Multiple myeloma has a garden variety of symptoms, ranging from bone pain to anemia. The various treatments for myeloma come with a broad assortment of side effects, ranging from neuropathy to neutropenia. Let’s face it: there’s a veritable smorgasbord of myeloma symptoms and side effects to sample every day in Cancerland.

My omnipresent symptom is fatigue. It was a bellwether when I was first diagnosed in 2004 and the canary in the mineshaft this summer when I relapsed.

My fatigue can be a showstopper. My fatigue can be a quiet, polite acquaintance. It can slam me when I least expect it or be surprisingly absent when it should be overwhelming me.

It is always there.

In response, I have devised a variety of common sense fatigue countermeasures. (I could call them “fatigue fighters,” but fighting takes way too much energy.) These are my top ten ways (in no particular order) to regroup, reenergize, and recharge when fatigue comes to call.

1. Nap. I learned back in 2004 that naps were not the exclusive right of infants and cats. Over time, I forgot that lesson and had to relearn it this fall. An often forgotten corollary to this is Get enough sleep each night.
2. Be flexible. I often lock myself into my day, my schedule, my to-do lists, both at home and at work. I have learned to shoehorn flexibility into my life when fatigue strikes. That means turning off the little voice that says “But April, it’d only take a few minutes to stop at the store and pick up those items.” The store can wait.
3. Eat and drink. When I am tired, I try to eat a little something – fruit, crackers – even if I am not particularly hungry. I also make sure to keep a glass of water close at hand and resort to it often. Sometimes that is all it takes to get me back on my feet.
4. Indulge. Never underestimate the power of a small treat: a piece of chocolate, taking a break from fixing supper to read an extra 30 minutes, driving home from the oncologist down a small scenic road rather than the highway. My husband Warren has a gift for making even the smallest moments of great reward when he sees me flagging.
5. Disconnect electronically. This is my greatest fatigue antidote in many ways. I am not a Luddite: I text, email, and use Facebook on a daily basis. But I am too easily pulled into the wired immediacy of our modern world and its exhausting demand of “staying connected” all the time. I deliberately disconnect in the evenings and most of the weekend by turning the cell phone off and not logging into my email or Facebook accounts. In lieu of the electronic chatter, I read books (print, not electronic), correspond the “old-fashioned” way, and draft my blog posts or this column longhand. The deliberate, slow pace helps me recharge.
6. Walk. Fatigue can force me to the couch. Even as small a walk as around the block can be enough to lift my energy levels. I am fortunate to live in a highly walkable community.
7. Meditate. Meditation, prayer, mindful reflection — call it what you want, it is a powerful tool against fatigue. I often light votives as I reflect and pray. Their bright spears of light fill me with hope and a sense of renewal.
8. Get outside. Nature is a huge restorer. Sometimes I combine this with a walk. Sometimes I just sit outside or in front of a window. Watching a brilliant sunset or dazzling sunrise paint the sky does me great good.
9. Give myself a break. I have written about being flexible and about being indulgent. This is about giving myself permission to be unwell. It is not unusual, when I am most fatigued, to realize I am pushing myself way too hard to show I’m “okay.” When this happens, I stop, draw a deep breath, and give myself permission to be ill without embarrassment or shame. This allows me to step away from the moment and regroup.
10. Do nothing. This last bit comes from the late, great children’s author Madeleine L’Engle. Writing about the final illness of her husband, she observed that we often tell ourselves “Don’t just stand there! Do something!” L’Engle found it far more important at times to do nothing and just stand there. Sometimes my best fatigue antidote is to do nothing and just wait it out.

The reality of living in Cancerland is that I live with a lot of fatigue. Multiple myeloma, both the disease and the treatment, wears you out.

I liken the fatigue to the waves on a large lake, one the size of Lake Superior. Sometimes the waves lap in small and break gently, sometimes they are strong, steady rollers, and sometimes they come crashing in, whipped high by the wind and storm. But the waves are always there. It is my daily challenge to know when to wade, when to brace myself as I walk along the shore, and when to climb to higher ground.