Tip 1: Exercise

Regular physical exercise helps maintain mental health and boost our mood. In fact, regular moderate physical exercise has been studied and included in our psychiatry guidelines as an approach to help treat depression.

Tip 2: Sleep

Good sleep habits can help improve our mood and prevent mental illness. One third of our lives is spent sleeping, so learning good sleep habits is definitely worthwhile.

Tip 3: Balanced Thinking

We can change our mood by changing how we think. If we notice we are having all or nothing thinking (for example,  “nothing goes my way”, or, “no one likes me”), practice making those thoughts more balanced by seeing the other side of things (“some things don’t work out for me but other things do”, or, “some people like me while others don’t like me”).

This is a key component of cognitive behavioural therapy and can actually help us start to change our moods to become less depressed or anxious and more positive and balanced.

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For nearly two decades, Dr. Laflamme, 53, has helped care for patients as a cardiac anaesthesiologist at Sunnybrook Health Sciences Centre. During most of that time, he was a patient too: for years, he lived with chronic renal disease.

By 2012, however, his disease had progressed to the point that he needed a kidney transplant. “I was told to start looking for a living donor. Otherwise, I would have to go on dialysis,” says Dr. Laflamme.

Fortunately, he was able to avoid dialysis by finding a living donor in time. His sister, France, donated her kidney to him in 2014.

“After receiving my kidney, I was determined to take care of it and treat it with respect,” says Dr. Laflamme. “My sister made a huge sacrifice by becoming a living donor, so if nothing else, I wanted to honour her decision by living a healthy life.”

He began cycling as part of his commitment to a healthy lifestyle, and before long, he was riding four or five times a week. Last year, a friend mentioned that he might be able to participate in the 2017 World Transplant Games (WTG) in Malaga, Spain.

“I had never heard of the event, but once I looked into it, getting to the Games became a huge motivator for me,” says Dr. Laflamme.

By his own admission, Dr. Laflamme was not an athlete before his transplant, and he had never competed in cycling before. Upon arriving at the WTG in June, though, he realized the event was about much more than winning medals.

“It was so inspiring to see all of these incredibly fit people, people you would never know had a transplant by looking at them, leading such healthy and active lives. The camaraderie among the participants was really amazing,” he says.

As an athlete living with a transplant, Dr. Laflamme says one of the largest obstacles to participating in sports is dealing with the side effects of the many medications transplant recipients must take. Some medications can affect balance, while others can cause muscle pain.

The biggest barrier, however, is often psychological. “For many of these organ recipients, they’ve lived with chronic disease for so long that they don’t know what it’s like to be healthy,” he says.

That inspired Dr. Laflamme to become an official Fit for Life ambassador for the WTG Federation, providing education and encouragement to other transplant recipients about getting involved in competitive sports.

“I’m helping to create a community of transplant recipients and teams where we can talk about goal setting, motivation and coaching. I didn’t have access to those kinds of resources after my transplant, and I think it would have helped so much during my recovery,” says Dr. Laflamme.

During this year’s WTG, Dr. Laflamme competed in three events: the 5km time trial, the 20km team ride and the 32km individual ride. He plans to add another event, running, to his schedule for the next WTG event in 2019, and has already started training with a coach.

“I haven’t felt this good in twenty years. Post-transplant, I’m healthier now than I’ve ever been.”

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What causes fatigue?

There are many causes of cancer-related fatigue and often a person will have more than one reason for being fatigued at any given time. There are treatments and things you can do to help with fatigue.  Talk to your health care team  about some of the causes of fatigue.

• It is important to remember that your body is fighting against your cancer.  This is very hard work and can result in the feeling of fatigue.
• Cancer treatments can cause fatigue. It is very common for a person who is getting chemotherapy or having radiation treatments to feel fatigued.
• Another common and treatable cause of cancer-related fatigue is anemia.  When a person is anemic, it means they have fewer red blood cells in their bloodstream than what they would normally have.  Anemia can be caused by cancer itself or can be a side effect of treatments. Sometimes anemia can be treated with medications that increase the body’s production of red blood cells. If you have anemia, your health care team might suggest that you receive a blood transfusion.
• When a person has been told they have cancer or is having treatment for their cancer, it is very common for this to be an emotional or distressing experience.  This can make a person feel fatigued.
• It is very common for a person with cancer to have trouble with sleeping.  Waking up often during the night and not getting enough sleep can make fatigue worse.
• Other symptoms like pain, trouble breathing and nausea (feeling sick to your stomach) can result in fatigue.

What’s important for me to know about fatigue?

Just like pain or nausea (feeling sick to your stomach), fatigue is a real symptom and it can have a big impact on your life.  You might think you are expected to feel fatigue when you have cancer.  You might also think it is not something you need to tell your health care team about. . There are things that can help you feel less tired and it is important for you to talk to your health care team about your fatigue as different suggestions can be made depending on the underlying cause.

Sometimes a person is worried their fatigue might mean their cancer treatment is not working. If you are worried about this, please discuss this with your health care team.

It is important for you to know what you can do about cancer-related fatigue:

• Exercise regularly (this is the most effective thing you can do to improve your fatigue)
• Keep a journal or diary of how you feel each day. This can help plan daily activities
• Let others help with tasks that need to get done (for example laundry or cleaning)
• Save your energy for the things you enjoy doing
• Don’t be afraid to ask for help. Friends and family might be willing to help, but may not know what to do.
• Try to balance activities with rest.
• Take one short nap not longer than one hour during the day.  If you find you need to sleep more than this please speak to your health care team as this may mean that there are issues other than fatigue that need to be looked at and explored further.

When should I speak to someone about the fatigue I’m feeling? When should I be concerned?

One way to think about whether you should speak to someone about the fatigue you are feeling is to think about how it is affecting your life.  If you are worried or distressed about the fatigue you are experiencing, speak to your health care team.  Also, you can ask yourself these three questions:

1. Am I more tired in general than before I had cancer?
2. Am I too tired to do things like go grocery shopping or go out for dinner with friends?
3. Am I too tired to get out of bed in the morning or get dressed?

If your answer is “Yes” to the first two questions, be sure to discuss fatigue with your health care team during your next visit.  If you also answer, “Yes” to the third question, you or someone you know should contact your health care team right away.  It is concerning if your fatigue is bad enough that it impacts your ability to do things like get out of bed or get dressed.

Fatigue is very common for a person living with cancer.  Many of the underlying causes of fatigue have treatments and ones that you can do yourself without the use of medication however just to be sure that you are following the right path and that there is no other reason for your fatigue it is important to to tell those caring for you at the place you are getting treatment so they can determine what the cause is and to jointly develop a plan to help you.

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A low-to-moderate intensity exercise program can substantially reduce cancer-related fatigue. Tips on implementing an exercise program that’s right for you.

Exercise reference »

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Strength training and speciality workouts from About.com »

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‘Find the best workout for you’ from WebMD »

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‘Physical Activity’ from the Public Health Agency of Canada »

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‘Pulse & Target Heart Rate’ from Cleveland Clinic »

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‘Physical Activity and the Cancer Patient’ from the American Cancer Society »

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