Coping with Chronic Illness


As a physician who administers only to hospitalized patients, I frequently encounter people when their life is most disrupted by illness.  As you might expect, when faced with major disruption of their lives, patients often wonder: “why me?”, “why now?”  The scenario usually goes something like this:

 I admit a patient to the hospital with an illness that has caused them to be much sicker than they are used to.  Most often, they’ve only noticed symptoms of that illness for a few days.  Because they were at their baseline state of health a week ago, and now they are so sick that they have to be admitted to the hospital, their expectation is that the illness must be new and severe.  But more often, the culprit is an illness that has been brewing for quite some time and only now become apparent (chronic illness).  When I explain that they are hospitalized with a chronic illness, their question is always the same – “If I’ve had this for 10 years, how come I felt fine a week ago?”  The reason that chronic illnesses are masked in their early stages is because of reserve capacity.

Your body is an amazingly well designed machine!  Like any well designed machine, it has to be constructed to operate under a wide range of circumstances (i.e. has to be designed with reserve capacity).  Consider your car for instance, what if automobiles were designed so that they could only operate between 60 F° and 90 F°? If that were the case, your car would only run about 9 months out of the year in Arkansas, and there would be no cars in Alaska because they would only run about 2 months out of the year!  Instead your car is designed with a radiator to cool the engine when it gets too hot, lubrication to reduce heat from friction, and engine liquids that have very low freezing points so that the engine liquids do not freeze when it’s cold.  These technologies allow most cars to function normally within a wide range of temperatures between 10 F° and 110 F°.  As long as the range of circumstances a machine can tolerate is wide, it is easy to stay within that range, or said differently, to stay in balance.

Every organ within your body is designed with this same concept – to have a wide range of circumstances it can tolerate.   That is a beneficial design feature, but there is an unavoidable implication of that design feature – Unless you are testing your machine at its limits, you have no way of knowing that its range is narrowed!

Think about that in terms of the car discussed above.  When your car is new it has a wide range of temperatures that it can function under.  However, as it gets older, let’s say you never replace the antifreeze, and you never change the oil.  Eventually that car will get to the point that it can no longer tolerate the extremes of temperature that it used to.  There was a time in that car’s young life when it could have driven across the Arizona dessert and not had any problem, but eventually the cars tolerance narrows to the point that it cannot tolerate the extreme heat of the desert.  So if your car was already struggling, but you were NOT trying to drive it across the desert, would you know that its range of temperature tolerance had narrowed?  If your car could still tolerate 85 F°, but could no longer tolerate 110 F°, you could still drive it just fine in Arkansas.  The only way you would know (other than looking at the convenient gauges on the dash) that your car was no longer tolerant of heat would be to drive it in the heat and have it break down.

In the early years of chronic illness, the symptoms are often so slight that they will not be noticed from one day to the next.  This is best illustrated with chronic lung illnesses like Chronic Obstructive Pulmonary Disease (COPD).  A young healthy person has almost twice as much lung function as they need for their routine daily activities like walking around the grocery store.  Your lungs are designed with so much more lung function than you use on a daily basis so that you can run in a marathon if you choose to, or so that you might not die if you contract pneumonia.  In fact, a young healthy person has so much extra lung function that significant respiratory infections like influenza are tolerable without supportive care in the hospital.  Other significant respiratory illness like the common cold (adenoviral infection) might even be considered trivial to someone with healthy lungs.  In the early years of COPD, your lung function can be significantly and measurable impaired, and unless you are trying to run a marathon, you might not even notice it.  As your range of lung function narrows, you can eventually get to the point where a less serious event, like the flu or even the common cold, can throw your body out of balance and lead to hospitalization.

I’ve just described to you what an exacerbation of COPD is, and this is a common manifestation of a chronic illness which leads to hospitalization.  In order to cope with a chronic illness such as this, you have to understand that your body operates within a range of circumstances and that chronic illness is a narrowing of this range of tolerance.  The narrower the range is, the less severe an event has to be to throw your body out of balance.  Therefore, if your range of tolerance is already narrowed, the primary goal has to be not to let the range get narrowed more!  This is why smoking cessation is so important for anyone who has COPD.

This is the first part of a series on coping with chronic illness.  Mostly we’ve focused on acceptance of chronic illness and the role which reserve capacity plays in chronic illness.  Next time we will discuss setting goals and how to be aggressive in controlling your illness, yet not be overwhelmed by the mountain you are trying to climb.

Michael Pafford, M.D.

SMH Hospitalist

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