ELDER MUSIC: Try To Remember
The Specialness of Caregivers

Focus and Concentration Deficiency

It's really annoying. Since my surgery four weeks ago, I've lost focus. I can't concentrate long enough to get through an average news article or sift through a simple Google search results page and certainly not a book chapter.

Sometimes, when I read a sentence, there is a delay before I understand it. Not much; I've been describing it as the length of a slow finger-snap – just enough time so that the slippage is obvious to me.

When that happens with each sentence in succession, concentration drifts away and meaning is lost.

As it turns out, there is a name for this phenomenon as it occurs after general anesthesia. It's called Post-Operative Cognitive Disorder (POCD). TGB reader Linda commented about it here on 7 July.

She quotes from the American Society of Anesthesiologists:

"Confusion when waking up from surgery is common, but for some people – particularly those who are older – confusion can last for days or weeks..."

It's not exactly confusion for me. In fact, I never doubted that the gazillion bugs I saw crawling up the walls of my hospital room for a day or two following surgery were anything but hallucinations.

However, some other changes Linda tracked down that affect the process of cognition definitely apply to me:

”Cognition is defined as the mental process of knowing, including aspects such as awareness, perception, reasoning, and judgment. Typical complaints of those people reporting POCD are:

Easily tired

Inability to concentrate. For example, they cannot concentrate sufficiently to read a book or newspaper

Memory dysfunction. For example, they have a reduced ability to remember things recently said or done

Reduced ability to perform arithmetic. For example, they make mistakes with normal money transactions while shopping.”

I'm doing fine with arithmetic but the first three are definitely present in my life although I'm heartened to learn they are temporary. Meanwhile, I'm mostly annoyed by it but it does make napping and resting easier than it would be if I were eager to be reading.

ASIDE: Perhaps you have noticed in these blog posts since the surgery that they are all generated from my head alone - no research, no outside links, no facts and figures. That's unlikely to change until my brain fog (POCD) clears.

It is experience rather than reading and research that is making this months-long recovery period a sharp learning curve for me, and I expect there to be more of it.

For all the many years I've been studying ageing, I see now that I have never fully appreciated the difficulties old people face whether from a bodily assault such as my surgery, the natural progression of growing old or “just” managing a chronic disease or condition.

Only last Friday, after being home from the hospital for two weeks, did I finally get a usable grasp on my medications, their dosages, frequency and times of day. Food restrictions add another layer of complexity.

It took several hours to make a chart I can follow until my brain, out of daily practice, will finally know what meds to take when without consulting a list – and double-checking it to be sure I'm correct each time.

Fatigue requires daily management not only of one's own energy level but recognition of it by family members, friends and helpers. I tire so easily that I've given myself a routine of one hour up and about, one hour lying down or napping.

Even the normal activities of life are draining – the small amount of cooking I do, washing up the few dishes, paying bills, sorting the mail, answering email, etc. take their toll.

If there is an “event” in my day – a doctor visit, a physical therapist session at home, a friend stopping by, even phone calls with my medical team or friends – I need the next day to myself, to quietly regain my energy.

Until now, I did not realize how crucial the home assistance tools of recovery (see this post) are and it took a while longer for me to understand that for many elders, they are not temporary, that daily life without them can be nearly impossible.

It's hard to be old, something I've said in the past but did not know until experiencing it first hand how much effort goes into it every day.

That takes nothing away from the pleasures of life and it might be that the difficiulties make them even more precious.

Comments

As ever, you're handling this like a trouper. Thank you for sharing this so candidly.
You're a role model.

Thanks Ronni. It took me a year to recover from a lengthy general anaesthetic. To "normalise". An RN friend advised me this was normal.

I was in my forties then so can't imagine it in my seventies.

I had complete disinterest in books and reading. I remember thinking my job was complicated enough and there was nothing left over at the end of the day to concentrate. But there was a gradual return.

We'll find be you for writing about this.

