One of the things I noticed in myself when I was constipated due to heavy meds was that I was so irritable, less patient, less able to focus on multiple level tasks. Tell me one thing in one moment then I forget in the next. Get my attention on some new thing vs thing I'm familiar with (my hubby is a computer engineer so when he talks new paradigms and I'm constipated I can't follow his conversation), I'm lost. I end up staring into space playing I Spy with words I understand all buried in words I don't. It's amazing how much brain function a.k.a cognitive function I lose when I'm a week or two backed up. If you are blessed with great bowels, imagine having to pee so badly while waiting in line at a public bathroom, a portapotty -- or worse, while driving. Gasp. There is no other thing you can handle. That's a close analogy -- now spread that feeling across a week or two;)
I then thought of my son.
My son is very smart. He's also got an old soul. But catch him when he's constipated and he's a different child. He's what I just explained in myself -- hard to focus, irritable, fatigued. Less desirable behaviors emerge. I go through my mental checklist of items "did he sleep enough or well enough...is he hungry...is he tired...is it just ego related to typical development...?" I try finding connections when less desirable behaviors emerge.
Now more than ever I'm finding as soon as he can poop he is back to himself. Cognitive Function comes back. Everything is at equilibrium. Life's good.
Being on the other end of it I pretty much guessed. But now that I'm on the same end I really get it.
There are also disorders in which cognitive levels are affected. Now add constipation and there's a narly party going on in that individual's inner space. That's the take home message.
So what to do with someone with cognitive function challenges when constipation is a contributor? Though my constipation was a challenge post-mastectomy, I really was able to manage the feelings around it because I kept thinking "If I feel it I must be alive!" -- and this has to be good. But from time to time I struggled and I can only imagine that those meds are kindergartenish when compared to the big-boy stuff I'll be getting at chemo. In preparation for those drugs and associated cognitive functioning challenges (with or without constipation challenges), I prepared a list in advance that might help others around me. These are some suggestions I thought of for myself which are influenced from my work with clients who have suffered a traumatic brain injury (eg car accident or football blow), stroke, or the different types of dementia that come from Alzheimers, Parkinsons, MS, ALS, stroke, etc. These suggestions below are influenced from the training I received in speech language pathology:
10. Rephrase things (in case I need to hear it another way, forget the info, or just didn't quite get it)
9. Give visuals or concrete examples (to help memory or attention; specific examples include writing things down, using pictures, signing)
8. Remove distracting items (eg my kitchen sink filled with dishes is a good example. This affects attention -- generally this specific item has to do with messes like dirty dishes or piles of laundry on the bed. This is how I lived when school got tough -- as in having to take lots of tests or write lots of essays so I normally can block this and focus on the important stuff. But since I won't have tests or essays that need to be written while going through chemo AND I'll have chemo brain then I can see how this might be hard. Fortunately my family is learning how to help in these areas.)
7. Remove distracting sounds (loud movie on the television or loud music brings on a headache. Levels of difficulty = images flashing in front of me + too loud = hard to concentrate because I'm focussing my attention on the loudness. All of a sudden I've lost the plot of the tv story or the lyrics of a song).
6. Present items of conversation in a way that the brain does not have compete on a few levels (eg if trying to get out the door to meet time deadline like an appointment we are rushing to, then it's the wrong time to tell a story. Get out the door or tell the story. Not both. Story + lateness + trying to get out the door = 3 levels of brain difficulty. Or if telling a story, slow down since story + speed = two levels of difficulty. If telling a story in an area that I'm not familiar with then story + unfamiliar territory + speed = three different levels of difficulty. Again another attention type of thing. This divides my attention unevenly).
5. Speak in a voice that is calm (this lowers the cortisol hormone in the blood -- the one used to fight stress -- and it keeps my attention)
4. Limit demands or requests (If I'm looking like my body is focussing on recovery, this is one level of difficulty or demand on my body. Conversation on items that don't require me to make decisions is best -- like what's happening in my son's classes or what's on Dancing with the Stars or Switched at Birth. Life type questions like "What will happen to your family if you don't make it?" doesn't help. Demands like "Choose a color so I can paint your house" or "Maybe your son should read more blah blah blah types of books that I like to read because I don't understand why he likes such old types of books" don't fly either (ok, my mom is guilty of these last two. I love her dearly and she's been so helpful but demands or requests for change are so hard on my system. This not only challenges my attention (which is a part of cognitive function) but it raises my cortisol level -- again, the hormone that is used to fight stress. She's learning in this area of weakness).
3. Disguise demands or requests. (here I'm thinking food. Food is a requirement for recovery but if I'm feeling nauseous then requesting a certain item might not only divide my attention -- my focus on fighting nausea + food request -- but it will also raise my cortisol level. Disguising such a request comes in the form of offering options, using a calm voice, giving me extra time to think about it, placing it in front of me or taking it away. I'm thinking what I do with clients and I'm thinking ahead of what I normally can handle versus what I might not be able to handle during chemo.
2. Help on tasks that I can normally do pre-constipation or pre-chemo (think 'cut the person some slack', Thinking 'she knows how to do this' or 'she usually does this' is a gone paradigm in the face of body challenge such as constipation or chemotherapy. Again, I'm projecting into the future of chemo where I'm going to have memory fog plus possible constipation from the drugs. When I work with clients I look around their world in what's going on their life. It might just be a hard day so helping them carry things out -- a subcategory of cognitive function called 'executive function' helps. When it comes to 'cognition' a subcategory of it called 'executive function' is the big mama term that controls the other subcategories of cognition that I'll talk about at some point on my journey. These other subcategories of cognitive function include memory, attention, problem solving, reasoning, planning. Each subcategory then has more subcategories. For example, under attention alone there are then even more subcategories such as the ability to 'switch' tasks eg wash dishes then cook dinner or 'focus' on 'alternating' tasks eg wash and cook and wash and cook or 'divided' attention eg talk and drive or talk and cook etc etc etc. Throw in a time deadline and then the hormone cortisol might encroach on this territory and cause major chaos. The brain is amazing....when it works under ideal situations and non-ideal ones, too).
1. Be patient -- and give me a lot of laughter and love. These make me breathe :)
When it comes to cognitive function these are pretty much attention and memory types of stuff (and executive function) that also sneak into behavior. Understanding how these things play together make the world go round just a bit more in the world of someone whose system is outta wack.
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