Everyone is understandably feeling anxious right now. This is a world pandemic. Many people are ill and have died. Many more fall ill and die. It’s a scary time.
I have wanted to blog about fatigue for a while now, but have been too tired to. Oh the irony!
The reality is that many people suffer from fatigue even many years after cancer treatments have stopped.
Fatigue is more than feeling tired after a busy day at work, or looking after children. It can last weeks, months, even many years. You can sleep well, exercise, eat healthily and still feel fatigued.
I looked up fatigue on thesaurus.com and found these synonyms:
I do love, admire, enjoy a thesaurus.
I don’t think that it’s possible to completely avoid fatigue during and after treatment, but I have found some thimgs that can help.
1. Go to bed
It sounds obvious, but if you are tired, and you can, then go to bed early. It’s no use trying to power through until 11pm if you are knackered by 9. I learned this the hard way; you won’t do yourself any favours by trying to stay up late. It’s likely to lead to being overtired and struggling to fall asleep.
And if you need a nap in the day, then have one if possible. I have half-hour cat-naps sometimes, and they work brilliantly. Any longer and I would sleep worse at night. Or if you can’t nap, just lying on the sofa and reading a book can help.
2. Read before bed
The stress of cancer treatments and ongoing side-effects can cause insomnia. I always read for a while before going to sleep. If you don’t like reading, there are lots of great quality older child or young adult novels out there. They are accessable and well-written. Anything by these authors is good:
Eion Colfer, C S Lewis, Suzanne Collins, Tom Gates, Liz Pichon, JK Rowling, Malorie Blackman, Enid Blyton and Lauren St John.
And don’t go on social media if you can’t sleep! It will be like drinking an espresso for your brain.
3. Know your limits
If you can work, great. I was desperate to get back to work after active treatment finished, but I also knew that I would not cope with working full-time. Not everyone will have the option to work part-time, but pushing yourself to work all hours to prove how well you are doing, is likely to lead to burn-out.
Your body and mind have been through a shockingly intense time, and will take longer than you think to recover. Remember that chemo kills cells, and radiotherapy alters DNA. A couple of aspirin these are not.
When I first returned to work, I needed a short nap most afternoons before dinner, just to get me through to bed-time. And on my days off, I would make plans to do numerous chores or be super-sociable. I just couldn’t keep this up. I expected to be back to normal after my treatments, but my body wasn’t ready. I started giving myself an actual day off in the week, not out of selfishness but necessity. I felt so much better because of this.
4. Don’t worry about what other people think
You have probably had someone say to you,
“Your cancer treatment has finished. That’s great, so you are all better now.”
Or, “Cool, everything is back to normal now. And you look so well.”
Although well-intentioned, remember that anyone who hasn’t had cancer doesn’t know what they are talking about. They want to encourage you, and don’t know what else to say. But cancer is not a bad cold. The affects of chemo, radiotherapy, surgery and hormone treatments can cause numerous side-effects that may last for many years. And then there’s the psychological damage that cancer can cause.
You may be back to work, your hair may be growing back beautifully, and you might look very well. But that doesn’t mean that your body will spring back to perfect health within minutes of waving goodbye to your oncologist.
Fatigue is your body’s way of saying “Hang on, what just happened? I need to figure this out: just give me some time.”
You can’t force your fatigue to go, no matter how much you want to forget about ever having had cancer. So ignore those who tell you that you should be back working full-time, out partying every weekend and to stop moaning about being tired.
5. Do some light exercise
I’m not going to recommend joining a gym, because for me, that would be a huge waste of money. But try to do a little exercise. Sometimes I feel really tired, so go for a short (20-30 minute) walk. I always feel better afterwards. The tiredness won’t disappear, but I will probably sleep better that night. And I can then enjoy some chocolate while lazing on the sofa as a reward. ☺
Stretches are great too. If you had any surgery, daily streteches will improve your strength and reduce any chance of lymphodaema. Gentle exercise like stretching your arms abive your head a few times, and ‘walking’ your hands up the wall will be helpful.
Or if you used to do pilates or yoga, or think it might be for you, you could have a look on Youtube for beginners’ exercises.
Remember that weightlifting is not advised if you have had a mastectomy.
Breast Cancer Care have some useful info about exercise after treatment.
6. Be kind to yourself
Think if what you would say to a close friend who has gone through cancer. Now say it to yourself, and listen to your advice.
I have struggled a lot with this one. Possibly because I am a mum with young kids. Mums just have to get on with it, don’t they?
But you won’t do yourself or your family any favours if you wear yourself into the ground. It’s impossible to spring right back to your pre-cancer self, so give yourself a break.
Learn how to say “No.”
If your boss, friends or family ask too much or expect you to perform at maximum efficiency, explain that you have post-cancer fatigue. Talk about how common it is after treatment, and that you may look great but your body has been through a terrible time. They have probably never heard of it, and will hopefully be much more understanding when you explain it to them.
This doesn’t mean that you can never go for a family day out again. But maybe start with a half-day and see how you get on. Maybe ask your parents or friends to have the kids one afternoon so that you can have a mega nap. Don’t take on overtime at work if you are struggling to get through a normal day.
7. If you are worried or there are any changes, see a doctor
Your fatigue might be improved by something as simple as iron tablets, for example, if you have anaemia.
