Chronic Diseases

Objectives Define chronic disease. List behaviors that increase the likelihood of getting a chronic disease. Explain the relationship between chronic disease and medical care dollars. Discuss preventive measures for chronic disease. Describe the symptoms of cardiovascular disease, diabetes, and arthritis. Discuss the treatments for various cancers. Describe the diagnosis of cancers.

Chronic Versus Acute An acute illness lasts for a few days and doesn’t have long-term effects. Examples are colds or the flu. A chronic illness lasts a long time. Examples include cancer, diabetes, arthritis, and heart disease.

Economic Burden of Chronic Disease Chronic diseases contribute 75% of the $2 trillion medical care costs in the United States. Diabetes costs are $132 billion a year. Medical care costs for arthritis are more than $22 billion. Smoking costs are more than $75 billion. Cardiovascular diseases cost $300 billion in 2001. Costs related to physical inactivity were $76.6 billion in 2000.

Preventing Chronic Diseases Many chronic diseases are referred to as lifestyle diseases. Stopping smoking and improving diet and exercise habits can help prevent many chronic diseases. Vaccines may prevent some chronic illnesses. Spending more health care dollars on prevention could help.

Cardiovascular Disease High blood pressure Coronary artery disease (CAD) Peripheral artery disease (PAD) Cardiomyopathy Aneurysm (continued)

Cardiovascular Disease (continued) Valvular heart disease Pericardial disease Heart failure Arrhythmia Stroke

Symptoms of Heart Disease CAD: Chest pain from lack of oxygen to the heart PAD: Pain in muscles, cramping in legs, cyanosis, poor nail growth Pericardial disease: Chest pain from fluid buildup around the heart Heart failure: Swollen feet, legs, and abdomen; chronic fatigue; confusion; difficulty breathing; coughing with sputum

Plaque Buildup in Artery

Myocardial Infarction (Heart Attack)

High Blood Pressure Normal blood pressure is less than 120/80 mmHg. Prehypertension is 120/80 to 139/89 mmHg. Stage 1 hypertension is 140/90 to 159/99 mmHg. Stage 2 hypertension is 160/100 mmHg and above (Stein 2006).

Warning Signs of a Stroke Sudden numbness or weakness in the face, arm, or leg (especially on one side of the body) Sudden blurred or decreased vision in one or both eyes Sudden inability to move part of the body (paralysis) Sudden dizziness or headache with nausea and vomiting (continued)

Warning Signs of a Stroke (continued) Difficulty speaking or understanding words or simple sentences Difficulty swallowing Dizziness, loss of balance, or poor coordination Brief loss of consciousness Sudden confusion (WebMD 2006)

Controllable Risk Factors for Stroke High blood pressure Arterial fibrillation Uncontrolled diabetes High total cholesterol (more than 200 mg/dl) Smoking Alcohol (more than one drink per day) Being overweight Existing carotid or coronary artery disease

Arthritis Leading cause of disability in the United States Types of arthritis Osteoarthritis Gout Rheumatoid arthritis Fibromyalgia Systemic lupus erythematosus (SLE)

Signs and Symptoms of Arthritis Osteoarthritis: Degeneration of cartilage and underlying bone, usually in hips, knees, hands, and spine Gout: Acutely red, hot, and swollen joint with pain Rheumatoid arthritis: Inflammation of joint lining that erodes cartilage and bone, usually in hands and feet Fibromyalgia: Widespread muscular pain and fatigue SLE: Fatigue, pain or swelling in joints, skin rashes, and fevers

Osteoarthritis

Gout

Lung Disease (COPD) Chronic bronchitis: 8.9 million diagnosed Emphysema: 3.8 million diagnosed Number of deaths: 13,913 Asthma: 15.7 million diagnosed Number of deaths: 3,816 Lung cancer: 107,416 men and 89,271 women diagnosed Number of deaths: 90,139 men and 69,078 women (CDC 2009)

Signs and Symptoms of COPD Cough Sputum (mucus) production Shortness of breath, especially with exercise Wheezing (whistling or squeaky sound while breathing) Chest tightness

Chronic Bronchitis and Emphysema

Cancer Common types of cancer Treatment for cancers Lung cancer Prostate cancer Breast cancer Treatment for cancers Surgical removal of tumor Chemotherapy Radiation

Lung Cancer Diagnosed in over 170,000 Americans each year. Symptoms include the following: Shortness of breath Wheezing Chest pain Coughing up blood Can paralyze the vocal cords. Invades the esophagus. Overall 5-year survival rate is 16%.

Prostate Cancer Affects 70% to 90% of men over age 80. Noncancerous disorders of prostate: Benign prostatic hyperplasia Prostatic intraepithelial neoplasia Atypical small acinar proliferation Surgical treatment for prostate cancer: Preventive Diagnostic Curative

Rate of Survival for Prostate Cancer Cancer that has not metastasized: 5-year rate is almost 100%. 10-year rate is 93%. 15-year rate is 77%. Cancer that has metastasized: 5-year rate is 35%.

Breast Cancer Risk Factors Being a woman Having a mutation in the BRCA1 or BRCA2 breast cancer genes Having a previous biopsy showing hyperplasia or carcinoma in situ Having a family history of breast or ovarian cancer Having high breast density on a mammogram Having a personal history of breast or ovarian cancer Having your first child after age 35 (continued)

Breast Cancer Risk Factors (continued) Starting menopause after age 55 Never having children Getting older Being overweight after menopause or gaining weight as an adult Having more than one drink of alcohol per day Currently or recently using combined estrogen and progestin hormone replacement therapy (HRT) Having your first menstrual period before age 12

Warning Signs of Breast Cancer Change in look of one breast Change in breast size or shape Lump or thickening Warm sensation Nipple turned inward or appearing sunken Irregularly shaped nipple Rash on the nipple Tenderness Nipple discharge Breast pain

Diagnosing Breast Cancer Monthly self-exams Clinical exam Magnetic resonance imaging (MRI) Digital mammography Mammography

Breast Self-Exam

Breast Cancer Treatment Surgery Radiation Chemotherapy Hormone therapy Targeted therapies

Diabetes Two types Risk factors Type 1 is more common in young children; the body doesn’t produce insulin. Type 2 is the most common type; results from insulin resistance. Risk factors Overweight Lack of exercise Poor diet Diet high in carbohydrate and fat Family history Woman having a child > 9 lb (4 kg)

Signs and Symptoms of Diabetes Always tired Craving extra liquids Frequent urination Numbness and tingling in feet Always hungry Unexplained weight loss Blurred vision Sexual dysfunction

Diabetes Treatment Changing diet Exercising Taking medicine to reduce glucose in the bloodstream

Alzheimer’s Disease Usually begins around age 60. Symptoms include these: Memory loss Language deterioration Poor judgment Confusion Restlessness Mood swings