8 Ways to Battle Fatigue

When you live with multiple myeloma, fatigue can feel like a constant companion, following you wherever you go and affecting whatever you try to do. It can be so pervasive, you may have days when you simply don’t feel like moving off the couch.

Fatigue is probably the number one symptom people living with multiple myeloma grapple with. Philip Imus, MD, an assistant professor of oncology at Johns Hopkins Medicine in Baltimore, agrees. And, everyone experiences it differently. “For some, it is mainly annoying,” he explains. Other people may need to sleep more than before but are able to go about daily life as usual.

Still others may find themselves exhausted doing the same activities they did before being diagnosed with multiple myeloma, including going to work and caring for their families and households. Wherever you fit on the spectrum, there are things you can do to help fend off fatigue.

The Myeloma-Fatigue Connection

Multiple myeloma has a direct impact on bone marrow, where red blood cells are formed. This can cause anemia, a condition characterized by a shortage of these cells, which are responsible for moving oxygen throughout the body. When there’s a deficit of red blood cells, your oxygen levels can nose-dive, as can your energy levels.

Myeloma can also cause the body to produce high levels of cytokines: proteins that signal the immune system to respond to viruses, bacteria, and other potential causes of infection, according to Cleveland Clinic. The inflammation that results can leave you feeling depleted and tired, as if you have a cold or the flu.

If you have bone pain, a common symptom of multiple myeloma, dealing with that can be tiring, too, says Ammar Alzoubi, MD, a board-certified hematology oncology specialist at ChristianaCare Pathology Hematology in Newark, Delaware.

Then, there’s the toll that living with multiple myeloma can take on your mental health. Having cancer can lead to extreme anxiety and stress. “If you are worried about your prognosis and your future, this can certainly bring on fatigue,” Dr. Alzoubi says.

The Role of Treatment

Treatment for any type of cancer is notoriously debilitating. “The body is trying to process strong medications,” explains Grace Suh, MD, medical director of the Northwestern Medicine Cancer Center Delnor in Geneva, Illinois. “The immune system is working hard, and this puts stress on the body.”

Fatigue is also a direct side effect of certain multiple myeloma medications. These include:

• Immunomodulatory drugs such as lenalidomide (Revlimid) and pomalidomide (Pomalyst)
• Proteasome inhibitors such as bortezomib (Velcade), carfilzomib (Kyprolis), and ixazomib (Ninlaro)
• Monoclonal antibodies such as elotuzumab (Empliciti) and daratumumab (Darzalex)

Even pain relievers can factor into melanoma-treatment fatigue, by causing drowsiness or headache. And, if you happen to take medication for another health condition, such as high blood pressure or high cholesterol, that may exacerbate fatigue.

Managing Multiple Myeloma Fatigue

You may not be able to fully avoid feeling tired and run down as a result of living with multiple myeloma and undergoing treatment for it. When a wave of exhaustion hits, it’s important to respect it and rest as much as you need to, even if that means missing a day of work or canceling an appointment.

But, you can have some degree of control over how fatigue caused by multiple myeloma impacts your daily life.

1. Keep a fatigue journal. Note when you’re feeling energetic, when you need to nap, when you have trouble sleeping, and so on. Keeping track of highs and lows in your energy levels may reveal patterns that can help you and your doctor home in on what may cause your fatigue, says Dr. Imus. For example, if you tend to feel most listless after a treatment session, your medication is likely the main reason for the fatigue.
2. Reach out to your doctor. If you’re so debilitated by tiredness that you’re unable to function more often than not, talk to your doctor. Show them your journal, so they have a clear picture of what you’re experiencing and when you tend to be at your lowest. They may be able to change your medication, recalibrate the dose, or make other adjustments to your treatment that will help fend off fatigue, Imus says.
3. Don’t ignore other symptoms. Be sure your doctor also knows about other symptoms and side effects, such as bone pain or depression, that you’re dealing with, Alzoubi advises. Treating these problems may also help counter tiredness.
4. Keep moving. Find ways to be physically active every day, even if you aren’t up for a full-on workout. Take a stroll around the block, or devote 15 minutes to simple stretches. “Exercise can help with fatigue and your mood,” says Imus.
5. Don’t push yourself. After a treatment, rest, stay hydrated, and don’t overdo physical activity. “This is when you really need to listen to your body,” says Dr. Suh.
6. Find out if you can change your treatment time. Ask your doctor’s office if you can schedule appointments for Fridays. This gives you the weekend to take it easy, so you may feel strong enough to return to work or your regular weekday activities by Monday.
7. Eat well. This can be hard to do if you’re too wiped out to cook. But, committing to a well-balanced diet may boost your energy, says Suh. “We recommend a Mediterranean-style diet” — an eating plan that includes lots of fresh produce, lean proteins, and healthy fats.
8. Prioritize quality sleep. Aim for a regular schedule, meaning go to bed and wake up at the same times each day, Alzoubi says. If you need to nap, that’s fine. “Sleeping for an hour can give you more energy toward the end of your day, but don’t sleep for too long, or your nighttime sleep may be impacted,” he says.