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 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 contributor 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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