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Chronic Pelvic Pain and Chronic Pain
Tag: fatigue
The Best 35 Minutes Ever!
So, this one Saturday pre chemo I woke up feeling like a champ! I had slept a full ten hours…..without interruption! Holy Crap! I didn’t even feel like I had cancer! I had energy! I wanted to go kick some ass somewhere! I did a little dance. I told everybody in the house that I was ready to go. I sat down to breakfast 35 minutes later, smiling ear to ear. And then, without warning, it all started melting away. I felt the slow spread of heat and fatigue wash over me. I started getting short of breath and achy. I couldn’t speak in full sentences without taking a breath. Within a few minutes, my cancer symptoms had swept back in, enveloping me in that blanket of sick that I had just swore I had shucked off for the day. Here I was again, the lymphoma patient, set up for yet another day on the couch. Awe man! One of the hardest parts too is watching my husband’s temporarily hopeful facial expression slowly fade into a sad little empathetic smile that I have come to know so frequently. This is, my friends, just the way it is. There is a level of unpredictability about this whole thing that is never easy to reconcile, much less accept. Welp, I guess it’s time to dig out the remote again and settle in for some more Netflix. It is what it is. That’s fine. I’ll rest for now, plotting what amazing things I could do in that next 35 minutes! This is just one of the smaller battles Cancer. You can have this one. I’m saving myself for the real one. Cue mic drop.
Dr. Katz
Suckin the Life Outta Ya
Man this cancer thing is already kind of ridiculous, and I haven’t even started treatment. From the moment I found out, I firmly positioned myself in full bad-ass stance, made long term grandiose plans and capriciously swore that nothing would hold me down or stop me from caring for other people and patients. I was cocky. I was confident. I thought that it would help me beat this thing.
So, that was like….so last two weeks. Now let me tell you about what I actually should have done or learned…lol When I first learned that I had cancer, I had people telling me everything from reminding me how I need to slow down to I could work full time with this no problem with no pauses! Well of course I gravitated toward the full throttle advice! Who wouldn’t? I didn’t cancel patients right away. I started writing my book. I started a new podcast. I recruited my army, once I finally let the cat out of the bag. I cried for about two seconds and then I was ready to go! I was not done yet! Screw you cancer! You’re not the boss of me! Sound familiar? Anyone else been there? It doesn’t last too long does it?
Here is what I should have realized and learned. The first thing to realize when you are told you have cancer is that it has been around a lot longer than you thought. You need to add a couple of years in some cases to the time of diagnosis. Whaaat?! A couple of years?! That sucker has been sneaking around in my body for a couple of years? What the hell?! What that means is by the time you are diagnosed, it has been around long enough to give you symptoms. This means that the path from feeling normal to shitty has been significantly shortened before you even get the chance to process the fact that you have cancer in the first place. How rude!
Second, I should have realized that now is the time to plan carefully, anticipate and CONSERVE energy, not burn it all up before you even start. This is the time to try to be realistic, without guilt, about what you will be able to do and not do. This is my biggest challenge. Instead of just relaxing, I spend way too much time feeling guilty on what I am missing out on and who I am letting down. I am fixated on the fact that I am dropping the ball. Ugh! I went from feeling good to crappy in about a week. Now I walk across the room or just sit and promptly get short of breath, depending on the day. I have fatigue that is so intense that it literally comes out of no where and sucks the life out of you to the point that even breathing seems like too much effort. I am told that this is common with lymphoma since it is a condition that has a lot more inflammation associated with it. Therefore, your body requires a ton of excess energy and calories to try to fight it off. It makes sense I guess. My point is, that I waste time when I feel good trying to accomplish a million things until the next time I don’t feel good. I am not good at resting. How will this benefit me? It won’t. It will only make it tougher and take me longer to get better.
Last but not least, I should have realized that I have to let people help me! They are doing it because they want to, not because I am making them. I need to stop trying to do everything myself. I need to stop confusing accepting help with some weird acknowledgement of failure or weakness. What is my problem? I still don’t know…lol All I can promise is that I will work on it, because I intend to see this thing all the way through. Wish me luck!
Dr. Katz
I can’t seem to get anything done!
