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Fatigue - Any tips?

User
Posted 05 Sep 2020 at 11:48

Hello,

My dad is 70 and has been suffering with advanced prostate cancer for 8 years.

His treatment journey has been:

  • First 3 years Zoladex injection hormone therapy only (this has continued throughout the last 8 years)
  • Next 4 years Enzalutamide tablets
  • At the beginning of this year, he had a course of 6 rounds of chemotherapy  (Docetaxel) but stopped after 6 treatments as the side effect of intense fatigue was too intense

At each stage, his treatment has been changed due to an increase in PSA level.

His main side effect of the cancer and treatment has always been fatigue which has increased over the years.

After the Docetaxel, his consultant gave him time to recover, but that was in January of this year, so by the time he’d had a couple of months recovery, we went into lockdown across the country.

His consultant then advised he would speak to him again in four months. At the time this didn’t seem unusual, but thinking back, I feel that we should’ve questioned it as he would usually speak to him once a month.

Over the four months, dad continued to take a low does of steroids (Docetaxel). His fatigue worsened, so his consultant slightly increased his dose of this, but it seemed to make little difference.

When he had his official consultant with the consultant a few weeks ago, his blood tests showed that his PSA had gone from being 12 to over 250. His consultant advised that he wouldn’t be able to give him anymore treatment as he felt that my dad couldn’t cope with it.

Since then, he has been referred to a hospice and the doctor at the hospice has assessed him. He’s also had a district nurse come out to the house to assess if there was anything that could be done to help him in the house to make his life easier.

His main issue is fatigue. He cannot walk for more than a few steps without needing to lean on a work surface or cupboard for relief. He can slowly change his clothes but needs to take large breaks in between each piece of clothing. Mum now helps him wash.

He finds it difficult to sleep at night so generally goes to bed at 2am and wakes at 7:30am, but he doesn’t have a full nights sleep and often gets up in the night and cannot rest straight away so stands for maybe an hour to calm himself.

He suffers with aching in his chest and an elevated heart rate when doing any activity. He also suffers with feeling of anxiety (due to the concerns about where he is in his cancer journey).

His GP suggested doing a spirometry test to see if there was any other underlying condition, for example COPD, but due to Covid, we are unable to get this test done either on the NHS or privately.

Dad has asked for an inhaler as he was given one at the start of the year when he had a chest infection, and it helped over that period, so he wants to try one now to see if this will help him. But his GP and doctor at the hospice are reluctant to try him with one.

He hasn’t been able to do anything but sit in the house or drive mum two and from the shops for the past 6 months. He doesn’t want to go into any shops due to Covid.

His legs have swelled which may be from sitting for long periods of time, or may be partly due to the steroids. He now has an elevated foot rest that he is using to try to reduce some of the swelling.

My dad just wants to have a little bit more energy, not feel these aches in his chest, and feel a bit more confident as he now doesn’t feel confident to drive. In an ideal world, I’d want to get him tao the point where he can walk a little further - even just a few more steps so I could take him out for a coffee and a change of scenery. I bought him a stick last year and when he was walking outside, he felt that this was helpful.

His doctor at the Hospice decided to increase his dosage of steroid for a week, then reduce slightly, then reduce a bit more. Dad didn’t feel like the steroids were making a difference and told the doctors so she advised that he stopped taking them altogether. He felt awful straight away and felt he could do even less than before.

We’ve spoke to his GP, the hospice doctor and his consultant, but none have been able to provide help to elevate the fatigue.

Has anyone had a similar experience? Is there anything that you did / were prescribed that helped? Is there any general advice you could give?

If you’ve read this all, then I really appreciate it - I didn’t mean to make this post so long, but I felt I needed to explain the whole story!!

 

 

 

 

 

User
Posted 05 Sep 2020 at 17:33

Hello there

I can’t really offer any expert advice as this is all sadly new to my family but will share a bit about my dad who is having similar issues to your dad.

My dad is 84 with advanced prostate cancer diagnosed 2 years ago - all reasonably ok on hormone injections until about Feb this year, when scans show cancer spread to lymph nodes and symptoms appearing ie tiredness, pelvic pain, swollen foot, breathlessness.

Fast forward to now, dad now on Abiraterone past 4 weeks but symptoms have got seriously worse and the worse for him is the total fatigue, breathlessness, weakness in that he can barely walk to garden without being totally exhausted, dizzy, breathless and has to go back to bed.

I noticed he was quite pale sometimes and it seemed odd to me he was so breathless so asked the nurse this week about anemia and so he got a full blood test and yes he is anemic and he is getting a blood transfusion in hospital this Tuesday. We really hope this will help with the breathlessness and some tiredness though of course fatigue can be the cancer and the drugs too.

So I just wanted to advise it might be worth you asking your dad’s doctor/nurse if he has been tested for anemia in case that might help.

My dad also has a badly swollen leg which does go up and down a bit... this is due to the cancer in his lymph nodes...the nurse mentioned an NHS clinic that might help with this but closed due to Covid19!

my dad was also not sleeping well about a month ago due to some pelvic pain and twitchy legs but they gave him some morphine tablets and since then he has enjoyed really good sleep every night - thankfully as they need some good luck.

Really hope you can get your dad more comfortable ... it is really awful watching them suffer isn’t it.

anne

xx

User
Posted 05 Sep 2020 at 17:39
Yes it would be a good idea to check that the doctors have ruled out anaemia and also heart failure. Chemo can cause heart damage - not always explained to patients.

