Chronic Disease - Learning to Live with It

As much as this book is about preventing the kinds of chronic conditions that cause us to age-—heart disease, cancer, arthritis, Alzheimer's—the fact is that almost 80 percent of us will have a chronic condition at some point in our lives. So the question remains, "What happens if you get a chronic illness? How are you to treat it? How can you prevent its ageing effects?

For starters, a chronic disease does not mean that life is over. It is not time to call it quits. Life can and will go on. Every day we learn more about such diseases and more about staving off their effects. Such a diagnosis does not mean that you are now 'old,' but it does signal an important shift: You will have to learn how to live with the disease's 'chronicness,' and with the fact that it is a presence in your life, a presence that cannot be ignored without ill effect. Almost without exception, a diagnosis of chronic disease also signals that it's time to take your youth seriously. If you are diagnosed as having a chronic and potentially debilitating illness, you will have to learn how to live healthily—and youthfully-—-in spite of it.

Although having a chronic condition like diabetes or arthritis can age us, how we manage that disease can make an enormous difference. For example, if diabetes is not managed properly, a diabetic can age at twice the expected rate; he or she will experience almost two years of biological ageing for each passing calendar year. However, careful management of the disease can reduce the ageing effect by over 50 percent, and by as much as 80 percent. For Type II diabetes (non-insulin-dependent diabetes), proper management can make manifestations of the disease virtually disappear, leaving no significant ageing effect. Similarly, the ageing effect of heart disease can be retarded by as much as 70 percent with proper vigilance, and if the disease is diagnosed before significant structural damage occurs, the ageing it causes can even be reversed. We see similar benefits of disease management for everything from kidney disease to neurologic disorders to thyroid problems to cancer. No matter what ails you, the ageing damage that a chronic condition causes is always, always improved by proper management.

In fact, we should stop thinking about most of these conditions as diseases and start thinking about them as physical states of ageing. States that accelerate the speed of ageing. States that you can, at least, partly control. I do not like the term chronic disease. With the exception of a few contagious illnesses (HTV infection, for example), most of the chronic conditions that affect us as we age are not diseases in the way we generally think of the term—that is, as infectious diseases. Nor are they usually inheritable genetic diseases, in the sense that the problem has to do with something structurally wrong with us from the time we were born. Rather, these conditions are examples of the body beginning to come undone as a result of ageing. The image of a machine wearing down its parts is apt. These conditions—heart disease, kidney disease, endocrine malfunction—are what we mean by ageing. Yet, and this is important, these conditions also accelerate the rate at which other parts of us age, too. By managing such conditions, we can control, in large part, the degree to which they will age us.

What should you do if you are suddenly afflicted with heart disease, arthritis, or another age-accelerating condition? First, do not despair. Instead, confront the situation head on. Develop a plan. You will need to understand the disease in and out and how it might affect and age you. Find a doctor who can work with you to develop a plan for disease management (It matters less whether your doctor is a generalist or a specialist; what is important is that he or she is knowledgeable about the condition and caring toward you). Read up on the condition yourself. Ask lots of questions. The more you know and understand, the better prepared you will be to fight the effects of the condition. Talk to your doctor about developing a well-rounded strategy for disease management, including diet, medications, exercise, stress reduction, and daily planning.

In general, managing a chronic condition means not just focusing on the condition itself, but treating your whole body with extra care. Those who suffer from almost every kind of chronic disease will want to pay extra special attention to retard or reverse more general ageing processes throughout the body. Eating a proper diet, exercising, managing your weight, and avoiding cigarettes and excess alcohol become key components of ageing management for almost all chronic diseases. All the things that can induce ageing when you are healthy become amplified by a chronic condition. Whereas your body may have once been able to handle long working days, no breakfasts, not enough exercise, or drinking too much, the condition you now have will make the margin for error much lower, because your body won't tolerate as much abuse.

Let's consider diabetes, for example. Diabetes is the sixth leading cause of death in this country, and the leading cause of blindness, not to mention one of the most significant causes of premature ageing. But it needn't be.

There are two types of diabetes, Type I and Type II.  Although they have different causes, the two types have largely the same effect: high levels of sugar in the blood. Diabetes, if not treated properly, can cause arterial ageing; blindness; kidney failure; liver damage; and, in advanced stages, limb loss and heart failure. However, by keeping blood sugar within the levels of people who don't suffer the disease—by managing diet, insulin, and exercise—diabetics can avoid much of the ageing that high blood sugar causes. A diabetic can control the ecosystem, as it were, of his or her body in such a way that the disease has little impact. However, doing so requires a lot of attention and commitment. Not just once in a while, but every single day.

