Chronic Disease Management

Alzheimer’s Disease

Understanding Alzheimer's Disease

Alzheimer’s disease is a permanent, progressive brain disorder that slowly destroys memory and thinking skills. Eventually the ability to carry out even the simplest day to day routines and tasks is diminished making the need for help with chronic disease management even more vital. In most people with Alzheimer’s, symptoms of this debilitating chronic disease first appear in their mid-60s. However this can vary. Experts suggest that more than 5.5 million Americans may have Alzheimer’s.

Alzheimer’s is the most common cause of dementia among older adults. Dementia is the loss of cognitive functioning—thinking, remembering, and reasoning—and behavioral abilities to such an extent that it interferes with a person’s daily life and activities. It can range in severity from the mildest stage, when it is just beginning to affect a person’s functioning, to the most severe stage, when the person must depend completely on others for basic activities of daily living.

Signs & Symptoms of Alzheimer's Disease

Mild forgetfulness can be a normal part of aging. If you have trouble remembering someone’s name but remember later, that’s not a serious memory problem.

However, if memory problems are seriously affecting your daily life, where you can’t function because of it, it could be early signs of Alzheimer’s disease. While the number of symptoms you have and how strong they are vary, it’s important to identify the early signs. You need to ask yourself some tough questions.

Memory loss

This is the most common symptom.

  • Easily forget information you just learned
  • Lose track of important dates, names, and events
  • Forget big things even happened?
  • Ask for the same information over and over again
  • Rely heavily on memory aids like Post-it notes or reminders on your smartphone?

Trouble planning and problem solving

  • Have trouble making plans and sticking to them
  • Have difficulty following a recipe, even one you’ve used many times
  • Difficult to concentrate on detailed tasks, especially if they involve numbers (For example, keeping track of bills and balancing your checkbook)

Daily tasks are a challenge

Even familiar things can become hard.

  • Have trouble driving to a location you go to often
  • Difficulty completing an ordinary task at work
  • Forget the rules of your favorite game

Times and places are confusing

  • Trouble with fully grasping something that’s not happening currently
  • Disoriented
  • Get lost easily
  • Forget where you are
  • Remember how you got to places

Changes in vision

  • Harder to read the words on the page
  • Have trouble judging distances
  • Trouble telling colors apart

This is important because it can affect your driving.

Words and conversations are frustrating

Conversations can be a struggle.

  • Avoid joining in on conversations
  • Have difficulty following along with the conversation
  • Suddenly stop in the middle of a discussion because you don’t know what to say
  • Keep repeating yourself

You lose things

  • Everyone misplaces things from time to time, but can you retrace your steps to find them again?
  • Put things in unusual places, like your watch in the refrigerator
  • Accuse people of taking things

Lapse in judgment

  • Making poor decisions lately
  • Make mistakes with money, like giving it away when you normally wouldn’t
  • Showering less often
  • Taking care of yourself less
  • Dressing for the wrong weather

Social withdrawal

  • Scaling back on projects at work
  • Being less involved with your favorite hobbies
  • Lack motivation
  • Watching television or sleeping more than usual

Mood changes

  • Get upset more easily
  • Feel depressed, scared, or anxious
  • Suspicious of people

Having one or two of these symptoms occasionally occur in your life does not necessarily say that you have Alzheimer’s Disease. Diagnosis of this chronic disease comes through a series of tests involving the frequency of the symptoms showing up or if it’s lingering for quite some time.

Risk Factors of Alzheimer's Disease

Scientists believe that in the majority, Alzheimer’s disease is caused by a combination of genetic, lifestyle and environmental factors that affect the brain over time.

Although the causes of Alzheimer’s aren’t yet fully understood up to this day, it’s effect on the brain is clear. This disease damages and kills brain cells. A brain affected by Alzheimer’s disease has many fewer cells and many fewer connections among surviving cells than a healthy brain.


Increasing age is the greatest known risk factor for Alzheimer’s. This diseases is not a part of normal aging, but the risk increases greatly by mid 60’s. The rate of dementia doubles every decade after age 60.

People with rare genetic changes linked to early-onset Alzheimer’s begin experiencing symptoms as early as their 30s.

Family history and genetics

The risk of developing Alzheimer’s appears to be higher if a first-degree relative ( your parent or sibling) has the disease. Scientists have identified mutations in three genes that virtually guarantee a person who inherits them will develop Alzheimer’s. But these mutations account for less than 5 percent of Alzheimer’s disease.