XO
WWW

Kudos to you for sharing all this with us. Gives a heads-up, and ideas how we can prepare for such a situation.

As I'm a widow with no children, I've tried to prepare for eventual assisted living. I already have arthritis, osteoporosis and other chronic conditions, plus a past with serious surgery that taught me the necessity of outside and/or family help. I think, for me, assisted living would be a good option and continue to visit, research the facilities close to me, speaking with residents, etc. I just do not think, with a serious illness, I could manage at home.

On the other hand, IF there are sufficient options for home assistance, that is a bridge I will cross when it comes -- if it does.

Hang in there, you're doing great!

I can relate to some of the things but my surgery was the end of April and a 'simple' hernia repair. I attribute them to aging for me.

Thank you so much for sharing this. I had hernia surgery and while it was no where near the major surgery you have had, it took me several months to get my brain out of the mist and get my energy back to anywhere near normal. We are all thinking of you and wishing you well.

I believe this is the way you feel when you have a significant loss in your life also..... such as the death of a family member. Perhaps it is a way to insulate yourself from the shock of it all. I know I experienced the complete lack of ability to concentrate long enough to watch a TV show or read a book when my husband passed away. I sometimes went through the motions but nothing was retained. It was all blurry and one of my friends informed me that I even had a blurry confused look about me.

Sounds like you're recognizing "those things which we can't change," in a big way.

Continue the accepting and fighting within, at the same time, but don't let the frustrations sap too much of your energy...you're where you are, and your body's capably ruling the roost!

You might try the online New Yorker jigsaw puzzles, which allow different solving levels.

Ronni, however long it took you to write that, your brilliance and cogency shine through, brain fog be damned.

Yes, it is a known aftereffect of general anesthesia, and also, no doubt, of the "bodily assault" you so vividly describe. Almost all of your energy must be going into healing. And of course healing is inseparably physiological and psychic. You've had a tremendous shock to your whole being.

As you said, if only patience were available at the pharmacy. It's probably the single most valuable skill you can cultivate. Does anyone have any tips for cultivating patience? It's a neglected art in our culture. It may be related to mindfulness, to staying in the present moment and not invidiously comparing your now self with your familiar past self. (Easier said than done, often near impossible.) Your now self has its own new discoveries and insights and, for all of us, they are invaluable., o pioneer.

Sympathy is so much easier to feel than empathy, I think. Empathy often comes only from having experienced that part of life, oneself. I've observed these mind issues in family and friends, and assured them from my "book learning" that they were normal. Undoubtedly, my understanding would be much deeper had I experienced such effects, myself.

Heck I share some of those issues with you & I didn't have surgery & 3 months ago when I had my cataracts removed, I was "awake" enough during that time to converse with the anesthetist! But I don't think that bothered me because I'm almost always fuzzy! LOL.

I did make a list for organizing my daily medications. That scared me & I do have to occasionally look at it to be certain I've put them correctly into the little boxes for the week. Life's a b.... isn't it! But oh you are doing beyond expectations after that so very long time under anesthesia. I can't imagine. As I've said, you are an inspiration & have helped all of us here in our TGB community. Luv ya' Dee:):)

It's pretty amazing how well you are carrying on this blog despite what you report as POCD or brain fog. Your thoughts and the presentation of them, are still well above average in their cogency, accuracy and quality. What you're sharing here is clearly very helpful and valuable to others.

Others here have mentioned meditation as a means of developing patience and exercising mindfulness. Meditation is difficult in the best of circumstances, but when the brain and body have come under recent assault, it may not be the best time for traditional meditation. At those times, I've found more quieting of my brain in taking bits of time, here and there, to do sudokus or other simple, but at least slightly mentally challenging, puzzles that take the focus off other things but still give it a purpose. Brains are probably the most difficult thing in the world to quiet, and we have so little understanding of what goes on in them in a post-operative or other traumatic state. You're doing an excellent job of describing the world in which you find yourself these days, and if I hadn't been following your story all along, I think it would be hard to imagine what you've been through over the past few weeks.

