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Life Beyond Cancer - Physical Issues

Physical issues can include:

Scroll through these topics or click on one to go directly to that content.

Fatigue

Fatigue is the most common complaint among survivors in the first year of recovery.  It is an overwhelming sense of exhaustion which rest and sleep do not always cure.  Researchers are trying to better understand the causes of this phenomenon.

How long will the fatigue last?  There is no normal pattern to this, but we do know that it generally depends on the type of cancer you have and your treatment.  It occurs most frequently with patients who have received chemotherapy.

It is not uncommon for survivors to feel frustrated with the fatigue because it lasts longer than they expected and interferes with their daily routine.

What can you do?

  • Talk to your doctor about what may be causing your fatigue
  • Exercise!
  • Follow a healthy diet and drink plenty of fluids
  • Avoid caffeine, alcohol, and smoking in the evening hours
  • Develop a bedtime routine, go to bed at the same time each night
  • If pain is a problem, ask your doctor how can it be better managed
  • Discuss with your doctor medicines or nutritional supplements that may help
  • Plan and prioritize your day to be active when you are the most energetic
  • Schedule a rest period after each activity
  • Let others help you
  • Focus on activities that give you the most joy
  • Consider joining a support group
  • Meditation or mindfulness based stress reduction strategies

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Memory and Concentration

Memory and attention problems are also common complaints among survivors.  Research has shown that 1 in 4 people have problems with “chemo brain” after receiving chemotherapy.  People describe problems with their attention, having difficulties multi-tasking, having trouble finding the right word (“it’s on the tip of my tongue”), and remembering things.

What can you do?

  • Keep a notebook and pocket calendar with you at all times.  Write it down!
  • Use a checklist system to remember tasks. Prioritize the tasks.
  • Use a day planner. Write down appointments immediately.
  • Use notes around house to “jog your memory”
  • Get plenty of rest
  • Avoid distractions.  Do one task at a time, if possible.
  • Maintain structure in your life, try to keep things the same
  • Put items back in their proper place so you remember where they are
  • Meditate to help relieve stress and increased confusion

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Bowel and Bladder Control Problems

Incontinence is defined as the uncontrollable loss of urine or feces.  This is an extremely upsetting issue that some survivors may face as they move into recovery.  Most people are ashamed, feel self-conscious, and are fearful to step out into the public world once again.  This problem is usually the result of nerve damage after having undergone surgery or radiation in the pelvic area.  The extent of your bowel or bladder problems depends on the extent of your treatment.

What can you do?

  • Ask your doctor about possible medications that may help
  • Do kegel exercises frequently throughout the day to help strengthen the urinary muscle
  • Empty your bladder on a scheduled basis to avoid accidents
  • Limit caffeine and alcohol to decrease urinary frequency
  • Avoid foods that may increase bowel frequency
  • Use an incontinence pad to absorb any unexpected leakage
  • If you have and are coping with an ostomy (an opening from inside the body to the outside to pass urine or waste material), there is information and support available to you.  Please refer to the resources list at the end of this section.

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Neuropathy (Numbness, burning and pain in hands or feet)

Neuropathy is an uncomfortable burning/tingling sensation in the hands and feet that is caused when nerve endings are damaged.  Neuropathy can be caused by chemotherapy, radiation or surgery.  If you are experiencing neuropathy, please talk to your health care provider.  Options that may be available to you are medication, acupuncture, topical ointments, and vitamin supplements.  Please refer to the resource list at the end of this section for further information.

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Pain

It is not uncommon for patients to experience pain.  Just as each person is unique, so is the pain.  Pain can be acute, lasting only a few days, or it can be chronic or long lasting.  Pain can also vary in intensity from mild to severe and may affect a single site or several parts of the body.  Pain can dramatically alter your quality of life.

What causes pain?  Pain can be categorized in three distinct ways:

Pain from the tumor
This generally occurs because the tumor is large enough to press on other areas of the body, causing discomfort or pain. 

Pain from cancer treatment
Chemotherapy, radiation, and surgery, or the combination of all three, can cause pain or discomfort.  It is important to keep an open dialogue with your health care provider about your pain so you will have the most appropriate plan for pain management.

Pain after Surgery
Generally, pain associated from surgery is a short-term problem.  Your health care provider will prescribe appropriate medication immediately following surgery to relieve your pain.  Pain relief benefits the healing process.

Alternative Therapies for Pain Relief

In addition to what your doctor has prescribed, there are a number of different alternative approaches that may minimize or alleviate your pain: 

  • Acupuncture
  • Meditation
  • Guided Imagery
  • Yoga
  • Mindfulness-based stress reduction
  • Exercise
  • Reiki

Please refer to the resource list at the end of this section to learn more about alternative therapies.

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Vaginal Changes

Vaginal changes are a common side effect in women who undergo cancer treatments.  Examples include dryness and decreased elasticity in the vaginal area.  This can cause pain/discomfort during sexual intercourse or pelvic examinations.  If this occurs, talk to your health care provider. [Over-the-counter, water-based lubricants are available at minimal cost and can restore moisture to the area.  Vaginal dilators are also available to help maintain elasticity and shape to the area, which can help decrease the amount of discomfort experienced during sexual intercourse.]

What can you do?

