December 4, 2019
Featuring Christina Ferraro, MSN,CNP, BMTCN, of the Cleveland Clinic Blood & Marrow Transplant Program and survivor Spin Tucker
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Christina Ferraro, NP, Cleveland Clinic
- Holidays are tiring for many but often overwhelming to cancer patients dealing with fatigue.
- Many people do not understand fatigue unless they have gone through it.
- Fatigue definition- defined as a distressing, persistent, subjective sense of physical, emotional, and/or cognitive tiredness or exhaustion related to cancer and/or cancer treatment that is not proportional to recent activity and interferes with usual functioning. You feel unrested even if you just woke up.
- It is important to focus on what we can change when managing fatigue. We cannot change a diagnosis, a treatment path, getting older, etc.
- We can try to change pain management, how one is coping/depression, our nutrition, our sleep habits, management of other possible health issues, muscle fatigue, and blood levels. We can also look at how we manage our time and prioritize what we can get done in a day.
- Sugar and excess carbs such as those found in alcohol can make sugar levels spike and plummet. Therefore, they can make fatigue worse.
- It is important to learn your limits with your energy and try not to overdo too much. You want to steadily grow in endurance but going way beyond your limits one day can cause great consequences for the next few days.
- Exercise is highly recommended to those with fatigue as building back muscle increase energy. It can also increase mood, help memory, and keep you at a healthy BMI, (body mass index).
- You can start very small, perhaps 5 minutes a day or by starting physical therapy. Livestrong and the YMCA have also developed a great program for cancer patients.
- 30 minutes a day as recommended for many adults is not realistic for most patients. It is important to start small an add to it as you can tolerate it.
- Relaxation, mindfulness, and CBT Therapy can improve quality of life and help people cope better. Some people also do better with medication for anxiety/depression as well.
- It is important to eat enough protein and healthy fats to promote healing.
- Keep hydrated, drink 8- 8oz glasses of water a day.
- Practice good sleep hygiene. Don’t watch TV or play on screens for 30 minutes before bed. Only sleep or be intimate in your bed. Other activities in the bed can make your brain more stimulated before sleeping. Don’t eat right before bed. Consider a sleep study if apnea suspected.
- Some people get Ritalin/Methylphenidate on occasion to help them have more energy for special events. Taking it daily will lessen its ability to help but it can give a boost for a special day or when trying to start back to an exercise routine.
- Fatigue is challenging. It is important to plan ahead, ask for help, and to prioritize what you need done.
Spin Zucker, Survivor
- He agrees that nutrition and exercise were critical to his recovery.
- Even if it tastes awful, you must start eating veggies, protein and vitamins. Stay away from junk food.
- Avoid caffeine and sugars.
- He wanted to just lay there when he recovered. He started small with 5 minutes a day on a treadmill.
- Exercising in the late afternoon helped him sleep better.
- Circadian rhythms are off and it is easy to wake up and have the mind ruminate on worries. Talking with your healthcare team about better rest is important.
- Don’t overly push yourself and depend on your supports.
How do you get people to understand fatigue?
It was suggested that articles could help. Also explaining that your body cannot be “motivated” beyond your limit. It literally will not let you do more.
What about marijuana use?
Christina Ferraro said they do not recommend it as there is just not enough studies out yet. Jennifer (SW), cautioned on possible interactions with other medications.
Steroid use during treatment is a big culprit for sleep issues. However, it is a necessary evil.
Is random fatigue normal?
Christina shared how any fatigue is normal. Keep up with health checks and communicate with your doctor. However, some fatigue can be related to excessive inflammation. One caller shared her doctor screens for inflammation with a CRP and LDH test. This caller recommends the anti-inflammatory diet on-line.
What about people who say you look great and don’t seem to understand more is going on despite how you look?
Spin recommended just growing in acceptance with this. However, he and another caller recommended attending a support group where other patients are more likely to understand.