You know now more than ever, to keep an eye on any changes in your body. Don’t put off making a doctor’s appointment if you notice anything or if fatigue is stopping you from carrying out normal daily activities.
Today I have a new accessory: a heart monitor.
I have to wear it for a week, and it records 24 hours a day. Thankfully, I am allowed to unplug it for a few minutes to have a shower every day.
It is annoying though, the sticky pad is itchy and uncomfortable. It’s like wearing a scratchy necklace that you can’t remove, not even to sleep.
I need it because I have been experiencing some issues that may be heart related, and have a dodgy pulse. Hopefully it’s nothing serious, and I am not worried about it. I guess I am so used to medical stuff now that it feels like another trivial health quirk.
It may be a complete coincidence, but people who have left-sided chest radiotherapy are warned that it can lead to heart disease even many years later. Obviously I don’t plan to have this.
I am a stickler for anniversaries. Tomorrow is 3 years since I had my last round of chemo. I can’t believe how quickly the time has gone.
I am starting to feel like a cancer veteran now. I can see myself in 30 years’ time, banging on about my experiences to the closest glazed-eyed youth.
One of the side-effects of cancer that you aren’t really aware of until it happens to you, is the financial cost.
I stopped work the day after my cancer diagnosis, and had 9 months off. Thankfully I have a very supportive workplace so didn’t suffer with a dramatic loss of income while going through active treatment. I am in education, and it was considered too high risk (to me) to be in work at this time.
I did return to work shortly before starting radiotherapy, and was able to work every morning before travelling the hour-long journey to have radiotherapy. I was determined to do this, as was desperate to return to ‘normal’ life. But it was incredibly tiring! I had no energy for housework, socialising or anything much really, for those five weeks. It was very difficult. But it did mean that I was earning again, which I both needed and wanted to do.
I suggest that if you or a close family member are diagnosed, that you look into what benefits you qualify for. Macmillan can help with this if you’re not sure where to start.
Cancer takes a toll on your finances. You may not need benefits, but it is worth looking into.
Also, if you have critical illness on your life insurance, speak to your insurer as soon as you can.
As for going back to work, there is no date that you ‘should’ go back. Every cancer, person and family is different, so don’t let anyone tell you that you need to go back, if you don’t feel ready. However, if you can go back part-time, I would recommend it. I felt so much better (mentally) for returning to work. I felt useful again, and was completely bored with with being at home.
You may not be able to go back to work as quickly as you would like, though. Often there are complications from treatments, not least of all fatigue. Fatigue is not just feeling a bit tired. It’s something that many cancer survivors have to put up with for years; long after friends are expecting you to be back to perfect health again. My advice is to be kind to yourself. Cancer is not like flu, you don’t suddenly spring back.
Of course, you may not be able to afford to be off work for long. Make sure that you know all of your rights in the workplace. And get support from friends and family: could someone make you hot meals for your first week back at work, or help with your laundry or grocery shopping? Don’t be afraid or too proud to ask for help. Often people do want to help, but they aren’t sure how to.
You may not feel like going back to the same job. Many survivors don’t feel like the same person after cancer. You may suffer from anxiety or PTSD, and may not be able to go back to a high-stress or long-hours job. If so, give yourself some time to think about what you really want, amd look into different options. Talk to loved ones to see what they think.
When you do return to work, make sure that you keep your manager in the loop, so that they can support you. They can’t help if they don’t know that you are struggling. All people who have been diagnosed with cancer are protected by the law, and employers are not allowed to discriminate against you. You are entitled to reasonable adjustments, and to apply for flexible hours. Could you work from home one day a week?
Going back to work can be surprisingly difficult, but it is one way to try to reclaim your life; to forge a ‘new normal’. Just make sure that you only do it when you are ready. Speak to your employer so that they can support you. And don’t expect everything to be exactly the same as before. Take your time with any changes, and remember to be kind to yourself. ☺
Paul Kalanithi was a man who spent his life trying to find Truth. First he searched for it in literature, then in neurosurgery and neuroscience. He studied at Stanford, Cambridge and Yale.
He wanted to understand the difference between brain and mind; between the physical and metaphysical. He was always acutely aware of his mortality, and was never afraid to face it.
‘When breath becomes air’ is a beautifully written autobiography of a man who had to make the difficult transition from a doctor who saved lives to a lung-cancer patient who knew that his would not be saved.
He continued to work as a surgeon despite aggressive treatment, and never gave up on his search for Truth.
This is an intelligent, thought-provoking and emotional story, and I would wager probably the best written book that I will read this year.
Paul talks about how even when we live, we are dying.
Often our search for beauty, truth, for why we are here, sits in the tension between life and death. We feel immortal, cannot grasp not exising; yet are faced with the inescapable truth that one day we will die.
Beauty is often found in the physical representation of our mortality: a flower that will soon wither; a sunset whose light will suddenly fade; a short-lived rainbow. Their very mortality makes their beauty even more sweet.
If we choose not to avoid our mortality, but instead stare it in the face, I believe that our search for Truth will be enabled. The pretence that if we don’t think about death then it will never find us, just blurs our vision.
Paul Kalanithi was a man with his eyes wide open. It’s stunningly refreshing.