Symptoms are problems that bother you. Persons with serious illnesses often have symptoms. Some they have had symptoms for a long time and others may be new. As a general rule, new symptoms should be discussed with a health care practitioner as soon as possible.

The list of symptoms listed alphabetically above occur commonly in persons with serious illnesses. Some, like sexual issues, and sleep problems occur early in an illness, whereas confusion is usually a much later problem. Nausea, eating problems, and diarrhea frequently accompany treatments for cancer. Always think of medications as being a possible cause of symptoms.

Your appetite may decrease because of medications, pain or discomfort, nausea and/or vomiting, mouth sores, dry mouth, difficulty swallowing, altered taste, constipation or diarrhea, and depression. Whenever possible, your primary care practitioner will try to treat the cause.

Things you can do when the cause can not be eliminated:

• experiment with different foods and liquids
• sit upright when eating
• eat frequent, small portions of food you like.
• eat foods high in protein and calories (Ensure)
• keep your mouth moisturized with sprays of water, lemon swabs or foods such as fresh pineapple
• use smaller utensils if your mouth is sore or dry

If you are having difficulty swallowing you should:

• keep your head elevated
• drink liquids in small amounts and frequently
• eat only soft foods
• avoid spicy, acidic, salty, sticky and excessively
• avoid alcohol and tobacco

Most often confusion is caused by medications or the late stages of a serious illness. Occasionally, it may come on suddenly--in that case, infection, heart or lung trouble may be the cause. Whatever the cause it is important to treat confusion when it is unexpected and to make sure that the confused person does not hurt him or herself.

Management of confusion:

• use safety precautions
• medications to decrease confusion may help
• use oxygen if necessary

Persons who say they are "constipated" are bothered most by straining and hard bowel movements. "Regularity" may be twice-daily bowel movements for some or two bowel movements a week for others.

Who Has Constipation?

Many persons worry that if they only have a few bowel movements a week, they are "constipated". However, 15% of persons who otherwise never feel constipated, have two or few bowel movements a week. Ask yourself these questions to decide if you are really constipated. Do you have difficulty passing stools? Are they usually hard? Do you have difficulty emptying? Is there pain? Are there other problems such as bleeding?

Unless these are regular symptoms for you, you are probably not constipated. If you are constipated, you can improve your condition without resorting to harsh treatments.

What Causes Constipation?

Doctors do not always know what causes constipation. But a person who eats a poor diet, drinks too little fluid, or misuses laxatives can easily become constipated.

• Ignoring the natural urge to have a bowel movement can result in constipation. Some people prefer to have their bowel movements only at home. But holding a bowel movement can cause problems if the delay is too long.
• Lengthy bed rest, after an accident or illness, and lack of exercise may help cause constipation. For patients who stay in bed and who suffer from chronic constipation, drug therapy may be the best solution. But simply being more active is a better idea for people who do not have to stay in bed.
• Drugs given for other conditions can cause constipation in some people. For example, certain antidepressants, heart medications, antacids containing aluminum or calcium, antihistamines, diuretics, narcotics, and anti-parkinson drugs all are known to cause constipation.
• Heavy use of laxatives is usually not necessary and often can be habit-forming. The body begins to rely on the laxatives to bring on bowel movements. Over time, the natural "emptying" mechanisms fail to work without the help of these drugs. For the same reason, the regular use of enemas can also lead to a loss of normal bowel function. Another side effect of heavy laxative use is diarrhea.
• Overuse of mineral oil -- a popular laxative-- may reduce the absorption of certain vitamins (A, D, E, and K). Mineral oil may also interact with drugs such as anticoagulants (given to prevent blood clots) and other laxatives, causing undesired side effects.
• Once in a while constipation may be caused by something abnormal or by a blockage of the digestive system. These disorders may affect either the muscles or nerves that create normal bowel movements. Your doctor can perform a series of tests to find out if constipation is the symptom of an underlying (and often treatable) disorder.

Treatment

If you suddenly become constipated, you should contact your doctor. If, on the other hand, you have had difficulty for a long time you should try the two approaches known to reduce straining and hard bowel movements: fiber in the diet and bulk laxatives.

