Rebecca Bechhold, MD, writes for medical professionals and her latest article is in response to the American Society of Clinical Oncology's recently published clinical guideline on how to evaluate patient fatigue. With fatigue being a common complaint with CLL, reading Rebecca's article can give you some insight into the difficulty doctors face in determining a cause for fatigue and even if they find a cause, suggesting an effective remedy.
When someone states they are “tired,” it prompts follow-up questions regarding activity, sleep, diet, and stress, among other things—just as a complaint of pain leads to where, what kind, how long, etc.
The simple answer to “Can’t you do something about that?” is often no, because there is no pathologic etiology; much of fatigue is lifestyle. But the approach to evaluation and recommendations is a sensitive and important part of supportive oncology.":
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Note particularly:
'“Physical activity can reduce cancer-related fatigue in post-treatment survivors.” A significant portion of the recommendations are aerobic exercise; strength training; and mind-body interventions like yoga, meditation, and massage, among others.
Pharmacologics are not shown to help.'
Neil
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Thanks Neil for sharing the article, and to Chris too for his comments.
I am finding my ankle orthotic (brace) helpful is getting about with confidence but find I run out of energy most days after about 15 minutes of moderate activity (mostly gardening). It bounces back after a break though eventually that ceases - I get about 3-4 hours of oomph a day. Before getting my brace ankle pain (arthritis) stopped me from being too active. Some times I wonder if it is the CLL and remind myself I need to get my Vit D and B12 checked again. I keep forgetting to make the appointment to visit the doctor - too many appointments in the last few years has me in avoidance mode!! I also keep forgetting to drink lots of water and think that mild dehydration probably plays a part too - as Neil points out, lifestyle factors need to be ruled out first. And as I haven't been able to shift a cough/cold for weeks I'm also wondering if low IG is a factor. My hematologist is keeping an eye on that - we're avoiding going back to IVIG infusions because I reacted to 2 different brands last year. I know I'm pushing myself hard lately - enjoying being stable on my feet without too much pain.
Chasing down the cause of fatigue can be tricky. I have learned that it's okay to have plenty of rest stops throughout the day and to alternative physical activity with sitting down tasks.
‘There is a rationale for fatigue in CLL. We know that CLL cells in the test tube can be shown to secrete a number of cytokines including IL-1, IL-6, IL-8. IL-10, TNF-alpha, TGF-beta. It is also known that when certain cytokines are used therapeutically (IL-2 and interferon) the side effects include prostrating fatigue.’
I would strongly agree with Chris that lifestyle changes are of tremendous benefit, especially when it comes to fatigue. We need to raise the heart rate by brisk walking, swimming or cycling to increase the blood flow. This also gets the neutrophils circulating which is another health benefit.
Of course this lifestyle change can be difficult for some, but just start slow and steady, you will soon feel the changes. Gathering up the motivation to get outside and to start moving is always the most difficult part. Starting these changes on a sunny day is a good incentive.
A pill might be an easy choice, but a little exercise does not cost us anything.
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