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Our doctors are happy to discuss your individual case with you. Serious inquiries only, please. To request an initial
team consultation, call Dr. Arenson, For more information
about CNI's Brain & Spinal Tumor Team, |
The following article originally appeared in the August 1999 issue of IN TOUCH with CNI (sign up to receive future issues of this newsletter).
Should any of the concerns or issues in this article be important to you, and should you like to discuss them with an experienced doctor, contact the CNI Center for Brain & Spinal Tumors office, and request a referral to one of our clinical health psychologists or neuropsychologists.
What does it mean when a formerly active, expressive, involved and energetic person just takes to a corner of the living room and seems to stop interacting with the world? What can a family do when she says "I'm fine," and really doesn't seem depressed or unhappy -- just 'shut down' -- just different?
And how does a family cope with the formerly efficient person who suddenly takes forever to do everything -- two hours in the bathroom, an hour to eat a sandwich, an endless amount of time just to pull on shoes and socks, a shirt and shorts in the morning before leaving the house? Or with the person who suddenly seems to use the worst judgment imaginable, under all sorts of circumstances, public and private: embarrassing things, but sometimes dangerously impulsive ones, too?
These are some of the painful and complicated issues psychologists working with brain tumor patients help deal with every day.
Those of us affiliated with the CNI Center for Brain & Spinal Tumors like to think that the intersection of the medical, surgical and psychological -- the expressly human -- is attended to in each setting where members of our team care for patients. However, there are certain ways that brain tumors may affect persons that may be harder to feel comfortable bringing up and talking about with one's doctor: effects on cognition, personality and behavior, coping and emotions, and sexuality are typicg these.
Not all brain tumors affect people in the same ways. The brain is comprised of billions of cells and countless neural networks, and each individual must be approached in terms of many possible, even unique ways his or her condition can express itself. Still, certain kinds of problems are seen with some ularity.
In the first place, there is an increasingly well understood "functional geography" of the brain: different areas of the brain control and influence very different capacities and abilities: a tumor in one area may lead to unexpected and dramatic feelings of depression, for example; just a few centimeters over, the same tumor might produce euphoria (inappropriate happiness or joviality), or even an attitude of indifference. Similarly, a tumor affecting a specific set of tracts in one frontal lobe, may result in difficulty controlling behavior ("impulsivity"); again, were an area nearby but different affected, the person might demonstrate a lack of initiative or drive, appearing somewhat "flat" orerested.
Emotions naturally are affected by brain tumors, both directly in a physiological sense, as well as out of the natural fear, worry and other feelings which naturally occur in any crisis. Both mood (the way we feel) and affect (how feelings are expressed) may be affected. In addition, many medications, treatments, and the effects of the tumor itself can add to the understandable worry and distress virtually everybody finds they experience under these circumstances. Sorting out what's expectable and normal from what may be more concerning and might benefit from intervention can be crucial. Figuring out how to feel hopeful again, how to cope with what at times may feel overwhelming -- how to remain and regain a sense of a secure and joyful self -- is as important an aspect of brain tumor care as is the more medical or surgical side of things in the long run.
Cognition -- which includes memory, problem-solving, attention, speech, language and perception -- all may be affected in persons with tumors. Again, the nature and degree of such effects vary enormously depending on the location, size and type of tumor. Complicating the clinical picture is the fact that many of the important and necessary treatments for brain tumors -- radiation therapy, surgery and chemotherapy -- can themselves lead to (sometimes temporary) changes in how the brain processes information. Neuropsychologists can often help both patients and families here, first analyzing the problem, and then looking for ways to help patients compensate for changes using areas of the brain that continue to n well.
Finally, sexuality is an arena of feeling, function and relationship very commonly affected in persons with serious medical conditions. Having a comfortable and professional place to bring such concerns if they arise, to sort out the nature of the worry and to develop strategies to manage the problem, is another important dimension of our team's care. As sexuality involves relationship, sometimes couple's counseling can greatly help with sexual changes and worries, in addition to looking for practical solutions to those problems that can be (sometimes fairly easily) solved.
Though tumors leading to emotional, cognitive, personality and relationship changes cannot always be absolutely and completely cured, the persons in whom they occur (and whom they affect) can almost always be helped and find a measure of .
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Colorado Neurological
Institute Center for Brain & Spinal Tumors
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