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    By situation · 13 tips

    Just diagnosed with a chronic illness

    In the first week, hold off on big decisions. After that, the things to keep up for the long run: take your medicine as prescribed and go to follow-up checks.

    1 The first week

    After a major blow

    In the week you are told a serious diagnosis, don't go alone to get the results, and put decisions other than treatment off until later

    In the first week after a cancer diagnosis, the chance of suicide is 12.6 times that of people without the diagnosis, and the chance of dying of cardiovascular disease is 5.6 times. By the first year, the suicide risk falls to 3.1 times, and it is more pronounced for cancers that are harder to treat. So bring someone with you on the day you get the report, and don't be alone when you get home. Leave things like quitting your job or selling your home until your next clinic visit.

    • Top value
    • Evidence A
    • Buys life
    Living with a chronic illness

    Take your medicine as prescribed to the end of the course, and don't stop just because you feel better

    People who take their medicine fully as the doctor said are about half as likely to die over the same period as people who take it on and off. Take that number with a grain of salt. People who take even a fake pill faithfully also die less often, which shows that part of the benefit comes from "people who can stick with their medicine already look after their health more."

    • High value
    • Evidence A
    • Buys life
    • Disputed
    Don't get hurt by the medicine cabinet at home

    If you take a medicine long term, such as a cholesterol or blood pressure drug, check the leaflet for grapefruit; if it is mentioned, don't eat grapefruit or pomelo and don't drink grapefruit juice

    Grapefruit can make some drugs rise in the blood to several times their usual level, which is like taking too much even though the amount you take hasn't changed. One grapefruit or one glass of grapefruit juice is enough to do this, and taking the drug a day later still leaves some of the effect. In serious cases it can damage muscle or kidneys, or cause a heart rhythm disorder that can lead to sudden death. Pomelo has the same effect; ordinary sweet oranges do not.

    • Moderate value
    • Evidence B
    • Buys life
    Living with a chronic illness

    Don't stop proper treatment to try folk remedies or health supplements

    For cancers that could have been treated, people who used only alternative therapy and skipped proper treatment had 2.5 times the risk of death of those who got proper treatment. People who used complementary therapy alongside treatment more often refused surgery, chemotherapy and radiotherapy, and the extra deaths come from there. Some herbs also weaken anti-rejection drugs and blood thinners, so ask your doctor in charge before taking any.

    • High value
    • Evidence B
    • Buys life

    2 Long-term management

    Living with a chronic illness

    Go for follow-up checks at the interval your doctor sets, and record every result in the same notebook

    With a chronic illness, what matters is the change over a period of time, not a single reading. Measuring your blood pressure at home on your own does not bring it down. Blood pressure drops more when you bring the readings to your doctor and the doctor adjusts your medicine by them. When you switch hospitals, a hospital should not make you repeat a test whose result carries the mutual-recognition mark.

    • Moderate value
    • Evidence B
    • Buys life
    Living with a chronic illness

    Get an eye-ground exam once when diabetes is diagnosed, then at the interval your doctor sets, and have your feet checked every year

    Diabetes damages the back of the eye and the feet, and you feel almost nothing until the damage reaches blindness or sores. Caught early, it can still be treated. With type 2 diabetes, get a dilated eye-ground exam at the time of diagnosis. With type 1, start 5 years after onset. If one or two exams were clear and your blood sugar is on target, the interval can stretch to once every one or two years. Have your feet checked every year.

    • High value
    • Evidence A
    • Buys life
    Living with a chronic illness

    If gout is diagnosed and you have tophi, bone erosion on imaging, or 2 or more attacks a year, take a urate-lowering drug long term, bring blood uric acid below 360 µmol/L and keep it there

    If you have tophi, bone erosion or 2 or more attacks a year, take a urate-lowering drug long term and bring uric acid below 360 µmol/L. If you have fewer attacks, talk with your doctor about whether to take it. When a nurse helped adjust patients' doses according to lab results, 95% reached the target after two years, versus only 30% with usual care. Once the target is reached, you still can't stop the drug, because avoiding certain foods lowers uric acid only a limited amount.

    • Moderate value
    • Evidence A
    • Buys life
    • Disputed
    Living with a chronic illness

    If you have had gout, don't eat large amounts of meat and seafood at one sitting at a barbecue or group meal, and drink less alcohol

    For people who have had gout, when the purine they ate over the previous two days was at its highest, an attack was nearly 5 times as likely as when it was at its lowest, even while taking urate-lowering drugs. Having two to four drinks the day before made an attack about 50% more likely; beer, liquor and wine all count.

    • High value
    • Evidence B
    • Buys life
    Living with a chronic illness

    If you have had a kidney stone, drink 2.5–3 liters of water a day and keep salt to no more than 6 grams

    For someone who has had a first calcium stone, if they do nothing, about a quarter will get another within five years. Among people who drank enough water every day, only a little over 10% had a recurrence in five years, more than half fewer. The British guideline gives the amount as 2.5 to 3 liters of water a day and no more than 6 grams of salt.

    • High value
    • Evidence A
    • Buys life
    Living with a chronic illness

    If tests find hepatitis B surface antigen positive, get a liver ultrasound plus an alpha-fetoprotein test every 6 months, let your doctor's assessment decide whether you take antiviral drugs, and once you start, don't stop on your own

    People carrying the hepatitis B virus who had a liver ultrasound and an alpha-fetoprotein test every six months had nearly 40% fewer deaths from liver cancer in a Shanghai trial. The more virus in the blood, the more liver cancer later. For people whose livers are already badly fibrotic or cirrhotic, taking antiviral drugs cut liver cancer by about half. Most of the drugs have to be taken long term, and if you stop on your own the virus easily rebounds.

    • Moderate value
    • Evidence A
    • Buys life
    • Disputed
    Living with a chronic illness

    If you have COPD (chronic obstructive pulmonary disease, 慢阻肺), have your doctor or pharmacist watch you use your inhaler once at each follow-up visit; if you have been hospitalized for an acute flare-up, go to pulmonary rehabilitation after you leave the hospital

    Of people who use inhalers, only about 30% have completely correct technique, and some mistakes keep the medicine from reaching the lungs. Patients who made a critical error were about twice as likely to be hospitalized or to visit the emergency room for a flare-up. After a hospital stay for an acute flare-up, people who did pulmonary rehabilitation were more than 50% less likely to be hospitalized again, and their quality of life and walking ability were also somewhat better. Whether it means fewer deaths has not been shown.

    • Moderate value
    • Evidence A
    • Buys life
    • Disputed
    Living with a chronic illness

    If you have diabetes, get a urine albumin-to-creatinine ratio and a blood creatinine test every year, and do the same if you have high blood pressure, to catch chronic kidney disease early

    Among adults in China with chronic kidney disease, only about 10% know they have it. People with diabetes who have their urine and blood tested every year can be found earlier. For those found to have high urine protein, taking a drug like dapagliflozin cuts the combined cases of kidney function worsening, reaching dialysis or death by about 40%, and deaths by about 30%.

    • Moderate value
    • Evidence B
    • Buys life
    Living with a chronic illness

    If you have finished surgery and chemotherapy for colon cancer, join a guided exercise program and keep at it for a full three years

    After surgery and chemotherapy for colon cancer, people who joined a three-year guided exercise program had about a 28% lower chance of recurrence, a new cancer or death, and about a 37% lower chance of death. 8 years later, about 90% of those who exercised were still alive, versus about 83% of those who only received printed materials. People who exercised had somewhat more muscle and joint injuries.

    • Moderate value
    • Evidence A
    • Buys life

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