Type I diabetes-—sometimes called juvenile diabetes because the disease often begins in childhood—occurs when the body quits making insulin, the hormone necessary to metabolize sugar in your food and to regulate glucose levels in your blood. Patients with this type of diabetes generally inject artificial insulin that substitutes for the natural insulin their bodies should produce. Carefully monitoring blood sugar and making sure to balance diet, exercise, and insulin levels, in such a way as to keep glucose levels within a normal range is a way of preventing damage.

Type II diabetes, or adult-onset diabetes, usually develops when a person is over forty, often older. It occurs when the cells in the body become insensitive to insulin. The insulin receptors on the outside of each cell no longer react to the insulin molecule that signals the cell to break down glucose. Hence, blood glucose levels remain high. Type II diabetes occurs most often in people who are overweight; although the reasons are unclear, excess weight seems to impede the body's ability to metabolize sugar properly. Type II diabetes affects about 10 to 15 percent of adults over age fifty-five but is more prevalent among some population groups than others, confirming a generic component. For example, African-Americans, particularly African-American women, are much more susceptible to the disease. Indeed, one out of four African Americans over age fifty-five has Type II diabetes. Among certain Native American populations, the prevalence can be as high as 80 percent. However, in many cases, the disease is triggered by a combination of genetic predisposition and lifestyle choices. Some 90 percent of the people who develop Type II diabetes are considerably overweight, and most of these people also do not exercise or have proper diets, both of which further exacerbate the condition. If you 'live young,' you will have less chance of developing the disease, no matter what genes you have.

Diabetic patients who take charge of their condition, vigilantly keeping their blood sugar levels within normal ranges, experience little premature ageing. Patients who lose excess weight, begin exercising, and eat balanced diets that are carefully calibrated to their diabetic condition can reverse the ageing effects of the disease altogether, suffering no more ageing than their disease-free peers. Think of it this way: The diabetic's body can no longer create the conditions it needs for healthy existence all on its own. However, it is possible for the diabetic to create an environment inside the body that keeps him or her in an equally healthy state.

Although not all chronic diseases can be managed in the same way, many other types of diseases are similar to diabetes in the way that they should be treated. Thyroid disease, kidney disease, any endocrine disease, and many gastrointestinal diseases are analogous. The most important element in controlling the effects of these conditions is constant vigilance. Diabetics and most others who have chronic diseases have to monitor their condition each and every day.

Although not all chronic conditions can be managed as well as diabetes, all chronic conditions can be managed so they do not do as much damage—or cause as much ageing—as they would if left untended. Even Alzheimer's disease, a condition with few effective treatments, can be managed in ways that slow the ageing that the disease can cause. For example, studies have found that Alzheimer's patients who participate in clinical trials-—and hence are provided with high-quality medical care and better support systems—are half as likely to end up in nursing homes within the same period as Alzheimer's patients who do not participate in such trials. Better disease management does not stop the disease but helps stave off its most ruinous effects.

Those who have a chronic condition should ask themselves: Can this condition make me more prone to other kinds of chronic conditions? For example, people who have arthritis may be less likely to exercise, and for an obvious reason: It hurts. However, modest exercise relieves the symptoms of many types of arthritis. Furthermore, not exercising may cause the sudden appearance of arterial disease-—arterial disease that had been staved off because of exercise. That is, the response to one chronic illness (lack of exercise because of arthritis) may bring about another chronic illness (arterial disease).

Ask your doctor if there are any hidden symptoms you should be looking for. Heart attack victims, for example, often suffer bouts of serious depression in their recovery period. Although it is unclear what the exact cause-and-effect relationship is—Does the heart attack cause a biologic depression? Do depressed people have more heart attacks? Or is having a heart attack simply depressing?—it is clear that those who are recuperating from heart attacks need to be aware of this possible condition. Depression can undermine a recovery program, making it difficult for a heart attack sufferer to get the energy to change eating habits or begin an exercise program, all the things that speed recovery faster and help offset ageing. Luckily, in most instances, depression can be successfully treated.

No matter what disease you have, beware of its emotional effects. It is frightening and disheartening to be diagnosed as having a chronic condition. After a lifetime of thinking of yourself as a healthy person, all of a sudden you have to reevaluate your self-image. Don't think that you have to go it alone. It is not uncommon for someone who is diagnosed as having a chronic condition to hide the news from loved ones, not wanting them to worry. But doing so leaves the ill person feeling isolated, and those around the sick person always sense that something is wrong because such a diagnosis changes a person's behaviour. I have seen this reaction innumerable times in my patients: Being told that you will have a condition for the rest of your life, a condition that may affect the quality and length of your life, generally makes a person reflect on the larger importance of his or her life.

If you are diagnosed as having a chronic condition, use your social networks. Talk to people who are close to you about your fears and worries. You will find that the people who care about you will want to help. They will help keep you on track, urging you to stay on the special diet or joining you in your new exercise routine. Do not hesitate to seek professional help from a therapist or counsellor if you feel overwhelmed by the news. To ward off the ageing effects of a chronic illness, you need to be prepared in both body and mind.