Medical Conditions

Medical Conditions

Heart Disease/Heart Failure

According to the Centers for Disease Control, heart disease is a major cause of disability in the United States. Many types of heart disease including congestive heart failure (CHF) and coronary artery disease affect more than 13 million Americans. Those living with end-stage CHF and terminal heart disease often make frequent doctor’s office, emergency room and hospital visits. More than one million people in the United States are admitted to inpatient settings for heart failure each year. Many of these hospital visits for breathing difficulties and fatigue could be prevented with the support of hospice care.

Symptoms

People with end-stage heart disease may experience frequent episodes of:
  • Chest pain
  • Fatigue
  • Shortness of breath
  • Repeated hospitalizations or ER trips
These patients may also have advanced CHF or other advanced coronary disease (chronic ischemic heart disease, left-sided heart failure, previous myocardial infarction) and experience:
  • Poor response to diuretics (sometimes called water pills) and vasodilators (medicines that dilate, or open, blood vessels, which allows blood to flow more easily).
  • Abnormal heart rate
  • Decreasing alertness – patient is emotionally withdrawn, sleeping more or having increased difficulty with comprehension.

ALS/Lou Gehrig’s

Amyotrophic Lateral Sclerosis (ALS), also called Lou Gehrig’s disease, is a nervous system disease that attacks nerve cells called neurons in your brain and spinal cord. The disease is progressive, meaning the symptoms get worse over time. Currently, there is no cure for ALS and there is no effective treatment to halt, or reverse, the progression of the disease.

Symptoms

  • Signs of ALS can appear gradually. You may notice a funny feeling in your hand that makes it harder to grip objects. Or, you may start to slur words before any other symptoms show up. Each person with the disease feels different symptoms.
  • Some common early symptoms include:
    • Stumbling
    • A hard time holding items with your hands
    • Slurred speech
    • Swallowing problems
    • Muscle cramps
    • Worsening posture
    • A hard time holding your head up>

Stages of the Illness

In the early stages of Lou Gehrig’s disease, symptoms can be subtle, and some patients may ignore them. As ALS progresses, patients continue to lose the ability to perform basic tasks. Eventually, patients reach a stage where they can no longer sit, stand or move without support. Breathing may require respiratory devices. The final stage of ALS is the death of the patient, usually within five years of diagnosis.

Cancer

There are more than 100 different types of cancer. The onset of cancer occurs when cells divide and begin to crowd out normal, healthy cells. Cancer is most commonly treated with surgery, chemotherapy and radiation. While treatment for cancer is often successful, there may come a time when treatment is no longer effective, or the patient may decide they no longer wish to pursue curative treatment. At this point, the focus turns to comfort care and supporting the patient and their family through this transition.

Symptoms

The signs and symptoms of cancer depend on where the cancer is located, how large it is, and how much it affects organs or tissues. If a cancer has spread (metastasized), signs or symptoms may appear in different parts of the body. Some of the general signs and symptoms of cancer are listed below. It’s important to remember that having any of these does not mean you have cancer. If you have any of these symptoms and they last for a long period time or worsen, see a doctor to find out what’s going on.

  • Unexplained Weight Loss
    • Unexplained weight loss of 10 pounds of more may be a sign of cancer. Unexplained weight loss occurs most often with cancers of the pancreas, stomach, esophagus, or lung.
  • Fever
    • Fever is very common with cancer, and often occurs after cancer has spread from where it first started. In some cases, fever may be an early sign of blood cancers like leukemia or lymphoma.
  • Fatigue
    • Fatigue may be a symptom as cancer grows. It can also occur early in some cancers like leukemia.
  • Pain
    • Pain may be an early symptom of many different types of cancer. For example, a headache that does not go away or gets better with treatment may be a symptom of a brain tumor. In some cases, pain due to cancer means it has already spread (metastasized) from where it started.
  • Skin Changes
    • The signs and symptoms of skin cancers and some other cancers that cause skin changes include:
      • Reddened skin (erythema)
      • Yellowish skin and eyes (jaundice)
      • Darker looking skin (hyperpigmentation)
      • Itching (pruritis)
      • Excessive hair growth

Stages of the Illness

Most types of cancer have four stages; 0 to 4.
  • Stage 0
    • This stage describes cancer in situ, which means ‘in place.’ Stage 0 cancers are still located in the place they started and have not spread to nearby tissues. This stage of cancer is often highly curable, usually by removing the entire tumor with surgery.
  • Stage 1
    • This stage is usually a small cancer or tumor that has not grown deeply into nearby tissues. It also has not spread to the lymph nodes or other parts of the body. It is often called early-stage cancer.
  • Stage 2 and 3
    • In general, these two stages indicate larger cancers or tumors that have grown more deeply into nearby tissues. They may have also spread to lymph nodes but not to other parts of the body.
  • Stage 4
    • This stage means that the cancer has spread to other organs or parts of the body. It may also be called advanced or metastatic cancer.