There's a quote attributed to the Hellenistic Jewish philosopher, Philo, (who's known by a couple of other names as well) that goes something like, "Be kind -- for everyone you meet is fighting a great battle." We tend to think of that as it applies to being kind to others, but perhaps it's at least as, or maybe more important to apply to ourselves.

As others have pointed out, your body is busy healing. Nothing is yet normal. I like that you have found something of a routine to allow healing. I really admire you for continung to write and post

I know you are doing your best to heal. May you continue to gather strength and clarity.

I echo Cathy Johnson's comments. I am amazed at the clarity and well written composition of your posts. I think you may be more aware of your inability to concentrate than of your skill in being able to write so well.

I have not had recent surgery so have not had anesthesia. Yet I suffer the same symptoms that you have written about. The brain is fascinating in it's ability to keep our many parts functioning well. Nonetheless, it is just another organ in our body and when disturbed it needs it's time to heal.

This is just my supposition, but I think morphine and other narcotic pain killers can cause an assault to the brain just as anesthesia does. You saw bugs crawling up the curtain and others saw butterflies while I saw a collage of grinning monster heads in bright colors. I also saw people (some I knew and others who were strangers) with green or purple heads.

Anything that messes with the brain must cause a disturbance and the brain must recover from that assault just as your stomach and digestive system must recover from surgery. Give it time. Concentration will return.

Your short hospital stay after surgery is probably the single best thing for a quick recovery. Due to complications, my post-op hospitalization lasted more than a month. I have still not fully recovered, hence my residency in an assisted living facility. The longer you are kept from your normal routine the worse things get until you reach a point where you become dependent on caregivers etc. for more and more help. That's the point where you begin to feel really old and you start to surround yourself with all the trappings thereof like walkers, canes, grabbers, bi-focals and pills for ailments you didn't know you had.

Ronni, we LIKE that you are generating content from inside your head--inside of this experience, to be more precise. That's a big plus, in my book.

All of us will (or have) faced this, and when we do, it's likely we'll brush up against younger people--doctors, their office staff, children and other relatives. They, basically, HAVE NO IDEA. I didn't when I was their age. My only conception, 25 years ago, of an aging future was to diet and exercise frantically so you could "seem young." Hah. That looks so silly now.

The parade moves along on the Internet, day after day, and when you feel like it again, it will still be there. Your own true experience is much more valuable.

Your last two paragraphs in today's post, puts it all in perspective:

It's hard to be old, something I've said in the past but did not know until experiencing it first hand how much effort goes into it every day.

That takes nothing away from the pleasures of life and it might be that the difficulties make them even more precious.

Still, If only there were a handbook.

Thank you once again for chronicling your journey.

Since you just wrote this last post you are doing better than the average person. You must not discount the "insult to the body" that your surgery created.
Cut yourself some slack and continue with your recovery. Eat well, sleep, and drink plenty of fluids to flush out any remaining anesthesia from your system. The "fuzzy brain" problem will go away as your body returns to normal.
Two years ago I got a new hip at 68 years old and the "fuzzy brain" problem lasted for several months. I am glad to report that all returned to normal after 6 months.
Thank you for allowing us to share your experience.

Your coping mechanisms and positive attitude surely seem to be well in place, along with a dose of honesty about the nuisance factor. I understand to some degree, from surgery, and now prednisone, how crucial and absolutely necessary budgeting our energy can be for us elders. I've just, perforce, surrendered to being unreliable for meetings with friends, and doing things I really enjoy. There's just no arguing with two or three nights of little sleep. Of course, we always hope these times are limited, that we'll get back to some kind of normalcy. And, fortunately, I've had a few role models who have come back from some pretty horrific stuff and are thriving. Makes being in the moment more important than ever.

