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Ask The Expert Welcome to our "ASK THE EXPERT Series" for breast cancer now what
On a regular basis a leading oncology expert will be available to answer questions during a real time Special Guest Chat session. After the chat hour, the transcript of the chat is placed in the breast cancer now what discussion board for members to read if not able to attend. Our expert will take that transcript and create a response article like this one below. Check out past topics posted in the Ask the Expert Achives.
Pain & Symptom Management Made Easy
How can I better manage fatigue after radiation treatment?Many women experience cancer related fatigue after chemotherapy or radiation that is constant, does not respond to rest and interferes with life in general, however fatigue can be managed. The first thing to do is to understand the underlying cause of the fatigue. Could it be related to anemia, diarrhea, dehydration, fever, nausea or vomiting and or pain? If this is the case then your physician could help with managing the symptoms that may include medications (ie: supplements, stimulants, anti emetics or opioids). Increasing fluid intake or changing your diet to include increased protein may also be helpful. You may find the following handouts by Oncology Nutrition, BC Cancer Agency worth exploring:
Dial-a-Dietitian is also a service available over the telephone and on-line 24/7 to offer consultation in this area as well. Dial 811 in British Columbia.
Depression is another cause of fatigue and occurs in 25% of cancer patients. If you have noted a change in your outlook, sleep pattern, appetite, work style or loss of interest in activities the underlying cause of the fatigue could be depression. Talking to a counsellor or physician could be helpful. There are medications to assist but sometimes it is enough just to speak with someone or become involved in a support group. Every day tips that may be helpful for you in managing fatigue include pacing yourself throughout the day by prioritizing your activities, taking small rest breaks, eating small well balanced meals frequently and drinking plenty of fluids (fluids help to get rid of waste products that build up as cancer cells die), asking for help, planning your day to take advantage of when you have the most energy and sharing your feelings with family and friends. Interestingly being physically active can decrease fatigue. Rhythmic exercises such as walking, cycling or swimming involving a large number of muscle groups can help to restore your energy. When exercising listen to your body, progress slowly and stop if something hurts. Energy therapies and or acupuncture could also be beneficial in managing fatigue. Energy therapies include Reiki, therapeutic touch, healing touch, magnet therapy and Qi gong. Underlying these is the belief that treatment is needed to either “balance” energy in the body or to relieve blockages of energy. For example Reiki is designed to establish an energy balance in the body that decreases tiredness and improves quality of life. Mindfulness-based Stress Reduction, a structured psycho-educational therapy that combines mindfulness meditation with yoga can reduce fatigue, pain, anxiety and high blood pressure. Relieving anxiety and stress through relaxation, music therapy, support groups, massage therapies and yoga can help to reduce fatigue.
Once treatments are completed your energy level will probably return, however some cancer survivors experience fatigue for longer periods of time after treatment.
Is medication helpful in the prevention or management of nausea/vomiting?Nausea and/or vomiting are caused by a variety of triggers or combination of triggers. It is important to establish the most likely cause before determining the treatment. Position, chemicals (ie: chemotherapy induced), mechanics and the central nervous system (ie: sights, smells, fear) are all possible triggers. The prevention or management of nausea/vomiting depends on the trigger keeping in mind that nausea/vomiting is often caused by a combination of triggers. If the trigger is positional (ie feeling nauseated when you turn your head) medications such as gravol are very helpful. If the trigger is chemical (chemo induced nausea) ondansetron is the gold standard and is given pre and post chemo often in combination with other anti emetics.
If the trigger is mechanical where the GI tract is ‘sluggish’ medications such as metoclopramide or domperidone are the best choice. Managing constipation is important and avoiding heavy meals or overeating are preventative strategies.
If the trigger is from the central nervous system (ie: sights, smells, memories of nausea) relaxation exercises, meditation and minimizing food odours are helpful. Cold food may be a better choice. Medications include ativan and cannabinoids (ie: marinol or cesamet).
Some non pharmacological strategies to manage or prevent nausea include acupuncture, chamomile, peppermint or ginger tea and behavioural therapies such as hypnosis, meditation and progressive relaxation.
Managing nausea and/or vomiting can be very complex if there is a combination of triggers and a combination of pharmacological and non pharmacological therapies is often the best strategy to take. So in answer to the question of whether or not meditation can be helpful the answer is yes it can be helpful in preventing or managing nausea in combination with other therapies.
I have been having serious joint pain. What can be done to manage the pain?Joint pain has been known to be a side effect from the Aromatase Inhibitors (AI) such as anastrozole, exemestane and letrozole. The AI’s work differently from tamoxifen. Tamoxifen blocks the tumour’s ability to use estrogen, and AIs reduce the amount of estrogen in the body.
There is a recent study that examined whether acupuncture provides pain relief for joint pain. The results indicated that after 6 weeks of therapy women reported an improvement in joint pain, stiffness, functional ability and physical well being. Approximately two thirds of the participants found acupuncture to be moderately relaxing and enjoyable. Many participants were taking an anti inflammatory such as ibuprofen (over the counter) or naproxen (prescription required) and the combination of the pharmacological and non pharmacological therapies provided relief. |
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