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Fatigue is a common side effect of many medications as well as a symptom of multiple health problems. Although not terribly painful, chronic unmanageable fatigue can be frustrating as well as debilitating. It is a symptom without any visible proof. It is not considered life threatening as long as you aren’t driving, operating heavy equipment, or engaged in a risk occupation. Few symptoms can disturb quality of life more than relentless fatigue can. However, you don’t have to take fatigue lying down.

Even if you know what is causing your fatigue, it is important to rule out other factors. Start by talking to your doctor. Fatigue is a symptom of many conditions such as thyroid dysfunction, anemia, depression, sleep apnea, liver disease, and peri-menopause. Report all drug and supplement use to your medical provider. Include vitamins, herbs, over-the-counter and recreational substances as well as prescribed medications. These may be contributing to your fatigue.

Your doctor may suggest medication. Caffeine is probably the safest substance to combat fatigue and it doesn’t require a prescription. Antidepressants, especially bupropion (Wellbutrin) are sometimes used for fatigue. If your situation is severe, your doctor might suggest more potent drugs such as modafinil (Provigil) or methylphenidate (Ritalin). Methylphenidate is a controlled drug, so tell your doctor if you have a history of substance abuse so you can use this drug safely.

Assuming you have already consulted your doctor, then examine three important factors that influence energy levels: sleep, nutrition and exercise. Inadequate or poor quality sleep can lead to feelings of daytime tiredness. Make sure you are getting sufficient sleep. The National Sleep Foundation states that the average adult needs 7 to 9 hours of sleep per night.

Be sure to eat food with high nutritional value. Fruits and nuts are good choices. Eat small, frequent meals. Make sure you are taking sufficient quantities of vitamins and minerals. Stay well-hydrated by drinking plenty of water. For the average adult, this means drinking a half to a whole gallon of water daily.

Light exercise is probably the single most effective antidote for fatigue. This is hard to believe, especially if getting out of bed is an ordeal. When you do not feel like moving, move anyway. As a popular advertisement says, “just do it.” Try 10 to 15 minute intervals, 2 to 3 times daily. If you are not accustomed to physical activity, start slowly and for shorter, less frequent periods. Some activities to try are walking, biking, swimming, dancing, gardening, Yoga, Tai Chi, Qigong, and Pilates.

Tips for Managing Fatigue

  • Stress can be draining. Learn relaxation techniques.
  • Unmanageable pain can be exhausting. Seek help for this.
  • Vary activities – don’t sit or stand too long.
  • Balance rest with activity. Try to rest before you get too fatigued.
  • Rest even if you aren’t tired. This may help you avoid future fatigue.
  • Take short naps – no more than 20 minutes and not close to bedtime.
  • Take a shower. Alternate water temperatures from hot to cold.
  • Spend 5 or 10 minutes in the sun.
  • Practice good posture.
  • Stretch.
  • Avoid alcohol, tobacco and recreational substances.
  • Make sure your room is sunny or well lit.
  • Ask for help.
  • Create short cuts.
  • Organize your work areas so you can work more efficiently.
  • Schedule your most demanding tasks for the time in the day when you are usually at your best.
  • Take “mini” vacations. Spend an afternoon doing something you really enjoy.
  • Find ways to laugh.
  • Practice deep breathing for a minute whenever you feel tired.

Attitude cannot cure fatigue, but it can be a powerful ally. Watch the negative “self-talk.” When all else fails, laugh. There is no doubt about it; fatigue puts a damper on life. However, humor with fatigue is more tolerable than misery with fatigue. The choice is yours.



Surrendering to the What Ifs


What if something bad happens?

Does your mind get caught up in the what ifs? What if I don’t finish my work in time? What if Kim Jon-un bombs the U.S.? What if I have to hit the brakes suddenly and the car following behind me hits me? What if I never go to sleep? What if this headache is caused by a brain tumor?

