Breast Cancer Treatment: Can I Lead A Normal Life After Recovery?
I am too tired for sex. How can I decrease fatigue?
Fatigue is a common problem for patients with cancer and is devastating because it directly impacts your daily activities and the lives of others with whom you associate.
When you are fatigued, feeling interested in sex is not on your agenda. Common causes of fatigue include side effects of medications, underactive thyroid gland, destruction of cancer cells, infection, uncontrolled pain, fever, poor nutrition, anemia, mental depression, poor sleeping patterns, anxiety, and emotional stress. Some causes of fatigue are easily treated. Before your visit to the clinic, describe and record the times of the day when you feel most tired. Certain medications like erythropoietin (Procrit, Epogen) (Amgen) or darbepoetin (Aranesep) (Amgen) can be given by injection to women who have anemia, and these medications have been shown to help with fatigue.
According to a Memorial Sloan-Kettering handout, other helpful techniques to decrease fatigue include Sleep extra hours, go to bed
• Earlier, or stay in bed later in the morning. If you are unable to sleep, you may benefit from a short course of sleep medications. Ask your healthcare provider if these are appropriate for you. Most prescriptions are short term because they can be habit forming.
• Eliminate difficult activities that cause fatigue, and pace you throughout the day.
• Schedule rest throughout the day.
• Ask for help from family and friends. Household chores like cooking, cleaning, and grocery shopping and child care can be delegated to family or friends. Do not be afraid to limit your activities
• And obligations.
Learn to say “no,” but do not isolate yourself from your social network.
• Ask your healthcare team if some of your medications could be contributing to your fatigue. If so, then discuss a substitute medication or whether you can limit your intake.
• Plan a well-balanced diet. Eat plenty of fruits and vegetables, and drink 8 to 10 glasses of water per day. Avoid caffeinated beverages or alcohol, especially in the evening hours. See a nutritionist, or consider incorporating some vitamin supplements.
• Maintain a light, tailored exercise plan. Exercise actually boosts your energy level as long as you do not overdo it. Start slowly with an easy exercise such as walking, and then gradually build up your stamina by increasing your walking distance as your fatigue lessens. Maintain a good balance between mild exercise and periods of rest.
• Plan special or important activities when you know your strength will be at its highest level. Sexual activity should take place when fatigue is at a minimum. Be open with your sexual partner about your level of fatigue. Skipping intercourse or just focusing on cuddling and kissing may be all that you feel comfortable with right now. Understand and accept your limits.
• Yoga, meditation, mindfulness training, and Tai Chi are all very good choices to help your brain and body relax.
• Listen to your favorite soothing music before bedtime, and avoid excessive stimulating activities before naps and bedtime. Quiet classical music can calm your brain and decrease disorganized thought patterns.
If you are feeling anxious or
• depressed, ask for professional help. Peer support groups are located all over
• Spiritual and religious connections can soothe and uplift the human spirit. Talk with someone in your religious institution.
• Rest frequently when you are tired. Recognize your limits, and do not embarrass to rest when necessary.
Consider using a cane, walker, wheelchair, or scooter if mobility is an issue. Use grab bars in bathrooms. Sit when getting dressed or putting on makeup, or allow yourself to hold onto the arm of your spouse, family member, or friend to keep steady while walking.
Excellent information about managing fatigue is available on the Internet. Contact the Oncology Nursing Society (www.cancersymptoms.org) or the National Comprehensive Cancer Network (www.nccn.org) for more information.
Improving Sleep Patterns
According to the National Commission on Sleep Disorders Research, over 40 million Americans suffer from some type of sleep disturbance-insomnia (inability to fall and remain asleep throughout the night), sleep apnea (stopping breathing during sleep leading to poor quality of sleep and not feeling refreshed in the morning), narcolepsy (immediate and unprovoked falling asleep), hypersomnia (sleeping too much), or restless leg syndrome.
Many women report increased insomnia, sleep apnea, and poor sleep patterns immediately before or during the menopause transition. Hot flashes and other underlying illnesses may be significant contributors to poor sleep quality. Most people are chronically fatigued because we rarely allow ourselves sufficient rest for our bodies and minds to recover from our busy daily activities. Overwork and over scheduling, combined with poor sleep habits, cause a life of exhaustion. Sleeping well at night can help you feel better and awake refreshed and may boost your energy level.
