Fatigue – feeling excessively tired or exhausted all or most of the time. Tiredness is not relieved by rest and can have an effect on physical, psychological and emotional well being.
Can be overwhelming. Find it difficult to do simple everyday things that we usually take for granted. A very common during and after treatment. It is the most disruptive side effect of treatment to daily life. It affects everyone differently and can cause different symptoms such as :
- difficulty doing the smallest things
- a feeling of having no energy or strength to do anything
- lack of concentration
- less attention to personal appearance
- having trouble thinking, speaking, decision making
- difficulty remembering things
- feeling breathless after light activity
- dizziness or a feeling of light headedness
- difficulty sleeping
- feeling more emotional than usual
- affects the way you think and feel-even watching TV, reading
- can affect relationships with family and friends – impatience and avoidance of socialising because it is too much effort
- following surgery
- radiotherapy – worse 2-3 weeks after treatment. Takes time to improve. Good days and bad days. Length of time to recovery varies can even take up to 1 year or longer.
- anaemia – shortage of hemoglobin, which carries oxygen around the body, found in red blood cells. Gives energy.
- Eating problems -may not be getting enough energy from food, nausea and vomiting, oral mucositis, difficulty in swallowing
- loss of appetite, taste changes
- Pain and effects of pain killers
- Psychological effects – anxiety, depression, stress, tension, poor sleep pattern
Coping at home
- Planning your day so that you have time to rest and so the things you want to do most
- be realistic about what you can do and try not to do too much
- don’t feel guilty if you have to ask for help off others
- spread tasks over the week
- do a little each day
- avoid heavy work, ask others for help
- sit down to do what chores you can
- use long handled dusters etc
- ask others to help when you can
- make a list
- write shopping list following the layout of the store
- shop at least busiest time
- ask for help with packing and carrying to the car
- shop with someone
- internet shopping
- convenience / pre cooked foods
- prepare extra dishes / freeze – when feeling less tired
- prepare double portions and freeze half
- don’t lift heavy pans, dish out at cooker
- ask others for help
- Explain to child that you are feeling tired and so will not be able to do as much with them
- Plan sit down activities
- accept offers of help
- Make time for activities that help you relax. Stress uses energy so can make you feel more tired.
- Talk to others about how you feel, any worries or concerns
- Distraction techniques: to take mind away from worrying techniques.
- Try to avoid situations that cause anxiety / stress
- Physical relaxation
- Mental relaxation
- Plenty of fluids
- Try to take advantage of times when appetite is best
- Try to keep a normal sleep pattern, even if you feel like sleeping all the time
- sleep just long enough
- wake up at the same time every day – to strengthen sleep routine and eventually leads to regular times of sleeping
- Reduce noise
- Keep a steady temperature
- Bedtime light snack-warm drink
- Avoid stimulants – caffeine and chocolate a few hours before bed
- Limit intake of alcohol – alcohol helps tense people to fall to sleep more quickly but the sleep tends to be broken.
- Know how naps affect you
- Know when to say enough is enough – get up if tossing and turning, watch TV etc wait until you are tired again and then go back to bed
- Audio tapes
- Mental exercises
Aim – to help improve quality of life during and after treatment.
As well as fatigue muscle weakness and stiffness can be caused due to effects of treatment. Severe fatigue can limit activity and this leads to muscle wasting and loss of function.
It is important to exercise a little if you can even when not feeling too well. Research shows that exercise can help with the side effects of treatment such as fatigue, pain, nausea and vomiting. It can also improve mood and feeling of confidence.
Too much exercise can make you feel tired so it is important to find the best level for you.
Exercise as much as you can to keep muscles working as well as possible.
Benefits of exercise:
- Maintains or improves physical abilities
- Improves balance, reduces risk of falls
- Prevents muscle wasting caused by inactivity
- Reduces risk of heart disease
- Improves blood flow to legs and reduces risk of blood clots
- Improves self esteem
- Reduces levels of anxiety and depression
- Decreases nausea
- Reduces symptoms of fatigue and improves quality of life.
How much exercise
Exercise should be based on what is safe effective and enjoyable. Nine exercises (see below) can be used during treatment and afterwards. Walking little but often as well as exercises. How much depends on your energy levels and whether still on treatment.
Maintaining an active lifestyle is key to good health. To be active try to accumulate at least 30 mins of physical activity throughout the day. You must work at moderate intensity meaning you are very slightly breathless.
Physical activity includes: walking, hoovering, gardening, climbing stairs – general everyday activity.
Types of exercise: swimming ( not during chemotherapy and radiotherapy) cycling, exercise classes, long walks, gym work, yoga etc. Walks are free and fresh air good.
To gain fitness you need to build up to:
- exercise 3 to 5 days a week
- 20-30 mins activity of choice
- moderate intensity, feel warm, may be slightly breathless but manageable for you
- It shouldn’t be so hard that its not enjoyable.
Most important thing is the habit of exercise. Start with one session a week and continue till you feel ready to add a second then a third etc. MAY TAKE MONTHS.
Listen to your body and work at your own pace. Pick things that you enjoy and realistic for you DO NOT EXERCISE OR STOP EXERCISING IF YOU HAVE OR DEVELOP:
- unusual fatigue or muscle weakness
- irregular pulse
- leg pains or cramps
- chest pain
- feeling sick or are sick during exercise
- vomiting within previous 24-36 hours
- dizziness, blurred vision
- difficulty breathing or numbness in hands and feet
- low blood counts
If on treatment or straight after treatment and feeling especially tired, exercise for a shorter time and lower intensity and plan exercise when on a good day.
Energy levels tend to go up and down during and after treatment for a period of time.
Nine useful exercises designed to improve circulation and prevent joints from becoming stiff. Helps to maintain and improve muscle strength and general mobility and function.
Begin by doing each exercise 5 times increase to 10 times when able to do so.
ON THE BED
1. ANKLE EXERCISES
- pull feet quite briskly up and down, 10 times each leg
- circle ankles in a clockwise and anticlockwise direction 10 times each leg
2. KNEE FLEXION / EXTENSION
- bend and straighten knee, 5 times each leg
3. STATIC QUADRICEPS
- pull foot and toes up, push the knee firmly into the bed and tighten thigh muscles, allowing your heel to lift slightly off the bed, 5 times each leg
4. ABDUCTION / ADDUCTION
- bring your leg out to the side as far as you can and then back to mid position, 5 times each leg
5.STRAIGHT LEG RAISE
- keep your leg straight by pushing knee down into the bed, pull your foot and toes up and lift leg approx Sins off the bed, 5 times each leg
SAT IN CHAIR
6. Pull yout toes up, tighten your thigh muscle and straighten your knee. Hold for a count of 3 and slowly relax your leg, 5 times each leg
7. ARM EXERCISES
- lift both arms up above your head and then in front of you, 5 times
8. SIT TO STAND
- sitting on a chair your arms crossed, stand up and then sit down slowly, 5 times
9. DEEP BREATHING
- relax your shoulders, correct your posture by straightening your back
- place hands on side of your chest
- breathe in slowly through your nose, expanding your chest and feeling the movement underneath your hand, hold 3 seconds
- then breathe through the mouth