by David Wallace
updated July 10, 2025
This is no wonderful “epiphany moment” article, just a quick report on a real myeloproliferative neoplasm (MPN) symptom I experience from time to time. Many mornings, I make a healthy smoothie to get me up and rolling. This morning I grabbed the wrong ingredient and sprinkled it in the smoothie just like it belonged as part of the perfect recipe blend.
BRAIN FOG!
Guess which one doesn’t belong?….seriously?….you guessed it, I put the Old Bay Seasoning (great on seafood) in instead of the inflammation-fighting cinnamon. My gut reaction was to skim it out, but I thought, what the hell, it was in too deep, and I don’t dare start over, lol! So I blended all the healthy smoothie ingredients together and drank it like a man. It only tasted off a bit….but I cursed at myself anyway, thinking, “this PV brain fog” got me again!
I can walk upstairs sometimes, and once I get to the top, it hits me, “now what was I coming up here for?” When I call a close friend with a few things to talk about, sometimes I forget the most important item I wanted to discuss. My friends are very understanding and welcome a call back when I remember (usually just a few minutes later). It gives them a little chuckle, and I laugh at myself too.
Part of this can be attributed to middle age forgetfulness. It’s normal to forget things on occasion. Since this happens more often than I would like and I am not elderly, I blame PV (polycythemia vera).
Has that sort of thing ever happened to you?
Post-it Notes to the Rescue
I have to admit, if I’m going to the grocery store for more than (2) items, I have a post-it note with everything I need to pick up, even if it is only three items. If I am out running errands, you better believe there’s a post-it note with each stop listed in sequential order.
I’m actually a very well organized person, so post-it notes, to-do lists, folders, story boards and even an old fashioned day-timer are part of my daily routine. For a high-tech guy who built this website from a stark white canvas, I don’t trust my cell phone to organize the tasks that run my life. I prefer good old-fashioned paper. The good news is, I know the difference between the brake and the accelerator, and I never forget that one!
How do you know when you have a Real problem?
Ever wonder?
Here’s a personal story that answers the question in a nutshell. My mom passed away a few years ago from the ravages of Alzheimer’s. It was a slow, nasty, tormenting decline, I’ll spare you the details. Since Alzheimer’s may carry a hereditary component, that concerned me.
So I asked one of the attending nurses and told her my PV background briefly: “How do you know the signs of early-stage dementia?” She gave me a perfect analogy: “When you lose (misplace) your car keys and find them later, that is normal. When you find your car keys and don’t know what to do with them, THEN you have a problem.” That truly resonated with me, confirming that I am, for the most part, normal.
If you have problems with fatigue or brain fog, talk to your doctor about medications to help (Adderral, Ritalin, Provigil are psychostimulants). Natural methods include exercise, energy conservation and numerous complementary therapies.
What the Research Says About Brain Fog in PV
While my experiences with “PV brain fog” are personal, there is a growing understanding in the medical community about the real, physical reasons behind these cognitive symptoms in people with myeloproliferative neoplasms (MPNs) like polycythemia vera. It’s not just “in your head,” and it’s more than simple forgetfulness.
Here are some of the clinical factors that may contribute to brain fog in PV:
1. Hyperviscosity and Reduced Blood Flow:
Polycythemia Vera is defined by the overproduction of red blood cells. This causes the blood to thicken and become more viscous. This thickened blood doesn’t flow as easily through the small blood vessels in the brain. This reduced cerebral blood flow can mean that parts of your brain aren’t getting the oxygen they need to function optimally, leading to symptoms like dizziness, headaches, and that classic “brain fog.”
2. The Role of Inflammation and Cytokines:
MPNs are now understood to be inflammatory diseases. Our bodies produce signaling proteins called cytokines to control inflammation. In people with PV, there is an overproduction of pro-inflammatory cytokines. These can cross the blood-brain barrier and disrupt normal brain function, contributing to fatigue and cognitive problems.
3. Micro-Thrombosis:
The same factors that can cause major blood clots in PV can also lead to tiny clots in the small blood vessels of the brain. These “micro-thromboses” can cause tiny, often unnoticed, areas of damage that, over time, can impact cognitive function.
4. Iron Deficiency:
One of the most common treatments for PV is phlebotomy, which is the medical term for drawing blood. While this is very effective at reducing the red blood cell count, it can also lead to iron deficiency. Iron is crucial for cognitive function, and a lack of it can cause symptoms that overlap with brain fog, such as fatigue and difficulty concentrating.
It’s important to talk to your doctor about any cognitive symptoms you are experiencing. They can help you determine the cause and discuss treatment options that might help, from managing your blood counts to addressing potential iron deficiency.
References:
- Al-Sayegh, H, Al-Kharazi, K, Al-Fadhli, J. Sudden hemichorea and frontal lobe syndrome: a rare presentation of unbalanced polycythaemia vera. BMJ Case Rep. 2017;2017:bcr2016218706. Published 2017 Apr 26. doi:10.1136/bcr-2016-218706
- ASH Staff. Too Many RBCs or Platelets Stall Blood Flow in Cerebral Capillaries. The Hematologist: ASH News and Reports. 2016;13(1). https://ashpublications.org/thehematologist/article/13/1/20/20349/Too-Many-RBCs-or-Platelets-Stall-Blood-Flow-in
Be sure to check out the entire series “Addressing MPN Symptoms” (2025 update):