Since my surgery two years ago, I've spent an inordinate amount of time wondering if what and how I'm feeling is an after effect, an ongoing side effect of meds, or just age and the "new normal." It doesn't really matter, since today is today and tomorrow hasn't come yet (but I fret about it anyway). Much of what I experience could just as easily be attributable to aging and there's nothing I can do about that. More easily fatigued, shorter attention span, minor memory lapses, etc. And I never was any good with arithmetic. I have a list of my meds and when to take them, that I consult every time I fill my little weekly pill boxes. I couldn't possibly keep them all straight otherwise and don't want to mess them up.

I appreciate Marjorie's suggestion that the fuzzy brain experience is our body's defense against what we've experienced. That feels right to me; I've had it after loss, though so far I've escaped surgery ...

As another blogger, I can almost understand what you are drawing on to write these very cogent posts from what feels to you like the mists -- after all, this is a discipline you've shaped your being through for over a decade.

Hang in there, friend; your core being is obviously holding up despite the insult.

I wish I had known about this POCD when I had a lengthy surgery 4 years ago. Most of my friends are somewhat younger than I am which is good in some ways and not so good in others. My friends had no problem agreeing with me that I had finally become dotty.

My condition has certainly improved, but now I am four years older (71), and it still takes me longer to read a book, as I run out of concentration.

I'm amazed and grateful that you are still faithfully publishing your blog posts with such frequency.

Onward and upward, because what else can we do?

Big blessings to you, Ronni.

Roni,
Thanks for your post. Sleep is so healing. Prayers for your radiant health.
Ellen

Ronni, maybe this is a good time to be foggy, given the ongoing train wreck of the current administration.

Otherwise, I second all the comments above, especially regarding the typical cogency and readability of your blog. Carry on! And--patience.

One day at a time. Keeping you in my prayers.

Ronni, just a quick note to tell you that this blog post (from your publisher Typepad) appeared in my Facebook news feed. Magic!

I keep thinking about that number: 14 hours! And I think of you and your journey every day. Sending you great big gentle virtual hugs. :-)

Ronnie, it sounds like you're taking excellent care of yourself! It takes time to heal. Prayers for continued healing.

Ronnie

The same happened to me after a major surgery I had last year.

After a while things get to normal.

Do not worry too much. The more you worry, th worse it gets.

Be well

Love

Beatriz

Just wanted to express my appreciation for all the wisdom I find here, in both posts and comments. Thank you.

You mention your daily posts these days are "from your head" and not research, but you are providing an amazing first hand account for all of us who may be faced with surgery at an older age...and your "head" is doing an amazing and interesting job posting..:-) When you mentioned the bugs crawling up the wall upon recovering from surgery it reminded me of when, many years ago, my Mother was ill and on an Intensive Care Ward following a severe heart attack. My sister and I went to visit her and she complained about the flies in her room...which we did not see. My sister was panicked and thought our Mom was losing her mind. But, the next day when we went to visit her they had moved her to another room, because, as the nurse explained, there had been a problem with the air conditioning vents and flies were getting into the room she had been in... So I guess they are not always hallucinatory. Your body is leading you, and using all its energy to heal from the surgery, which explains a lot of the tiredness...and is limiting the activity of your concentration levels so you can get the rest and enable your body to concentrate all its energy on making you well,so don't apologize for feeling tired, and take all the time you need to rest...eventually you will be back feeling more able to concentrate and read...and believe me...you may wish you had not, as most of our news these days is very depressing...meantime...concentrate solely on sleep, smiling, and eating as best you can..and healing. (And look on the bright side, I know
Ollie is enjoying more resting time with you.)

What must seem endless to you is coming across to us as really good progress. A 14 hour surgery is akin to being in a car wreck with internal injuries. Bruce made a good point about getting out of the hospital as soon as possible. Home can be frustrating but it's always better.

Have you found Ollie sitting on the lap table on your bed staring at you yet? That was the first image I got when you explained how you protect your body.

