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Fatigue


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Hello Everyone,

Happy Friday to you all.

Pardon me if this has been asked and answered before (I did try to do a search on all the topics but was unsuccessful). What are some ways that I can help my Mom with the tremendous amount of fatigue she is having? She is ALMOST finished treatments (had her 2 cycles of chemo (6 days each) and 30 of her 33 radiation treatments) and the doc said it is very, very normal. I know it is a huge blessing that she has had so few side effects. She has had procrit but she is just so 'zonked'. She definitely is not trying to over-do it and can accomplish normal tasks but I just wonder if something may give her a little more pep?

I think I read that someone recommend Ginseng. True? Any other words of wisdom from the group?

Thank you!

Kimberly

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Good Morning Kimberly,

I have no clue on this one. I was totally wiped out by my chemo treatments. I still get easily tired and I've been finished with chemo for a year. My ONC said that in some cases chemo is really hard on your metabolism, which is my case. I try and eat a healthy, varied diet and have snacks as well. I take a "whole foods" multiple vitamin that I got at a vitamin store, nothing "high" in anything just your 100% daily amounts and I take a calcium supplement. I'm sure you are going to get some great ideas from the others. I would try to have some high protein snacks around and see if that helps.

Dana

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Hi Kimberly,

I have tried Provigil, Megace (also increases appetite), Concerta, and Ritalin. Right now on Concerta and does help get me through the day. Exercise helps (ride a stationary bike an hour per day) also. Below is an article on fatigue which is posted on GRACE. Also (see below) posted in Lung Cancer In The News forum is Provigil: Narcolepsy Drug Fights Cancer. I’m on a lot of meds which also can cause fatigue, just a thought. Other reasons lack of nutrition, stress anemia and depression. Worth discussing with Mom’s doctor. Of course everyone is different and reacts differently. Hope this helps.

Rich

http://lungevity.org/l_community/viewto ... t=provigil

http://cancergrace.org/cancer-treatment ... ed-fatigue

Fatigue is one of the most common symptoms for patients with cancer, reported in up to 90% of patients undergoing chemotherapy or radiation therapy. Patients who are cancer survivors can still be affected by fatigue months to even years out from their last treatment. Cancer-related fatigue (CRF) specifically refers to the distressing tiredness or decreased energy out of proportion to activity associated with cancer or cancer therapy. It does not respond to rest. It can affect concentration, sleep patterns, and emotional coping, separate from depression. It is also a symptom that is easily overlooked, as it is often “expected” or assumed to occur alongside treatment, and patients with non-cancer diseases also experience fatigue.

In cancer, there can be many contributing factors to the fatigue that patients experience, and oftentimes, the fatigue is from multiple causes, both directly and indirectly related to the cancer. As many patients experience, the cancer itself can cause physiologic problems, such as anemia or electrolyte imbalances (think of sodium or calcium), or these chemical changes can occur from cancer treatments. For both chemotherapy and radiation therapy, fatigue is a known side effect; in chemotherapy, it tends to be more concurrent with treatment or immediately in the days afterwards between cycles; in radiation therapy, the fatigue tends to accumulate throughout the course of the radiation. Pain, if not controlled, can contribute to fatigue. It is also known that in advanced cancer, fatigue is caused by a metabolic syndrome of the cancer, similar to how loss of appetite and weight loss are also caused by this same metabolic syndrome. If patients are hospitalized due to complications like infections, this can cause both fatigue during the hospitalization as well as afterwards due to deconditioning (generalized weakness after a prolonged period of decreased mobility).

Despite the fact that fatigue is extremely common, it can be difficult to convey how much fatigue a patient has —how do you measure it? For patients, it can be helpful to consider how you would “rate” your fatigue on a numeric scale of zero to 10, similar to the scales used in measuring pain levels, and how much fatigue affects your daily life.

