Increase energy so no nap needed?

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Question from BC survivor: I have had multiple rounds of chemo, but none since October 1998. I have never regained the energy I had before I started chemo. Are there any ways to help combat the fatigue? I know I will never get back to where I was but would like enough energy to go through a day and not want to take a nap.
Answers - Russell Portenoy Much of this question was addressed in previous answers. I would only add that patients with very severe fatigue for a prolonged period of time, who don't have an obvious treatable cause, like a depression or sleep disturbance or poor nutrition, and who don't respond well to stimulant drugs or to exercise might yet have other options. There are other non-pharmacological techniques that some people find helpful. For example, by working with a psychologist some patients find cognitive approaches that allow them to function better and to maintain some control over the fatigue. There are also other drugs that are rarely tried if psycho stimulants are not effective or are contraindicated. Some doctors try using specific anti-depressant medications that are more activating, even if patients are not feeling depressed.
Marisa Weiss, M.D. Can you give examples of the cognitive approaches?
Russell Portenoy A cognitive approach might be, for example, pacing, or the use of diaries or calendars to help ensure that activities are performed at certain times of the day when energy level is relatively high. The goal of a cognitive approach is to allow a patient to function as best as they possibly can and avoid the frustration and disturbances of life functioning that occur if fatigue is persistent.
Lillian Nail In terms of the pacing or energy conservation approach there is very little literature on this now. There is a study underway trying this with patients undergoing treatment but we don't have the results yet. It's an area of interest but rarely tested. One of the key issues is identifying the pattern of your fatigue and scheduling your activities to match the pattern.

The Ask-the-Expert Online Conference called Ease Fatigue, Boost Energy featured Lillian Nail, Ph.D., R.N., Russel Portenoy, M.D., and Marisa Weiss, M.D. answering your questions about ways to manage fatigue and increase energy levels.

Editor's Note: This conference took place in March 2001.


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