My sense of time seems really off lately. And by lately, I mean the whole last 7 months or so. I have found myself having difficulty reconciling the fact that I have the appearance of more time, without actually being able to accomplish more. I keep thinking that I know that I have more time on my hands because I can’t run off and do half the things that I used to. My weekends are no longer taken up by sporting events, concerts, dinner outings, or much of anything really. That means I should be able to get all kinds of leftover crap done, doesn’t it. Yet, I find days going by lately when I feel like I didn’t really accomplish anything. How is that possible? Granted, I probably set myself up for failure with my overachieving list of goals to accomplish that significantly outpaces the number of available hours. I have to own that part. But, usually I can get at least some of it done. I spent a long time pondering this little puzzle with no helpful insights until now. I finally figured out where my thought process was going astray.
I was thinking negatively in terms of my lack of physical accomplishments and looking for concrete physical barricades to my goals. I hadn’t stopped to consider the mental barriers to productivity that we all have been suffering from lately. It really hasn’t been about the lack of time. In truth, with the lack of activities available, I have had more physical time to accomplish more things: I just haven’t wanted to and it is ok to admit it out loud. With all of the stress around me lately, I just plain old have run out of mental energy to stay productive all the time. I have run out of things that I want to clean. I have run out of ways that I want to use to fill my time. I have subconsciously made myself a pact to take a step back, relax and sometimes just be. To my surprise, I realized that this was not necessarily a bad thing! This is just me practicing self-care without realizing it. I am trying to conserve what’s left of my mental energy for when I really need it, not when I am just trying to keep constantly busy. I am trying to rejuvenate and refresh. This is ok! I have to give myself permission for this and I would suggest that you do the same. Stop finding new things to beat yourself up for. A million things do not need to be accomplished every single day. Sometimes there needs to be a day to just breathe. Pummelling ourselves with endless, impossible to finish tasks will not reset or fix the out of control tension going on in the world today. Overscheduling ourselves just to say that we are doing something is actually doing more harm than good. I think we need to relearn how to just sit every now and then. It’s only when we stop moving for a second that we can actually appreciate what we have.
Have a great day everybody!
Dr. Katz
We are all tired.
Hey everybody. Show of hands…who seems to be tired all the time lately? I bet there is a ton of you. No matter how much sleep you get, no matter how well you eat, no matter how much caffeine you drink, that thick blanket of fatigue just never leaves lately. But why? My guess is that this persistent exhaustion isn’t actually just physical, it’s emotional as well. I mean sure, I am one of the believers that constant mask wearing puts you at risk for CO2 retention and respiratory acidosis, which can cause fatigue, but I know that is not the whole story.
So, why are we so exhausted? There are ten basic causes for fatigue that are the most common. Some of them we do to ourselves and some of them we have no control over. Let’s review.
The first one is poor diet. If you eat a diet full of refined sugars and carbs, you will be totally wiped out because all you get from that is short energy bursts followed by crashes. Likewise, if you are trying to diet and you are not actually getting enough calories to keep your body going, you will simultaneously just drain your own energy reserves throughout the day. On the other hand, if you eat a well balanced diet with no meal skipping, you will stay fueled the whole day!
The second one is using electronics before bed. I am totally guilty of this one. I mean, who is not filling their heads with the latest anxiety-causing social media right before they want to go to sleep? Sometimes it is the only time that we feel like we can “catch up” on the world right? Did you know that using electronics before bed turns up your fight or flight response which increases your pulse and blood pressure for several hours? It also decreases your melatonin levels. Both of those things are sure to keep you up longer. Ideally, you should aim to “unplug” at least three hours before bed time to give yourself a fighting chance.
The third one is sleep apnea. Sleep apnea happens when you literally stop breathing multiple times during the night, even if you don’t know that you’re doing it. This happens because your airways close while you are sleeping because of extra soft tissue. Not sure if this applies to you? Ask your bed buddy, if you have one, if you are keeping them up at night with your intense snoring. If the answer is yes, talk to your doctor about it and get treated.
The fourth one is anemia. If you are anemic with low hemoglobin, your red blood cell count is low and they are not getting enough oxygen and therefore you are tired all the time. The most common cause of anemia for women would be iron deficiency from menstrual blood loss. Some symptoms of anemia might be skin pallor, elevated pulse, fatigue or weakness. If you think you are anemic, talk to your doctor before self treating.