Lung Disease

Lung disease is any type of problem in the lungs that prevents the organs from working properly. The three main types of lung diseases are airway diseases, lung tissue diseases and lung circulation diseases. Each of them have different symptoms.

Types of Lung Disease

  • Airway diseases
    • These diseases affect the tubes (airways) that carry oxygen and other gases into and out of the lungs. They usually cause a narrowing or blockage of the airways. Airway diseases include asthma, COPD and bronchiectasis.
  • Lung tissue diseases
    • Pulmonary fibrosis and sarcoidosis are examples of lung tissue diseases. These diseases affect the structure of the lung tissue. Scarring or inflammation of the tissue makes the lungs unable to expand fully. This makes it hard for the lungs to take in oxygen and release carbon dioxide. People with this type of lung disorder often say they feel as if they are “wearing a too-tight sweater or vest.” As a result, they can’t breathe deeply.
  • Lung circulation diseases
    • An example of a lung circulation disease is pulmonary hypertension. These diseases affect the blood vessels in the lungs. They are caused by clotting, scarring, or inflammation of the blood vessels. They affect the ability of the lungs to take up oxygen and release carbon dioxide. These diseases may also affect heart function.

Symptoms

The following symptoms could be the first signs of lung disease, including COPD, asthma, and lung cancer:

  • Chronic cough: A cough that you have had for a month or longer is considered chronic and indicates that your respiratory system is not functioning normally.
  • Shortness of breath: Shortness of breath that doesn’t go away after exercising, or after little or no physical effort is abnormal.
  • Chronic mucus production: Mucus, also called sputum or phlegm, is produced by the airways as a defense to fight infections or block irritants. If mucus production lasts more than a month, this could indicate lung disease.
  • Wheezing: Noisy breathing or wheezing is a sign that something is blocking your lungs’ airways.
  • Coughing up blood: If you are coughing up blood, it may be coming from your lungs or upper respiratory tract.
  • Chronic chest pain: Unexplained chest pain that lasts for a month or more.

Stages of the Illness

There are four stages of lung disease. As lung disease progresses, the stage will increase to reflect the severity of your symptoms.
The stages of chronic lung disease:
  • Mild or stage 1
  • Moderate or stage 2
  • Severe or stage 3
  • Very severe or stage 4 also known as end-stage lung disease

Alzheimer’s and Other Dementias

Dementia is not a disease, but a term that covers a wide range of symptoms. It is caused by damage to brain cells. These changes in the brain can cause problems with thinking, memory and behavior. There is no cure for dementia. It is a terminal illness. The most well-known cause of dementia is Alzheimer’s disease. Dementia can also be caused by other diseases of the brain, like Parkinson’s Disease or Huntington’s Disease or in people who have experienced multiple strokes.

Types of Dementia

Four Most Common Dementias

ALZHEIMER’S DISEASE

Accounts for 50-70% of all dementias. Typically, there is gradual memory loss followed by a continued decline in other areas of mental and physical functioning. Usually, there is difficulty managing everyday activities, followed by the inability to care for oneself. Verbal communication decreases over time, as does the ability to walk and control the bowel and bladder. The greatest risk factor for Alzheimer’s disease is advanced age. 

LEWY BODY DEMENTIA

Shares symptoms of both Alzheimer’s and Parkinson’s disease. There is gradual and fluctuating mental alertness, along with physical symptoms of Parkinson’s (such as a shuffling walk, slowed movement, muscle stiffness). Vivid visual hallucinations, brief periods of unconsciousness, repeated falls, sleep disturbance and sensitivity to some anti-psychotic medications may occur.

VASCULAR DEMENTIA

Often in combination with Alzheimer’s, vascular dementia is a deterioration of mental function caused by reduced blood flow to the brain (strokes or narrowing of blood vessels). Although vascular dementia is not reversible, treating risk factors like high blood pressure can slow the disease progression. Vascular dementia may appear much like Alzheimer’s, although if strokes continue, sudden changes may be more evident.

