Confusion and memory impairment, and their connection to heart issues.

I recently had coffee with an old friend from my former life as a government employee.  I was working with her approximately five or so years ago when I blacked out and fell off the treadmill.  As I think I have mentioned in previous blog posts, at the time, I was in a state of constant exhaustion, and I sensed that my life was out of balance.  I had almost no energy, and my outstanding memory had vanished into thin air.

This good friend, who also is retired now, indicated that the change in my memory and my situational awareness was striking.  She said another colleague approached her, wanting to know “What’s wrong with Mel?”  They shared examples of times I seemed to have forgotten things.  As a manager in the office, I would ask them to perform certain tasks one way, and then I would do something that conflicted with my own instructions.  Looking back with hindsight on a time that was very destructive for my health and well-being, I was not surprised when she told me this.  But even though I knew something was “not quite right” at the time, the perception of others regarding my actions and my behavior might have been helpful.  I had to stop myself from asking:  “Why in God’s name didn’t you tell me that I was losing it!”  
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But several thoughts leapt to my mind and caused me to keep my mouth shut:  (1) Would I have listened to anyone who pointed out that I seemed to be having a cognitive issue?  Or would I have been defensive?  (2) Would I myself know how to approach a friend who seemed to be having cognitive issues?   I realized that my good friend cared a lot for our friendship and for me.  But it is a different matter to know how to broach this sensitive subject with a good friend.  It is especially difficult when it is someone you know and have respected for years.

But the problem is that there are a number of serious health conditions that might have been brewing based on what my friend and the other colleague observed in my behavior.  The American Heart Association lists a number of heart failure warning signs and symptoms, many of which I have mentioned in previous posts.  But I’m not sure I ever mentioned that confusion and impaired thinking is a warning sign/symptom of heart failure. 

Why does this happen?  The AHA says that changing levels of certain substances in the blood, such as sodium, can cause confusion.  (Damn – is there anything that sodium doesn’t impact?  Who knew?  As much sodium as I used and overused, I am amazed I didn’t enter into a state of delirium!)  The Heart Rhythm Society says:  “The reduced blood flow to your brain may cause feelings of confusion, impaired thinking, or mental sluggishness.”  According to the Cleveland Clinic, it is not just the volume of the blood but the quality of the blood:  Dizziness, confusion, difficulty concentrating, fainting:  You may have these symptoms because your heart is not pumping sufficient oxygen rich blood to the brain.

I wondered how an insufficient supply of oxygen-rich blood might impact the brain’s memory function.  In February 2012, the website for the British publication The Telegraph reported that researchers found that individuals with heart failure had worse short and long-term memory recall than those who were healthy.  MRI scans also showed loss of grey matter in parts of the brain important for memory, reasoning and planning, according to Professor Osvaldo Almeida of the University of Western Australia.

In my career with the Federal government, I spent the last ten years in executive positions.  My duties required much reasoning and planning and my lawyer skills were put to good use.  My memory was apparently legend among my colleagues.  They would often stop by to probe my extensive memory banks.  No wonder I was so scared when my world seemed to be falling apart a few months prior to the treadmill fall.  I could not put my finger on what the issue was, but I suspected that a number of cylinders in my brain did not seem to be engaged or working properly.  I encouraged colleagues not to rely on my memory because I could no longer bring facts and events to mind as if I was pulling a rabbit out of a hat. 
 
Equally distressing, I could see that I no longer had the stamina and the mental acuity to keep up with the pace and scope of my responsibilities.  But I didn’t know why.  Things did appear to improve a bit when my heart problem was unveiled.  My memory seemed to improve a bit after the pacemaker was implanted and my heart was being regularly paced.  But it never seemed to be as reliable as it had been.  What was the cause? 
 
When I was researching the material for this blog post, I found a New York Times article on a prominent lawyer who had a heart attack and underwent surgeries to bypass blockages in his coronary arteries. 
According to the article, he came through the surgery fine -- physically. But he had memory problems and even simple tasks, like writing letters, eluded him.  
 
His doctors kept telling him that it was temporary, and he just needed to wait a while longer.  But no matter how long he waited, his ability to study a topic, organize it in his memory and speak competently about it at length the next day had disappeared.  He consulted books and tapes on memory enhancement.  He tried computer exercises and reading non-fiction.   Nothing he tried worked.  So he quit his law job after two years.  The article says that this man is the extreme example, but that he is not alone. 
 
It was hard for me to read this man’s story and not feel the tears forming at the corner of my eyes.  I felt like I had found a kindred spirit.  You see, when you are a lawyer you rely on your ability to organize, analyze and relate a fact pattern in a compelling fashion.  Your ability to tell a story to an audience and have them sitting on the edge of their seats, and your ability to convince them that your opinion is right, these abilities are largely reliant on memory and the grey matter in the brain.  Without it, you might as well turn off the lights and go home. 

I realize that the article pertains to bypass patients, and maybe victims of strokes.  It does not discuss at all the impact of memory impairment in heart failure patients.  But I have to wonder if the impact on my memory and my advocacy skills could have been triggered by my heart failure?  Even though I was never a trial attorney, and I also spent a number of years working outside the field of law, my positions required me to use those lawyer skills to research, analyze, commit information to memory, and articulate positions throughout each day.  I am convinced that as my heart failure increased, it hindered my ability to perform as I had for many years.
 
According to a 2016 article on the Cardiosmart website, one in three patients doesn’t return to the workforce following a heart failure diagnosis.  This article was based on research from a Danish study.  It also found that certain patients were more likely to return to the workforce than others. For example, younger adults between 18–30 years old were more than three times as likely to return to work as adults ages 51–60.  I realize that we are not in Denmark, but it appears that Cardiosmart accepts the validity of this study and so do I.  So while I still feel guilty for retiring at age 56 when others were work well into their 60s and 70s, I have come to accept that my decision to retire apparently is a normal response to heart failure.
 
I believe that over the five year period, my memory has improved a bit, and is more than sufficient for what it is required to do at this point.  But I am also aware that I need to be vigilant.  Why?  Because doctors are learning that the loss of memory is a factor they may want to consider as they treat patients who have more advanced cases of heart failures.  The Australian professor mentioned earlier in this post noted in the European Heart Journal that he and his colleagues warned that "patients with heart failure may have trouble following complex management strategies, and, therefore, treatment messages should be simple and clear".  This tells me that I need to continue to exercise my brains cells and keep my mind as active as I can so that I can keep up with my treatment, exercise, diet and medication regimens.
 
That is one reason why this blog is so important to me.  My memory may have some mileage on it, but I can still analyze what it feels like to have heart failure, to put it into context, and even find something hopefully witty to say on occasion.  I get to recall events, research and analyze facts, and tell a compelling story related to the need for balance if you want your life to be rich in experiences and friends. 
 
Working on this blog is just small percentage of the mental workload that I used to have.  But it makes me feel alive and I believe that I am contributing something that might be able to help others.  It gives me hope that my stories will continue to abound and make people laugh.  It keeps me going when I hit an obstacle in heart failure that slows me down.  In my experience, the pen truly has become mightier than the sword as I write my way around each heart failure obstacle and I develop a better perspective.  Hopefully as the gray cells continue to perk along, the words will flow from my pen.  My heart may fail, but I pray that  my soul remains strong, vital and enlightened.