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Living with Cognitive Difficulties. A.K.A. "Fibro Fog" or "Brain Fog."

Most people with fibromyalgia or Chronic Fatigue Syndrome will, from time to time, experience cognitive problems. This sudden lack of memory and  inability to speak or think clearly can be humiliating, leaving an other wise intelligent person with feelings of shame and hopelessness.

Cognitive problems, (known as fog for the remainder of the article) rear their thick, ugly heads at the most inopportune times. You call your doctor's office, only to stare at the clock in a panic when the nurse asks if you can make a 3:00 p.m. appointment. You know how to tell time, you know your families schedule, so why can't you figure out if you have time to make a 3 p.m. appointment?

Or perhaps you are having a nice family dinner and you need the salt. You turn to the person next to you and say; "Will you please pass the . . ." Your mind whirls and your cheeks redden, but you couldn't come up with the word salt if your life depended on it.

Before we get into the causes and strategies of brain fog, I would like to offer a word of caution. Often times it is easier to blame every symptom known to man to Fibromyalgia or Chronic Fatigue, but always consult your doctor when you experience a new symptom. Fog can be caused by contraindications from medications or other, serious health issues.

I also want to point out that there are certain medications purported to stave off fog, use at your own risk. Drugs such as Modafinil and Provigil can wake up your brain, but only for a limited time. Often times when the drug wears off you are left in worse shape than when you started. Do your own research and consult with your care provider before deciding if these drugs will benefit your lifestyle and health.

Fog Triggers

  • Fatigue: Disruption to your sleep schedule can trigger fog.

  • Overexertion: You had a good day and spent it cleaning, cooking and generally over-doing things.

  • Stress: Both good and bad stress can bring on fog. Schedule down time after stressful events if possible.

  • Over-stimulating situations: Family functions, trips to the mall, holidays etc. Enjoy and don't beat yourself up the next day.

  • Normal people illness: Things such as the common cold or the flu can shut down a healthy person so don't let guilt take over.

  • Medications: Research your medications to make sure you are safe.

What Can you Do?

1. I am going to fall back on the old acronym, K.I.S.S., (keep it simple stupid) as a starting point. I used to have a place for everything, I was a chronic, obsessed organizer. What better way to keep track of needed items? Well, there were days I couldn't remember just where I did store a needed receipt, a W-2 form or a card containing a PIN number and I would end up tearing the house apart looking for it.

Now, I have one sturdy box that my kids wrapped in foil and decorated with fancy fish stickers on my desk. Everything, and I do mean everything I need to keep track of goes in that box. If I buy a gift for someone, the receipt goes in the box as soon as I get home. When hubby brings his w-2 form home, it goes in the box. License renewal forms, doctor cards, user names and passwords for email and gaming sites, you name it.

I have peace of mind knowing no matter what piece of paper I need, I will find it in that box. It has eliminated missed appointments and other embarrassing situations.

2. Jot down thoughts, things you need to buy, appointments and social obligations as soon as you think of them. Do this in whatever style is easiest for you, choose something you are able to do quickly and easily. For some this may mean typing a note into a blackberry or other PDA, for others it may mean using post it notes or a notebook kept nearby. Keep a small notebook and pencil in a purse, backpack or glovebox for things you need to jot down when away from home. I don't own one myself, but others have told me that they purchased one of those voice recorders you can put on a key chain and they record things they need to remember.

Hang a dry erase board or a chalkboard in a well-traveled area and the minute you realize you need to buy dish soap, write it on the board and check that board every time you leave the house. Once a month I write pertinent dates such as birthdays, anniversaries, school concerts etc. on the board and read it daily so I don't forget something. I also write the expiration date of my prescriptions and my Drs. phone number on this board so I don't wake up and find myself without refills one morning.

3. Develop a medication system. I can't count how many days I would forget to take my Zoloft after breakfast. Now, I am not one for clutter and I hate things sitting all over flat surfaces, but I finally had to give in and place my medicine bottles on my desk top. Now I see them as soon as I finish eating. Often times I would stare at a bottle, unable to remember if I took the pill or not. To fix this problem I turn the bottle upside down, standing it on its cap after I have taken it. If there is a bottle standing upright at the end of the day I know I forgot to take something.