I am writing this with tears in my eyes. Ronnie, you posted, "It's hard to be old, something I've said in the past but did not know until experiencing it first hand how much effort goes into it every day".

Also, a quote from Cathy Johnson, where she quotes from the philosopher, Philo-"Everyone you meet is fighting a great battle."

Yes, a lot of effort DOES goes into it and a great battle IS being fought! I have peripheral neuropathy in my feet and legs which makes it difficult to walk, to sleep, to sit at the computer, to quietly try to read a book, to sit and watch TV (I love replays of "The Golden Girls"), etc.

So, dear Ronnie, continue your upward spiral and try to have patience, knowing that this, too, shall pass and you will continue to be loved and respected by all of your devoted followers.

Thank you so much for your past and present blogs. I review them daily- first thing I do when I go online.---------------Very best wishes, Estelle

As an addendum to the above comments, I am 91 years young.-----------Estelle

"All the art of living lies in a fine mingling of letting go and holding on."

(Havelock Ellis)


Your Montreal Fan

I had a year from hell. Within a ten month period, I was a passenger in a bad car accident (broken leg, kneecap and ribs), two months later I smashed ankle resulting in surgery and metal in my leg . I was in a wheelchair, walker or recliner for 5 months. Two weeks after recovering from the above, I got diagnosed with breast cancer. This was all in 2012.

You know what helped some. I started drawing and making cartoons of my experience. I just got a pad of drawing paper and used colored markers because they were easier.

I don't mean to compare my situation to yours. I just though maybe drawing or coloring might bring a modicum of more peace. Best to you, Ronnie. I have been following you since you began this blog.

Paula

The most valuable thing you can give us, Ronni, is your own experience. Especially because of the comment responses! The regulars chime in to share their own experiences... and the net effect, for me, is to help me realize that this is normal. It is okay. People cope. People are good at coping. It's a thing we humans do.

That revelation is so very reassuring! The worst thing about growing old would be to do it alone, thinking you were the only one who had these accumulating problems, that it was just you, that if somehow you just did something different... But of course it's not like that. Everyone you meet is fighting a great battle.

I had a far less invasive surgery, a lung biopsy, in April, and experienced some of the same aftereffects. My attention span was limited. I could only handle surfing short articles on the internet and writing short comments in various forums. I couldn't manage books, and I totally wimped out on engaging with the online game I have been moderating! I am only now starting to get my energy back to the point where I can even think about a bit of physical exercise.

Until you mentioned it, I didn't know about POCD. I knew my energy was down... that made sense... but why did my brain not want to work? Scary!

Thank you for your last sentence. Yes, well noted. When it really sinks in that these fleeting moments are all we've got, they do become oh-so-much more precious.

When I read these posts about various illnesses, surgeries, challenges, and the trials of not being quite the same person we were 5, 10, or 15 years ago it makes me appreciate and be grateful for just an ordinary day.
This isn't to say I don't have my own list of health challenges but I try very hard to keep it in perspective.
There is a tv show on Bravo called The Actor's Studio that at the end of what is basically an hour of fawning over a particular actor the host asks 5 questions to each guest.
One of the questions is what is your favorite word and I think my favorite word just might be perspective right after the world grateful. Both are sometimes a challenge to see but the rewards are many.
All the best to you Ronni as you continue this difficult journey. Look how far you have come since the surgery. Clearly its going to be a months long process but something tells me you'll make it.
Keep up the posts about your health and progress. I actually find it so much more interesting than lamenting Trump.
I'm quoting a recent article in the New Yorker where David Remick wrote "Trump won't be forever" and neither will this current mental confusion and tiredness you are experiencing.
Tera

I think you're doing great, Ronni. I can't imagine that I would be doing half as well as you are at this point. To quote the late Lillian Rubin, "Old age sucks--always has, always will." On the other hand, it is what it is.

