Chronic Disease Management

Turning Healthcare Data Into Intelligence

AHDI has been successfully managing chronic conditions for employers for well over a decade. We identify chronic conditions in a population through medical benefit claims or self-identification utilizing a Health Risk Assessment. Our Healthcare Navigator™ Nurses are trained in Motivational Interviewing to coach those identified with any of the 27 conditions that we track. Our goal is long term behavioral change to improve patient self-management. The program will reduce claims costs depending on the prevalence of chronic disease in a population and the employer’s support for program participation. We have evaluated the financial effectiveness of the program on four occasions. The most recent evaluation has been accepted for publication in a peer-reviewed medical journal and is available here. This evaluation indicates a reduction in cost of about 14% compared to what would be expected, given all of the members’ medical conditions. Since these members account for about two-thirds of the total medical claims cost for self-funded plans, the average total expense reduction is about 9%.

27 Chronic Diseases List

  • Asthma
  • Atherosclerosis
  • Atrial Fibrillation
  • Chronic Obstructive Pulmonary Disease
  • Chronic Kidney Disease
  • Congestive Heart Failure
  • Coronary Artery Disease
  • Depression
  • Diabetes
  • Epilepsy
  • Human Immunodeficiency Virus
  • Hyperlipidemia
  • Hypertension
  • Hyperthyroidism
  • Hypothyroidism
  • Metabolic Syndrome
  • Multiple Sclerosis
  • Parkinson's Disease
  • Polymyalgia Rheumatica
  • Pre-Diabetes
  • Pulmonary Hypertension
  • Pulmonary Hypertension w/ COPD
  • Regional Enteritis (or Crohn’s Disease)
  • Rheumatoid Arthritis
  • Sleep Apnea
  • Thrombo-embolic Disease
  • Ulcerative Colitis

Please Select a Topic

Asthma

Asthma is due to the narrowing of the airways to the lungs, affecting your ability to breathe normally.

Narrowing of the airways is usually caused by inflammation that may be due to many different factors.  Treatment is aimed at decreasing symptoms, maintaining normal activity and preventing flare-ups and hospitalizations and long-term complications.

Asthma requires long-term management.  Visits with your doctor are important for monitoring of your condition, reducing the frequency of asthma attacks, measuring the capacity of your lungs, teaching you ways to manage your condition, and improving your ability to function. You should be getting at least these services:

  • Two visits to your doctor per year *
  • One spirometry (breathing test) per year (for patients 10 years of age or older)

Optimal care may well require additional observation and intervention such as the regular use of medication to reduce inflammation in the airways.  You are encouraged to discuss this with your physician. 

Asthma is generally not considered well controlled if:

  • You need to use a fast-acting “rescue” inhaled medicine more often than three times a week or
  • If your symptoms wake you up at night or
  • If your symptoms interfere with your normal activities.

As with any chronic medical condition, you should understand how this illness might affect you and how to prevent complications.  You should understand what treatment is most appropriate for you and work as part of a team with your doctor and other healthcare professionals to get the best care for yourself. 

Information to help you get the best care is available from several sources.  The best and most convenient place to get this information is from your physician’s office.  Also, most hospital libraries have sections devoted to patient education and the librarians are usually very helpful. 

For this condition, another excellent, up-to-date and unbiased source of information is the American Lung Association.  If you have Internet access at home, work, public library, or elsewhere, look up their website at http://www.lungusa.org. Click on Lung Disease, then Asthma.

If you do not have Internet access, you can contact them for free printed materials on asthma at their national address:

American Lung Association
1301 Pennsylvania Ave., NW
Suite 800
Washington, DC 20004

If a local American Lung Association is not listed in your telephone book, call (800) 548-8252.

 

 

 

 

 

Atherosclerosis / Peripheral Arterial Disease

Atherosclerosis is more commonly called “hardening of the arteries”.  The condition may affect arteries in any part of the body, but the term is most often applied to disease in the arteries that supply blood to the legs: the “peripheral arteries”.  Peripheral arterial disease is usually accompanied by atherosclerosis in the coronary arteries (increasing the risk of heart attack) and brain (increasing the risk of stroke).  There may be no symptoms associated with peripheral vascular disease until the condition is far advanced.  The disease may produce pain in the calves of the legs when walking and may cause the feet to be cold or fail to heal after minor injury. 

Peripheral arterial disease requires long-term management.  Regular visits with your doctor are important to monitor your condition and possible side effects of medications used to control it. You should be getting at least these services:

  • One visit to your doctor per year* (At your visits, take off your shoes so that your doctor can examine your feet for signs of poor blood flow.)
  • One Low-Density Lipoprotein (“bad cholesterol) test per year

Optimal care may well require additional observation and intervention.  You are encouraged to discuss this with your physician. 

Treatment of peripheral arterial disease may involve:

  • Avoiding tobacco products, particularly cigarettes.
  • Controlling blood pressure, often to 130/80 or less (a systolic pressure of 120 or less is normal)
  • Controlling cholesterol and other blood lipids. Keeping the LDL-C (low-density lipoprotein cholesterol) less than 100 is generally recommended for people who have this problem. 
  • Regular exercise as recommended by your doctor.
  • Aspirin or other medications to keep blood from clotting in narrowed arteries or medications to improve blood flow through narrowed arteries.
  • Surgical treatment of obstructions is sometimes required in severe cases that do not respond to management with medications in combination with exercise and other lifestyle changes.

As with any chronic medical condition, you should understand how this illness might affect you and how to prevent complications.  You should understand what treatment is most appropriate for you and work as part of a team with your doctor and other healthcare professionals to get the best care for yourself. 

Information to help you get the best care is available from several sources.  The best and most convenient place to get this information is from your physician’s office.  Also, most hospital libraries have sections devoted to patient education and the librarians are usually very helpful. 

For this condition, another excellent, up-to-date and unbiased source of information is the National Heart, Lung, and Blood Institute.  If you have Internet access at home, work, public library, or elsewhere, look up their website at http://www.nhlbi.nih.gov/health/dci/Diseases/Atherosclerosis/Atherosclerosis_WhatIs.html .

If you do not have Internet access, you can contact them for printed materials at:

NHLBI Health Information Center
Attention: Web Site
P.O. Box 30105
Bethesda, MD 20824-0105

Or their phone number is: (301) 592 8573

Atrial Fibrillation

Atrial Fibrillation is a condition that affects the normal beating of the heart.  Medication can sometimes return the heart to normal beating.  Sometimes this is treated by cardioversion (electrical shock to the heart).  Some patients who are not returned to a regular heartbeat or have recurrence of fibrillation may require medications to control the heart rate and to “thin” their blood.   A “blood thinner” is an anticoagulant and is taken to reduce the chance of blood clots and strokes.  A side effect of blood thinners can be bleeding.

Visits with your doctor are important for finding the cause of fibrillation and for monitoring your current heart rate and rhythm.  Patients taking blood thinners require close follow-up and frequent blood tests to reduce the chance of bleeding.  You should be getting at least these services:

  • One regular visit with your doctor a year *

Optimal care may well require additional observation and intervention.  You are encouraged to discuss this with your physician. 

