The problem of cancer-related fatigue (CRF), familiar to so many of us, has been the object of study in hundreds of articles in peer-reviewed medical journals for the past ten years.
An article entitled, "Cancer-Related Fatigue: The Scale of the Problem" (M. Hofman, J.L. Ryan, et. al), published in the May, 2007 issue of The Oncologist, provides a decent overview of the condition, starting with a description:
Cancer-related fatigue (CRF) is characterized by feelings of tiredness, weakness, and lack of energy, and is distinct from the “normal” drowsiness experienced by healthy individuals in that it is not relieved by rest or sleep. It occurs both as a consequence of the cancer itself and as a side effect of cancer treatment, although the precise underlying pathophysiology is largely unknown.It is one of the most common, most persistent, and most debilitating effects of cancer and cancer treatment.
Very, very few of the hundreds of studies indexed in PubMed propose any newly-discovered effective treatments for CRF, unfortunately. But there are a few mainstays. One major remedy from the start has been, and remains, physical exercise. The idea appears to be that maintaining or increasing one's muscle mass and aerobic endurance are helpful in the long run for combatting deconditioning and a worsening cycle of fatigue. That's certainly been at least one of the prompts for the Livestrong program, perhaps the best-known exercise-based rehabilitation programs for people on the other side of cancer treatment.
Recently, claims have been advanced for American ginseng, though the authors caution that such a remedy is probably most effective during chemotherapy and radiation, not afterwards.
Another recent overview of treatment options originally published in Germany, "Cancer-Related Fatigue: Epidemiology, Pathogenesis, Diagnosis, and Treatment" (M. Horneber, I. Fischer, et. al), from the March 2012 issue of Deutsches Aertzblatt, offers a thorough but succinct description of the problem and its implications, along with several interesting remedies that were new to me. Have you ever heard, just to mention one, that Dexmethylphenidate (more commonly known as Focalin, which is in the same drug family as Ritalin) has had some good effects? Me neither; I don't know whether it's approved for this use in the U.S. I have recently heard that it's starting to be a relatively common remedy prescribed for CRS, even as an off-label use.
I have to admit, I do not have the energy to do what I used to do at a drop of a hat. No more 8-hour drives by myself. Hell, no more 4-hour drives by myself! No more late, late nights working. (Though on occasion I violate the latter limitation.) Part of that may be attributed to aging, of course. And sometimes, despite what I assume to be a lack of improvement if not outright decline in stamina, I surprise and please myself by doing better at a task than I did several months or a year earlier. That was the case the week before last when I was the sole driver of a car full of teenagers to Cedar Point and back, a 2.5 hour trip each way for us. In the middle of the drive home, after midnight, I was still in better shape than I had been in the fall, when my older daughter and I traded off the driving. I appreciate such encouragement, as rare as it seems to be. (I have to add that a few days afterwards, my acupuncturist was distressed by how depleted I felt to her.)
Not surprisingly, given my own predilections, I've been pursuing a smorgasbord of remedies for my own CRF symptoms for the past three years. Follow me over the Victorian place-holder for some details....
Before I offer some of those details, I need to give a little bit of context, such as it is.
Now, I am probably going to misrepresent the hell out of what I am going to describe next, by way of my own working hypothesis regarding my personal energy and how I safeguard/squander/replenish it. It's an idiosyncratic blend of a very amateur reading of both traditional Chinese medicine and Ayurveda, and in fact I wouldn't mind at all if anyone reading this wanted to weigh in with more precision.
As I understand it, the TCM idea is that we each have a certain quantity of life energy, called qi or chi, which is something we draw upon every day. It can be restored, and it certainly can be depleted. We have a characteristic predilection to a certain amount, variable by individual at birth, but it is also affected by the balance--or lack of it--among our energy lines, called meridians and channels, which connect all of our major organs. Imbalance of the meridians can drain the battery faster, in effect. (TCM is not mechanistic, but sometimes those metaphors have explanatory value.)
There's also a constitutional energy with which we are born, called jing, which is largely inherited and largely fixed. Drain the qi battery too far, too often, and you can get in big trouble dipping into the jing resources.
In Ayurveda, there are similarities (superficially described here) about the ideas of energy flow and blockages, though the key points are called chakras. If a chakra is blocked or out of line, then the rest of the being does not function very well, and the resulting debilitation can be progressive in body and mind and spirit.