It's hard not being able to do stuff no matter what the reasons, be they temporary or permanent. I suppose I'll have to accept encroaching limitations. I can try to do it with a degree of grace and dignity. Patience has never been my strong suit. Bet you all figured that one out way before I did!

I experienced that brain fog after a surgery when I was in my mid-fifties. When I returned early t0 my job as a programmer (single mom of two) I found I couldn't understand the programs I had written. I recovered in a few weeks, thank God for an understanding boss, but that really scared me. You are doing the right things, rest, heal.

So true, we don't often truly know another's experience until we've had the same, no matter the level of our empathy, sympathy and caring. I've not had major surgery with accompanying anesthesia, but there are matters of cognitive function with which I have some familiarity.

Perhaps now you may appreciate why I earlier described how when my brain felt so exhausted that I could no longer meaningfully absorb new book readings and research I resorted to material I didn't usually read. I wanted humorous relief, so I turned to short writings such as I could find in Reader's Digest "Life In These United States" -- brief, simple words and thoughts, good for a chuckle at the moment, gone from the mind afterward with no need to remember -- a distraction from realities intruding thoughts. FWIW those readers I've worked with experiencing similar cognitive limitations due to various medical causes have often derived pleasure from doing the same. One-liner's, photos with captions, other such writings can be enjoyable.

I'm curious if you'd be able to enjoy/follow audio books right now. It requires less concentration than reading, and it could be a nice distraction. Maybe something fun and light, like Erma Bombeck, or...

Ronni I hope you know how valuable your comments are. My Dr friend always reminded me that even having a tooth filled is an assault on your body and you have to treat yourself gently and give yourself time to recover!

Like all the comments by your wonderful Team Ronni above, I find what you are nonetheless able to do and write absolutely mind-blowing. In the closest thing in my life to what you are going through (which is light miles away), I was unable to read for months and gave up the computer and its virtual world, too.

I decided that focusing on what I couldn't do would only make things worse for me and for my husband who was taking care of me and moved into a parallel universe and was blessed by being able to sleep.

These posts of yours should be part of a textbook ... or, as I have suggested in the past, a collection of your posts in a book that would be a must and a great gift to have by one's bedside.

The honesty and clarity with which you write are precious gifts to us all. Thank you.

In reading Joared's comment about humorous relief, I highly recommend The New Yorker cartoons.

Thanks Ronnie....I've certaiinly had this after my last two surgeries. It's been a couple of months now, and I still need naps.

I'm having the Cognitive Disorder without having the surgery and I don't know why...

Classof65

In addition to what's happening internally after surgery, there are many external challenges for the elderly person that adds to the confusion. Here are some things I have learned to expect:
1. The physician may or may not diagnose the correct situation. Even if they do, they may not prescribe the appropriate medication (intervention) or the right dosage.
2. The physician may or may not call you back during a crisis.
3. The physician's nurse or "clinical assistant" may or may not call you back during a crisis.
4. The pharmacy may or may not have the prescribed drug available. And if they do, your insurance may or may not cover it.
5. The prescribed medication may or may not work, or work in a timely fashion.
6. Neither the physician, the nurse, the clinical assistant or the pharmacist want to hear your personal viewpoint or experience on the subject at hand.
Consequently, to deal with the current medical system in the US, I have learned to lower my expectations that anything will work the way it is supposed to, and line up an advocate who can help me fight the inevitable battles.
I learned this from the school of hard knocks.
Diane Davis

I'm sitting home recuperating from pneumonia, which is nothing like what you're experiencing, but has had some great strange side effects from drugs (i.e. steroids.) At least that's what I'm blaming my lack of focus upon. I have had 5 books going at a time, and can only read a few pages of each before becoming scattered, bored, or something. They range from light to serious, fiction to ancient history. But there was a note about listening to books, which I tried, and most of them were great at putting me to sleep. I'd play solitaire on my phone while trying to listen. There were days I also slept more than was awake, as healing process took over. This too shall pass, Ronnie.

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