One of the major complications of atrial fibrillation is caused by the formation of blood clots within the atrium of the heart.  If such a clot forms, it can break loose and be carried by blood flow to the brain, causing a stroke.  Anti-coagulation therapy with Coumadin® (warfarin) is often prescribed to prevent this complication.  Because too much of this medicine can cause bleeding problems, its effect must be closely monitored.  This is done with a test called a Prothrombin Time – the result of this test is usually expressed as the “INR” (which stands for “International Normalized Ratio”).  The INR value for atrial fibrillation should generally be between 2.0 and 3.0. 

As with any chronic medical condition, you should understand how this illness might affect you and how to prevent complications.  You should understand what treatment is most appropriate for you and work as part of a team with your doctor and other healthcare professionals to get the best care for yourself. 

Information to help you get the best care is available from several sources.  The best and most convenient place to get this information is from your physician’s office.  Also, most hospital libraries have sections devoted to patient education and the librarians are usually very helpful. 

For this condition, another excellent, up-to-date and unbiased source of information is the American Heart Association.  If you have Internet access at home, work, public library, or elsewhere, look up their website at www.americanheart.org.   Either use the “Search” function or click on Conditions then Arrhythmia’s . If you do not have Internet access, you can contact them for free printed materials on atrial fibrillation at their national address:

American Heart Association
National Center
7272 Greenville Avenue
Dallas, Texas 75231

Or you may call their national telephone number at: (800) AHA-USA1 or (800) 242-8721

 

Each state has a Heart Association affiliate that also has these printed materials.  If the local affiliate is not listed in your phone book, the national association can provide you with the telephone number and address. 

 

Chronic Obstructive Pulmonary Disease

Chronic Obstructive Pulmonary Diseases (COPD) includes chronic bronchitis and emphysema. Damage to the airways and air sacs of your respiratory system may result in shortness of breath.  Treatment for this group of illnesses is directed at slowing or stopping the progression of the disease and at reducing shortness of breath.  Individuals with this condition are very susceptible to respiratory infections and should take precautions during cold and flu season. 

COPD is a chronic condition that requires regularly scheduled follow-up visits with your doctor.  Visits to the doctor are important because they allow your physician to check the lungs and the oxygen level in blood, and make changes to treatment. You should be getting at least these services:

  • One visit to your doctor a year
  • One Spirometry (breathing test) per year

Optimal care may well require additional observation and intervention.  You are encouraged to discuss this with your physician. 

Important issues in managing COPD include:

  • Avoiding cigarette smoke and other irritants
  • Getting a flu shot every fall
  • Having a ‘pneumonia shot’ (pneumococcal vaccine) at least twice, about five years apart
  • If your oxygen levels are low, using extra oxygen has been shown to lengthen life and reduce heart failure
  • If your problem is worse than mild, regular use of inhaled medications such as bronchodilators and a steroid may be appropriate

As with any chronic medical condition, you should understand how this illness might affect you and how to prevent complications.  You should understand what treatment is most appropriate for you and work as part of a team with your doctor and other healthcare professionals to get the best care for yourself. 

Information to help you get the best care is available from several sources.  The best and most convenient place to get this information is from your physician’s office.  Also, most hospital libraries have sections devoted to patient education and the librarians are usually very helpful. 

For this condition, another excellent, up-to-date and unbiased source of information is the American Lung Association.  If you have Internet access at home, work, public library, or elsewhere, look up their website at http://www.lungusa.org.  Click on Lung Disease then COPD or you may use the Search feature.

If you do not have Internet access, you can contact them for free printed materials on COPD at their national mailing address:

              American Lung Association
              1301 Pennsylvania Ave., NW
              Suite 800
              Washington, DC 20004
 

If a local American Lung Association is not listed in your telephone book, call (800) 548-8252.

 

 

 

 

Chronic Kidney Disease

Chronic Kidney Disease is a disorder in which the kidney’s ability to perform its function and cleanse the blood of toxins (impurities, poisons) is impaired.  This illness can lead to kidney failure and the need for kidney dialysis.  Progression of this problem can be greatly slowed with good medical care.  Complications of this condition can greatly damage other parts of your body.

Visits to the doctor are important because they allow the doctor to monitor your condition at regular intervals, look for complications caused by the disease and treatment and teach you ways to care for yourself. You should be getting at least these services:

  • One visit with your doctor per year *
  • The following tests one time a year: Hemoglobin or Hematocrit, serum Creatinine, Potassium, Calcium and Phosphorus.

Optimal care may well require additional observation and intervention.  You are encouraged to discuss this with your physician. 

As with any chronic medical condition, you should understand how this illness might affect you and how to prevent complications.  You should understand what treatment is most appropriate for you and work as part of a team with your doctor and other healthcare professionals to get the best care for yourself. 

Information to help you get the best care is available from several sources.  The best and most convenient place to get this information is from your physician’s office.  Also, most hospital libraries have sections devoted to patient education and the librarians are usually very helpful. 

For this condition, another excellent, up-to-date and unbiased source of information is the National Kidney Foundation. If you have Internet access at home, work, public library, or elsewhere, look up their website at www.kidney.org. If you do not have Internet access, you can contact them for free printed materials on kidney disease at their national address:

National Kidney Foundation, Inc.
30 East 33rd Street
New York, NY 10016

Or call them at (800) 622-9010

Local or State Kidney Foundation affiliates can also provide you with these educational materials. 

Congestive Heart Failure

This illness is a result of the heart’s inability to pump blood effectively enough to meet the body’s needs. Every part of the body relies on adequate blood flow and oxygen.  If blood flow is not adequate to all parts of the body, other internal organs may be affected.  Symptoms of this illness may include weakness, shortness of breath, and swelling in the legs.  Treatment is aimed at relieving the symptoms and improving the heart’s ability to pump blood.

Visits to your doctor are important because they allow the doctor to monitor the condition at regular intervals, initiate and manage treatment and look for complications due to the treatment or illness. You should be getting at least these services:

  • One visit to the doctor per year*
  • The following laboratory tests: one serum creatinine and potassium

Optimal care may well require additional observation (such as occasional measurement of heart function) and treatment with medications to reduce the heart’s workload.  You are encouraged to discuss this with your physician. 

As with any chronic medical condition, you should understand how this illness might affect you and how to prevent complications.  You should understand what treatment is most appropriate for you and work as part of a team with your doctor and other healthcare professionals to get the best care for yourself. 

Information to help you get the best care is available from several sources.  The best and most convenient place to get this information is from your physician’s office.  Also, most hospital libraries have sections devoted to patient education and the librarians are usually very helpful. 

For this condition, another excellent, up-to-date and unbiased source of information is the American Heart Association.  If you have Internet access at home, work, public library, or elsewhere, look up their website at www.americanheart.org.  Either use the “Search” function or click on the Conditions then Heart Failure.   If you do not have Internet access, you can contact them for free printed materials on congestive heart failure at their national address:

American Heart Association
National Center
7272 Greenville Avenue
Dallas, Texas 75231

Or you may call their national telephone number (800) AHA-USA1 or (800) 242-8721

Each state has a Heart Association affiliate that also has these printed materials.  If the local affiliate is not listed in your phone book, the national association can provide you with the telephone number and address. 

