Living with symptoms The symptoms caused by cancers and other serious or terminal illnesses can be particularly unpleasant to live with. Dr Ros Taylor looks at how you can alleviate some of the more common side effects.

In this article

Fatigue Weight loss

Nausea Appetite loss

Breathlessness and panic

The fatigue of a serious illness can be overwhelming. It often starts first thing in the morning, even after a good night's sleep. It has many causes: the illness itself, anaemia, medications and treatments such as chemotherapy - and stress and worry. It's a weariness that comes with no exertion at all. Some patients can even find it difficult to walk across a room.

Few sufferers mention fatigue to doctors because they don't think anything can help. In fact, there are few straightforward medical treatments, but there are a number of practical tips which can make it more bearable:

• Imagine you have a bucketful of energy for the day. Decide what you want to do with it. Don't waste it on anything you don't have to do.
• Decide to take several short naps during the day. Don't wait until you're so exhausted that you fall asleep and then miss what you were planning to do.
• Curiously, exercise can help fatigue. A short walk around the garden might improve your energy levels, appetite and sense of achievement.
• Discuss your fatigue with your doctor or nurse. There may be a simple answer.

Losing weight when you have cancer makes everyone anxious. To those around you it'll be a sign that your condition is deteriorating, and for you it may signify you're losing your strength. The fact is that some cancers cause marked weight loss even if you're managing to eat well. The cancer stops the food being used by the body normally. This is called cachexia and is difficult to reverse. Eating enough calories isn't the whole answer.

But it's still important to try to eat a nutritious diet, as well as 'a little of what you fancy' - it'll help with energy levels and general strength. Eating is one of life's pleasures. Your social life may revolve around food and many patients with cancer would like to eat, but appetite loss, taste changes and nausea often get in the way. There's no place, incidentally, for extreme diets or huge doses of vitamins - these become a distraction and an obsession and often lead to malnutrition rather than improved wellbeing.

Nausea is an unpleasant symptom which can be caused by the cancer itself or the treatment. There are many ways to help.

Medication can be valuable, but it's important to take tablets regularly to actually prevent nausea, rather than wait until you feel sick, when the tablets won't work as well. Some find 'sea bands' help: these are elasticated wristbands that stimulate acupuncture points that help with nausea. They have no side effects. Ginger is a well-known natural remedy that helps nausea. Try a cube of crystallised ginger or a ginger nut biscuit on waking. In Sweden, swallowing crushed ice is used a lot for cancer patients with nausea.

Sometimes it's hard to eat at all. A complete lack of appetite is common in very advanced disease. Your carers will find it hard to watch you eating so little, as feeding is so bound up with caring and love. But right at the end of life, it's completely natural not to eat, and nurses and doctors should be helping carers to come to terms with this, so that the pressure to eat is taken away.

However, earlier in the illness, many patients want to eat but simply have no appetite, and so can easily become demoralised and lose hope. These tips can help:

• Relax. Anxiety and stress are potent causes of appetite loss.
• Plan meals ahead. If you've no appetite, you won't want to make much effort at mealtimes, so make sure the fridge is full.
• Eat lots of snacks throughout the day if full meals are impossible.
• Eat small amounts of natural foods rather than processed supplements.
• Appetite is often at its peak in the morning, so aim for a high-calorie breakfast.
• Take some exercise or some alcohol before a meal to stimulate the appetite.
• Eat small portions packed with calories.
• Treat constipation, if you're suffering from it.
• Ask your doctor about medications that can help with appetite.

This is a difficult symptom to live with. Relatives report it's harder to care for a breathless patient than for a patient in pain. Breathing is so fundamental to life, that any threat to it can be frightening.

Anxiety and breathing problems are closely linked. If you feel breathless, you begin to panic, which makes you more breathless, which makes you more panicky, and so on - a vicious circle which is difficult to break. Many fear that suffocation or choking might occur, but this is rare. The key is to learn how to control and relax your breathing. Simple tricks to help a panic attack by slowing your breathing down and breathing with your stomach muscles can be easily taught. Ask your doctor for help.

Here are some practical tips to help everyday breathlessness:

• Set priorities for what's important and plan ahead. Literally, save your breath.
• Allow extra time for physical activities and incorporate rest breaks into them.
• Keep a fan with you.
• Put on a towelling robe after a bath, rather than get too puffed out by drying yourself too vigorously.
• Prepare meals that don't need too much chewing.
• Choose loose clothes and sit down to wash and dress.
• Ask your doctor, your district nurse or your hospice nurse whether anyone can help with your breathlessness. Many nurses now have special training in this field.