Most genetic mechanisms of Alzheimer’s among families remain largely unexplained. The strongest risk gene researchers have found so far is apolipoprotein e4 (APoE4), though not everyone with this gene goes on to develop Alzheimer’s disease. Other risk genes have been identified but not conclusively confirmed.

Down syndrome

Many people with Down syndrome develop Alzheimer’s disease. Signs and symptoms of Alzheimer’s tend to appear 10 to 20 years earlier in people with Down syndrome than they do for the general population. A gene contained in the extra chromosome that causes Down syndrome significantly increases the risk of Alzheimer’s disease.


Women seem to be more likely than men to develop Alzheimer’s disease, in part because they live longer.

Mild cognitive impairment

People with mild cognitive impairment (MCI) have memory problems or other symptoms of cognitive decline that are worse than might be expected for their age, but not severe enough to be diagnosed as dementia.

Those with MCI have an increased risk of later developing dementia. Taking action to develop a healthy lifestyle and strategies to compensate for memory loss at this stage may help delay or prevent the progression to dementia.

Past head trauma

People who’ve had a severe head trauma seem to have a greater risk of Alzheimer’s disease.

Lifestyle and heart health

There’s no lifestyle factor that has absolutely shown to reduce your risk of Alzheimer’s disease.

However, some evidence suggests that the same factors that put you at risk of heart disease also may increase the chance that you’ll develop Alzheimer’s.

Examples include:
  • Lack of exercise
  • Obesity
  • Smoking or exposure to secondhand smoke
  • High blood pressure
  • High blood cholesterol
  • Poorly controlled type 2 diabetes
  • A diet lacking in fruits and vegetables

These risk factors are also linked to vascular dementia, a type of dementia caused by damaged blood vessels in the brain.

Lifelong learning and social engagement

Studies have found an association between lifelong involvement in mentally and socially stimulating activities and a reduced risk of Alzheimer’s disease. Low education levels — less than a high school education — appear to be a risk factor for Alzheimer’s disease.

Chronic Disease Management for Alzheimer's Disease


Current Alzheimer’s medications can help for a time with memory symptoms and other cognitive changes. Two types of drugs are currently used to treat cognitive symptoms:

Cholinesterase inhibitors

These drugs work by boosting levels of a cell-to-cell communication by providing a neurotransmitter (acetylcholine) that is depleted in the brain by Alzheimer’s disease. The improvement is modest. Cholinesterase inhibitors can improve neuropsychiatric symptoms, such as agitation or depression, as well.

Commonly prescribed cholinesterase inhibitors include Donepezil (Aricept), Galantamine (Razadyne) and Rivastigmine (Exelon). The main side effects of these drugs include diarrhea, nausea, loss of appetite and sleep disturbances. In people with cardiac conduction disorders, serious side effects may include a slow heart rate and heart block.

Memantine (Namenda)

This drug works in another brain cell communication network and slows the progression of symptoms with moderate to severe Alzheimer’s disease. It’s sometimes used in combination with a cholinesterase inhibitor. Side effects may include constipation, dizziness and headache.
Sometimes other medications such as antidepressants are used to help control the behavioral symptoms associated with Alzheimer’s disease. But some medications should only be used with great caution. For example, some common sleep medications — Zolpidem (Ambien), Eszopiclone (Lunesta) and others — may increase confusion and the risk of falls.

Anti-anxiety medications — Clonazepam (Klonopin) and Lorazepam (Ativan)

These can increase the risk of falls, confusion and dizziness. Always check with your doctor before taking any new medications.

Creating a safe and supportive environment

Adapting the living situation to the needs of a person with Alzheimer’s is an important part of any treatment plan. For someone with Alzheimer’s, establishing and strengthening routine habits and minimizing memory-demanding tasks can make life much easier.

You can take these steps to support a person’s sense of well-being and continued ability to function:

  • Always keep keys, wallets, mobile phones and other valuables in the same place at home, so they don’t become lost.
  • See if your doctor can simplify your medication regimen to once-daily dosing, and arrange for your finances to be on automatic payment and automatic deposit.
  • Develop the habit of carrying a mobile phone with location capability so that you can call in case you are lost or confused and people can track your location via the phone. Also, program important phone numbers into your phone, so you don’t have to try to recall them.
  • Make sure regular appointments are on the same day at the same time as much as possible.
  • Use a calendar or whiteboard in the home to track daily schedules. Build the habit of checking off completed items so that you can be sure they were completed.
  • Remove excess furniture, clutter and throw rugs.
  • Install sturdy handrails on stairways and in bathrooms.
  • Ensure that shoes and slippers are comfortable and provide good traction.
  • Reduce the number of mirrors. People with Alzheimer’s may find images in mirrors confusing or frightening.
  • Keep photographs and other meaningful objects around the house.


