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Deborah Brandon

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Surviving Chronic Disease

10 Steps for Coping With a Chronic Condition

Dealing with the pain and aggravation of a broken bone or burst appendix isn’t easy. But at least there’s an end in sight. Once the bone or belly heals, you’re pretty much back to normal. That’s not true for high blood pressure, heart failure, diabetes, arthritis, osteoporosis, or other chronic conditions. With no “cure” in sight, they usually last a lifetime.

You can live with a chronic condition day to day, responding to its sometimes swiftly changing symptoms and problems. Or you can take charge and manage the disease instead of letting it rule you.

Earlier this year, the pharmaceutical company GlaxoSmithKline commissioned a Harris poll to survey 3,000 adults and 1,000 doctors about living and coping with chronic conditions. The results, presented as a report called “Chronic Care in America,” offer five helpful strategies for coping with a chronic condition. We’ve included four of these, and added six additional.

  •  Get a prescription for information. The more you know about your condition, the better equipped you’ll be to understand what’s happening and why. Instead of turning to the Internet – the Wild West of health information – direct your questions to your doctor or nurse. If you want to do more in-depth research, ask them about trusted sources of medical information on the Web. If your doctor won’t give you the information you need, you might want to start looking for a new doctor.
  •  Make your doctor a partner in care. We’d put this one more bluntly: Take responsibility for your care, and don’t leave everything to your doctor. One way to do this is to listen to your body and track its changes. If you have hypertension, learn to check your blood pressure. If your heart has rhythm problems, check your pulse. For heart failure, weigh yourself every day and chart your symptoms. This kind of home monitoring lets you spot potentially harmful changes before they bloom into real trouble.
  •  Build a team. Doctors don’t have all the answers. Seek out the real experts. A nurse might be a better resource for helping you stop smoking or start exercising. You’ll get the best nutrition information from a dietitian.
  •  Coordinate your care. In an ideal world, the specialists you see for your heart, your diabetes, and your arthritis would talk with each other every now and then about your medical care. In the real world, this doesn’t usually happen. A primary care physician can put the pieces together to make sure your treatments are good for the whole you.
  •  Make a healthy investment in yourself. Part of the treatment for almost any chronic condition involves lifestyle changes. You know the ones we mean – stopping smoking, losing weight, exercising more, and shifting to healthier eating habits. Although these steps are sometimes relegated to the back burner, they shouldn’t be. In the Chronic Care in America survey, the people who made such changes were more likely to be successfully managing a chronic condition than those who didn’t. Investing the time and energy to make healthy changes usually pays handsome dividends, ranging from feeling better to living longer.
  •  Make it a family affair. The lifestyle changes you make to ease a chronic condition such as high cholesterol or heart disease are good for almost everyone. Instead of going it alone, invite family members or friends to join in.
  •  Manage your medications. Remembering to take one pill a day is tough; managing 10 or more is daunting. Knowing about the drugs you take – why you take them, how best to take them, and what problems to watch out for – is as important as learning about your condition. Merely reading a book about prescription drugs sometimes prompts more worries than it allays. Talking with your doctor, nurse, or a pharmacist can put drug information into perspective.
  •  Beware of depression. Dark, dreary moods plague a third or more of people with chronic diseases. Depression can keep you from taking important medications, seeing your doctor when you need to, or pursuing healthy habits. Read up on the signs of depression. Let your doctor know if you think you’re depressed or heading in that direction.
  •  Reach out. Doctors, nurses, and other health care professionals aren’t always the best reservoir for information about what it’s like to recover from open-heart surgery or live with heart failure. To get the real scoop, look for a support group in your area and talk with people who have been through what you are facing.
  •  Plan for end-of-life decisions. If the diagnosis of a chronic condition, or life with one, has you thinking about death, channel those thoughts to the kind of care you want at the end of your life. Spelling out whether you want the most aggressive care until the very end, or whether you’d prefer hospice care and a do-not-resuscitate order, can save you and your loved ones a lot of confusion and anguish later on.

(This article was first printed in the December 2003 issue of the Harvard Heart Letter. For more information or to order, please go to http://www.health.harvard.edu/heart.)