Assuming his bloods and heart are okay, it is worth calling the PCUK nurses as the charity has done some work on HT-induced fatigue and may be able to suggest things you haven't tried. I would also consider buying or renting a mobility scooter so you can get him out and about- a lift in his spirits is worth a hundred tablets.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 05 Sep 2020 at 19:55

Dad should not be pushed too hard or for too long so should be assessed but might then benefit from some physiotherapy and a planned  exercise program.

Edited by member 05 Sep 2020 at 19:56  | Reason: Not specified

Barry
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User
Posted 05 Sep 2020 at 17:33

Hello there

I can’t really offer any expert advice as this is all sadly new to my family but will share a bit about my dad who is having similar issues to your dad.

My dad is 84 with advanced prostate cancer diagnosed 2 years ago - all reasonably ok on hormone injections until about Feb this year, when scans show cancer spread to lymph nodes and symptoms appearing ie tiredness, pelvic pain, swollen foot, breathlessness.

Fast forward to now, dad now on Abiraterone past 4 weeks but symptoms have got seriously worse and the worse for him is the total fatigue, breathlessness, weakness in that he can barely walk to garden without being totally exhausted, dizzy, breathless and has to go back to bed.

I noticed he was quite pale sometimes and it seemed odd to me he was so breathless so asked the nurse this week about anemia and so he got a full blood test and yes he is anemic and he is getting a blood transfusion in hospital this Tuesday. We really hope this will help with the breathlessness and some tiredness though of course fatigue can be the cancer and the drugs too.

So I just wanted to advise it might be worth you asking your dad’s doctor/nurse if he has been tested for anemia in case that might help.

My dad also has a badly swollen leg which does go up and down a bit... this is due to the cancer in his lymph nodes...the nurse mentioned an NHS clinic that might help with this but closed due to Covid19!

my dad was also not sleeping well about a month ago due to some pelvic pain and twitchy legs but they gave him some morphine tablets and since then he has enjoyed really good sleep every night - thankfully as they need some good luck.

Really hope you can get your dad more comfortable ... it is really awful watching them suffer isn’t it.

anne

xx

User
Posted 05 Sep 2020 at 17:39
Yes it would be a good idea to check that the doctors have ruled out anaemia and also heart failure. Chemo can cause heart damage - not always explained to patients.

Assuming his bloods and heart are okay, it is worth calling the PCUK nurses as the charity has done some work on HT-induced fatigue and may be able to suggest things you haven't tried. I would also consider buying or renting a mobility scooter so you can get him out and about- a lift in his spirits is worth a hundred tablets.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 05 Sep 2020 at 19:55

Dad should not be pushed too hard or for too long so should be assessed but might then benefit from some physiotherapy and a planned  exercise program.

Edited by member 05 Sep 2020 at 19:56  | Reason: Not specified

Barry
User
Posted 05 Sep 2020 at 22:54

Originally Posted by: Online Community Member

Hello there

I can’t really offer any expert advice as this is all sadly new to my family but will share a bit about my dad who is having similar issues to your dad.

My dad is 84 with advanced prostate cancer diagnosed 2 years ago - all reasonably ok on hormone injections until about Feb this year, when scans show cancer spread to lymph nodes and symptoms appearing ie tiredness, pelvic pain, swollen foot, breathlessness.

Fast forward to now, dad now on Abiraterone past 4 weeks but symptoms have got seriously worse and the worse for him is the total fatigue, breathlessness, weakness in that he can barely walk to garden without being totally exhausted, dizzy, breathless and has to go back to bed.

I noticed he was quite pale sometimes and it seemed odd to me he was so breathless so asked the nurse this week about anemia and so he got a full blood test and yes he is anemic and he is getting a blood transfusion in hospital this Tuesday. We really hope this will help with the breathlessness and some tiredness though of course fatigue can be the cancer and the drugs too.

So I just wanted to advise it might be worth you asking your dad’s doctor/nurse if he has been tested for anemia in case that might help.

My dad also has a badly swollen leg which does go up and down a bit... this is due to the cancer in his lymph nodes...the nurse mentioned an NHS clinic that might help with this but closed due to Covid19!

my dad was also not sleeping well about a month ago due to some pelvic pain and twitchy legs but they gave him some morphine tablets and since then he has enjoyed really good sleep every night - thankfully as they need some good luck.

Really hope you can get your dad more comfortable ... it is really awful watching them suffer isn’t it.

anne

xx

Hi Anne 🙂,

 

Thank you for your reply. Funnily enough, his doctor is having him tested for anemia this week! After speaking to him this evening, it seems that the doctor has also told him that the swelling in his legs is Lymphoedema. I suggested the sleeping tablets to him, and he seems keen to try them so we're going to speak to the doctor about it this week.

 

I really appreciate your reply and I wish you, your dad and your family all the best xx

User
Posted 05 Sep 2020 at 22:59

Originally Posted by: Online Community Member
Yes it would be a good idea to check that the doctors have ruled out anaemia and also heart failure. Chemo can cause heart damage - not always explained to patients.

Assuming his bloods and heart are okay, it is worth calling the PCUK nurses as the charity has done some work on HT-induced fatigue and may be able to suggest things you haven't tried. I would also consider buying or renting a mobility scooter so you can get him out and about- a lift in his spirits is worth a hundred tablets.

Thank you Lyn - the symptoms of heart failure do resonate with how he has been feeling. It's something that I will raise with his doctor. 

I completely agree - if I can raise his spirits I know he is all the better for it 🙂.

User
Posted 05 Sep 2020 at 23:04

Originally Posted by: Online Community Member

Dad should not be pushed too hard or for too long so should be assessed but might then benefit from some physiotherapy and a planned  exercise program.

Thanks Barry 🙂. If we can get him to the stage of physiotherapy and some light exercise, that would be amazing.

 
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