Coping with multiple conditions including HNPP

Many people living with HNPP have the arduous task of coping with more than one condition on top of the neuropathic symptoms. From dystonia and asthma to peripheral oedema, or mental health conditions, those with HNPP battle a range of conditions. So how do you deal with multiple diagnoses?

Coping with multiple issues can be a bit overwhelming, and it adds a layer of challenge that might not be present for the friend of a friend who has one of your illnesses in common, but runs 5k races.

“In people with multiple chronic conditions, physical and emotional symptoms can compound and build off of each other, resulting in a larger negative effect on their daily lives.”

“Challenges of self-management when living with multiple chronic conditions”, Clare Liddy, 2014

More than one in four Americans have multiple (two or more) concurrent chronic conditions (MCC), according to the U.S. Department of Health & Human Services. As a result, people with several different illnesses tend to have poorer day-to-day functioning. In England, UK, the figure is said to be about 2.9 million people with multiple long-term conditions and the number is thought to be rising.

A 2012 study in the British Medical Journal says that doctors are still unprepared with dealing with ‘multimorbidity’ – that is, the coexistence of multiple chronic diseases and medical conditions in one individual. The authors say: “Despite the increasing numbers of patients with multimorbidity, evidence on the effectiveness of interventions to improve outcomes in such patients is limited.

“The clinical care of these patients is complex and the evidence base for managing chronic conditions is based largely on trials of interventions for single conditions, which too often exclude patients with multimorbidity.”

The impact of multimorbidity

And research shows that multimorbidity has an additional impact on those individuals including emotional challenges of dealing with a group of chronic conditions. Clare Liddy, MD, an Associate Professor in the Department of Family Medicine at the University of Ottawa in Ontario, says “In people with multiple chronic conditions, physical and emotional symptoms can compound and build off of each other, resulting in a larger negative effect on their daily lives.

“These symptoms are interdependent and symptoms of one condition can be aggravated by the symptoms, treatment, or medications of another condition. Some symptoms might overshadow others and reduce the patient’s ability to manage his or her care.”

Liddy suggests ‘re-prioritising’ to learn to cope with the negative effects of the various illnesses.

• Changing cognitive approaches – patients with multiple conditions found that changing their thinking or conscious mental processes had a positive effect on them. Living with multiple chronic conditions became a way of life for some people, who reported fluctuating between “living a life and living an illness.” Liddy notes the current changes in those with multimorbidity:
  • reframing and regulating the amount of attention given to their situation
  • engaging in life and body listening
  • relinquishing control to another source – faith and doctors seem to be heavily relied upon
  • changing their beliefs (for example assigning new meanings to daily chores or activities)
  • self-monitoring – keeping an eye for any changes
  • self-advocacy – approaching and asking for help whenever necessary.

Other important tasks to note include:

• Social support – an important part of dealing with comorbidity is to have a support network of some sort. However, if you have the incorrect kind of support, friends and family may become a barrier to self-management, and they may end up interfering where unnecessary. The key is to create clear-cut boundaries and let them know how and when they can help you. Group activities such as walking have been shown to help with psychological issues, such as loneliness and depression. Joining a support group can also help.
• Read about your condition extensively – the better equipped you will be when approaching your healthcare providers if you know what to expect. At times, you may find practitioners giving you contradictory information. Note it down, and then approach them carefully with what you have observed.
• Multiple care approach – you may detect that some medical practitioners are still not completely skilled at dealing with multiple conditions, they may prioritise one condition over the other, so it’s important to keep that in mind and see that they can also deal with the other issue(s) in a similar manner. The best chance of this is to have a multidisciplinary team working with your needs.
• Organise your medication – if you have lots of medicines to take, it can be hard to keep track. Some people find a dosette box or pill organiser (a plastic box which is separated into different compartments for each day and each time of day) helpful. You can get these from pharmacies or buy them online. Usually you would fill these once a week – ask someone to help you if necessary. Or you could try making a daily chart to show when you should take each medication. Or you could label your medication containers with the time you should take them, or keep medication where you are likely to take it at the time – for example, put breakfast tablets in the kitchen, and bed time pills on your bedside table. If you can’t manage with taking 18 tablets a day, it may be worth revisiting your doctor and being honest about it.
• Take it day-to-day – this means prioritising your needs on any given day, for example, if you feel more tired due to one of your illnesses, then rest, or if you’re feeling depressed more so than usual, then address those needs first.

It’s unbelievably difficult to cope with one let alone several chronic illnesses. And it’s exacerbated by the fact that doctors are only just coming to see how big an impact this is having on society as a whole. However, thinking of it as a list of things to keep crossing off, over time with good care, more coping skills, better management of medication changes, surgeries and therapies, it will seem that tiny bit easier.