Senior man smiling performing indoor cycling in gym

Exercise

EXERCISE

Exercise and Chronic Disease: Get the Facts By Mayo Clinic Staff

If you have a chronic disease — such as heart disease, diabetes, asthma, or back or joint pain — exercise can have important health benefits. However, it’s important to talk to your doctor before starting an exercise routine. He or she might have advice on what exercises are safe and any precautions you might need to take while exercising.

Find out what you need to know about exercise and chronic disease.

How Can Exercise Improve a Chronic Condition?

If you have a chronic condition, regular exercise can help you manage symptoms and improve your health.

For example:

  •  Heart disease. Strength training can improve muscle strength and endurance, make it easier to do daily activities, and slow disease-related declines in muscle strength.
  •  Diabetes. Regular exercise can help insulin more effectively lower your blood sugar level. Physical activity can also help you control your weight and boost your energy.
  •  Asthma. Often, exercise can help control the frequency and severity of asthma attacks.
  • Back pain. Regular low-impact aerobic activities can increase strength and endurance in your back and improve muscle function. Abdominal and back muscle exercises (core-strengthening exercises) help reduce symptoms by strengthening the muscles around your spine.
  •  Arthritis. Exercise can reduce pain, help maintain muscle strength in affected joints and reduce joint stiffness.

What Exercises Are Safe?

Your doctor might recommend specific exercises to reduce pain or build strength. Depending on your condition, you might also need to avoid certain exercises altogether or during flare-ups. In some cases, you might need to consult a physical or occupational therapist before starting to exercise.

If you have low back pain, for example, you might choose low-impact aerobic activities, such as walking and swimming. These types of activities won’t strain or jolt your back.

If you have exercise-induced asthma, you might choose activities that involve short bursts of activity — such as tennis or baseball. If you use an inhaler, be sure to keep it handy while you exercise.

If you have arthritis, the exercises that are best for you will depend on the type of arthritis and which joints are involved. Work with your doctor or a physical therapist to create an exercise plan that will give you the most benefit with the least aggravation on your joints.

How often, how much and at what intensity can I safely exercise?

Before starting an exercise routine, it’s important to talk to your doctor about how long your exercise sessions can be and what level of intensity is safe for you.

If you haven’t been active for a while, start slowly and build up gradually. Ask your doctor what kind of exercise goals you can safely set for yourself as you progress.

nutrition

Nutrition

Nutrition and Physical Activity: Foundations for Health (by CDC)

Healthy eating and regular physical activity can prevent injury, disability, and early death from many chronic conditions, including obesity, heart disease, stroke, some cancers, diabetes, depression, and osteoporosis. They also can help people maintain healthy weight. Unfortunately, few Americans make healthy food choices on a regular basis, and many do not get enough physical activity to receive health benefits.

According to the 2009 Behavioral Risk Factor Surveillance System, 67.5% of U.S. adults aged 18 years or older do not eat fruit at least 2 times a day, and 73.7% do not eat vegetables at least 3 times a day. The 2008 National Health Interview Survey found that 36.2% of adults report no leisure-time physical activity and 81.8% do not meet current federal guidelines for physical activity and muscle strengthening. Results from the 2009 Youth Risk Behavior Surveillance System found that 81.6% of adolescents do not meet current guidelines for aerobic physical activity. Physical inactivity is estimated to cost the United States about $75 billion in medical costs each year.

Barriers to Healthy Lifestyles

Some Americans, including those with disabilities, experience more barriers in their pursuit of healthy lifestyles than others. For example, the quality and accessibility of a community’s food and physical activity environment affects the health of its residents. People who live in neighborhoods in which more residents have low incomes or are members of racial or ethnic minority groups often have poor access to healthy foods and few places for safe physical activity. Such conditions contribute to significant health disparities related to obesity. Increasing access to healthier food options and safe places to be physically active are important strategies for reducing health disparities and improving population-level health outcomes.
Public health officials and policy makers have begun to recognize that public health initiatives that focus on changing policies and environmental factors at federal, state, and local levels can help to remove the barriers that prevent people from making healthy lifestyle choices.

