Lung Disease
If you suffer asthma, emphysema, chronic bronchitis or other respiratory disorders, planning ahead can help you weather flare-ups.
"Every patient with a chronic illness that has exacerbations should have a very specific action plan, which is worked out with the doctor," says Dr. Norman Edelman, a Stony Brook, New York, pulmonologist and consultant for scientific affairs to the American Lung Association. "When you get sick, when it gets worse, here's what you do."
That might include upping medication dosages, or adding additional drugs such as antibiotics or steroids like prednisone, he says.
Ask your doctor to help you draw up plans for lifestyle changes. For instance, a regular exercise plan can improve your lung function. Installing or maintaining home air conditioners or other filters can keep out pollen, dust mites and other allergens that might trigger asthma attacks. Using a peak flow meter can help you gauge your lung capacity.
Keep in mind that air travel or visits to high-altitude locations can affect lung function, and arrange for supplemental oxygen on flight if you need it.
Watch out for symptoms that include increasing shortness of breath, an increasing cough, a cough productive of sputum or blood, persistent chest pain, inability to sleep at night, headaches or blue lips or nail beds. Your doctor may ask you to keep a journal of your symptoms, rating their frequency and severity.
Cancer
There are as many instructions for improving cancer patients' care as there are types of cancer, says Dr. Ted Gansler, director of medical content for the American Cancer Society. Before starting treatment, learn about your particular type of cancer. There are multiple forms of breast, lung or skin cancer, and multiple stages of each, depending on how far the malignancy has spread.
"Then you can start looking into what some of the treatment options would be for somebody with your stage and type of cancer," Gansler says.
Ask your doctor how long the treatment will take, what its side effects are, how severe they are, how long will they persist and what can be done to relieve them. Inquire how effective the treatment is at both extending life expectancy and improving quality of life. Ask about clinical trials, which may test treatments for early- and interim-stage diseases as well as for advanced disease.
Because cancer treatments can tax your body's limits, "One of the main things patients can do is be alert to catching side effects of treatment," Gansler says.
If you're undergoing chemotherapy, ask how to handle a fever and at what temperature you should call your doctor. Also report any shortness of breath, abnormal bleeding or areas of pain or redness, Gansler says.
Diabetes
"Diabetes is almost completely a self-managed disease,"says Dr. Marian Parrott, vice president of clinical affairs for the American Diabetes Association. "Your doctor's job is to teach you how to take care of it. Your job is to do it.
If you need help managing your condition, ask for referrals to a diabetes educator who can teach you to monitor blood glucose and to log and interpret those results. Or visit a nutritionist who can help develop an individualized meal plan. Sticking to a healthy diet, exercising regularly and keeping your weight under control are crucial to preventing heart disease, which poses a greater risk to diabetics.
Take your insulin or medication religiously, record your blood glucose levels daily, and bring your log to each office visit, Parrott says.
Eye exams, foot exams, kidney tests and cholesterol and blood pressure monitoring can help you avoid diabetic complications, she says. If these tests slip through the cracks, don' t hesitate to remind your doctor.
A bout of the flu or other common illness can throw your blood sugar off kilter, requiring more stringent monitoring and more finely calibrated insulin dosages, she says. Prepare for that possibility with your doctor, Parrott says.
"Everybody should have a sick-day plan [for managing diabetes]," she says.
Heart disease
Few conditions call for such extensive lifestyle changes as heart disease. "You're saying to people: You need to stop smoking, exercise more regularly and improve your diet," says Dr. Richard Stein, chief of cardiology at Brooklyn Hospital Center in New York and a spokesman for the American Heart Association.
Ask your doctor about support for those changes. A skilled nutritionist can devise a meal plan to fit your tastes and lifestyle, making it easier to stick with. And a cardiac rehabilitation program offered by your local YMCA or community center may keep you on the exercise treadmill better than willpower alone.
Patients with high cholesterol or elevated blood pressure sometimes have trouble remembering medication since their conditions are largely without symptoms. "You're taking pills for lab tests, not something you can feel," Stein says.
To keep on top of your medication, Stein suggests leaving it near your orange juice or vitamins. Or take it when you brush your teeth. "Tie it to your daily routine," Stein says.
Be alert to physical symptoms that could signal a heart attack, including chest pain that worsens with exertion, profound fatigue, shortness of breath, sweating or burning abdominal pain not relieved by antacids, he says.
Seek help for those symptoms immediately, such as calling 911. Early intervention can make the difference between a minor episode and a fatal heart attack, Stein says. Even if you've been to the emergency room repeatedly on false alarms, don' t be ashamed to show up again.
"If you don't go, you run the risk of having a heart attack and shortening your life tragically," he says. "So I'd rather you go and be embarrassed than suffer a heart attack."
eborah Sullivan Brennan is an Idyllwild, California-based writer specializing in health and environmental issues. She is a regular contributor to the Los Angeles Times and to several health Web sites including Apria.com.