Most of us ponder over the what ifs. When I find myself engaged in this sort of future-tripping, I apply various tools to talk myself down. Here are examples:

  • What if I don’t finish my work in time? Lucinda, you are making up a story. You have never suffered a major consequence as a result of unfinished work. The world isn’t going to end.
  • What if Kim Jon-un bombs the U.S.? That will be really bad, but there isn’t anything you can do about this. Be sure you tell people how much you care about them, since other people may also be feeling scared. On the plus side, you won’t have to worry about getting your work done.
  • What if I have to hit the brakes suddenly and the car following behind me hits me? Lucinda, you have never been rear-ended. Give yourself plenty of room to stop, and when it is safe, let the person pass you. Do not give them the finger. They may be worried about Kim Jon-un too.
  • What if I never go to sleep? You’ve always gone to sleep eventually. Try meditating, since you seem to sleep just fine when you do that.
  • What if this headache is caused by a brain tumor? It is probably just one of those 24-hour tumors that goes away by itself. If you still have it tomorrow, you can consult with someone who actually has a license to practice medicine.

Using the What Ifs as a Tool for Change

A friend told me that she has transformed the what ifs into a positive tool rather than one used to create anxiety. What if despite the rain, I have a great day? What if I practice being kind? What if I am grateful? What if I try something I’ve never liked before or thought I couldn’t do? What if this situation isn’t as it seems?

I tried using what ifs during my workout. What if working out is fun? What if I can do more than I did during my last workout? What if I smile during my workout?

The results were phenomenal. I had the most fun I’ve ever had at the gym, and it didn’t feel as hard. The thought that I looked ridiculous with a smile on my face made me grin even more. It was such a success, I’ve been applying the what ifs ever since.


Improving Your Memory

cognitive decline

Just because memory decline is natural does not mean we can’t change the process.

In last week’s blog, I discussed age-related memory loss and cognitive decline. This week I provide some tools to help you slow down the process.

Just because memory decline is natural does not mean we can’t change the process. The brain is like a muscle in that if you don’t use it, you lose it. An active brain can grow new cells and work more effectively.

Here are some ways to keep your brain healthy:

  • Be physically active on a daily basis. A combination of stretching, strength training, and aerobic activity is an ideal approach.
  • Eat a nutritious diet. Fruits and vegetables, along with other high-value nutritional foods can provide nourishment for our brains. Do not skip meals.
  • Drink enough water.
  • Manage stress. Meditation and relaxation techniques can help us to think more clearly.
  • Avoid alcohol and unhealthy substance use.
  • Get sufficient sleep. The average adult needs 7 to 9 hours of sleep a night.
  • Breathe. Oxygen is essential to our brains.
  • Stay mentally active.

How do we stay mentally active? Here are some tips:

  • Read more or listen to audio books.
  • Do puzzles and brainteasers.
  • Learn new things, particularly drawing or painting.
  • Go to lectures, plays, museums, or concerts.
  • Cut down or eliminate T.V. watching.
  • Take up a musical instrument.
  • Maintain social and family connections.
  • Study a new language.
  • Find a hobby.
  • Play games.
  • Learn to juggle.
  • Take adult education classes.
  • Learn to dance.
  • Shake up your routine. Rearrange your furniture, drive a different route to familiar places, or wear your watch on your other wrist.

As for forgetfulness, there are techniques that can be used to help us improve our memory. Libraries usually have books on memory improvement. A few suggestions:

  • Organize yourself.
  • Create habits and routines.
  • Write things down and keep your lists in the same place.
  • Do one task at a time, rather than multi-tasking.
  • Pay attention to what you want to remember.
  • Visualize what you want to recall.
  • Use repetition to fasten something into your memory bank.
  • To remember long lists, create a story or connections between items.

