Diagnosis of a chronic disease is the first and almost an inevitable shock which one receives during the adult life. There is a stage of doubt and denial in the beginning. Sooner, however, the reality needs to be faced as a part of life. An early recognition and acceptance is always good for the long-term management and prevention of later complications.
Chronic diseases often referred to as non-communicable diseases, together pose a major health-care crisis in the 21st century. A bane of modern life-style and longevity of life, the crisis has attracted a global call for action for different governments and international agencies including the UN General Assembly thus bringing the NCD agenda to the highest level of attention. Considered in the past as ‘life-style diseases’ or ‘a punishment of the rich’, they are even more common and burdensome amongst the poor, and in the developing countries.
Chronic diseases include a host of different diseases of which the four major groups (cancers, diabetes, chronic cardiovascular diseases and chronic respiratory diseases) account for priority action at the international level. India has included chronic mental disorders and chronic renal disease also in its ambit for its Control Programmes. It is now estimated that one or the other chronic disease (or diseases) is/are likely to afflict almost every individual beyond the age of 60 years. What the governments do for their control at the national and the international levels is a subject of policy and planning. What the individuals can do to safeguard the health and cope with the burden is an issue of interest and understanding for all of us.
Living with NCDs is a fact of life . How to happily live and cope with a disease depends upon an individual’s personal perceptions and understanding of the disease as much as on the medical facilities available for its treatment. The natural history of chronic diseases is variable from slow for most of the illnesses to rapid progressive for others. Fortunately, most of them are compatible with a normal life span and style with modifications here and there. For example, diabetes, hypertension, ischaemic heart disease, asthma and mental disorders can be effectively managed with regulated dietary alterations, regular medication, avoidance of precipitating factors/ triggers, and rehabilitative measures. On the other hand, diseases such as cancers, chronic obstructive lung disease, chronic heart, brain, kidney or liver failures are bound to progress sooner and later culminating into a premature fatal end. With appropriate managements, the progress of most of these disorders can be delayed and life span prolonged. More importantly, the ‘quality of life’ can be significantly improved.
It is also an accepted fact that the chronic progressive diseases as above reach an end stage in their natural history when curative treatments have little to offer. Only about 5 percent of us are going to be fortunate to die a sudden death, the rest are destined to be bed ridden from a chronic end-stage disease for variable periods before the final exit This is the stage for palliative-care i.e. symptomatic management of troublesome complaints ( intractable pain, breathlessness, sleeplessness, severe anorexia, vomiting, gastrointestinal upsets etc.) Unfortunately, several of the symptom-relief medicines are also likely to be detrimental for other organ functions and survival. As a classical example, the powerful opioid drugs used for relief of most of the complaints as above, may result in fatal respiratory depression. This ‘rule of double-effect’ is acceptable in specific situations, of course with a multitude of medical, procedural and legal implications.
Preventive steps are most important for the individuals to undertake. Four important risk-factors which are common to most of the NCDs (i.e. tobacco smoking, obesity, lack of physical activity and alcohol intake) have been identified the world over. Unfortunately, the prevalence of these factors is quite high – physical inactivity is almost universal in India. Obesity is partly contributed by physical inactivity and partly by the intake of unhealthy diet. High intake of sugars, fats and salt is responsible for several of the ill health effects. Incidentally, the risk factors have a significant social, economic and cultural background. The behavioural changes required for their control and avoidance are difficult and slow. Nonetheless, it is important to minimize their occurrence for a meaningfully, healthy life.
The bottom line of living and coping with chronic disease is to accept its occurrence and win it over with the available armament.
It is worth remembering what was said almost four centuries ago at the dawn of modern medicine – ‘Acute disease is an act of God; of chronic diseases the patient himself is the author” (Thomas Sydenham).
