"Sit-Rep" .. No.56 ... "Fatigue"

31 May by Coach Ingram

Sit-Reps
Sit-Rep .. No.56 .. "Fatigue" ... know that it's coming and deal with it!) 🤷🏽‍♂️
https://youtube.com/shorts/zmxX-VCej9A?si=YpMOx-eErk30ofqZ
(a.k.a. “You end up fighting the things that are supposed to help you.)

😏I have been having a terrible time staying active. There’s the physical pain that often makes it difficult just to walk or move.

Then, there’s a lack of motivation that discourages making the attempt, and if those two factors aren’t sufficient deterrents, there is the overwhelming fatigue that makes it practically impossible not to just stand up and go to bed, again!

So, I did what I tell everyone not to do… I played “Internet Detective”.

🤔 I asked about the possible connection between my fatigue and the medications that are supposed to help me.

‼️Once again, I’m not giving medical advice, or trying to influence your decisions. I’m simply putting my experiences on the table and letting you know what you or your relative or friend might someday have to deal with.

If you know that it might someday enter the picture, you might be able to better prepare for it.‼️

As for me, I’m okay.

I know that I have to find things that make me want to get up and get back in the race.

I know that I have to continue to stay active, physically and mentally.

I know that I have to recognize fatigue and deal with it or, to find the energy to overcome it when that needs to be done.

So… “Next play…!”

👉🏽 Below is the information that came back from my Internet 🕵🏾‍♂️ Detective Inquiry:

🗣️Several of the medications shown in your screenshot can contribute to fatigue, drowsiness, weakness, or increased sleepiness, especially when taken together daily.

Here’s the breakdown:

Hydrocodone
This is the biggest fatigue contributor on your list. It commonly causes:
drowsiness
slowed reaction time
mental fog
increased need for sleep
lower energy/motivation
If taken multiple times daily, the sedating effect can accumulate.
Prednisone
Prednisone is tricky because it can cause:
insomnia/restlessness in some people
fatigue and muscle weakness in others
“crash” feelings as the dose wears off
Long-term use can also affect sleep quality and muscle strength.
Abiraterone acetate
Fatigue is a very common side effect. Many patients report:
low stamina
weakness
needing naps
reduced exercise tolerance
Amlodipine and Lisinopril
These can sometimes contribute to:
tiredness
lightheadedness
lower energy, especially if blood pressure drops too low
Eliquis
Eliquis itself usually doesn’t directly cause sleepiness, but if it contributes to bleeding or anemia, fatigue can occur.

The bigger picture
YOU ALSO MENTIONED PREVIOUSLY THAT THE PAIN BEING TREATED MAY INVOLVE METASTATIC BONE CANCER PAIN. IN THAT SETTING, FATIGUE OFTEN COMES FROM MULTIPLE OVERLAPPING CAUSES, NOT JUST MEDICATION:

cancer itself
chronic pain
disrupted sleep
opioid use
reduced activity
anemia
treatment side effects
emotional stress on the body

So yes — based on this medication combination, it would be very understandable to experience:

increased fatigue
daytime sleepiness
lower endurance
needing more rest than usual

Important thing to monitor
There’s a difference between:

expected tiredness
and
concerning oversedation

You should contact the prescribing team promptly if there is:

extreme difficulty staying awake
confusion
slowed breathing
repeated nodding off
dizziness/falls
inability to function normally

especially with scheduled opioid use.

One practical observation
Your hydrocodone schedule in the image appears fairly regular throughout the day. That can help maintain pain control, but it also means:

sedation may remain more constant
energy dips may become predictable

Sometimes physicians adjust:

dose timing
opioid type
long-acting vs short-acting medications
supportive medications
to reduce fatigue while still controlling pain.

If the fatigue has become significantly worse recently, it’s worth reporting specifically — not just “I’m tired,” but:

how many hours sleeping
whether naps are new
whether you feel mentally foggy
whether weakness is worsening
whether pain meds are still helping adequately

That gives the oncology or pain-management team something actionable to work with.

‼️‼️👉🏽Adding Eligard changes the picture quite a bit regarding fatigue and energy levels.

Eligard suppresses testosterone production as part of androgen-deprivation therapy, commonly used in prostate cancer treatment. One of the most common downstream effects is:

fatigue
loss of physical energy
muscle weakness
reduced stamina
increased need for sleep/rest
decreased motivation or “drive”

When combined with:

Abiraterone acetate
Prednisone
scheduled Hydrocodone

…the fatigue effects can become cumulative.

Why this combination can feel especially draining
1. Testosterone suppression
Eligard lowers testosterone dramatically. Testosterone affects:

muscle mass
recovery
red blood cell production
energy levels
sleep quality
mood
endurance

Many men on long-term hormone therapy describe:

“heavier legs”
exercise intolerance
needing naps
reduced explosiveness and strength
mental fatigue

For someone with an athletic background, the contrast can feel especially noticeable.

2. Cancer-treatment fatigue is different from ordinary tiredness
This kind of fatigue often does not improve fully with:

extra sleep
caffeine
motivation
willpower

People frequently describe it as:

“running on half a battery”
“body exhaustion”
“can’t recover normally”

3. Hydrocodone compounds the sedation
Even if the opioid dose is medically appropriate, it layers onto:

hormonal fatigue
treatment fatigue
pain-related exhaustion

That combination can absolutely increase sleeping time or daytime drowsiness.

One important distinction
If you are:

sleeping more but still functioning,
tired but mentally clear,
and able to wake normally,

that is more consistent with expected cumulative fatigue.

More concerning would be:

sudden severe lethargy
confusion
inability to stay awake
shortness of breath
new weakness
dizziness/falls

Those deserve medical attention promptly.

Practical reality
With:

metastatic cancer pain,
hormone suppression therapy,
Abiraterone,
Prednisone,
and regular opioid use,

it would be medically unsurprising to experience substantial fatigue and increased sleep requirements.

That does not automatically mean something is “going wrong,” but it is something the oncology team should continuously monitor because sometimes:

anemia develops,
electrolytes shift,
blood pressure drops,
medication timing needs adjustment,
or pain management can be optimized differently.

A lot of patients try to “push through” this kind of fatigue because they’re used to being highly active. In many cases, the better strategy is controlled energy management:

pacing activity,
protecting sleep quality,
maintaining light movement/exercise if possible,
and reporting changes early rather than after a major decline.

So, there you have it. This won’t change anything but, it might help you prepare better if it does happen to you or someone you know.

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