FRONTOTEMPORAL DEMENTIA

Is characterized by two things: changes in behavior and problems with language. Initial symptoms often include uninhibited or inappropriate social behavior, which loved ones and caregivers may find very distressing. The person with frontotemporal dementia may appear apathetic, lose the ability to empathize, and lack insight. Spatial skills and memory remain relatively intact until advanced stages of the disease. Frontotemporal dementia typically occurs between the ages of 35 and 75, and family history is a risk factor.

Stages of the Illness

  • Early Stage – The person might:
    • Have trouble recalling names, words, or recent events.
    • Be confused about time or place.
    • Lose things often and for long spans of time; not be able to retrace steps to find lost items.
    • Have trouble speaking or writing in a way that makes sense.
    • Have trouble doing familiar tasks; show poor judgement.
  • Middle Stage – This stage can last for many years. Symptoms are more obvious. The person needs help with daily tasks. Many cases of dementia are not caught until this stage or later. The person might:
    • Forget family members or big life events.
    • Be more confused about time or place and get lost easily.
    • Not be able to talk or write clearly, or at all.
    • Withdraw from activities.
    • Not be able to drive.
    • Not be able to cook, clean, or manage other household tasks.
    • Need help eating, toileting, bathing, dressing, or walking.
    • Have personality changes, have mood swings, become more aggressive, or lose self-control.
    • Be more anxious at night.
  • Late Stage – Symptoms are at the worst at this stage. The person relies on others to do daily tasks and will need full-time care. The person might:
    • Not know where they are, who they are, or who the people around them are.
    • Have big changes in personality; be easily upset or angered.
    • No longer be able to stand, walk, speak, or swallow.
    • Use gestures, reactions, or facial expressions instead of talking.
    • Be very weak and frail.

How Do I Know It's Dementia?

Work with your doctor who may do head scans and neuropsychological testing. This helps rule out treatable conditions that may cause memory impairment, like depression, medication side effects, thyroid conditions, problems with vision and hearing, excess use of alcohol and nutritional imbalances.

Clinicians specializing in memory disorders are now able to diagnose Alzheimer’s disease with greater than 90% accuracy. Brain autopsy remains the only definitive way to confirm that someone had dementia. Arrangements for brain autopsy should be set up well in advance of the person’s death. For further information, speak with your healthcare provider or social worker.

How is Dementia Treated?

Treatment of dementia is limited, and currently, there is no cure. However, two classes of medications are approved to treat Alzheimer’s disease. They may slow the course of disease by about six months in 33% of patients.

How Does Dementia Progress?

Progression varies according to the type of dementia.  Life expectancy can range from one to 30 years. For Alzheimer’s disease, the average is six to eight years after first symptoms. Because dementia progresses through the brain, physical and mental functions are affected, such as thinking, memory, self-care abilities, continence and mobility.

People with advanced stage dementia usually lose the ability to communicate verbally, walk independently, control bladder and bowel function and participate in self-care. At this stage, hospice care can be beneficial for patient and family, focusing on comfort and quality of life. Infection, usually aspiration pneumonia, is the most common cause of death. 

HIV/AIDS

Human Immunodeficiency Virus (HIV) is a disease which causes the body’s immune system to attack itself. If left untreated, HIV can lead to acquired immunodeficiency syndrome (AIDS). AIDS is the most advanced stage of HIV. It currently has no cure.

Symptoms

The symptoms of HIV and AIDS vary, depending on the phase of infection. Most people infected by HIV develop a flu-like illness within one or two months after the virus enters the body.

Possible signs and symptoms include:
  • Fever
  • Headache
  • Muscle aches and joint pain
  • Rash
  • Sore throat and painful mouth sores
  • Swollen lymph glands, mainly on the neck

Stages of the Illness

Thanks to better antiretroviral treatments, most people with HIV in the U.S. today don’t develop AIDS. However, untreated, HIV typically turns into AIDS in about 10 years. When people get HIV and don’t receive treatment, they will typically progress through three stages of the disease.