• Try to eat about a cup of fruit and vegetables (peas, strawberries), either cooked or raw, each day. Dried fruit such as apricots, prunes, and raisins are especially high in fiber. A bowl of whole grain cereals (All-Bran, Puffed Wheat) and breads can be very helpful as well. Try to cut back on highly processed foods (such as sweets) and foods high in fat.
• Try adding small amounts (a tablespoon or two) of unprocessed bran ("Miller's Bran") to baked goods, cereals, scrambled eggs, soups, and fruit as a way of increasing the fiber content of your diet. Start with one or two tablespoons and increase to five tablespoons of bran a day. (You can get "Miller's Bran" at most health food stores. Unprocessed bran is usually sold in health food stores or the health food section of supermarkets. It should not be confused with the packaged cereals that contain large amounts of bran or bran flakes. These are high in phosphorus). If your diet is well-balanced and contains a variety of foods high in natural fiber, you usually do not need to add bran to other foods. If you do use unprocessed bran, remember that some people suffer from bloating and gas for several weeks after adding bran to their diets. All changes in the diet should be made slowly to allow the digestive system to adapt.
• Drink as much fluid as you urinate each day plus an additional three cups of liquid. Use part of your fluid allowance as a warm drink first thing in the morning or before bed in the evening. This often helps trigger bowel activity. Warm tea or lemonade work well.
• Stay active. Even taking a brisk walk after dinner can help you stimulate the muscles in your intestines.
• Try to develop a regular bowel habit. If you have had problems with constipation, attempt to have a bowel movement shortly after breakfast or dinner.

If the above treatments do not work, try adding other bulk laxatives such as psyllium (Metamucil).

• Avoid taking laxatives if at all possible. Although they will usually relieve the constipation, you can quickly come to depend on them. Then the natural muscle actions required for bowel movements will be impaired.
• Those most likely to be helpful and safe for long term use are lactulose, sorbitol (least expensive), and cisapride. Wetting agents (docusate) do soften stool.
• Irritant laxatives (senna), milk of magnesia, and enemas should only be used once in a while.
• For once-in-a while use, try a mixture of apple sauce, prune juice, and bran (so-called "black magic")

Above all, do not expect to have a bowel movement every day or even every other day. "Regularity" differs from person to person. If your bowel movements are usually painless and occur regularly (whether the pattern is three times a day or three times each week), then you are probably not constipated.

A person who has two or more loose or watery bowel movements a day has diarrhea. Diarrhea that last more than a few days can cause weakness, weight loss, skin soreness and poor nutrition.

Causes of diarrhea lasting more than a few days

• infection
• radiation therapy to abdomen or pelvis
• chemotherapy
• antibiotics and other medications
• other diseases

Things you can do when the cause cannot be eliminated:

• increase your fluid intake to two-three quarts of non-carbonated fluids a day
• eat small frequent meals
• avoid high lactose (milk) foods
• avoid spicy or greasy foods, caffeine and very hot or cold foods
• if possible, eat foods that are high in protein and calories and low in fiber
• apply protective ointments or anesthetics (A&D ointment, hydrocortisone or tucks) to clean toilet paper and place it on the sore area to decrease irritation

Tiredness or fatigue can be mild or complete---"feeling all worn out".

Fatigue and tiredness may be caused by:

• Serious illness
• Stresses involved in living with a serious illness
• Pain
• Decreased nutritional intake
• Sleep problems
• Medicines
• Cancer treatments

Eliminating the causes of your fatigue may not be possible, but there are things you can do.
Things you can do when the cause cannot be eliminated:

• avoid over-working yourself especially when you are feeling better than usual.
• prioritize activities - carry out the essential ones first
• combine essential activities with those that are up-lifting and pleasurable.
• plan shorter activities
• schedule regular rest periods after each activity
• use assistive devices to help you get around and in the bathroom
• avoid low slung chairs and beds that require a lot of effort to get out of.
• place medicines, phone, drinking water, toilet chair and other essentials close by.
• sit rather than stand for activities such as showering, shaving, brushing teeth, preparing food.
• let others do things for you

You should call your health carepractitioner or a visiting nurse if you are not able to dress, move, bathe or go to the bathroom without getting tired.

Some causes for several days of nausea and vomiting are:

• medications
• cancer treatments
• uncontrolled pain
• bowel blockage

Causes for new nausea and vomiting that lasts for several days should be checked by your primary care practitioner.

Things you can do when the cause can not be eliminated:

• medicines called anti-emetics may help. Ask your health care provider about taking these on a regular schedule to prevent nausea and vomiting.
• frequently drink small amounts of fluids during the day except after meals
• avoid fatty, fried and strong smelling foods
• frequently eat small amounts of crackers, foods, fresh fruits, chicken soup or broth, jello, bland or soft foods,
• try relaxation techniques
• keep your mouth clean: brush at least twice a day.

The loss of sexual intimacy may result in feelings of loss, loneliness, and uselessness. Medications and illness may make sex unappealing or uninteresting.

Things to do:

• talk about sexual concerns and intimacy with your loved one and your health care practitioner.
• realize there may be no "cure" for the problem
• explore other ways to be intimate with your partner
• consider sexual counseling when needed.