 

 

Coronary Artery Disease

Coronary artery disease is a condition in which the blood vessels (coronary arteries) that supply blood and oxygen to the heart muscle narrow or become completely blocked.  The lack of oxygen to the heart may lead to angina (chest pain) and ultimately to a myocardial infarction (heart attack).  In some individuals angina can be treated with medication and life style changes, while others may require surgery.  The goal of treatment is to alleviate symptoms and decrease the chance of heart attack and damage to the heart.

Another end-result of coronary artery disease is congestive heart failure.  Congestive heart failure is a condition in which the heart is unable to pump blood at a rate sufficient to meet the body’s need.  This will cause weakness, shortness of breath and swelling in the legs.

Visits with your doctor are important for monitoring of your current condition, medication side effects and follow-up care. You should be getting at least these services:

  • One visit to the doctor per year *
  • One Low-Density Lipoprotein (“bad cholesterol”) test per year

Optimal care may well require additional observation and intervention.  You are encouraged to discuss this with your physician. 

Several issues are important in keeping coronary artery disease under control:

  • Smoking or other tobacco use dramatically increases risk
  • Controlling lipid levels in the blood reduces the risk of heart attacks. Keeping “bad cholesterol” (LDL or Low Density Lipoprotein cholesterol) less than 100 is generally recommended
  • Controlling blood pressure reduces risk. Keeping systolic blood pressure less than 140 is generally recommended. 

As with any chronic medical condition, you should understand how this illness might effect you and how to prevent complications.  You should understand what treatment is most appropriate for you and work as part of a team with your doctor and other healthcare professionals to get the best care for yourself. 

Information to help you get the best care is available from several sources.  The best and most convenient place to get this information is from your physician’s office.  Also, most hospital libraries have sections devoted to patient education and the librarians are usually very helpful. 

For this condition, another excellent, up-to-date and unbiased source of information is the American Heart Association.  If you have Internet access at home, work, public library, or elsewhere, look up their website at www.americanheart.org. Either use the “Search” function or choose Conditions then Cholesterol.   If you do not have internet access, you can contact them for free printed materials at their national address:

American Heart Association
National Center
7272 Greenville Avenue
Dallas, Texas 75231

Or you may call their national telephone number at (800) AHA-USA1 or (800) 242-8721

Each state has a Heart Association affiliate that also has these printed materials.  If the local affiliate is not listed in your phone book, the national association can provide you with the telephone number and address. 

 

Depression

Depression is a common disorder affecting a person's mood.  The illness may be characterized by feelings such as sadness, loneliness, lack of pleasure, and withdrawal.  Treatment may include medication and counseling.  Early identification and treatment can greatly improve outcomes.  Treatment is aimed at reducing symptoms, improving mood, and returning the patient to normal daily activities and enjoyment of life.  Patients who have had positive outcomes following therapy can have relapses.  Early detection and treatment of relapses can reduce the severity and duration of the relapse. 

Visits to your doctor are important to monitor your progress for signs of relapse, and medication adjustment if prescribed. You should be getting at least these services:

  • One visit to your doctor per year*

Optimal care may well require additional observation and intervention.  You are encouraged to discuss this with your physician. 

As with any medical condition that has a tendency to recur, you should understand how this illness might affect you and how to prevent complications.  You should understand what treatment is most appropriate for you and work as part of a team with your doctor and other healthcare professionals to get the best care for yourself. 

Information to help you get the best care is available from several sources.  The best and most convenient place to get this information is from your physician’s office.  Also, most hospital libraries have sections devoted to patient education and the librarians are usually very helpful. 

For this condition, another excellent, up-to-date and unbiased source of information is Mental Health America. If you have Internet access at home, work, public library, or elsewhere, look up their website at www.nmha.org.  Start with the ‘search bar’ or go to the bottom of the page and under Educate, choose Depression.   If you do not have Internet access, call Mental Health America at (800) 969-6642 for free brochures and information.  Materials are also available from the association’s many local affiliates. 

Diabetes Mellitus

Diabetes is an illness affecting the body’s ability to breakdown carbohydrates (sugars) due to a lack of insulin or resistance to insulin’s effects.  Insulin is produced by the pancreas and maintains proper blood sugar in your body.  Some individuals with this illness can control their blood sugars by managing their diet while others will require oral medication or insulin injections. Both low and elevated blood sugars can be dangerous.  Long term elevation of blood sugar can lead to damage to nerves, impaired vision, damage to blood vessels and kidneys, and susceptibility to infection.  By carefully managing blood sugar levels, diabetics can minimize long-term complications.

Visits to your doctor are important for monitoring of blood sugars and detection of complications.  In addition to monitoring your diet and blood sugars at home, you should be getting at least these services:

  • Two visits to your doctor per year (more often if your blood sugars are not well controlled)*
  • Two Glycohemoglobin (Hemoglobin A1c) tests per year
  • One Creatinine per year
  • One Lipid Panel per year
  • One Urine Albumin/Creatinine ratio or other test for early kidney disease per year (if no kidney disease or treatment for early diabetic kidney disease)

Optimal care may well require additional observation and intervention.  You are encouraged to discuss this with your physician. 

Goals for diabetes management should include:

  • Avoidance of cigarettes and other tobacco products.
  • Keeping blood sugar levels controlled. This is best assessed with a glycohemoglobin level (also called a hemoglobin A1c, or HgbA1c).  The hemoglobin A1c level reflects the average blood sugar over the prior month or so.  Adequate sugar control is considered a HgbA1c level of less than seven.  (The normal value is less than six and reflects an average blood sugar of less than 126.)
  • Keeping blood pressure low. Pressures of less than 130/80 are generally recommended.
  • Catching vision problems early with a yearly eye examination by an Ophthalmologist or Optometrist (The eye doctor should dilate your pupils in order to do a thorough examination of the retina in the back of the eye.)
  • Keeping blood lipids controlled. The following levels are generally recommended:
    • A ‘bad cholesterol’ (LDL or Low Density Lipoprotein cholesterol) level of less than 100
    • A ‘good cholesterol’ (HDL or High Density Lipoprotein cholesterol) level of more than 40 for men and 50 for women
    • A triglyceride level of less than 150

As with any chronic medical condition, you should understand how this illness might affect you and how to prevent complications.  You should understand what treatment is most appropriate for you and work as part of a team with your doctor and other healthcare professionals to get the best care for yourself. 

Information to help you get the best care is available from several sources.  The best and most convenient place to get this information is from your physician’s office.  Also, most hospital libraries have sections devoted to patient education and the librarians are usually very helpful. 

For this condition, another excellent, up-to-date and unbiased source of information is the American Diabetes Association.  If you have Internet access at home, work, public library, or elsewhere, look up their website at www.diabetes.org.

If you do not have Internet access, you can contact them for free printed materials.

American Diabetes Association
Attn: Center for Information
1701 North Beauregard Street
Alexandria, VA 22311

Their telephone number is (800) 342-2383

You may also contact any local American Diabetes Association affiliate for those same materials. 

Epilepsy

Epilepsy is a chronic disorder causing abnormal firing of nerve cells in the brain.  The illness causes the brain to experience seizures.  These seizures may affect thinking, consciousness or muscle activity in any or all parts of the body.  Seizures are most often controlled by taking medication regularly. 