4. Don't be so quick to erase messages from your answering machine. Often times you may need to listen to them again to remember who to contact and what number to call.

5. Tell important things to a trusted friend or family number who knows about your fog. This way they can call you and ask what time your doctor appointment is, gently reminding you of something you need to do.

6. Create a central location for items you find yourself searching for. The container can be as decorative or as plain as you like, just make sure it is an easy to access site. When you come home deposit your car keys, gloves, pagers and outgoing mail in the receptacle and you will never search for these items before leaving the house again.

7. One step at a time, de-clutter and organize your house. Make a central location for magazines, get rid of unused items creating clutter by offering them on or an other avenue. As you purge your house of stuff you will feel less overwhelmed as time goes by. If you have multiple remote controls for you A.V. equipment, consider a one time purchase and programming of a universal remote so you don't stare at the pile wondering which one will turn on the DVD player on foggy days. Store multiple items needed for one task together, such as coffee, tea bags, filters and cups so you and grab each item quickly without thought.

8. Avoid multi-tasking on foggy days. We tend to dig in our heels and fight the changes in our health, figuring if we just push it we can do things the same as we do on good days. This can turn around a bite us. Avoid watching T.V. while on the phone or preparing meals. Don't use cell phones while driving or shopping, don't prepare a recipe and clean up at the same time. On foggy days, multi-tasking can lead to mistakes that can at the least ruin a good dinner and at the worst, pose a safety hazard.

9. Build a repertoire of canned responses and phrases. Figure out what you want to say and how you want to say it before you use the phone. Once you learn what you want to say it will come out even on the foggiest of days. i.e. "Hello, this is Jane Doe and I would like to schedule an appointment with the doctor," or "I would like to order a pizza and have it delivered." Writing down the reason you are calling before you pick up the phone can also be helpful when dealing with businesses, schools etc. i.e. "I am calling to let you know Betty will be absent from school today due to illness. Her teacher is (teachers name) and her homeroom is (101). In front of you would be a note with the teachers name and the homeroom number so you don't fumble when talking to the secretary.

10. Establish routines. If mornings are difficult, lay out the clothes you want to wear the night before. Go over a mental checklist as you envision yourself executing the steps needed to dress and make sure you have underwear, socks or pantyhose, bottom, top, jacket etc. Pull all ingredients for a dish before you start cooking and put each one away after you use it. If there is a container of thyme on the counter when you are done you will know you forgot to put it in the dish. Make a mental note of how many items you are going to the store to buy. If you know you need 10 items, but you only have 9 items in the cart you know you are forgetting something. (refer to note or voice recorder for a reminder)

11. Find your sweet spot, that one time of day when you know you will be at your mental best, alert and functioning. Schedule activities around this time as much as possible. Make phone calls, pay the bills, balance the check book etc.

12. Nurture yourself. Fog can be your bodies way of letting you know that you are overdoing things. Back off and do something restful and restorative such as napping, deep breathing, exercise, listening to music or watching a funny movie. The rest and endorphins released from these activities can help blow the fog away.

13. Work on sleep issues. Fog can be triggered by a lack of restful sleep. If you are still experiencing a lack of sleep, or restful sleep talk to your doctor about getting help with this.

14. Talk to others. By joining either a brick and mortar support group or an online support group you can garner the wisdom of others. They can offer solutions, failures and a listening ear, just talking about a problem can help to remove some of the stress. Remember to pay attention to dietary needs! When we are tired and achy we have a tendency to neglect our diet, but despite our abnormalities we still have human bodies that need fuel to function. You need potassium, protein, vitamins and more to be healthy. When fog appears think of the last time you ate and if needed, force yourself to eat a snack.

15. One more time . . . Check your medications, vitamins and supplements to make sure you are not taking something you may be allergic to or something that may interact with another medication.

Jane Kohler
2009 FMS


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