Shortness of breath is usually very bothersome. It has many causes.

Things you can do when the cause cannot be eliminated:

• limit activities that increase shortness of breath
• avoid things that make it worse i.e. cold, humidity, tobacco smoke.
• elevate the head in bed. Sleep in a recliner or on several pillows.
• use oxygen and "fluid" medications if needed
• codeine and other narcotics are very helpful, but you will also need to take laxatives
• decrease anxiety with relaxation exercises, and meditation.
• keep the mouth moisturized with sprays of water, lemon swabs, or foods such as fresh pineapple

Some of the common problems are:

• pressure sores
• swelling
• itching
• infection

Things you and your caregiver can do:

• use soft beds and special surfaces e.g. sheepskin, or foam egg crate
• avoid rough sheets, tape, vigorous drying with towels, too much heat.
• keep skin clean and dry by using non-irritating soap or warm water
• prevent pressure sores with frequent position change and good nutrition.
• assess high risk areas - pelvic area, heels, ankles and hips - daily.
• treat itchiness with a cool bath with sodium bicarbonate, moisturizing lotions, or medicated lotions.

There are many reasons why people may have problems sleeping such as pain, medication side-effects, difficulty breathing or worrying about your condition. Sleeping problems range from difficulty falling asleep and staying asleep to waking up too early in the morning. If you don't get a good night's sleep, you may become irritable, unable to concentrate, and tired.

Managing Sleep Problems

If you have trouble falling asleep or staying asleep, try some of the following suggestions:

• Go to bed only when sleepy. There is no need to sleep eight hours every night and there is no benefit from staying in bed when you can't sleep. Staying in bed more than five hours a night is of no value if you are not sleeping.
• Use your bedroom only for sleeping. For safety your bedroom area should have a smoke alarm, a lamp that's easy to turn on, and a telephone by your bedside. After turning off the light, give yourself about 20 minutes to fall asleep. If you are still awake or if you lose your drowsiness, get up and go into another room until you feel sleepy again.
• Follow a regular schedule. Get up at the same time. Don't have one schedule for the work week and one for the weekend. A regular routine at bedtime, like reading a book or taking a warm bath, will tell your body it's time to sleep.
• Write down what you are doing each day. See if you are pushing yourself too hard.
• Avoid daytime naps. If you take daytime naps, you are likely to stay awake at night. If you must nap, take a short nap before 3 PM. If you usually feel so tired during the day that you fall asleep without planning to nap, please talk to a doctor.
• Try to exercise regularly. Brisk walking four times a week improves sleep. Moderate exercise several hours before bedtime will also help you sleep.
• Beware of what you eat and drink.
• Smoking is not only dangerous (starting a fire by falling asleep with a lit cigarette), but nicotine is a stimulant and will keep you awake.

If you still have difficulty, try these "tricks:" Try not to worry about your sleep. Some persons find that playing mental games is helpful. For example, think black, a black cat on a black velvet pillow on a black corduroy sofa, etc.; or tell yourself it's five minutes before you have to get up and you're just trying to get a few extra winks. A warm bath with a drink of warm milk or herb tea may help. However, beverages taken before bedtime may increase the need to go to the toilet. Several studies show that exposure to very bright light for one hour during the morning will help sleep by resetting "REM" patterns closer to normal.

Should I Use Medications?

Sleep medicines you can buy without a prescription usually contain antihistamines. These medicines are generally not harmful if used only a few times a year, but they can make you drowsy and more likely to have accidents the next day.

Prescription sleep medicines are often habit forming and may build up in your body.

You need to talk to a doctor about any medications you are using for sleep.

Special Treatments

• Leg Cramps: The best treatment for restless legs and leg cramps is to stand two feet away from a wall and lean forward against it keeping your feet flat to the floor. Hold and repeat. Quinine works well for leg cramps and clonazepan pills may help restless legs. These medications must be prescribed by a physician.
• Sleep Apnea: Treatments for sleep apnea include devices to be worn at night (trouble some), continuous air pressure using a device through the nose (bothersome), and even surgery (50% effective). The cheapest and safest first approach is to reduce weight when necessary and avoid alcohol.
• Sleep Clinics: Your doctor may recommend that you visit a sleep clinic. Sleep clinics may be used used to make diagnoses and recommend treatments for persons who have sleep apnea or severe sleeping problems not responding to any of the above described approaches.

We have tried to make the How's Your Health error-free. However, those involved in its preparation can not warrant that all of the information is accurate and complete. When you use How's Your Health as a guide for your health and medical care, be sure to discuss any questions about it with your doctor, nurse, or other health care worker.