Visits to your doctor are important for evaluating the current condition, monitoring and adjusting medications, and monitoring compliance with medication. You should be getting at least these services:

  • One visit to your doctor per year *

(Visit with a Neurologist within 3 months IF hospitalized or if two or more emergency room encounters for epilepsy within 90 days)

Optimal care may well require additional observation and intervention.  You are encouraged to discuss this with your physician. 

As with any chronic medical condition, you should understand how this illness might affect you and how to prevent complications.  You should understand what treatment is most appropriate for you and work as part of a team with your doctor and other healthcare professionals to get the best care for yourself. 

Information to help you get the best care is available from several sources.  The best and most convenient place to get this information is from your physician’s office.  Also, most hospital libraries have sections devoted to patient education and the librarians are usually very helpful. 

For this condition, another excellent, up-to-date and unbiased source of information is the Epilepsy Foundation. If you have Internet access at home, work, public library, or elsewhere, look up their website at www.efa.org. If you do not have Internet access, you can contact them for free printed materials on epilepsy at their national address:

The Epilepsy Foundation
8301 Professional Place
Landover, MD 20785

Or call them at (800) EFA-1000 or (800) 332-1000

Local affiliate organizations can also provide you with educational materials.

HIV

The initials “HIV” stand for “Human Immunodeficiency Virus”.  This is the infectious agent that causes AIDS (Acquired Immunodeficiency Syndrome).  Individuals with this illness are prone to unusual cancers and infections.  Although there was little effective treatment available when the syndrome was first described in the early 1980’s, very good therapy is now available for the HIV infection itself as well as for the unusual infections to which it predisposes.  It is therefore very important to receive aggressive medical care for this condition from the time of diagnosis.

At the very minimum, most individuals with this chronic illness should receive:

  • Two visits to your doctor per year*
  • One T-Cell/CD-4 Counts per year
  • Two HIV Quantifications
  • Two CBCs (complete blood counts) per year
  • For adult women with the condition, one Pap Smear test for cervical cancer per year

Optimal care may well require a great deal more evaluation and therapy. You are encouraged to discuss this with your physician. 

As with any chronic medical condition, you should understand how this illness might affect you and how to prevent complications.  You should understand what treatment is most appropriate for you and work as part of a team with your doctor and other healthcare professionals to get the best care for yourself. 

Information to help you get the best care is available from several sources.  The best and most convenient place to get this information is from your physician’s office.  Also, most hospital libraries have sections devoted to patient education and the librarians are usually very helpful. 

There are many other sources of information, not all of them reliable. One excellent, up-to-date and unbiased source of information is the website WebMD.  If you have Internet access at home, work, public library, or elsewhere, look up their website at http://www.webmd.com/hiv-aids/default.htm

If you do not have Internet access, your local public health department should have printed materials.  Another resource for information is the director of HIV Programs at the Food and Drug Administration.

HIV/AIDS Program Director
Office of Special Health Issues
Food and Drug Administration
10903 New Hampshire Avenue
Bldg. 32, Room 5367
Silver Spring, MD 20993 

Or phone them at: (301) 796-8460

 

Hyperlipidemia / High Cholesterol

Hyperlipidemia is a condition where there are large amounts of lipids (fats) in the blood.  Examples of lipids are cholesterol and triglycerides.  The most serious effect is “hardening of the arteries”.  Studies have shown that proper treatment of this condition can lower the chances of heart attacks, strokes and other vascular problems.  Some patients with this condition will respond to changes in their diet, while others will require medication to lower the levels in the blood.  The kind of medication will vary depending on which lipids are elevated.

Lipid testing is important because the test can assist the doctor in determining how best to treat the condition so as to prevent or lower your chances of complications.  You should be getting at least these services:

  • One Lipid Panel per year

Optimal care, particularly for patients who require medication, may well require additional observation and treatment.  You are encouraged to discuss this with your physician. 

Management of hyperlipidemia generally includes the following:

  • Avoidance of cigarettes and other tobacco products
  • Keeping blood pressure controlled. Blood pressures should be less than 140/90, no more than 130/80 if you also have diabetes or other problems.
  • Keeping lipids themselves controlled. “Bad cholesterol” (LDL or Low Density Lipoprotein cholesterol) levels are generally recommended to be kept less than:
    • 160 even if you have no other risk factors
    • 130 if you have some combination of a family history of coronary artery disease at a relatively young age (less than 55 for men, 65 for women), your blood pressure is high or requires treatment, or your “good cholesterol” (HDL or High Density Lipoprotein cholesterol) is less than 40.
    • 100 if you also have diabetes, coronary disease or peripheral vascular disease

 

As with any chronic medical condition, you should understand how this illness might affect you and how to prevent complications.  You should understand what treatment is most appropriate for you and work as part of a team with your doctor and other healthcare professionals to get the best care for yourself. 

Information to help you get the best care is available from several sources.  The best and most convenient place to get this information is from your physician’s office.  Also, most hospital libraries have sections devoted to patient education and the librarians are usually very helpful. 

For this condition, another excellent, up-to-date and unbiased source of information is the American Heart Association.  If you have Internet access at home, work, public library, or elsewhere, look up their website at www.americanheart.org

Either use the “Search” function or click on Conditions then Cholesterol to look up information about hyperlipidemia and related topics.  If you do not have Internet access, you can contact them for free printed materials on hyperlipidemia at their national address:

American Heart Association
National Center
7272 Greenville Avenue
Dallas, Texas 75231

Or you may call their national telephone number at (800) AHA-USA1 or (800) 242-8721

Each state has a Heart Association affiliate that also has these printed materials.  If the local affiliate is not listed in your phone book, the national association can provide you with the telephone number and address. 

Hypertension

Hypertension is a term for abnormally high pressure in the arteries.  There are usually no symptoms associated with high blood pressure itself.  However, having high blood pressure increases risks of stroke, heart failure and heart attacks, kidney failure and loss of circulation to your feet.

Hypertension requires long-term management.  Regular visits with your doctor are important to monitor your blood pressure and possible side effects of medications used to control it. You should be getting at least these services:

  • One visit to your doctor per year*
  • One serum creatinine per year

Optimal care may well require additional observation and intervention.  For example, if you are taking a diuretic (“water pill”) or a drug of a type called either an “ACE inhibitor” or Angiotensin Receptor Blocker”, you should have your kidney function and blood potassium level checked at least once a year.  You are encouraged to discuss this with your physician. 

Hypertension is generally considered poorly controlled if:

  • The systolic pressure (the first and higher number of the pair of numbers measured in mmHg) is over 140
  • The diastolic pressure (the second and lower number of the pair measured) is over 90 mmHg.
  • If you also have other conditions which cause blood vessel disease, most importantly diabetes, pressures should be lower: 130/80 or less. (A systolic pressure of 120 or less is normal.)

As with any chronic medical condition, you should understand how this illness might affect you and how to prevent complications.  You should understand what treatment is most appropriate for you and work as part of a team with your doctor and other healthcare professionals to get the best care for yourself. 

Information to help you get the best care is available from several sources.  The best and most convenient place to get this information is from your physician’s office.  Also, most hospital libraries have sections devoted to patient education and the librarians are usually very helpful. 

For this condition, another excellent, up-to-date and unbiased source of information is the American Heart Association.  If you have Internet access at home, work, public library, or elsewhere, look up their website at http://www.americanheart.org.  Click on Conditions then High Blood Pressure.

If you do not have Internet access, you can contact them for free printed materials.                

