Question & Answer Details
 

Chemo Related Fatigue - The Wet Spaghetti Syndrome
When faced with the prospect of chemotherapy treatments, the big issues are, of course, treatment options and effectiveness. After that, what looms large is the issue of side effects. Here, I will address the most common complaint which amazingly is not nausea (there are wonder drugs available to treat this now) but fatigue.

CRF or chemo related fatigue is not to be confused with tiredness, which is an expected result from activities of the day or lack of sleep, and is usually relieved by sleep. With the fatigue of chemo, you can sleep and sleep and sleep and the fatigue will be there when you wake up. It is characterized by a complete lack of energy, lack of motivation, can be paralyzing, and certainly interferes with quality of life and the ability to function. You may have heard the term “chemo brain”, and what that describes is that inability to concentrate, to remember, to just not feel clear, and is a common lament of many people undergoing chemotherapy.

Recently, I held a fatigue workshop and asked everyone who attended to describe their fatigue. The responses ranged from “wrung out dishrag” to “wet spaghetti”, and everything in between that just makes you think of a debilitating, droopy, all encompassing malaise. Although fatigue can have many root causes including anemia, hypothyroidism, cancer disease state, stress and depression among other conditions, it’s kind of a “chicken before the egg” syndrome in that, for instance, anemia can lead to fatigue that can lead to depression that can then exacerbate fatigue and just create a downward spiral. So treating the underlying cause, if one exists is the first step.

Chemotherapy related fatigue varies in its intensity and duration from person to person. It can last for a few days or several months following completion of treatment. When an underlying cause has been eliminated or identified and treated, research has shown that there is a way to combat the fatigue of chemotherapy. The following is a BEAT THE FATIGUE plan of action that will help in giving you the best shot at keeping your life as status quo as possible.

• EXERCISE !!!! Studies have shown that regular aerobic exercise can actually combat fatigue and depression in people receiving chemotherapy treatments. Start slowly to give your body time to adjust. You can begin by simply walking around the block. Walking, swimming, gentle running, cycling are all good ideas. You should not be exercising to the point where you experience soreness, stiffness, shortness of breath or exhaustion. (Right off the bat we’re eliminating weight lifting, marathon running and long distance swimming!!)
• Like the downward spiral mentioned above, if you experience fatigue and do nothing but sleep (yikes!! don’t become a couch potato!), it will cause increased fatigue, which will cause more need to sleep, and so on and so on.
• Of Course, consult with your physician before beginning any exercise routine.

• Nutrition, Maintain basic calorie and fluid needs.

• Carbohydrates - Foods that give you sustained energy are important including bread and potatoes. They also give you needed calories to stabilize weight.

• Protein – Foods that rebuild and repair damaged body tissue include milk, meats and poultry
• Fluids – A minimum of 8 cups of fluid per day will prevent dehydration.This includes water, juice, milk, broth and other beverages but better not to include beverages with caffeine

For the following special circumstance situations, you should contact your physician, nurse practitioner or chemo RN to order a nutrition consult:
1. Inability to maintain weight
2. Fluid loss from prolonged or persistent diarrhea and/or vomiting
3. Swallowing difficulty

Cluster your activities
If you have to food shop, pick up the cleaning, stop at the post office, etc. try to keep errands close geographically. That is, do whatever you can in a particular area and don’t get bogged down with too many tasks. You’ll wear yourself out and feel defeated. For instance, if you have to pick up children after school, plan to stop on your way home if something is located along that route
If at all possible, delegate, delegate, delegate!

Pace yourself
Give yourself time so you don’t have to stress at meeting deadlines. Don’t try to pack so much into your day; be happy with each accomplishment – little successes go a long way!
Take short rests frequently and whenever you feel the need

Avoid temperature extremes
Chemotherapy treatment can cause both heat and cold intolerance depending on the treatment (some are non-discriminatory and cause both!! This includes very hot or very cold foods and beverages. Although a nice long hot bath seems like a wonderful thing, it can add to fatigue and just make you want to sleep

Get rid of the guilt
If you have always been active and cannot (or should not) maintain that level of activity during treatment, just do what you can. Again, little accomplishments add up to positive feedback rather than frustration. If you have always done homework with the kids and can’t handle it right now, tap other resources (spouse, grandparents, significant other, friends). If you’ve always cooked every night for your family or spouse, let someone else wear the apron for a while. Learn to accept help! Remember that someday you may be the one offering it to someone else. And keep in mind that things like cleaning, repairing etc. are not critical and will be there when you’re ready.
Again, delegate, delegate, delegate!!!!