The fifth one is diabetes that is undiagnosed or poorly controlled. Diabetes causes excess sugars to stay in the bloodstream instead of going into the muscle where they can be used for fuel. As a result, you stay fatigued all the time. Some symptoms of diabetes could be frequent urination, excess hunger, excess thirst, and fatigue. If you think you might have diabetes talk to your doctor.
The sixth one is dehydration. We are all racing around lately without stopping just to try and keep up with the world around us. One sign of dehydration could be darkening of your urine when you go to the bathroom. If you notice, start increasing your fluids and see if it changes. We need to take the time to drink water frequently throughout the day. Experts say that we should aim for at least 3.7 liters(15.5 cups) a day for men and 2.7 liters( 11.5 cups) per day for women. How many of us are even close to that? I better get drinkin!
The seventh one is too much caffeine intake. I think that the world in general is guilty of this nowadays. There is no dietary recommendation for caffeine. It can be found in some medications, chocolate, caffeinated teas and sodas, and energy drinks. While caffeine can give you a temporary boost, it doesn’t last. How much caffeine is too much depends on the person. The effects of too much caffeine include increased blood pressure, elevated heart rate, premature heart contractions, and headaches. With caffeine, it really is a vicious cycle. You start drinking caffeine because you are tired. The caffeine then makes your body race and you get more fatigued. Then you find yourself “needing” more caffeine. Then when you try to wean yourself off of caffeine, you can get ridiculous headaches as it washes out of your system. In an ideal world, I would say don’t even try it in the first place. Mind you, I am saying this as I am sipping my dollar sized McDonald’s coffee.
The eight one is a chronic infection of some kind, most commonly a bladder infection. If you have been recently treated for a bladder infection and have no other symptoms except a lingering fatigue, go back to your doctor and get rechecked. You could have some infection left over.
The ninth one is thyroid issues. The thyroid is that little gland in your neck that literally has it’s fingers in multiple body functions, not the least of which, your metabolism. If your thyroid is underactive(hypothyroid), that could slow your metabolism and make you feel really sluggish. It could also affect your skin and make it difficult for you to lose weight. If your thyroid is really underactive, you might even notice a bulge in your neck and have trouble swallowing. If you think you have thyroid issues, call your doctor and get checked.
Last, but definitely not least, depression and stress are a major cause of fatigue. At least 25% of people suffering from depression report fatigue and a loss of appetite, in addition to the classic depressed mood that we think of. This is the one that I think is really affecting all of us right now with the the state of the world like it is. Depression causes feelings of sadness, anxiety or hopelessness for an extended period of time. People who are depressed often have sleep problems, which only add to the fatigue. Stress stimulates our flight or fight response which overtaxes our metabolism and can leave us feeling worn out and tired. Who doesn’t feel all of those things right now? The world is just not the same. We feel out of control. We feel like the joy has been sapped out of all our favorite things. We are spending a lot of energy looking for someone to blame for how things are instead of using our energy to deal with it. In my practice alone, the percentage of patients that I am helping with depression has risen 75%. This is a real problem and we need help.
So, we have talked about the causes. For the first nine, the strategy is fairly obvious: treat the underlying condition and the symptoms should resolve. Correct the lifestyle slip ups and the symptoms should get better. The last one, depression and stress, is a much harder mountain to climb. There is no one strategy that works for everyone because it is not a straightforward issue. You know what my first suggestion is going to be: talk to your doctor! Clue them in to what is going on with you and maybe they can help. Talk to your family and your friends. Maybe they are feeling the same way! Support each other the best we can! Seek counselling and therapy. I know that I personally have a list of counsellors ready to help at my office at any one time. Don’t try to tackle it all on your own! There is no harm, no foul, and no defeat in seeking help. The real battle is lost when you don’t take advantage of the resources around you and something terrible happens. Then the consequences spread like ripples on a pond, not only affecting you, but everyone you care about as well. Make sure you take the time to realize your own importance, especially now. No one can do that for you. I will make you a promise right now, we doctors are here for you.. We understand and we are tired too, but we will always be here.