American Heart Association National Center
7272 Greenville Avenue
Dallas, Texas 75231

Call your local American Heart Association affiliate for those materials.  If a local American Heart Association is not listed in your telephone book, call (800) 242-8721 to be connected to your regional affiliate office.

Hyperthyroidism

Hyperthyroidism is a disease causing too much thyroid hormone.  Elevated thyroid levels can lead to dangerous complications such as nervousness, eye changes, weight loss, irregular heart beat, and tremor.  Treatment is aimed at blocking the effect of thyroid hormone and reducing the amount of hormone to a normal level.  Often the treatment can lead to too little hormone and therefore must be monitored closely.

Visits to your doctor are important to monitor the thyroid hormone level in your blood and screen for signs of hypothyroidism (low thyroid hormone).  Follow-up is also important to monitor for side effects from the treatment, and for changes to the eye, heart, or blood pressure.  You should be getting at least these services:

  • One visit to the doctor per year *
  • One set of Thyroid Function Tests (TSH and T4) per year

Optimal care may well require additional observation and intervention.  You are encouraged to discuss this with your physician. 

Thyroid function tests are needed to make certain that your dose of thyroid medication (if any) is still appropriate.  The T4 test measures the amount of thyroid hormone in the blood.  TSH stands for Thyroid Stimulating Hormone.  The TSH test tells whether your body is ‘satisfied’ with the amount of hormone available.  For example, even if the T4 test is in a normal range, you may need more medication if the TSH test result is high – indicating that your body is ‘asking for’ more. 

As with any chronic medical condition, you should understand how this illness might affect you and how to prevent complications.  You should understand what treatment is most appropriate for you and work as part of a team with your doctor and other healthcare professionals to get the best care for yourself. 

Information to help you get the best care is available from several sources.  The best and most convenient place to get this information is from your physician’s office.  Also, most hospital libraries have sections devoted to patient education and the librarians are usually very helpful. 

For this condition, another excellent, up-to-date and unbiased source of information is the American Thyroid Association. If you have Internet access at home, work, public library, or elsewhere, look up their website at http://thyroid.org.  You can access some of their educational materials on-line and find additional educational resources listed including links to other sites.  Click on ATA Publications then Patient Brochures, then Hyperthyroidism.  If you do not have Internet access, you can contact them for low-cost printed materials on thyroid disorders at their national address:

American Thyroid Association
6066 Leesburg Pike, Suite 550
Falls Church, Virginia 22041

Or call them at (703) 998-8890

Hypothyroidism

Hypothyroidism is a disorder in which the thyroid gland does not secrete enough thyroid hormone.  Hypothyroidism can also follow radiation treatment for over-active thyroid or after surgical removal of all or part of the thyroid gland.  Insufficient amounts of thyroid hormone can cause lowered metabolism, weight gain, sleepiness, dry skin, loss of hair and lowered body temperature.  The treatment of choice is thyroid medication to replace the insufficiency.

Visits to your doctor are important to monitor the response to treatment and to adjust medication.  Once an appropriate dose of replacement hormone has been determined, you should be getting at least these services:

    • One regular visit to your doctor a year*
    • One TSH per year

Optimal care may well require additional observation and intervention.  You are encouraged to discuss this with your physician. 

Thyroid function tests are needed to make certain that your dose of thyroid medication (if any) is still appropriate.  The T4 test measures the amount of thyroid hormone in the blood.  TSH stands for Thyroid Stimulating Hormone.  The TSH test tells whether your body is ‘satisfied’ with the amount of hormone available.  For example, even if the T4 test is in a normal range, you may need more medication if the TSH test result is high – indicating that your body is ‘asking for’ more. 

As with any chronic medical condition, you should understand how this illness might affect you and how to prevent complications.  You should understand what treatment is most appropriate for you and work as part of a team with your doctor and other healthcare professionals to get the best care for yourself. 

Information to help you get the best care is available from several sources.  The best and most convenient place to get this information is from your physician’s office.  Also, most hospital libraries have sections devoted to patient education and the librarians are usually very helpful. 

For this condition, another excellent, up-to-date and unbiased source of information is the Thyroid Foundation of America. If you have Internet access at home, work, public library, or elsewhere, look up their website at http://thyroid.org. You can access some of their educational materials on-line and find additional educational resources listed.  Click on ATA Publications then Patient Brochures then Hypothyroidism.  If you do not have Internet access, you can contact them for low-cost printed materials on thyroid disorders at their national address:

                                           American Thyroid Association
                                           6066 Leesburg Pike, Suite 550
                                           Falls Church, Virginia 22041

Or call them at (703) 998-8890

Metabolic Syndrome

Other names for this problem include “Insulin Resistance Syndrome” or “Syndrome X”.  This problem is associated with being overweight – particularly carrying extra fat around the waist.  It typically involves elevated blood sugar and blood pressure as well as abnormal levels of fats in the blood with high triglycerides and low levels of HDL-C (high density lipoprotein cholesterol – or “good” cholesterol).  It very often leads to diabetes and coronary artery disease – and to all the problems related to those conditions.

Metabolic syndrome requires long-term management.  Regular visits with your doctor are important to monitor your condition and possible side effects of medications used to control it. You should be getting at least these services:

  • One visit to your doctor per year*
  • One Lipid Panel measurement per year
  • One Fasting Blood Sugar or Glycohemoglobin test (Hgb A1c) per year

Optimal care may well require additional observation and intervention.  You are encouraged to discuss this with your physician. 

Treatment of metabolic syndrome may involve:

  • Avoiding tobacco products, particularly cigarettes.
  • Loosing weight through improved diet and regular exercise.
  • Controlling blood pressure, often to 130/80 or less – which may require medications.
  • Controlling cholesterol and triglycerides.
  • Controlling blood sugar levels.

As with any chronic medical condition, you should understand how this illness might affect you and how to prevent complications.  You should understand what treatment is most appropriate for you and work as part of a team with your doctor and other healthcare professionals to get the best care for yourself. 

Information to help you get the best care is available from several sources.  The best and most convenient place to get this information is from your physician’s office.  Also, most hospital libraries have sections devoted to patient education and the librarians are usually very helpful. 

For this condition, another excellent, up-to-date and unbiased source of information is the National Heart, Lung, and Blood Institute.  If you have Internet access at home, work, public library, or elsewhere, look up their website at http://www.nhlbi.nih.gov/health/dci/Diseases/ms/ms_whatis.html .

If you do not have Internet access, you can contact them for printed materials at:

NHLBI Health Information Center
Attention: Web Site
P.O. Box 30105
Bethesda, MD 20824-0105

Or phone them at: (301) 592 8573

Multiple Sclerosis

Multiple Sclerosis is a chronic disorder affecting the brain, spinal cord and the myelin sheaths around the peripheral nerves.  Myelin sheaths are layers around the nerves that promote the movement of electrical impulses along the nerves.  The cause of the disorder is unknown.  The progression of the disease varies from patient to patient with flare-ups and remissions.  Signs and symptoms may include paralysis, weakness, loss of movement, depression, loss of vision, and nerve pain.  Severe flare-ups might require hospitalizations and treatments with steroid medication.  In addition to medication, rehabilitation therapy can improve quality of life.