You can use memory devices, also called mnemonics, to aid memory. A classic mnemonic is “My Very Educated Mother Just Served Us Nine Pickles” (the first letter of each word is also the first letter of the planets in our solar system – Mercury, Venus, Earth, etc.) or “Thirty days has September, April, June, and November. When short February’s done, all the rest have 31” (used to remember how many days are in each month).

If you think your cognitive issues aren’t garden variety aging, be sure to talk to your medical provider. There are medications to help with dementia. Various supplements are being tested for memory enhancement capabilities, but hasn’t found anything conclusive.

If you are forgetful, go easy on yourself. Stay positive and maintain a sense of humor. Remember being happy is much more important than remembering where you put your keys.


It is all right to forget where you put your keys; forgetting what your keys do is cause for concern.

Have you ever misplaced something, searched for the item and in the middle of the search, forgot what you are looking for? If so, welcome to the club. Misplacing objects, forgetting things, occasionally driving and realizing you forgot where you were headed, and putting the milk in the cupboard, are common but frustrating experiences. These occurrences become more frequent as we age.

If you are the type of person who has been blessed with a good memory, this change can be extremely disconcerting. The “A” word leaps to mind (Alzheimer’s), followed by other worst fears, such as brain tumors, strokes, and various neurological impairments.

What was I saying? Oh, yes, I was talking about memory loss. With age, forgetfulness generally increases, while ability to concentrate decreases. Pay attention to your peers and you will notice that others are experiencing memory loss, particularly with name recall. A typical conversation while discussing a movie with my friends goes something like this: “It was a great movie and it had So and So in it. I can’t remember his name, but I know you will know exactly who I mean.  He’s been in a lot of movies, but I can’t think of a single title right now. He starred in that movie opposite What’s Her Name.” If I am lucky, the other person fills in the blanks, but usually my friends are just as forgetful as I am.

The average adult brain is made up of over 100 billion nerve cells. We used to think that the brain stopped developing when we were young, but we now know that we can continue to develop our minds at least in to our 70’s and that there is no age limit on learning new things. We learn more slowly as we age. Comprehension and reaction times slow. Multi-tasking becomes more difficult as we grow older. Short-term memory suffers far more quickly than long-term memory. We oldsters can likely remember who the U.S. President was in 1970, but are unable to recall what we had for lunch yesterday or today.

In spite of all this reassurance, we still wonder if something is wrong.  How do we know when to be concerned? Here are some possible early indications of Alzheimer’s or other cognitive abnormalities:

  • Repeatedly asking the same question after it has been answered.
  • Inability to complete familiar tasks.
  • Increasingly showing poor judgment.
  • Decline in the ability to think abstractly.
  • Changes in personality and mood with no apparent cause.

In short, it is normal to forget how to add, but abnormal to be confused about the concept of numbers. It is all right to forget where you put your keys; forgetting what your keys do is cause for concern.

There are many treatable conditions that can cause cognitive impairment, so it is important to obtain a good medical evaluation before concluding that your cognitive decline is normal aging. Hearing loss, sleep problems, thyroid disease, psychiatric disorders, stress, vitamin deficiency, alcohol, and drugs are just a few factors that can have an impact on our ability to think, communicate, and function effectively. Always talk to your medical provider about changes in your health.

Next week I will provide some tips on what you can do to help slow the process of mental decline.

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Autumn is a time of beauty and flu shots

Autumn is here, which means that flu season is around the corner. The flu is not a cold or “just a small bug.” Influenza is a potentially life-threatening illness, and if you have never had it, consider yourself lucky.

One of the worst disasters in history was not a war, hurricane, earthquake, or tsunami. It was the influenza pandemic in 1918-19. It affected 20 to 25 percent of the world. Also called the Spanish flu, the worldwide death toll was 20 to 50 million people. More people died in a single year from the Spanish flu than during 4 years of the 14th century’s bubonic plague. In the United States, 675, 000 Americans died. This is 10 times the number of Americans who had just been killed in World War I.