Totally oversimplified, I'm sure, but it's practicable for me in many circumstances.
Without blaming the victim (myself), my working hypothesis is that a serious imbalance, over a prolonged period of time, provided the opportunity for my cells to go awry and grow into a cancer. That might have been an excess of estrogen, ingested or self-generated; it might have been a chronic depletion in my qi, great enough to cause me to dip into the jing reserves. It might have been an energy blockage in the chakras that reduced my physical body's ability to clear out the malformed cells before they managed to gain traction. Of course, it might have been one, all, or none of these factors, or something else entirely. The mystery of why some people develop cancer and others don't is not likely to be resolved soon, no matter the paradigm.
Again, without beating myself up about it, let me just say I didn't do my best by my physical body for many years. And now, while I am far from diligent in all my self-care practices, I really do believe that my degree of CRF is an indicator of when I have overdone.
It's of a different quality than mere fatigue, which can be resolved pretty quickly by extra rest. No, the CRF I experience is of bone-deep weariness, body and spirit, bad enough that I sometimes feel like screaming from frustration. When it's at its worst, I remember how debilitated I felt when my cancer was raging but not yet diagnosed--and I vow to do anything possible to pull back from that degree of exhaustion.
And the week before last, I was just about there. As you might imagine, I was utterly drained by the end of NN14. I had a lot of fun, don't get me wrong, but it was a LOT of work ahead of time, some of it physically demanding. By the time the event started, I was already behind on my rest. It only got worse from there. A couple of nights in the hotel, I could barely get undressed, I was so damn tired. The Monday afterwards, I was barely coherent.
Then, two days after that, my father became suddenly very ill. I went to stay with him overnight in the ER, assuming that he'd get into a room pretty quickly because he was so sick. I was wrong. So I spent the night wedged on top of two inadequately padded folding chairs to make sure he made it through. He did, but it felt pretty precarious at the time; he was septic.
Since that difficult day, my dad has rebounded, amazingly enough. I have too, but making two more round trips up to see my parents in a week (plus the aforementioned trip to Cedar Point, a long-promised venture that had already been postponed once) really pushed me to my limit.
My medical providers helped, no question. I had an extra bodywork session from my Ayurvedist and a restorative treatment from my acupuncturist.
As an aside, let me describe my felt reaction to a typical acupuncture treatment. To me, it's as though my idle speed (sorry, I am a Motor City girl, after all) were kicked way, way down. It's not good for a car engine to race while not in gear, and it's not good for my own energy to revv unproductively. I always leave an acupuncture session feeling far more relaxed and mellow than when I arrived.
For that matter, having body work in Ayurveda is also calming, though it comes from different sources altogether--either oils/aromatherapy and/or pressure point releases. (It always amazes me just how tense I can get. But it's also lovely to realize that my shoulders are not attached to my ears.)
But my practitioners can't do it all. I also had to step up my self-care regimen to recover from this exacerbated state of fatigue. That has included extra sleep; extra rest (especially outdoors, if possible); slow and steady exercise, like gentle walking and yoga stretches; extra monitored breathing. I had one day of smoothies only, to give my digestive system a little break.
The bigger lesson, in the end, is not to get to the bottom of the reservoir. Whether it's a metaphorical fuel tank or a literal one, there's no telling what kind of residue will be pulled into the system then when I'm running on fumes, so better not to go so low. In another few days, I should be back to my baseline CRF state: needing at least 8 hours of sleep plus a good long nap in order to function adequately.
How about you? Has CRF been a problem for you at all? If not, how were you so lucky? ;) If so, then how have you dealt with it? Have you seen improvement? Are you the same? Or have things gotten worse?
I am interested in hearing all about it, and I trust others are too.
Monday Night Cancer Club is a Daily Kos group focused on dealing with cancer, primarily for cancer survivors and caregivers, though clinicians, researchers, and others with a special interest are also welcome. Volunteer diarists post Monday evenings between 7:30-8:30 PM ET on topics related to living with cancer, which is very broadly defined to include physical, spiritual, emotional and cognitive aspects. Mindful of the controversies endemic to cancer prevention and treatment, we ask that both diarists and commenters keep an open mind regarding strategies for surviving cancer, whether based in traditional, Eastern, Western, allopathic or other medical practices. This is a club no one wants to join, in truth, and compassion will help us make it through the challenge together.