Yesterday I was putting away the fish I'd just brought at the market into the big white cold thing in the kitchen. As I went back to the hallway to get rid of my keys, I noticed something was off. I was still carrying the fish. I opened the big white cold thing again and found my keys inside.
This week's all about a profound brain fog. I can't find words for commonplace objects (had to call my mother to discover that my keys had been in the fridge). Instead of my normally fairly nimble brain, there is an empty space, positively echoing between my ears. As for my memory? I'm having trouble remembering my own name"
The basics of brain fog
Brain fog is a colloquial term for the mental fuzziness experienced by many people with RA. A 2012 study by So Young Shin gave a variety of cognitive test to individuals with RA and found that approximately 30 percent had problems with mental clarity and sharpness.
A number of factors related to having RA contribute to brain fog. One is the inflammation of the disease. A 2009 study by Mark Swain saw a link between inflammation in the body and feelings of malaise and fatigue. Chronic inflammation can cause a domino effect within the body, which releases proteins called cytokines in the brain. These cytokines can have an impact on neurotransmitters, which again, may change behavior and emotion.
Pain can also contribute to brain fog. The results of a 2010 Canadian study showed that people with RA who had high levels of pain experienced problems with mental functions related to planning and working memory. Years ago, a social worker told me that dealing with pain takes up a lot of room in your brain, leaving less capacity for things like memory and the ability to focus. I was very grateful that I wasn't losing my mind.
Medications play a role. In Shin's study, participants who took steroids and who had risk factors for heart disease (e.g., high blood pressure, high cholesterol) were more likely to experience issues related to mental clarity. As well, many people who take immunosuppressants, such as methotrexate or Biologics, report that their brain gets fuzzier the first few days after taking the drug.
Other factors contributing to brain fog may include depression and anxiety, which are fairly common in people who live with chronic illness and chronic pain. One study found that as many as 20 percent of people with RA experience depression. Causes contributing to depression may include inflammation, as well as the difficulties inherent in living with RA.
Coping with brain fog
There are a number of things you can do to reduce brain fog or cope with it.
Treating your RA. As with so many other aspects of living well with this disease, one of the best things you can do for brain fog is to treat your RA. Reducing your inflammation and your pain will start to clear up your mind. I still remember shortly after I'd started taking Biologics experiencing the lifting of the fog in my mind. One day, I even came up with an equation for something fairly basic. Still, for this particular math dyslexic writer, it was an astonishing experience.
Treating your pain. Making sure you have adequate pain management is the other side of the coin of treating your RA. Being in pain takes a lot of energy, both physically and mentally. Talk to your doctor about the impact pain has on your life so the two of you can together find a better solution. If your family doctor or rheumatologist are uncomfortable treating your pain, ask for a referral to a pain specialist.
Resting. Getting enough rest is also a key factor to clearing your mind. People with RA typically need more sleep than the general population. Information from Johns Hopkins recommends that people with inflammatory arthritis get 10 hours of sleep at night or eight, with a daily nap of two hours. Getting enough sleep and rest can help you manage RA pain and fatigue, as well as brain fog.
A nutritious diet. Many people with RA find that different diets may contribute to an increased sense of well-being. Which diet works seems to depend on the person. Some people swear by the Mediterranean diet, others find that eating vegan or vegetarian diets are helpful, and yet others use a Paleo approach. What they all have in common is cutting out foods that aren't good for you, such as fast foods, sugar, and highly processed foods.
Taking care of yourself. When you are tired and in pain, it's easy to let other things slide, including your appearance. Getting out of the sweatpants and ratty T-shirt can make you feel better about yourself. As a freelance writer, it doesn't matter if I write in my PJs. Several years ago, I realized that wearing my crappy, yet comfortable, clothes made me feel pretty crappy. I created a rule that during the day, I have to wear proper clothes and it's made a difference in how I feel.
Be organized. Writing notes to myself is an essential part of remembering what I need to do. I use Post-it notes, apps on my smart phone, the calendar feature in my email program (those reminder dings have saved me on more than one occasion), and in a pinch, I write on my hand. Other ways of organizing my life include using a pill organizer for my medication, arranging my CDs and movies in categories, and regularly cleaning out the fridge, freezer, and cupboards. Organizing my day into a routine helps me get things done and forgetting less. Having a pattern is a trigger for my brain to focus on particular things at particular times.
What do you do to manage brain fog? Have you ever put your keys in the fridge?
Lene writes the award-winning blog The Seated View. She's the author ofYour Life with Rheumatoid Arthritis: Tools for Managing Treatment, Side Effects and Pain and 7 Facets: A Meditation on Pain.