Tuesday, September 27, 2011

That Dirty Word: FATIGUE

Fatigue is the most common side effect of cancer treatment. It is associated with treatments such as chemotherapy, radiation, biotherapy, surgery and cancer itself.  Fatigue experienced as a side effect of cancer treatment is not necessarily linked to exertion or activity, not completely relieved by rest, and more severe than fatigue of everyday life.

There are different patters of fatigue depending on the type of treatment a peson is receiving. People undergoing radiation treatment notice that fatigue increases over time, seems to be worse in the evening and is usually the worst at the end of treatment. Most people return to their pre-treatment activity level within three to twelve weeks, but for some it may take up to a year.

Thyroid cancer patients and survivors who have undergone thyroidectomy may experience a continual level of fatigue during their lifetime related to difficulties processing synthetic hormones or adjusting the optimal dosage for to their needs.

For people undergoing chemotherapy, the fatigue peaks right after treatment. These people will also notice that their fatigue is worse when their blood counts are at the lowest point. Some individuals received both radiation and chemotherapy at the same time, this increases the fatigue they experience.

Fatigue's impact can be felt physically, cognitively and emotionally. It means having less energy to do the things you do or want to do. Completing daily activities at home or work becomes more difficult. I can best describe cancer fatigue as having the lowest energy level with  arms and feet that feel like they weight a million pounds. Just gettin up and out of bed in the morning was nearly impossible for a little while.

Cancer related fatigue decreases your ability to concentrate or attention span, levels of alertness, comprehension, cognition and memory. Doing simple math like balancing the checkbook became a challenge. Making phone calls virtually impossible. Emotionally I found myself impatient, irritable and unmotivated regardless of how important something was.

Besided the actual cancer treatment there are several causes for extreme fatigue. These include emotional distress, sleep disturbances, medication, nutrition,  anemia (low red blood cell count), pain and other health conditions. Therefore more than just one cause may be contributing to the experience of fatigue during and after cancer treatment.

Your healthcare team will make every effort to rule out any condition that can be treated to improve your fatigue. Unfortunately often the exact cause cannot be found.  One of the best ways to manage cancer related fatigue is to keep a diary with daily fatigue ratings to monitor patterns of fatigue over time. 

Track when fatigue occurs and rate it from 0 (no fatigue) to 10 (you cannot get out of bed). Most people will begin to notice a pattern and be able to plan and do activities that are important to them when they are the least tired. The last 3 or 4 months of my biotherapy I knew I had to take a nap mid-morning and mid-afternoon if I wanted to be clear and present for my children during lunch and dinner.

Research has shown that exercise relieves fatigue. Walking daily will improve fatigue and emotional wellbeing greatly. It prevents muscles from weakening due to lack of use!  I thank God everyday for my dog, Mr. Max Schnauzer who I walk 3 times a day, rain or shine and who kept me motivated to walk even on days when I thought I couldn't even sit up.  Many mornings I made myself get up and get going for our morning walk and found that once we started walking I did feel better.

Mr. Max Schnauzer is a very special dog and he seems to sense when our daily routine is a bit much for me. He has been known to sit down near a bench so I can rest or simply turn around and take me home after only a few minutes. I owe a great deal of my fatigue fighting strategy success to my four legged little friend.

If weather is an issue or if you prefe peoples company over a furry creature many malls open early for walkers, so you do not have to worry about  bad weather, too high or too low temperatures. Always check with your healthcare team before beginning a walking program and listen to your body, if you are over doing it your body will let you know.

Another interesting fatigue fighting do is sitting down to complete tasks. When showering use a bath chair. Sorting and folding clothes can also be done sitting down. Sit at the kitchen table to cut and dice foor or mix ingredients. I used a counter height chair or bar stool many times to iron clothes and even do the dishes!

If you have little ones don't underestimate the fun and entertainment value of board games and reading books. Let them help you with putting on your socks and shoes, picking up toys, getting mail from the mailbox, making breakfast (fruit, toaster oven waffles or cold cereal) even lunch (PBJ's or TV dinners) and even taking out the garbage (I kept smaller trash cans around so the bags would not become too heavy for them).

Give yourself permission to accept help, delegate tasks and simply let go. You are more important than things or a picture perfect home. Have someone carry your groceries to the car. Let family and friends assist with meal preparations or household chores it's ok if you just sit down and read a good book or listen to music while others take care of the rest.

Establish and maintain a regular bedtime/wake time routine to ensure a good night's sleep. Avoid heavy meals, caffeine, alcohol or nicotine right before bedtime. Take a power nap for 30 minutes if you are tired during the day and remember to use an alarm to wake you. Do not let long daytime naps disrupt your nightime sleeping.

Uncontrolled pain can contribute to fatigue. It can disrupt sleep at night. Sometimes, the pain medication itself can cause fatigue or sleepiness. There is a fine line in adjusting pain medication so that you are pain free without being too drowsy. It's important that you communicate with your healthcare provider about your pain.

Maintain a balanced diet that includes plenty of protein for energy, fluids to maintain hydration, vegetables and fruit for vitamins and minerals. Often, people will not feel like eating large meals during treatment. I didn't so I made myself "graze" on smaller healthy meals and snacks throughout the day making sure that I had "something" to eat or drink with my family during their regular meal time.

Fatigue is one of the most debilitating symptons for people undergoing cancer treatment. And many times is a long term problem for survivors after treatment. Knowing that fatigue is a common side effect of the cancer experience and that there are ways to manage it can enhance a person's confidence and overall physcological well-being.

Remember it is always very important to communicate with your healthcare team about how fatigue is affecting your life. Fatigue helped me learn how to prioritize, delegate, let go and enjoy the little things in life. It was a lesson I needed to learn and I am glad I did.

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