Visits to the doctor are important to evaluate the progression of the disease and treat its symptoms.  Monitoring and treating multiple sclerosis can improve the comfort and quality of life for individuals with the disorder.

You should be getting at least this service:

  • One visit to your Neurologist a year *

Optimal care may well require considerable additional observation and intervention.  You are encouraged to discuss this with your physician. 

As with any chronic medical condition, you should understand how this illness might affect you and how to prevent complications.  You should understand what treatment is most appropriate for you and work as part of a team with your doctor and other healthcare professionals to get the best care for yourself. 

Information to help you get the best care is available from several sources.  The best and most convenient place to get this information is from your physician’s office.  Also, most hospital libraries have sections devoted to patient education and the librarians are usually very helpful. 

For this condition, another excellent, up-to-date and unbiased source of information is the National Multiple Sclerosis Society. . If you have Internet access at home, work, public library, or elsewhere, look up their website at www.nmss.org. If you do not have Internet access, you can contact them for free printed educational materials at their national address:

The National Multiple Sclerosis Society
733 Third Avenue, Third Floor
New York, NY 10017

Or call them at (800) 344-4867

Local affiliate Multiple Sclerosis Societies can also provide you with these materials. 

Parkinson's Disease

Parkinson’s disease is a disorder resulting from a deficiency of dopamine.  Dopamine is a chemical in the brain.  This disorder may cause muscle tremors or rigidity, lack of facial expression, difficulty walking, droopy posture, depression, or changes in mental function. Medication can be given to reduce the symptoms.  Surgical approaches may be helpful in severe cases.  Side-effects from medications may include nausea and a racing feeling of the heart and involuntary movement of the face, arms or legs. 

With any disease that limits mobility, it is important to remain as active as possible. In early stages the patient should maintain normal activity.  As the disease progresses, a regular exercise program is important.  Physical therapy can help maintain normal activity and offer you assistance with ways to adapt to changes associated with the disease.

The rate of progression of Parkinson’s varies widely.  It requires long term follow-up and treatment to slow progression.  Visits to the doctor are important to monitor the progression of the disease and functional status of the patient.  You should be getting at least these services:

  • One visit to the doctor a year. In the later stages more frequent follow-up may be required to manage the disease. * 

Optimal care may well require additional observation and intervention.  You are encouraged to discuss this with your physician. 

As with any chronic medical condition, you should understand how this illness might affect you and how to prevent complications.  You should understand what treatment is most appropriate for you and work as part of a team with your doctor and other healthcare professionals to get the best care for yourself. 

Information to help you get the best care is available from several sources.  The best and most convenient place to get this information is from your physician’s office.  Also, most hospital libraries have sections devoted to patient education and the librarians are usually very helpful. 

For this condition, another very good source of information is The National Parkinson’s Foundation. If you have Internet access at home, work, public library, or elsewhere, look up their website at www.parkinson.org. If you do not have internet access, you can contact the Parkinson Foundation at:

The National Parkinson Foundation
1501 N.W. 9th Ave/Bob Hope Road
Miami, FL 33136-1494

Or call them at: (800) 327-4545

Polymyalgia Rheumatica

Polymyalgia Rheumatica is a chronic condition occurring primarily in older individuals. Pain and stiffness in the muscles of the neck, chest, and pelvis characterize the illness.  People with this condition often experience fatigue, fever and weight loss.  The cause of this condition is unknown.  This condition can be chronic and responds very well to steroids (e.g., cortisone or prednisone).  Side effects of steroids may be serious, however.

A risk associated with this condition is Temporal Arteritis.  Temporal Arteritis can lead to blindness if not treated early and correctly.  Patients with Polymyalgia Rheumatica should promptly report the symptoms of severe headache, scalp tenderness or changes in vision to their doctor.  These symptoms may be signs of Temporal Arteritis. 

Visits to your doctor are important for monitoring of disease activity and side effects of the medication.  A clinical evaluation and an ESR (sedimentation rate or “sed rate” test to measure inflammation) best assess disease activity. Because anemia is often associated with this disease regular monitoring of the blood count is also necessary.  You should be getting at least these services:

  • Two visits to the doctor a year *
  • Two ESR (erythrocyte sedimentation rate) or CRP (c-reactive protein) blood tests a year
  • One Complete Blood Count (CBC) a year

Optimal care may well require additional observation and intervention.  You are encouraged to discuss this with your physician. 

As with any chronic medical condition, you should understand how this illness might affect you and how to prevent complications.  You should understand what treatment is most appropriate for you and work as part of a team with your doctor and other healthcare professionals to get the best care for yourself. 

Information to help you get the best care is available from several sources.  The best and most convenient place to get this information is from your physician’s office.  Also, most hospital libraries have sections devoted to patient education and the librarians are usually very helpful. 

For this condition, another excellent, up-to-date and unbiased source of information is the National Institute of Arthritis and Musculoskeletal and Skin Diseases. If you have Internet access at home, work, public library, or elsewhere, look up their website at www.niams.nih.gov. You can access some of their educational materials on-line and find additional educational resources listed. Start with http://www.niams.nih.gov/Health_Info/Polymyalgia/polymyalgia_ff.asp  Another good reference page is from   American College of Rheumatology :http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/polymyalgiarheumatica.asp.  If you do not have Internet access, you can contact the National Institute of Arthritis and Musculoskeletal and Skin Diseases for free or low-cost printed materials at their national address:

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Information Clearinghouse
National Institutes of Health

1 AMS Circle
Bethesda, MD 20892-3675

Or call them at: (877) 226-4267

Pre-Diabetes

Individuals with Pre-diabetes have blood sugars that are too high to be considered normal, but not so high as to meet the criteria for diabetes. The development of diabetes can be prevented or delayed with management of blood glucose levels when an individual is diagnosed with pre-diabetes. Type 2 diabetes, (the type related to pre-diabetes) is an illness affecting the body’s ability to breakdown carbohydrates due to resistance to insulin’s effects.  Long term elevation of blood glucose can lead to damage to nerves, impaired vision, damage to blood vessels and kidneys, and susceptibility to infection and research has shown that this damage may begin with pre-diabetes.

Visits to your doctor are important to monitoring this condition and to achieve normal blood sugars or at least keep it from advancing to diabetes.  In addition to monitoring your diet and exercising regularly, you should be getting at least these services:

  • One visit to your doctor per year *
  • One Fasting Blood Sugar or Glycohemoglobin test (Hgb A1c) per year
  • One Lipid Panel per year

Optimal care may well require additional observation and intervention.  You are encouraged to discuss this with your physician. 

Goals for pre-diabetes management should include:

  • Maintaining normal blood glucose levels
  • Avoidance of cigarettes and other tobacco products.
  • Weight control through diet as well as exercise
  • Maintaining normal blood pressure
  • Maintaining normal blood lipids

As with any chronic medical condition, you should understand how this illness might affect you and how to prevent complications.  You should understand what treatment is most appropriate for you and work as part of a team with your doctor and other healthcare professionals to get the best care for yourself. 

Information to help you get the best care is available from several sources.  The best and most convenient place to get this information is from your physician’s office.  Also, most hospital libraries have sections devoted to patient education and the librarians are usually very helpful. 