SWFLI Supports Healthy Nutrition and Physical Activity

The Centers for Disease Control and Prevention (CDC) has identified the following target areas for improving nutrition and promoting active living:

  • Increase consumption of fruits and vegetables.
  • Increase physical activity.
  • Increase breastfeeding initiation, duration, and exclusivity.
  • Decrease consumption of sugar drinks.
  • Decrease consumption of energy-dense foods, which are high in calories.
chronic-disease-banner

Understanding Chronic Disease

WHAT IS CHRONIC DISEASE? (CENTER FOR MANAGING CHRONIC DISEASE)

Chronic Disease is a long-lasting condition that can be controlled but not cured. Chronic illness affects the population worldwide. As described by the Centers for Disease Control, chronic disease is the leading cause of death and disability in the United States. It accounts for 70% of all deaths in the U.S., which is 1.7 million each year. Data from the World Health Organization show that chronic disease is also the major cause of premature death around the world even in places where infectious disease are rampant. Although chronic diseases are among the most common and costly health problems, they are also among the most preventable and most can be effectively controlled.

CHRONIC DISEASE STATISTICS

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Asthma

  •  7.1 million (9.5%) U.S. children have asthma [source]
  •  10.5 million school days were missed due to asthma among children 5-17 years old in 2008 [source]
  •  754,000 emergency department visits were related to child asthma in 2004 [source]
  •  18.9 million (8.2%) U.S. adults have asthma [source]
  •  1.8 million visits to emergency departments were related to asthma in 2004 [source]

Alzheimer’s Disease

  •  7,900 (7.5%) hospice patients have Alzheimer’s as a primary diagnosis [source]
  •  231,900 (15.5%) nursing home residents have Alzheimer’s Disease [source]
  •  83,494 annual deaths are due to Alzheimer’s Disease [source]
  •  Cause of Death Rank: 6 [source]
  •  An estimated 5.1 million Americans may have Alzheimer’s disease [source]

Breast Cancer

  •  In 2009, 211,731 women were diagnosed with breast cancer in the U.S. [source]
  •  40,676 cancer deaths occurred in the U.S. in 2009 [source]
  •  2,591,855 American women were alive in 2007 who had a history of breast cancer [source]
  •  Cause of Death Rank for Women: 2 [source]
  •  Breast cancer in the United States is the most common cancer in women, no matter your race or ethnicity [source]

Diabetes

  •  11.9% of adults 20 years+ have diabetes (diagnosed or undiagnosed) [source]
  •  8.5% of adults 20 years+ have diagnosed diabetes [source]
  •  37.3 million medical visits have diabetes as a primary diagnosis [source]
  •  362,000 (24%) nursing home residents have diabetes in the U.S. [source]
  •  69,071 annual deaths are due to diabetes in the U.S. [source]
  •  Cause of Death Rank: 7 [source]
  •  $174 billion is the estimated total annual cost of diabetes in America [source]
  •  $116 billion is the total direct annual medical costs due to diabetes in the U.S. [source]
  •  $58 billion is the total indirect annual costs (disability, work loss, premature mortality) due to diabetes in the U.S. [source]
  •  25.8 million people in the U.S. have diabetes [source]
  •  7 million people have undiagnosed diabetes in the U.S. [source]
  •  1.9 million: Number of new cases of diabetes diagnosed in people aged 20 years+ in 2010 [source]
  •  1 in 3: Ratio of Americans who will develop diabetes by 2050 [source]

Epilepsy

  •  About 2.8 million Americans are affected by Epilepsy [source]
  •  10% of people will experience a seizure sometime during their lifetime [source]
  •  150,000 new cases of epilepsy are diagnosed in the United States annually [source]
  •  $15.5 billion: Estimated annual medical costs and lost or reduced earnings and production due to Epilepsy in the U.S. [source]