In general, if there is a specific cause of the fatigue (i.e., anemia, infection, electrolyte imbalance, etc), then the primary strategy is to treat that underlying cause. This includes treating depression and anxiety, both of which can cause fatigue separate even from cancer. For CRF without a specific cause, there are several treatment approaches to consider for fatigue: lifestyle-related and medications. Among strategies other than medications, all patients can benefit from strategies to adapt to fatigue, prioritizing specific goals and learning energy conservation techniques. Exercise has been studied and demonstrated to manage and improve fatigue as well. The key is to set realistic goals and to not overdo it. A specific type of exercise (i.e., swimming versus jogging) has not been established, but regular aerobic exercise has been thought to be more beneficial than weight training. Sometimes, oncologists can refer patients to specific physical therapy or outpatient rehabilitation programs to help with types of exercise and exercise planning. In conjunction with exercise, good sleep habits can also help with managing fatigue and maximizing energy.

In terms of medications, there has been study of treatments for CRF, but no definitive studies pointing to the most effective one. Certain psychostimulant drugs have been examined and found to be helpful in fatigue. Ritalin (methylphenidate), while known as a treatment for attention deficit & hyperactivity disorder (ADHD), has been seen in several small studies to improve energy and fatigue, though this effect has been equivocal in larger studies. Similarly, provigil (modafanil) has also been used for CRF as well, due to benefits seen in the fatigue associated with depression. Other medications that have been used for CRF include megace (megestrol acetate) and corticosteroids like decadron or prednisone with the goal of both improving fatigue and appetite.

Cancer-related fatigue is certainly a pervasive symptom, but a multi-tiered approach including non-pharmacologic therapies can be helpful and provide patients with tools to manage fatigue.

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  • 2 weeks later...

Hi everyone,

Sorry that I have been off the grid for a while ... but this is still on the topic. Mom continued to be very, very tired through the end of the week (gee, was that ONLY last week) and her rad onc prescribed megace to help with appetite...btw, she said it tastes horrid! Also, her blood counts - both white and red - were very, very low - even lower on Friday than Monday. So 2 units of blood were ordered for Friday. That seems to have made a WORLD of difference. Her energy level was way up over the weekend and we lounged by the pool for 2 days!!! Yesterday, counts were back up to normal range (happy dance anyone?!?!) And, net/net she has only lost 3 pounds during the whole course of treatments. No nauseau to speak of and no esphogitis (her rad onc is truly amazed). Blessings, indeed.

Now, she will have to treatment, shots, pokes or prodding until her CT scan and lab work on the 21st. Following that we have a long weekend planned with family at the beach (helping me with scanxiety) and check in with the doc on the 29th.

Thank you all for being with me and supporting me through this part of the journey. I can't say thank you enough. I know there is more to come but I am not worrying about that now. Not borrowing any trouble, right?!?!

Blessings to all,

Kimberly

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Kimberly,

Thats good news and will pray for even better news to come.

With my dad, the treatments, nausea, low blood counts, dehydration, pain medication, ALL contributed to fatigue.

He took megace and it helped alot with his appetite, low-dose iron and steroids too. He also got shots to boost blood counts and transfusions always helped his rebound well too.

I hope your mom's fatigue eases up soon. Rich and other's posted some great suggestions on long-term treatments/medications/suggestions for fatigue. I hope some of that helps.

Please keep us posted. Will keep your mom in my prayers.

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I got the megace for my husband too. When I gave it to him he said....how can this increase anyone's appetite....it makes me want to puke. So, I called the pharmacy and asked if they could add flavoring to it. The have raspberry, cherry, strawberry and green apple. Now he takes it happily!

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  • 1 month later...

My mom has been on Megace for a week. She too looked at us (sisters and I) as though we had just handed her a tiny cup of poison. She said, "Didn't you know it was that horrible?" LOL My aunt laughed and said, "Well, it's not like I'm tasting your medications before I give them to you." HA HA.

Today I gave Mom 2 TBL of Milk of Magnesia because she hasn't used the restroom in 8 days. But I know that pain meds can cause constipation. So, now that we're off the pain pills, we need to regulate her digestion again. But when she took it she made a horrible face and said, "Oh GOD, I thought you were giving me sip of a vanilla shake...WHAT was THAT?" LOL

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