For this condition, another excellent, up-to-date and unbiased source of information is the American Diabetes Association.  If you have Internet access at home, work, public library, or elsewhere, look up their website at www.diabetes.org or look at their web address specific to pre-diabetes at http://www.diabetes.org/pre-diabetes.jsp

If you do not have Internet access, you can contact them for free printed materials.

                             American Diabetes Association
                             ATTN: Center for Information
                            1701 North Beauregard Street
                             Alexandria, VA 22311

Their telephone number for the Center for Information and Community Support is (800) 342-2383

You may also contact any local American Diabetes Association affiliate for those same materials. 

Pulmonary Hypertension

It is possible to have high blood pressure (hypertension) in the pulmonary arteries; those arteries that supply blood to the lungs.  Pulmonary hypertension makes it harder for blood to flow through the lungs due to narrowing of these arteries. This causes the right side of the heart to work harder to pump blood and over time the heart muscle weakens and fails. Pulmonary artery pressure is much harder to measure than just applying a blood pressure cuff to an arm and therefore often escapes detection much more often than does high blood pressure in the “systemic” arteries.  Pulmonary hypertension is most commonly associated with chronic lung disease but may also be associated with some types of heart disease, auto-immune diseases, and other, rarer, conditions. 

Visits to your doctor are important to monitoring the course of the underlying condition and to detect complications of pulmonary hypertension at an early stage.  You should be getting at least these services:

  • Two visits to your doctor per year*

Optimal care may well require additional observation and intervention.  You are encouraged to discuss this with your physician. 

Goals for pulmonary hypertension management should generally include:

  • Controlling the underlying medical condition
  • Maintaining normal blood oxygen levels
  • Keeping pulmonary artery pressures as close to normal as possible
    • This may require specific medications
    • If your pulmonary hypertension is related to low oxygen levels, you should receive supplemental oxygen
  • Preventing blood clots (that may cause pulmonary embolism)
  • Receiving influenza vaccine every fall

As with any chronic medical condition, you should understand how this illness might affect you and how to prevent complications.  You should understand what treatment is most appropriate for you and work as part of a team with your doctor and other healthcare professionals to get the best care for yourself. 

Information to help you get the best care is available from several sources.  The best and most convenient place to get this information is from your physician’s office.  Also, most hospital libraries have sections devoted to patient education and the librarians are usually very helpful. 

For this condition, other excellent, up-to-date and unbiased sources of information are: The National Heart Lung and Blood Institute and the Pulmonary Hypertension Association.  If you have Internet access at home, work, public library, or elsewhere, look up their websites at http://www.nhlbi.nih.gov/health/dci/Diseases/pah/pah_what.html and http://www.phassociation.org respectively.

If you do not have Internet access, you can contact them at

NHLBI Health Information Center
P.O. Box 30105
Bethesda, MD 20824-0105

(301) 592-8573

Or try:

Pulmonary Hypertension Association
801 Roeder Road, Ste. 1000
Silver Spring, MD 20910

(301) 565-3004

Pulmonary Hypertension with COPD

It is possible to have high blood pressure (hypertension) in the pulmonary arteries; those arteries that supply blood to the lungs.  Pulmonary hypertension makes it harder for blood to flow through the lungs due to narrowing of these arteries. This causes the right side of the heart to work harder to pump blood and over time the heart muscle weakens and fails. Pulmonary artery pressure is much harder to measure than just applying a blood pressure cuff to an arm and therefore often escapes detection much more often than does high blood pressure in the “systemic” arteries.  Pulmonary hypertension is most commonly associated with chronic obstructive lung disease (COPD) but may also be associated with some types of heart disease, auto-immune diseases, and other, rarer, conditions. 

Visits to your doctor are important to monitoring the course of the underlying condition and to detect complications of pulmonary hypertension at an early stage.  You should be getting at least these services:

  • Two visits to your doctor per year*
  • If your pulmonary hypertension is related to low oxygen levels, as is usually the case in COPD, you should also be receiving supplemental oxygen.  

Optimal care may well require additional observation and intervention.  You are encouraged to discuss this with your physician. 

Goals for pulmonary hypertension management should generally include:

  • Controlling the underlying lung condition
  • Maintaining normal blood oxygen levels
  • Keeping pulmonary artery pressures as close to normal as possible. This may require specific medications (not just extra oxygen) 
  • Preventing blood clots (that may cause pulmonary embolism)
  • Receiving influenza vaccine every fall

As with any chronic medical condition, you should understand how this illness might affect you and how to prevent complications.  You should understand what treatment is most appropriate for you and work as part of a team with your doctor and other healthcare professionals to get the best care for yourself. 

Information to help you get the best care is available from several sources.  The best and most convenient place to get this information is from your physician’s office.  Also, most hospital libraries have sections devoted to patient education and the librarians are usually very helpful. 

For this condition, other excellent, up-to-date and unbiased sources of information are: The National Heart Lung and Blood Institute and the Pulmonary Hypertension Association.  If you have Internet access at home, work, public library, or elsewhere, look up their websites at http://www.nhlbi.nih.gov/health/dci/Diseases/pah/pah_what.html and http://www.phassociation.org  respectively.

If you do not have Internet access, you can contact them at:

NHLBI Health Information Center
P.O. Box 30105
Bethesda, MD 20824-0105

(301) 592-8573

Or try:

Pulmonary Hypertension Association
801 Roeder Road, Ste. 1000
Silver Spring, MD 20910 
(301) 565-3004

Regional Enteritis (or Crohn’s Disease)

Regional Enteritis (or Crohn’s Disease), is a chronic inflammatory disease of the gastrointestinal tract, primarily in the small and large intestines.

You should be getting at least these services:

  • One visit to your doctor per year *

Treatment often includes medications for inflammation, immune suppression, antibiotics, or surgery. For individuals with long-standing severe disease, a colonoscopy every two years is often recommended to screen for signs of colon cancer. You are encouraged to discuss this with your physician

As with any chronic medical condition, you should understand how this illness might affect you and how to prevent complications.  You should understand what treatment is most appropriate for you and work as part of a team with your doctor and other healthcare professionals to get the best care for yourself. 

Information to help you get the best care is available from several sources.  The best and most convenient place to get this information is from your physician’s office.  Also, most hospital libraries have sections devoted to patient education and the librarians are usually very helpful. 

For this condition, another good source of information is the Crohn’s & Colitis Foundation of America. If you have Internet access at home, work, public library, or elsewhere, look up their website at www.ccfa.org. You can access some of their educational materials on-line and find additional educational resources listed. If you do not have Internet access, you can contact them for low-cost printed materials at their national address:

Crohn’s & Colitis Foundation of America
386 Park Avenue South
17th Floor
New York, NY 10016

Or call them at (800) 932-2423

There are state affiliate organizations that can also provide you with educational materials.  If not listed in your telephone directory, the national organization can provide you with contact information.

Rheumatoid Arthritis

Regional Enteritis (or Crohn’s Disease), is a chronic inflammatory disease of the gastrointestinal tract, primarily in the small and large intestines.

You should be getting at least these services:

  • One visit to your doctor per year *

Treatment often includes medications for inflammation, immune suppression, antibiotics, or surgery. For individuals with long-standing severe disease, a colonoscopy every two years is often recommended to screen for signs of colon cancer. You are encouraged to discuss this with your physician

As with any chronic medical condition, you should understand how this illness might affect you and how to prevent complications.  You should understand what treatment is most appropriate for you and work as part of a team with your doctor and other healthcare professionals to get the best care for yourself. 

