Fatigue

Kathleen,

Congratulations on making the decision not to tackle fitness goals alone. There are a wide variety of fitness tricks and nutritional approaches that might be helpful, however many find that the best approach is often the one that considers (in no particular order):

1) Life/family responsibilities (i.e. your energy demands)
2) How regularly & intensely you trained before chemo
3) Resources ($, access to exercise equipment, facilities, etc)
4) Current energy levels and your energy cycles (i.e. good day vs bad day)

Because those variables can really impact how you approach slimming down, I'll include just a few exercise-based and nutrition-based notes.


Exercise
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* Get a journal and record snapshots of your general activities, nutrition and exercise. Journaling will keep you honest and enable you to, truly listen to your body. Speaking of snapshots, you may also want to take before photos and put them in your journal and wallet. They can be powerful motivators.

* Listen to your body and obey it. This really bears repeating. Pay close attention to not only how your body feels right after a workout but how it feels 1-2 days later as well! The journaling will help a lot, review it weekly.

* In the beginning, start with short, low to moderate intensity workouts, 20-30mins long. Do them only on your higher energy days. Avoid exercising on low energy days at first...consider making gentle stretches the most that you do on low intensity days. Some people find that they can only handle 10-15mins. That's ok. You might even try doing 2 short but vigorous workouts of 10-15mins, gradually increasing the length of workout by a few minutes and decreasing intensity before increasing intensity and length.

* As you progress (after a few weeks or so) you may want to try incorporating 1-2 more intense interval (burst) style workouts per week. They are a great way to help boost the metabolism without introducing some of the inflammatory effects that could potentially accompany lots of long workout sessions.

* If you are more of an enthusiast and are ready for it, very controlled interval training using a modified tabata scheme, could be a useful strategy, minding the caveats above. The Tabata scheme is based on 4 minute exercise cycles composed of 8 continuous, 30-second rounds of exercise, where you work as hard as you can for 20 secs and rest for 10 secs. Initially, 20 secs will probably be way too much. Consider the following scheme for progression:

Initial Stage => Modified Tabatas, w/ 8 rounds of 5-10 secs full-out exercise followed by 20-25secs break.

Progression => Add 2-5 secs of work every 1-2 weeks or as tolerated.

* If you choose to work with a trainer, make sure to find one that's sensitive to not only the inevitable energy swings but also the importance of balancing movement around joints (e.g. pushes and pulls are balanced) as well as moving in all planes.

Nutritionally
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* Especially in the beginning, try to train only when you're both rested and well nourished (eat ideally 1-2hours beforehand). Smoothies/Shakes are great for pre/post workout meals since it can be a bit easier to absorb the nutrients easier.

* Eat every 3.5-4hours (~4-6x per day) and Eat your largest meals earlier in the day and taper your meals as it gets later. Last meal should be the smallest, though still complete.

* Typical meals should include (low GI & fibrous carbs, lean complete proteins, good, higher omega 3 fats). Of course, avoid processed foods in favor of loading up on leafy greens and the like (organic is best)!

* Discuss _any_ supplementation (multivitamin/mineral, probiotics, fish oil, etc) with your doctor first.

* Try to avoid snacking within ~2 hours of bedtime. If you must, try to limit the damage by stocking the fridge and cupboards with fibrous, low GI/GL foods (glycemic index/glycemic load)

I'll close by encouraging you to remember to periodically add to your mental/spiritual toolkit for navigating the almost inevitable bumps along the road to your body transformation, it's often great to add an inspirational quote, story or song to your journal, on your journal review day (for example). Sorry if that was waay more than you were bargaining for, but I hope you'll find the info useful. Enjoy!!!

The best way to deal with fatigue from radiation therapy is creating a balance between getting enough rest and staying active enough. To succumb to the fatigue and give up physical activity would create a vicious cycle resulting in less energy and more fatigue. Yet you don't want to push yourself too much. It is all right to go to bed earlier, get up a little bit later or even take a nap during the day if one feels that tired but it is important to schedule a routine daily activity such as walking and stick with it throughout the course of radiation therapy. The other very important factor is to stay hydrated. Dehydration would negatively impact one's level of energy and may even interfere with their sleep pattern. This is particularly important during the warmer seasons and during the routine daily activity. Extremes of temperature should be avoided. A minimum of 8 cups of fluid per day will prevent dehydration. (That is 64 ounces, 2 quarts, or 1 half-gallon). Beverages containing caffeine do NOT count neither do alcoholic ones. Maintaining good nutrition can help you feel better and have more overall energy. Sticking to a regular schedules such as going to bed at a certain time and eating at regular hours would also be very helpful in creating that fine balance between resting and staying active.

Fatigue is one of the most distressing side-effects of cancer treatment and a side-effect that negatively impacts quality of life. Unfortunately, fatigue does not disappear when treatment ends. Many patients have reported that fatigue post-treatment is ongoing and long-lasting. As a cancer survivor who underwent six surgeries, chemotherapy, and radiation therapy, I felt that it took over two years for me to feel like I had returned to a sense of normalcy in regard to energy and exercise. Fatigue can be physical, mental, or both. The treatment of course depends on the cause but there are general preventive strategies and then ways of taking care of oneself in order to heal and re-nourish.

If you are working long hours or doing more physical work, allow yourself more time to sleep and rest. Take work breaks to sit and rest. Delegate tasks if possible during times of stress. Ask your nurse or physician about taking vitamin or mineral supplements and consider eating smaller meals 4-6 times per day to help you maintain a higher energy level. Avoid foods that contain a lot of sugar and avoid caffeine, alcohol, and other drugs.