Regular exercise is an important part of everybody’s wellness plan — and those with Alzheimer’s are no exception. Activities such as a daily walk can help improve mood and maintain the health of joints, muscles and the heart.

Exercise can also promote restful sleep and prevent constipation. Make sure that the person with Alzheimer’s carries identification or wears a medical alert bracelet if she or he walks unaccompanied.

People with Alzheimer’s who develop trouble walking may still be able to use a stationary bike or participate in chair exercises. You may be able to find exercise programs geared to older adults on TV or on DVDs.


People with Alzheimer’s may forget to eat, lose interest in preparing meals or not eat a healthy combination of foods. They may also forget to drink enough, leading to dehydration and constipation.

  • High-calorie, healthy shakes and smoothies. You can supplement milkshakes with protein powders (available at grocery stores, drugstores and discount retailers) or use your blender to make smoothies featuring your favorite ingredients.
  • Water, juice and other healthy beverages. Try to ensure that a person with Alzheimer’s drinks at least several full glasses of liquids every day.
  • Avoid beverages with caffeine, which can increase restlessness, interfere with sleep and trigger a frequent need to urinate.

Certain nutritional supplements are marketed as “medical foods” specifically to treat Alzheimer’s disease. The Food and Drug Administration (FDA) does not approve products marketed as medical foods. Despite marketing claims, there’s no definitive data showing that any of these supplements is beneficial or safe.

Chronic disease management for Alzheimer’s can seem overwhelming at times; however, Magnolia Family Medicine & Wellness is here to help you navigate through this difficult journey.


Understanding Asthma

Asthma is a chronic disease in which your airways narrow and swell and produce extra mucus. This can make breathing difficult and trigger coughing, wheezing and shortness of breath.

For some people, asthma is a minor nuisance. However, for others, it can be a major problem that interferes with daily activities and may lead to a life-threatening asthma attack.

Asthma can’t be cured, but its symptoms can be controlled. Because asthma often changes over time, it’s important that you work with your doctor to track your signs and symptoms and adjust treatment as needed.

Causes of Asthma

It isn’t clear why some people get asthma and others don’t, but it’s probably due to a combination of environmental and genetic (inherited) factors.

Exposure to various irritants and substances that trigger allergies (allergens) can also trigger signs and symptoms of asthma.

Asthma triggers are different from person to person and can include:

  • Airborne substances, such as pollen, dust mites, mold spores, pet dander or particles of cockroach waste
  • Respiratory infections, such as the common cold
  • Physical activity (exercise-induced asthma)
  • Cold air
  • Air pollutants and irritants, such as smoke
  • Certain medications, including beta blockers, aspirin, ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve)
  • Strong emotions and stress
  • Sulfites and preservatives added to some types of foods and beverages, including shrimp, dried fruit, processed potatoes, beer and wine
  • Gastroesophageal reflux disease (GERD), a condition in which stomach acids back up into your throat

Signs & Symptoms of Asthma

Asthma symptoms vary from person to person. You may have infrequent asthma attacks, have symptoms only at certain times — such as when exercising — or have symptoms all the time.


Asthma signs and symptoms include:

  • Shortness of breath
  • Chest tightness or pain
  • Trouble sleeping caused by shortness of breath, coughing or wheezing
  • A whistling or wheezing sound when exhaling (wheezing is a common sign of asthma in children)
  • Coughing or wheezing attacks that are worsened by a respiratory virus, such as a cold or the flu

Signs that your asthma is probably worsening include:

  • Asthma signs and symptoms that are more frequent and bothersome
  • Increasing difficulty breathing (measurable with a peak flow meter, a device used to check how well your lungs are working)
  • The need to use a quick-relief inhaler more often

Chronic Disease Management for Asthma

Because asthma is a chronic disease, prevention and long-term control are key in stopping asthma attacks before they start. Treatment usually involves learning to recognize your triggers, taking steps to avoid them and tracking your breathing to make sure your daily asthma medications are keeping symptoms under control. In case of an asthma flare-up, you may need to use a quick-relief inhaler, such as Albuterol.


