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Tips For Reducing Fatigue
Ernest H Rosenbaum, MD; Barbara F. Piper, RN, OCN, DNSc.; Marilyn Dodd RN, PhD; Kathleen Dzubur, MS; Michael Glover, Pat Kramer, RN, MSN, AOCN; RoseAnn Kurshner, RN, BSN, MEd; Francine Manuel, RPT

Fatigue: What a Patient Needs to Know
Facts on Fatigue
Problems of Fatigue

What Causes Fatigue
What Physicians Need to Know
Fatigue Associated with Medical Therapy: Causes and Solutions

The Fatigue Reduction Program for Improved Quality of Life
Fatigue Diagram

Patients are often misinformed about fatigue as 61% assumed the condition would disappear by itself and 45% said that there was nothing their physician could do about this condition. Twenty five percent said their physician did not explain the cause of their fatigue or possible treatments. These are some simple techniques to keep in mind:

- 1. Develop a realistic daily schedule. This should include rest and structured work times. Listen to your body and don't overexert yourself as this may exacerbate fatigue.

- 2. Use energy saving tips - aids to daily living (ADL) such as dressing while sitting on a chair or toilet seat.

- 3. Rehabilitation Exercises including physical and occupational therapy may be of help along with mild exercises or walking - classes designed to overcome fatigue are recommended. Family members or friends can help take you on walks to provide a helping hand when you are tiring. Mild to moderate exercise to help promote energy are a boost for quality of life even though you may feel tired. Exercise: Winningham has reported increased exertion/activity tolerance before onset of physiologically based fatigue in patients participating in an exercise program.

- 4. Avoid too much rest. Whereas over exercise may cause fatigue by using important energy stores, lack of exercise can also cause fatigue through physical deconditioning and deterioration.

- 5. Enjoy accomplishments such as a short walk or even showering.

- 6. Eat a healthy diet prepared with the aid of a nutritionist to improve energy. Maintain appropriate levels of protein, vitamins, minerals, or supplements to ensure adequate nutrition.

- 7. Control emotional fatigue with psychosocial support and relaxation techniques - like self-hypnosis. Guided imagery can be very effective. Be patient with yourself and try not to be too self-critical if you are unable to perform exercises or work. Try to keep faith and believe in yourself that with time you will feel better.

- 8. Take time to pamper yourself: Enjoy a bath, get a massage, listen to your favorite music, watch a sunset or visit the sea shore.

- 9. Keep a fatigue journal of your progress. Note when fatigue occurs, lifts or lingers. This can help you to make a realistic daily schedule and may need to lower or drop work load or change your lifestyle.

- 10.Talk with your doctor about prescribing drugs to relieve fatigue such as Psycho-stimulants: Methylphenidate (Ritalin), Pemoline and dextroamphetamine (Dexadrine). These may be of help although there are no completed studies for cancer-related fatigue. Please note that constant monitoring is necessary when taking these drugs as adverse side effects including anorexia, insomnia, anxiety, delirium and tachycardia may result. Antidepressants such as elavil nortriptyline and desipramine or bupropion may help as antidepressants and may help increase energy. Steroids have also been of some help.

- 11. If anemia is a problem, Epoetin-alfa or a similar drug approved for cancer treatment of related fatigue may be helpful

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