  • Stage 1: Acute HIV Infection
    • Within 2 to 4 weeks after infection with HIV, people may experience a flu-like illness, which may last for a few weeks. When people have acute HIV infection, they have a large amount of virus in their blood, but people with acute infection are often unaware that they’re infected because they may not feel sick right away or at all.
  • Stage 2: Clinical latency (HIV inactivity or dormancy)
    • This period is sometimes called chronic HIV infection. During this phase, HIV is still active but reproduces at very low levels. People may not have any symptoms or get sick during this time. For people who aren’t taking medicine to treat HIV, this period can last a decade or longer, but some may progress through this phase faster.
  • Stage 3: Acquired immunodeficiency syndrome (AIDS)
    • AIDS is the most severe phase of HIV infection. People with AIDS have such badly damaged immune systems that they get an increasing number of severe illnesses.

Liver Disease

Your liver helps your body digest food, store energy, and remove poisons. There are many types of liver diseases including diseases caused by viruses, such as hepatitis A, hepatitis B, and hepatitis C; diseases caused by drugs, poisons, or too much alcohol such as fatty liver disease and cirrhosis; and liver cancer.

Symptoms

Symptoms of liver disease (also called hepatic disease) can vary, but they often include:
  • Swelling of the abdomen and legs
  • Bruising easily
  • Changes in the color of your stool and urine
  • Jaundice, or yellowing of the skin and eyes
Sometimes there are no symptoms. Tests such as imaging tests and liver function tests can check for liver damage and help to diagnose liver diseases.

Stages of the Illness

The four stages of liver disease include:

  • Stage 1
    • Initial Stage of Liver Disease – inflammation of the liver or bile duct
  • Stage 2
    • Fibrosis of the Liver – Stage 2 damage or scarring from the first stage begins to block the normal blood flow of the liver 
  • Stage 3
    • Cirrhosis of the Liver – A chronic condition, cirrhosis of the liver creates permanent scarring that blocks the blood flow. This dangerous stage causes other serious conditions and symptoms that increase the severity of the liver disease. 
  • Stage 4
    • Liver Failure and Advanced Liver Disease – In the final stage of the disease, liver failure signals the end of all normal liver function.

Kidney Failure

Chronic kidney disease (CKD), also called chronic kidney failure, describes the gradual loss of kidney function. Our kidneys filter waste and excess fluids from your blood, which are then excreted in the urine. When chronic kidney disease reaches an advanced stage, dangerous levels of fluid, electrolytes, and wastes can build up in your body.

Symptoms

In the early stages of chronic kidney disease, patients may have few signs or symptoms. Chronic kidney disease may not become apparent until your kidney function is significantly impaired. Signs and symptoms of kidney disease are in most cases nonspecific, meaning they can also be caused by other illnesses. Additionally, signs and symptoms of kidney disease may not appear until irreversible damage has occurred. Signs and symptoms of chronic kidney disease develop over time. Some include:

  • Loss of appetite
  • Changes in how much you urinate
  • Nausea
  • Vomiting
  • Fatigue and weakness
  • Sleep problems
  • Decreased mental sharpness
  • Muscle twitches and cramps

Stages of the Illness

While there is typically no cure for CKD, there are treatments that can help. Chronic kidney disease is divided into 5 stages based on the level of kidney function, with stage 1 being minimal loss of kidney function to stage 5 classified as kidney failure and the need for dialysis or a transplant. Kidney disease is a progressive disease, meaning that kidney function can continue to decline over time, eventually resulting in kidney failure.

Neurological Diseases

Neurological disorders are diseases of the brain, spine and the nerves that connect them. There are more than 600 neurologic diseases such as Huntington’s disease, Muscular Dystrophy, ALS (Lou Gehrig’s Disease), Spina Bifida, Parkinson’s Disease and Epilepsy.

Types of Neurological Diseases

Major types of Neurological Diseases and Disorders include:

  • Diseases caused by faulty genes, such as Huntington’s disease and muscular dystrophy.
  • ALS / Lou Gehrig’s Disease.
  • Problems with the way the nervous system develops, such as spina bifida.
  • Degenerative diseases, such as Parkinson’s disease and Alzheimer’s disease.
  • Diseases of the blood vessels that supply the brain, such as stroke.
  • Injuries to the spinal cord and brain.
  • Seizure disorders, such as epilepsy.

Symptoms

When something goes wrong with part of your nervous system, you can have trouble moving, speaking, swallowing, breathing, or learning. You can also have problems with your memory, senses, or mood.

Stages of the Illness

Diseases like Parkinson’s disease, Multiple Sclerosis, Muscular Dystrophy, Huntington’s disease and other life-limiting neurological disorders all have various stages of progression. The physical hardship of the neurological disease affects the patient and the family as a whole.