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From OncoLog, August 2011, Vol. 56, No. 8

House Call: Managing Disease-Related Fatigue

Patients and doctors often can make fatigue less severe Feeling tired during a long illness seems normal. The idea of illness is closely tied to the image of someone lying in bed, and fatigue occurs with many chronic diseases. However, overwhelming fatigue is not something a patient simply has to accept. In fact, fatigue related to chronic illness is likely to improve with mindful treatment.

When fatigue is not normal

How do you know when to ask for help when dealing with fatigue? “The key is interference with functioning,” explained Carmen Escalante, M.D., chair of and a professor in the Department of General Internal Medicine at The University of Texas MD Anderson Cancer Center. If you persistently have trouble doing everyday tasks because you are too tired, or if rest and sleep no longer seem to restore your energy, you are probably experiencing severe fatigue and should seek help.

Fatigue may go unreported because its nature varies from situation to situation. For example, many people associate fatigue with physical exhaustion, but fatigue can also show itself as depression or the inability to concentrate. In fact, a lack of energy can decrease your ability to function physically, mentally, or emotionally.

Fatigue can be particularly hard to manage as a symptom of a chronic illness such as cancer, multiple sclerosis, muscular dystrophy, gastric disease, or thyroid disease. Some gastric diseases can prevent the absorption of food, diminishing available energy. Some diseases of the blood can reduce circulating oxygen, making physical activities more difficult to perform. For people with cancer, fatigue often becomes more distressing after aggressive treatments such as radiation therapy and chemotherapy.

Managing fatigue

Dr. Escalante said that managing fatigue related to chronic disease requires a comprehensive approach. Because fatigue is multidimensional, its exact cause can be hard to pinpoint and treat. Pain, lack of nutrition, infection, dehydration, stress, depression, anxiety, or hormone imbalances may contribute to fatigue. Many patients with chronic diseases have multiple health problems that may affect fatigue and its management. Therefore, according to Dr. Escalante, the first step of controlling fatigue is seeking out all potential causes rather than viewing fatigue as an independent problem.

Fatigue related to chronic disease can often be managed by adjusting your habits. Dr. Escalante said that one of the most effective strategies for fighting fatigue is exercise. Severely fatigued patients tend to think that they need more bed rest, as they would with normal physical fatigue, but sometimes the opposite is true: Evidence shows that simple exercise can be one of the most powerful ways to fight fatigue. Even a light regimen of about 21/2 hours of exercise spaced throughout the week can raise your energy level.

However, too much exertion can be dangerous with conditions like recent surgery, bone metastases, or immunosuppression. Your physician can help you determine the level of exercise that’s right for you. Physical therapy may be more appropriate for some patients.

Mental activity also may reduce fatigue, especially if your condition prevents physical activity. You can engage your mind with a puzzle, a craft, or a good book.

A controlled sleep schedule also can help restore energy. Going to bed at the same time every night and getting out of bed at the same time every day may reduce sleep problems. Cognitive behavioral therapy, which helps patients address negative thoughts that affect behavior, has also been shown to improve symptoms of chronic fatigue.

You might ask your doctor whether you should try a new drug regimen. Some medications have the potential to cause fatigue, and in some cases a different medication may serve the same purpose without the side effect. In addition, physicians sometimes prescribe psychostimulants to help patients gain more energy, especially patients who are adjusting to a new exercise routine or a more regular sleep schedule.

Misconceptions about fatigue

Although fatigue is a common symptom of many chronic diseases, some people are reluctant to seek treatment for it. Not everyone will think anything is wrong when fatigue accompanies a long illness. Some believe, mistakenly, that the best treatments for their disease will be withheld from them if they admit they are tired.

Another misconception is that fatigue means your disease is getting worse. In fact, cancer survivors sometimes continue to feel exhausted after they have been cured.

Fatigue itself can affect how willing you are to do something about feelings of fatigue. Nevertheless, the majority of fatigued patients can be helped if they work with their health care provider to develop a fatigue management strategy.

— S. Bronson

For more information, talk to your physician, visit www.mdanderson.org, or call askMDAnderson at 877-632-6789.

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