Information to help you get the best care is available from several sources.  The best and most convenient place to get this information is from your physician’s office.  Also, most hospital libraries have sections devoted to patient education and the librarians are usually very helpful. 

For this condition, another good source of information is the Crohn’s & Colitis Foundation of America. If you have Internet access at home, work, public library, or elsewhere, look up their website at www.ccfa.org. You can access some of their educational materials on-line and find additional educational resources listed. If you do not have Internet access, you can contact them for low-cost printed materials at their national address:

Crohn’s & Colitis Foundation of America
386 Park Avenue South
17th Floor
New York, NY 10016

Or call them at (800) 932-2423

There are state affiliate organizations that can also provide you with educational materials.  If not listed in your telephone directory, the national organization can provide you with contact information.

Sleep Apnea

Sleep apnea usually is a condition that disrupts your sleep many times on most nights. You often move out of deep sleep and into light sleep when your breathing pauses or becomes shallow.  This results in poor sleep quality that makes you tired during the day.  The condition may also be a cause of high blood pressure, stroke, heart failure, dangerous irregularities of heart rhythm, pulmonary hypertension, and depression.  The most common form of sleep apnea (obstructive apnea) is often associated with loud snoring.  The interruptions in breathing that are typical of the condition are usually noticed by a partner rather than by the patient. 

Bringing sleep apnea under control often requires a number of doctors’ office visits, testing in a specialized sleep laboratory and, if a common form of treatment called CPAP (continuous positive airway pressure) is used, also working with a respiratory therapist to achieve treatment that is both comfortable and effective.  After that intense period of intervention, follow-up is still required. 

Visits to your doctor are important to monitoring how you are doing with treatment and to make certain that it is still effective.  You should be getting at least these services:

  • One visit to your doctor per year*  

Optimal care may well require additional observation and intervention.  You are encouraged to discuss this with your physician. 

Goals for sleep apnea management should generally include:

  • Weight control (achieving as close to an ideal weight as possible)
  • Avoiding alcohol and other drugs that can depress breathing before bedtime

As with any chronic medical condition, you should understand how this illness might affect you and how to prevent complications.  You should understand what treatment is most appropriate for you and work as part of a team with your doctor and other healthcare professionals to get the best care for yourself. 

Information to help you get the best care is available from several sources.  The best and most convenient place to get this information is from your physician’s office.  Also, most hospital libraries have sections devoted to patient education and the librarians are usually very helpful. 

For this condition, other excellent, up-to-date and unbiased source of information is: The National Heart Lung and Blood Institute.  If you have Internet access at home, work, public library, or elsewhere, look up their website at http://www.nhlbi.nih.gov/health/dci/Diseases/SleepApnea/SleepApnea_WhatIs.html

If you do not have Internet access, you can contact them at

NHLBI Health Information Center
P.O. Box 30105
Bethesda, MD 20824-0105

Or call them at: (301) 592-8573

Thrombo-embolic Disease

Thrombo-embolic disease is a condition in which blood clots form in the veins (usually the deep veins of the legs).  These clots sometimes break loose, flow with the blood returning to the heart, and get caught in the arteries of the lungs.  This problem of venous clots (thrombi) blocking arteries in the lungs is called pulmonary embolism and is sometimes fatal.  Even if they do not result in pulmonary embolism, blood clots in the deep leg veins (deep venous thrombophlebitis) can be serious as they may destroy the valves in the veins and result in chronic swelling and pain.  This chronic complication is called post-phlebitic syndrome.

After suffering deep venous thrombophlebitis, patients often need to take anti-coagulant medication (so called “blood thinners”) for a period of months to keep the problem from recurring.  If post-phlebitic syndrome occurs, treatment to control swelling may need to be life-long. 

In the first year after diagnosis, you should be getting at least these services:

  • One visit to your doctor per year*

Optimal care may well require additional observation and intervention.  You are encouraged to discuss this with your physician. 

Treatment for thrombo-embolic disease generally includes:

  • Coumadin® (warfarin) or other anticoagulant for at least several months after diagnosis
    • If you are taking warfarin, you should have blood tests at least every 6 weeks to tightly control the effect of the drug
  • Avoiding sitting or standing still for long periods by taking ‘walking breaks’.
  • Wearing elastic “gradient” stockings when sitting or standing to prevent blood from pooling in the veins

As with any chronic medical condition, you should understand how this illness might affect you and how to prevent complications.  You should understand what treatment is most appropriate for you and work as part of a team with your doctor and other healthcare professionals to get the best care for yourself. 

Information to help you get the best care is available from several sources.  The best and most convenient place to get this information is from your physician’s office.  Also, most hospital libraries have sections devoted to patient education and the librarians are usually very helpful. 

For this condition, other excellent, up-to-date and unbiased source of information is: The National Heart Lung and Blood Institute.  If you have Internet access at home, work, public library, or elsewhere, look up their website at http://www.nhlbi.nih.gov/health/dci/Diseases/Dvt/DVT_WhatIs.html

If you do not have Internet access, you can contact them at

NHLBI Health Information Center
P.O. Box 30105
Bethesda, MD 20824-0105

Or call them at: (301) 592-8573

Ulcerative Colitis

Ulcerative Colitis is a chronic disease affecting the lining of the colon (large intestine).  The cause of the disease is unknown.  Sign and symptoms of the disease may vary in severity and duration, but often are associated with periods of diarrhea, lower abdominal pain and blood and mucus in the stools.  Skin, liver and joints may also be affected.  Flare-ups and remissions are common with this condition.  Treatment is aimed at bringing about remission (periods without symptoms or disease activity) with few medication side effects while maintaining nutritional status and normal social functioning. Complications may include poor nutrition, anemia, electrolyte imbalances, and arthritis.  There is an increased risk of colon cancer for patients with a long history of the disease. 

Because of the many complications, routine visits with the doctor are recommended to monitor the disease, your general health status and response to therapy. You should be getting at least these services:

  • One visit to your doctor a year (but more frequently during periods of disease activity) *

Optimal care may well require additional observation and intervention. For individuals with long-standing severe disease, a colonoscopy every year or two is recommended to screen for signs of colon cancer. You are encouraged to discuss this with your physician. 

As with any chronic medical condition, you should understand how this illness might affect you and how to prevent complications.  You should understand what treatment is most appropriate for you and work as part of a team with your doctor and other healthcare professionals to get the best care for yourself. 

Information to help you get the best care is available from several sources.  The best and most convenient place to get this information is from your physician’s office.  Also, most hospital libraries have sections devoted to patient education and the librarians are usually very helpful. 

For this condition, another good source of information is the Crohn’s & Colitis Foundation of America. If you have Internet access at home, work, public library, or elsewhere, look up their website at www.ccfa.org. You can access some of their educational materials on-line and find additional educational resources listed. If you do not have Internet access, you can contact them for low-cost printed materials at their national address:

Crohn’s & Colitis Foundation of America
386 Park Avenue South
17th Floor
New York, NY 10016

Or call them at (800) 932-2423

There are state affiliate organizations that can also provide you with educational materials.  If not listed in your telephone directory, the national organization can provide you with contact information.