The right medications for you depend on a number of things — your age, symptoms, asthma triggers and what works best to keep your asthma under control.

Preventive, long-term control medications reduce the inflammation in your airways that leads to symptoms. Quick-relief inhalers (bronchodilators) quickly open swollen airways that are limiting breathing. In some cases, allergy medications are necessary.

Long-term asthma control medications

Long-term asthma control medications, generally taken daily, are the cornerstone of asthma treatment. These medications keep asthma under control on a day-to-day basis and make it less likely you’ll have an asthma attack. Types of long-term control medications include:

  • Inhaled corticosteroids.
  • Leukotriene modifiers.
  • Long-acting beta agonists.
  • Combination inhalers.
  • Theophylline

Quick-relief (rescue) medications

Quick-relief medications are used as needed for rapid, short-term symptom relief during an asthma attack — or before exercise if your doctor recommends it. Types of quick-relief medications include:

  • Short-acting beta agonists.

    These inhaled, quick-relief bronchodilators act within minutes to rapidly ease symptoms during an asthma attack. They include Albuterol (ProAir HFA, Ventolin HFA, others) and Levalbuterol (Xopenex).Short-acting beta agonists can be taken using a portable, hand-held inhaler or a nebulizer — a machine that converts asthma medications to a fine mist — so that they can be inhaled through a face mask or a mouthpiece.

  • Ipratropium (Atrovent)

    Like other bronchodilators, ipratropium acts quickly to immediately relax your airways, making it easier to breathe. Ipratropium is mostly used for emphysema and chronic bronchitis, but it’s sometimes used to treat asthma attacks.

  • Oral and intravenous corticosteroids

    These medications — which include Prednisone and Methylprednisolone — relieve airway inflammation caused by severe asthma. They can cause serious side effects when used long term, so they’re used only on a short-term basis to treat severe asthma symptoms.


Understanding Diabetes

Diabetes is one of the worlds deadliest chronic diseases. This is a chronic disease that occurs when the pancreas is no longer able to make insulin, or when the body cannot make good use of the insulin it produces. Insulin is a hormone made by the pancreas. The pancreas acts like a key to let glucose from the food we eat pass from the blood stream into the cells in the body to produce energy. Carbohydrates we take are broken down into glucose in the blood. Then, insulin helps glucose get into the cells. Not being able to produce insulin or use it effectively leads to raised glucose levels in the blood (known as hyperglycemia). Long term high glucose levels are associated with damage to the body and failure of various organs and tissues.

Signs & Symptoms of Diabetes

Symptoms of Diabetes vary depending on the level of blood sugar elevation. Some people, especially those with prediabetes or type 2 diabetes, may not experience symptoms initially. However, with Type 1 diabetes, symptoms tend to come on quickly and be more severe.

Some of the signs and symptoms of type 1 and type 2 diabetes are:

  • Increased thirst
  • Frequent urination
  • Extreme hunger
  • Unexplained weight loss
  • Presence of ketones in the urine (ketones are a byproduct of the breakdown of muscle and fat that happens when there’s not enough available insulin)
  • Fatigue
  • Irritability
  • Blurred vision
  • Slow-healing sores
  • Frequent infections, such as gums or skin infections and vaginal infections

Complications of Diabetes

Diabetes, if not diagnosed and treated early will impose long-term complications which can develop gradually. The lesser controlled your blood sugar level is and the longer you have diabetes — the higher the risk of complications. Eventually, diabetes complications may be disabling or even life-threatening.

Possible complications include:

Cardiovascular disease

This is the most common complication of diabetes, which is the risk of various cardiovascular problems, including coronary artery disease with chest pain (angina), heart attack, stroke and narrowing of arteries (atherosclerosis). If you have diabetes, you’re more likely to have heart disease or stroke.

Nerve damage(neuropathy)

Excess sugar can injure the walls of the tiny blood vessels (capillaries) that nourish your nerves, especially in your legs. This can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and gradually spreads upward.

Left untreated, you could lose all sense of feeling in the affected limbs. Damage to the nerves related to digestion can cause problems with nausea, vomiting, diarrhea or constipation. For men, it may lead to erectile dysfunction.