  • Apply water-based lubricants to the external vaginal area.  Examples of lubricants that can be bought over-the-counter or at your local pharmacy are:
    • Astroglide
    • K-Y Liquid
    • Sylk
    • Wet
  • Vaginal moisturizers can be helpful.  These are different from lubricants.  They are used inside the vagina.  This is a non-hormonal product and can be purchased over-the-counter.  It is generally used 3-5 times a week and is placed up inside the vagina, regardless of sexual activity.  It moisturizes the tissue that makes up the vaginal canal, thus helping hydrate the membranes and increase the elasticity or pliability of the vagina, which can help reduce pain during intercourse.  An example of a vaginal moisturizer is Replens.
  • Consider the use of graduated vaginal dilators.  These are used to stretch the vaginal opening in order to maintain elasticity in the area. Stretching the area will help make a pelvic exam more comfortable, make sexual intercourse more comfortable and will allow you to feel more confident.  Talk to your health care provider about this option.  Refer to the resource list at the end of this section for a link on how to use vaginal dilators.

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Difficulty Swallowing

People who have radiation to the head and neck area are most vulnerable to this particular side effect.  Eating soft, bland foods moistened with sauce or gravy is very helpful.  Other useful tips include:

  • Use a blender to process solid foods
  • Try high caloric, protein drinks (Ensure, Boost)
  • Take sips of fluids every few minutes to moisten the mouth
  • Talk to a nutritionist
  • Involve a speech pathologist
  • Maintain routine appointments with your dentist
  • Use oral rinses of warm water and salt or a non-alcoholic based mouth rinse throughout the day

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Mouth Sores

It is not uncommon for people to have problems with inflammation of the mucus membranes (lining of the mouth) and/or the tissues in the mouth (gums, tongue, roof of mouth).  Mouth sores usually present as red, burn-like sores/ulcers in the mouth and can be extremely uncomfortable.  It is most commonly caused by chemotherapy and radiation to the head and neck.  The risk increases when chemotherapy and radiation treatments are given simultaneously. 

What can you do?

  • Clean teeth and mouth every 4 hours and at bedtime
  • Sip on ice chips
  • Rinse mouth with warm water and salt (or a non-alcoholic based mouth rinse)
  • Talk to your health care provider regarding oral or topical pain medications

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Lymphedema

Lymphedema is swelling in a part of the body, most frequently the arm.  It is caused when lymph nodes, located under your armpit, have been surgically removed or have been exposed to radiation.  Lymph fluid accumulates in the tissue of the arm causing swelling that starts at the fingertips and moves upward.  This accumulation of fluid can be painful if the swelling is extensive and can also limit your ability to use the arm.  If you feel lymphedema is becoming a problem for you, talk to your health care provider. 

What can you do?

  • Mild resistance training starting with light weights
  • Keep skin clean and moisturized
  • Avoid blood pressures and blood draws in the affected arm
  • Consider seeing an occupational therapist in your area who specializes in lymphedema
  • Use a compression garment if recommended by your physical or occupational therapist 
  • Wear sunscreen and bug spray when outdoors

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Osteoporosis

Osteoporosis is a common side effect of people undergoing cancer treatment.  It is defined as the thinning of bone tissue and loss of bone density which is accelerated by sudden drops in estrogen levels.  Estrogen is a natural protectant of bones. Therefore, with decreases of estrogen in the body, the risk of osteoporosis rises.  People who are at risk for osteoporosis are:

  • Post-menopausal women
  • Men or women receiving hormonal therapies
  • People who received high doses of steroids as part of their treatment
  • Treatments that decrease or block hormonal pathways

What can you do?
Exercise is a very important component for decreasing your risk for osteoporosis.  A combination of moderate aerobic activity (brisk walk, mowing the lawn, dancing) and resistance training/exercise is best and will have lifelong benefits. Modifying your dietary habits is also very important. Include foods rich in calcium such as spinach, kale, tofu, milk, cheese, yogurt, and orange juice.  Vitamin D is also an important component to bone health.  Very few foods contain vitamin D.  Tuna, salmon, mackerel and fish liver oils are all good sources of this vitamin.  Talk to your health care provider to see if vitamin D supplements are appropriate for you.

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Menopausal Symptoms

After chemotherapy, some women stop having their regular menstrual cycles every month.  In addition, medications taken as part of cancer treatment (Tamoxifen, Arimadex) can cause changes in a woman’s body by decreasing the production of hormones.  These drugs can also cause menopausal symptoms, which may include:
Irregular or absent periods

  • Hot flashes
  • Fatigue
  • Vaginal dryness
  • Decreased interest in intimacy and sexual intercourse
  • Memory and attention issues
  • Depression and anxiety

What can you do?

  • Modify your diet to include more fruits/vegetables and less processed foods
  • Exercise
  • Acupuncture
  • Meditation
  • Yoga
  • Massage
  • Mindfulness-based stress reduction
  • Speak to your healthcare provider to discuss options that might be available to you

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Skin, Hair and Nail Changes

Chemotherapy and radiation affect rapidly growing cells, including skin, hair and nails.

The skin is the largest organ in our body, and it is constantly renewing itself to provide the best barrier against infections while retaining vital fluids. This process makes the skin extremely vulnerable to chemotherapy, which can lead to rashes, itching, dry skin, and skin infections.

Hair loss is also common during chemotherapy, and sometimes can persist well after therapy has been completed.  If you have been told that you will probably lose your hair, be prepared for the loss of your pubic hair, as well.

Nails, which are formed from skin, can also be affected by chemotherapy, especially those drugs that are taxane based. Vitamins, such as Biotin, can be used to strengthen nails after treatment.

Radiation can cause skin irritation.  It is normal and expected that your skin becomes red and flaky from the cumulative effects of radiation.  The skin may become painful and infected and require treatment with antibiotics or anti-inflammatory creams.  Keep your radiation team informed of any changes that may occur.

Overall, limit your exposure to the sun by wearing sunscreen with SPF 30 and wearing protective clothing.

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Resources

 

 

 

 

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