Food & Fitness

  •  69.2% of adults age 20 years+ are overweight or obese [source]
  •  35.9% of adults age 20 years+ are obese [source]
  •  18.4% of adolescents age 12-19 years are overweight [source]
  •  18% of children age 6-11 years are overweight [source]
  •  12.1% of children age 2-5 years are overweight [source]
  •  21% of adults engaged in regular aerobic and muscle-strengthening leisure-time activities in the U.S. in 2011 [source]
  •  48% of adults met neither the aerobic nor muscle-strengthening guidelines for physical activity in the U.S. in 2011 [source]

Heart Disease

  •  26.5 million (11.5%) adults have heart disease in the United States [source]
  •  12.4 million annual medical visits and 2 million annual hospital outpatient department visits have heart disease as primary diagnosis in the U.S. [source, source]
  •  135,700 (9.3%) home healthcare patients with heart disease as primary diagnosis [source]
  •  597,689 annual deaths are due to heart disease in the U.S. [source]
  •  Cause of death rank: 1 [source]

Spinal Cord Injury

  •  In the U.S., about 200,000 people are living with a spinal cord injury [source]
  •  $15,000-$30,000: Average annual medical cost [source]
  •  Lifetime costs of a spinal cord injury can vary from $500,000 to more than $3 million depending on the severity of the injury [source]
  •  46% of spinal cord injuries are the result of motor vehicle accidents [source]
  •  About 50-70% of injuries occur in 15-35 year olds [source]

CHRONIC DISEASES AND HEALTH PROMOTION (CENTERS FOR DISEASE CONTROL AND PREVENTION)

Chronic diseases – such as heart disease, stroke, cancer, diabetes, and arthritis – are among the most common, costly, and preventable of all health problems in the U.S.

Four Common Causes of Chronic Disease

  • 7 out of 10 deaths among Americans each year are from chronic diseases. Heart disease, cancer and stroke account for more than 50% of all deaths each year.1
  •  In 2005, 133 million Americans – almost 1 out of every 2 adults – had at least one chronic illness.2
  •  Obesity has become a major health concern. 1 in every 3 adults is obese3 and almost 1 in 5 youth between the ages of 6 and 19 is obese (BMI ≥ 95th percentile of the CDC growth chart).4
  •  About one-fourth of people with chronic conditions have one or more daily activity limitations.5
  •  Arthritis is the most common cause of disability, with nearly 19 million Americans reporting activity limitations.6
  •  Diabetes continues to be the leading cause of kidney failure, nontraumatic lower-extremity amputations, and blindness among adults, aged 20-74.7
  •  Excessive alcohol consumption is the third leading preventable cause of death in the U.S., behind diet and physical activity and tobacco. 8

Chronic Diseases are the Leading Causes of Death and Disability in the U.S.

Four modifiable health risk behaviors—lack of physical activity, poor nutrition, tobacco use, and excessive alcohol consumption—are responsible for much of the illness, suffering, and early death related to chronic diseases.

  •  More than one-third of all adults do not meet recommendations for aerobic physical activity based on the 2008 Physical Activity Guidelines for Americans, and 23% report no leisure-time physical activity at all in the preceding month.9
  •  In 2007, less than 22% of high school students10 and only 24% of adults11 reported eating 5 or more servings of fruits and vegetables per day.
  •  More than 43 million American adults (approximately 1 in 5) smoke.12
  •  In 2007, 20% of high school students in the United States were current cigarette smokers.13
  •  Lung cancer is the leading cause of cancer death, and cigarette smoking causes almost all cases. Compared to nonsmokers, men who smoke are about 23 times more likely to develop lung cancer and women who smoke are about 13 times more likely. Smoking causes about 90% of lung cancer deaths in men and almost 80% in women. Smoking also causes cancer of the voicebox (larynx), mouth and throat, esophagus, bladder, kidney, pancreas, cervix, and stomach, and causes acute myeloid leukemia.14
  •  Excessive alcohol consumption contributes to over 54 different diseases and injuries, including cancer of the mouth, throat, esophagus, liver, colon, and breast, liver diseases, and other cardiovascular, neurological, psychiatric, and gastrointestinal health problems.15
  •  Binge drinking, the most dangerous pattern of drinking (defined as consuming more than 4 drinks on an occasion for women or 5 drinks for men) is reported by 17% of U.S. adults, averaging 8 drinks per binge.16
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