Taking care of yourself is always a challenge! Getting enough rest and sleep is vital. Sleep hygiene includes basic measures such as staying in bed only to sleep, establishing a routine wake time and bedtime (creating a bedtime routine), avoiding caffeine and alcohol and heavy meals before bed, no napping after 3 p.m., etc. It is important to talk to your healthcare provider about insomnia. The use of relaxation techniques such a progressive muscle relaxation, guided imagery, and yoga are measures that help aid restorative rest and sleep.

A major strategy to offset fatigue is to walk or exercise according to your healthcare provider’s recommendations. Exercise can increase your energy and boost your mood! If fatigue is caused by undue emotional stress then counseling is advised. Lastly, allow yourself time to relax and carry out activities that you enjoy! Developing new interests and being stimulated by new friends, new work, etc., can help with emotional fatigue which is often a side-effect of physical fatigue.

Hi there,

This is a big one that we hear about frequently as people transition back to work. Below are some tips/suggestions that we know to be simple and effective to get you thinking about how to manage side effects at work.

First off forget about multitasking. As hard as that may be in our super connected fast paced world, for many people managing fatigue and concentration challenges during or post-treatment successful multitasking is near impossible and very frustrating. Instead, write down a list of priorities and then turn off your email, phone and instant messenger and focus on accomplishing one thing at a time. Make sure to drill big projects down into manageable tasks for that very important feeling of accomplishment that comes with ticking things off your list.

Second, literally write everything down (from meetings to in passing ideas to people you need to follow up with to groceries), so if you forget you’ll always have a record. And keep one notebook with all your "to do" things so they are all in one place and take it everywhere so you are never scrambling without it.

In terms of your actual workspace, ban clutter and clear your desk or work area so that when you are going through tasks one by one there aren't a million distractions and you don't feel overwhelmed by all that still needs to be finished.

Third, rehearse everything from presentations to work updates and even phone calls so that you feel practiced, professional and focused.

Other things to consider, is your job flexible enough to let you ease back into the work world either by starting part-time and ramping up to full time as you get your feet under you again or by telecommuting one or two days a week for a while to eliminate the commute part of your day. Obviously, for some professions (surgeons, teachers, toll booth collectors) telecommuting isn't a feasible option so you have to think through what would be possible given your particular situation. Or, if your side effects are more debilitating do you need to look into availing yourself of any legal rights you may have. To determine what you might be eligible for I recommend you review some of our articles here: http://www.cancerandcareers.org/en/at-work/Legal-and-Financial and then call the Cancer Legal Resource Center (1-866-THE-CLRC) to discuss your specific situation.

Finally, remember to take a moment for yourself in your day, no matter how busy or how stressful. Try taking a break, with a few deep breaths to refocus or take a walk either around the office or the block.

Hope this helps!

Best,
Rebecca

Rebecca V Nellis
Director of Programs
Cancer and Careers

Nearly 100%. And the mechanisms of this fatigue are the subject of much research. Different cells in the body's immune system have been implicated. These cells can cause inflammation that leads to fatigue. Other more tangible explanations include pain, difficulty sleeping due to the diagnosis and treatment, history of chemotherapy, etc — both disease and treatment related. It is likely a complex, multifactorial reason.

Hi, Kelly:
Those are great suggestions. They are things that I typically do - but I have gotten away from walking regularly due to school (and living in South Florida summer heat!). Maybe the key for me is to get more oxygen into my body on a consistent basis.

Fatigue is one of the most common side effect of breast cancer treatment. This side effect may appear at any time during the treatment. Rest does not alleviate the feelings of tiredness and fatigue. Fatigue may also continue after the treatments have ended.

To fight fatigue, it is important to exercise. Exercising 4 hours a week is recommended. You may find exercise partners at your support group, with friends, or fellow breast cancer survivors. You may also join a wellness center or gym and even get a personal trainer. This will improve your quality of life and physical fitness.

It is important to rest and eat properly along with drinking plenty of water and staying hydrated because your body is fighting the death of cancer cells (and healthy cells). Hydration assists metabolism. Your diet should include fruit, vegetables, and whole grains along with vitamins and minerals. Try to eat 15 calories a day for each pound you weigh. Eat several times a day, including nutritious snacks to boost your calories and protein intake. Good snacks are raisins, cranberries, apricots, yogurt, string cheese, carrots, vegetables, and prepackage energy bars. Liquid nutritional supplements such as Ensure come in different flavors and these provide extra calories and energy boosts. Protein assists in rebuilding the cells in your body and helps in the healing process.

Keep to a routine of when you eat and exercise. Exercise when you feel most energetic. Take naps when you need them as well.

The most common symptoms of anemia are:
- feelings of weakness
- fatigue
- feelings of lightheadedness or dizziness
- faster than usual heart rate
- headaches
- pale skin (nail beds)
- feelings of mental confusion or mood changes including irritability
- ringing in the ears (tinnitus)
- feeling out of breath (especially during exercise)

The severity of the symptoms will vary depending on the degree of anemia. Anemia may be present without any of these symptoms and may be discovered during a visit to your physician with blood tests results.

Symptoms of blood pressure changes may include:
- Fatigue - tiredness, weakness, difficult to do daily activities
- Dizziness or a feeling of fainting when changing positions such as arising from bed, standing or sitting up
- Nauseated
- Perceiving irregular heartbeats
- Experiencing sweatiness
- Experiencing chills
- Breathlessness and chest pain due to the heart not having enough blood to pump throughout the body
- Skin palor (pale)

Factors contributing to hypotension and low blood pressure include:
- Side effects or adverse effect of chemotherapy treatment
- Situations that decrease the amount of blood in the body and therefore decrease the amount of blood the heart can pump
- Certain medications
- Losing fluids from nausea, vomiting and diarrhea which leads to lower than normal amount of blood in your body
- Dehydration may also occur from hot weather, exercising, sweating, or fever