Thursday, July 13th, 2000
Chronic disease requires careful monitoring
By Dr. Anthony Policastro
Nanticoke Memorial Hospital

We all know people who are in and out of the hospital. There are some diseases in which this is common.
For example, asthma, COPD (emphysema), diabetes and heart failure are all associated with frequent hospitalizations. These diseases have several things in common. The first of them is related to the fact that there are things the patient may do to prevent a relapse. It might involve avoiding an allergic substance in asthma. It might involve stopping smoking in COPD. It might involve diet in both diabetes and heart failure. In each instance, there is an opportunity to keep the problem from getting out of control. Unfortunately, the things that the patients must do are difficult.

An asthmatic who is allergic to a household pet might find it hard to give up the pet. Over the years in pediatrics, I have had several situations in which the parents would rather have the child admitted to the hospital than give up the family cat.
Nicotine addiction is hard to break. Even patients with bad COPD who are bedridden and require oxygen full time, continue to smoke.
A strict diabetic diet requires the individual to pay attention to everything he/she eats. It requires counting portions of food. It requires avoidance of high calorie snacks. This is a very different lifestyle than most Americans are used to having.

Heart failure requires careful monitoring of salt and water. Salt is present in many foods. Staying on the very low-salt diet required by heart failure is very difficult. Thus, prevention of a relapse is complicated.
That leads to the second major point. In most of these chronic problems, there are warning signs when things are getting out of control.
The asthmatic patient and COPD patient might see worsening of their cough. They may also see increased shortness of breath compared to their usual state. The diabetic patient will begin to see higher blood sugars than normal. The heart failure patient will notice a significant weight gain.
It is important to notice these problems early. It is important to seek medical help as soon as possible. The hope is that it will result in eliminating the need for hospitalization completely. If hospitalization does become necessary, the severity of the problem, the amount of treatment and the length of the hospital stay are all decreased.

There is an old saying in medicine. It goes: "Asthma is a lot like a fire. The sooner you begin pouring water on it, the easier it is to put out." A similar statement is true about all of these illnesses. It is true that an ounce of prevention is worth a pound of cure.

These are the common illnesses that result in frequent hospitalizations. There are many others as well. They also have things that the patient may do to prevent re-admission. They also have signs of the problem getting worse so they can go to the doctor early.
There are two areas that cannot be controlled by the physicians. Some people develop illnesses that will require them to be hospitalized from time to time. They cannot always control getting the disease. They cannot control the fact that these diseases are associated with hospitalization.
They can control the frequency of hospitalization by paying attention to treatment of their disease. They can control the length of time that they are in the hospital by getting to the doctor before their symptoms get too bad.

If we have one of these problems or have a family member who does, these are two important lessons to remember.

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