Public health officials warn us that the world is at risk for another pandemic. Immunizations are one of the best defenses against diseases and epidemics. Contrary to popular myths, vaccination does not give us the disease. It protects us.

Influenza, also known as the “flu” affects an average of 5 to 20 percent of the United States’ population. According to the Centers for Disease Control and Prevention (CDC), every year more than 200,000 people are hospitalized and about 36,000 people die from flu-related complications. Infants, young children, elderly and people with certain health conditions are at the greatest risk for serious complications.

The best way to prevent passing the flu is by not getting it. The best way to avoid the flu is through vaccination. Flu shots are available now.

There are steps you can take to protect yourself and others from the flu:

  • Keep your distance from people who are sick
  • If you have the flu, avoid close contact with people
  • If you are sick, stay home from work, school and other public places
  • Cover your mouth with tissue when you cough or sneeze
  • If you do not have tissue close by, turn your head and cough into your upper sleeve
  • Properly dispose used tissue
  • If you have the flu, wash your hands before touching food or objects that other people may use
  • If you don’t have the flu, wash your hands after touching publicly shared objects
  • Clean publicly shared items, such as telephones, keyboards, and faucet handles
  • If soap and water are not available, use sanitizing wipes or gels to clean your hands
  • Keep yourself healthy by developing good sleeping, eating, and exercise habits

If you do get the flu, be sure to rest and drink plenty of liquids. To reduce fever, stay cool, but not cold. Acetaminophen, removing layers of blankets and clothing, and lukewarm sponge baths can provide relief. Call your medical provider if you cannot get symptoms under control, such as fever, vomiting, or diarrhea. Since you can pass this to others, call for advice and let your medical provider determine if you need to be seen.

There are antiviral medications that can reduce the severity of the flu. These are effective if taken within the first 48 hours of the flu. Call your medical provider as soon as you show signs of the flu and discuss if antiviral medication is appropriate for you.

For more information: www.cdc.gov/flu


What ‘Never Giving Up’ Means

Beauty is always around us

A year before my cousin Debbie died, my father would call her with some words of encouragement. He told me that he wanted to help her so she wouldn’t give up. “It’s important that we don’t give up the fight,” he’d say.

Then he got his cancer diagnosis. He felt awful. For awhile, his symptoms and chemo were relatively easy. He’d come back from the cancer center and say, “I feel like a wimp. Most people have it much harder than I do. If they aren’t giving up, I can’t give up.” He trudged on. As long as there was someone who was sicker than he was, he felt motivated to keep trying. Then he was the sickest one, the one everyone compared their experience to. Then he ran out of options.

I don’t know what it meant to my father to, ‘keep up the fight’ or to ‘not give up.’ It seems to me that some things we are powerless over, and to fight these things is a colossal waste of energy (although that doesn’t mean I don’t try). And what are we fighting? Was my dad fighting cancer? Or death? I think he was fighting for the will to keep fighting. He grew up when Winston Churchill’s words were more than a mere slogan, “Never, never, never give up.”

But cancer isn’t an enemy; it is a disease. And although one can argue that disease is an enemy, it really isn’t. Disease can be a teacher. The deadly nature of cancer and other serious illnesses can wake us up. When life is short, it seems much more precious.

But here is the truth. Cancer or no cancer, illness or no illness, life IS short. We will succumb to death. Beauty is always around us and we don’t need a death sentence in order to appreciate our precious existence.

As for giving up, here is what we don’t have to surrender to: fear. Yes, we can feel cowardly and wimpy, and want to curl into a fetal position and watch Seinfeld episodes for the rest of our lives. It’s OK to be afraid, and to yield to that fear for awhile. Eventually, perhaps you will find what I’ve found. A person can only handle so much fear and Seinfeld, and in time, you find yourself letting go of it. You step outside and see the most glorious sunset of your life, and life feels endurable. What we don’t have to give up is life’s exquisite beauty.