Help with Brain Fog Symptoms

Mirtazipine (Remeron) has helped my father-in-law regain weight and sleep at night through his post-nephrectomy adjuvant immunotherapy.

I've got a Ritalin prescription for when chemo fog keeps me from concentrating at work.

Between the Ritalin and caffeine, I can get through the mental fatigue most work days, but they only partially address the real physical fatigue.

I found that a blood transfusion (1 unit) was a huge energy booster for a few weeks after it was administered. My hemoglobin was not at the "acute low" threshold of 8.0, but had been chronically low (8.5-9.5) for so long it was impacting my ability to exercise.

A lot of doctors (including palliative docs and oncologists) still think in terms of the acute low hemoglobin treatment, but others are starting to consider blood transfusions based more on symptoms than just hemoglobin level. It's definitely an issue for those on long-term chemo/immunotherapy.

If the mirtazipine has a positive impact on her sleep quality, that might help with the fatigue as well.

Depression is also a big contributor to fatigue, so the mirtazipine might help on that front too, but it wouldn't hurt to explore other mental health avenues (counseling) if depression is involved.

@seinfeld01
I don’t have personal experience with cannabis for cancer but I have heard only excellent things about it. Apparently, it can address with much success, a host of different cancer side effects. I don’t know for certain about this but it may be a more natural product than a prescription drug and thus easier for the liver to digest. It sounds as though your mother really needs something to get her through the worst of this disease. I wish her all the best. Sounds as though she has some kind and creative medical support.

That’s a good suggestion. I was prescribed Remeron for a few months when I had major depression with constant nausea. It did help with my appetite, it made me crave carbs.

Hi @seinfeld01, welcome to Mayo Connect. It sounds like your mother has been through a lot, sorry for you both. The recent symptoms are concerning. I’m curious has she had a recent PET scan? Or a urinalysis? I’ve seen bladder infections have strange impacts on older adults.

She has had brain scan and confirmed it was clean. No signs of dementia or Alzheimer’s either. She was on trazadone to help sleep for 2 months but they stopped it in case that was partial cause for brain fog.

Have not inquired about urinalysis. Hadn’t thought of that honestly. Would she have had other symptoms if that were the case because she’s been saying that part has been fine.

I think UTIs are under recognized in the elderly. They apparently contributed to a number of adverse mental events with my 85-year-old father.

It’s difficult to provide answers, as each patient reacts to illnesses differently. The loss of appetite is concerning. How is she feeling?

Don’t underestimate the potential for a UTI to cause impressive mental symptoms in the elderly, with no urinary symptoms. My elderly mother would hallucinate and see little people all over her house when she had a UTI. I was amazed to learn about this poorly understood syndrome in the elderly. My 94 year old uncle recently became very lethargic, poor appetite, and quite confused before diagnosed with a UTI. It is certainly worth looking into. Can you contact her PCP to order a urinalysis?

My father also experienced the kinds of hallucinations with a UTI that @sepdvm 's mother experienced. Once we discovered the pattern, we also got a little lucky from his misfortune of needing a urinary catheter (due to enlarged prostate), as we were able to see discoloration and low output in his catheter drain bag.

Steroid prescriptions can also be problematic in the elderly. Sometimes steroids are administered to slow down or stop the immune response when patients are having difficulty on an immunotherapy drug, and they sometimes cause sleep deprivation and hallucinations that may be sort of a "waking sleep" behavior when the regular sleep cycle is severely disrupted.

I (non-medically trained) would recommend proceeding with caution using psychoactive drugs like THC (dronabinol or medical cannabis) if mental status is already altered. Something less potent like CBD might provide comfort, calm, and relief without the risk of "tripping out."

I’m sorry I don’t know the name of the liquid medications, but the loss of appetite will facilitate rapid decline. Our Oncologist prescribed a liquid that I put into my wife’s drinks. Worked very well.

Also I buy Premier Drinks at Costco, they are less expensive than ensure and provide better protein and vitamins. I would start her on those to supplement her food intake until the medications kick in..