If you have trouble sleeping or a poor quality of your sleep, try these suggestions at night:
Go to bed and get up at the same time each day. Establish and stick with a nightly routine. Your body needs predictability.
• Keep the temperature in your bedroom comfortable. Hot flashes can interrupt sleep even if they do not awaken you during the night.
• Keep the bedroom quiet and dark when you are sleeping. Try earplugs or background or “white” noise such as a CD with ocean sounds or raindrops. If you cannot make your bedroom dark, wear a sleep mask. Unplug your telephone, cellular phone, or iPhone, and shut down your computer and BlackBerry.
• Do not let pets sleep in your bedroom. They are often “bed hogs” and can move around, thereby interrupting your sleep. If you want your pet nearby, then consider a special bed at the foot of your bed or somewhere else in the master bedroom! Create a bedtime routine. Play
• Cards, read, or enjoy other quiet activities immediately before you go to bed. Most sleep experts suggest that you not watch television or use the Internet before bed, as these activities may be too stimulating.
• Use your bed only for sleep and sex. Create a loving, tranquil environment. Purchase new, comfortable sheets and linens. Try a nice feathery pillow cover!
• Take only your own prescription medications, and use them as directed. Take any prescribed sleeping pills 40 to 60 minutes before bedtime. Some fast-acting medications must be taken right before going into bed. Consult with your healthcare professional if you think that you may need a prescription sleep aid.
• Use a relaxation exercise just before going to sleep. Try muscle relaxation (while lying face up, tense and relax each muscle from the bottom of your feet to the top of your head), mental imagery, massage, a warm bath, calm music or a soothing classical symphony, or light reading.
• Do not eat a heavy or high-fat meal before going to bed. Limit your fluids before going to bed.
• Avoid caffeinated beverages, nicotine, and alcohol in the late afternoon and evening. Try drinking decaffeinated herbal teas that are calming (e.g., passion lower or chamomile).
• If you cannot fall asleep within a reasonable time, get out of bed and do something relaxing. Continue reading your book or listening to music. Staying in bed can become frustrating.
• Try keeping a sleep diary, including the time you go to bed, what you did before sleeping, when you took naps, and whether you wake up during the night.
Document how you feel in the morning, and bring this booklet to your healthcare provider, who may use this information to diagnosis a sleep disorder.
If you cannot get your mind
• Away from worries, make a list of your concerns and things you can do to decrease or eliminate that worry (e.g., ask the doctor about a symptom, discuss your fears with a friend or your partner). Organize your calendar for the next day. Sometimes just writing things in an organized fashion can be helpful. Then you can release your inner demand that they must be done immediately and understand that you will do them tomorrow, next week, or whenever.
If you have trouble sleeping or a poor quality of your sleep, try these suggestions during the day:
• Exercise (any type each day, but not before bedtime).
• Keep a sleep diary to share with your doctor. Your healthcare clinician may be able to offer suggestions or prescribe a sleep aid.
• Do not take daytime naps.
Magnolia Myrick:
I think if you had “inner spiritual meaning” before cancer, then you will have it after and maybe more so. I certainly did. If you didn’t have it, the occasion of cancer is a real good time to search for meaning and truth, whatever that might mean to you, if for no other reason than it will make you feel better. Ask around if you think finding “inner spiritual meaning” or a connection to something or someone higher or greater than yourself will help. You’ll find somewhere to start; go from there.
Sometimes just writing things in an organized fashion can be helpful.
Terms:
Insomnia Disorder with sleep-inability to fall asleep.
Sleep apnea – A sleep disorder characterized by pauses in breathing during sleep.
Narcolepsy – A sleep disorder characterized by sudden and uncontrollable episodes of deep sleep.
Hypersomnia – A sleep disorder characterized by excessive amounts of sleepiness.
Restless leg syndrome – A condition that is characterized by an irresistible urge to move one’s body or legs to stop uncomfortable or odd sensations.