Kidney damage(nephropathy)

The kidneys contain millions of tiny blood vessel clusters (glomeruli) that filter waste from your blood. Diabetes can damage this delicate filtering system. Severe damage can lead to kidney failure or irreversible end-stage kidney disease, which may require dialysis or a kidney transplant.

Eye damage(retinopathy)

Diabetes can damage the blood vessels of the retina (diabetic retinopathy), potentially leading to blindness. It can also increase the risk of other serious vision conditions, such as cataracts and glaucoma.

Foot damage

Nerve damage in the feet or poor blood flow to the feet increases the risk of various foot complications. Left untreated, cuts and blisters can develop serious infections, which often heal poorly. These infections may ultimately require toe, foot or leg amputation.

Skin conditions

Diabetes may leave you more susceptible to skin problems, including bacterial and fungal infections.

Hearing impairment

Hearing problems are more common in people with diabetes.

Alzheimer’s disease

Type 2 diabetes may increase the risk of dementia, such as Alzheimer’s disease. The poorer your blood sugar control, the greater the risk appears to be. Although there are theories as to how these disorders might be connected, none has yet been proved.


Depression symptoms are common in people with type 1 and type 2 diabetes. Consequently, depression can affect diabetes management.

Complications of gestational diabetes:

Most women who have gestational diabetes deliver healthy babies. However, untreated or uncontrolled blood sugar levels can cause problems for you and your baby.

Complications in your baby can occur as a result of gestational diabetes, including:
  • Excess growth. Extra glucose can cross the placenta, which triggers your baby’s pancreas to make extra insulin. This can cause your baby to grow too large (macrosomia).
  • Very large babies are more likely to require a C-section birth.
  • Low blood sugar. Sometimes babies of mothers with gestational diabetes develop low blood sugar (hypoglycemia) shortly after birth because their own insulin production is high. Prompt feedings and sometimes an intravenous glucose solution can return the baby’s blood sugar level to normal.
  • Type 2 diabetes later in life. Babies of mothers who have gestational diabetes have a higher risk of developing obesity and type 2 diabetes later in life.
  • Death. Untreated gestational diabetes can result in a baby’s death either before or shortly after birth.
Complications in the mother also can occur as a result of gestational diabetes, including:

Preeclampsia. This condition is characterized by high blood pressure, excess protein in the urine, and swelling in the legs and feet. Preeclampsia can lead to serious or even life-threatening complications for both mother and baby.

Subsequent gestational diabetes. Once you’ve had gestational diabetes in one pregnancy, you’re more likely to have it again with the next pregnancy. You’re also more likely to develop diabetes — typically type 2 diabetes — as you get older.

Chronic Disease Management for Diabetes

Diabetes is a chronic disease that cannot be treated at home. Our doctors will help you make a diabetes treatment plan that is right for you — and that you can understand. You may also need other health care professionals on your diabetes treatment team, including a foot doctor, nutritionist, eye doctor, and a diabetes specialist (called an endocrinologist).

Treatment for diabetes requires serious tracking over your blood sugar levels (and keeping them at a goal set by your doctor) with a combination of treatment options like medications, exercise, and diet. By paying close attention to your diet and lifestyle, you can minimize or avoid the “seesaw effect” of rapidly changing blood sugar levels, which can require quick changes in medication dosages, especially insulin.

Type 1 Diabetes Chronic Disease Management:

Insulin injections come in several different forms, with each working slightly differently. Some last up to a whole day (long-acting), some last up to eight hours (short-acting) and some work quickly but don’t last very long (rapid-acting). You’ll most likely need a combination of different insulin preparations to effectively treat your chronic disease.

There are alternatives to insulin injections, but they’re only suitable for a small number of patients.

They are:
  • insulin pump therapy – where a small device constantly pumps insulin (at a rate you control) into your bloodstream through a needle that’s inserted under the skin
  • islet cell transplantation – where healthy insulin-producing cells from the pancreas of a deceased donor are implanted into the pancreas of someone with type 1 diabetes (read about the criteria for having an islet transplant)
  • a complete pancreas transplant

Type 2 Diabetes Chronic Disease Management

You have several options to manage this chronic disease. Diet, exercise, and medication work together to bring your blood sugar under control.

Your doctor will help you figure out if you need to take medicine, which kind is right for you, and how often you should take it.

Over your lifetime, you’ll probably handle your chronic disease in different ways. Sometimes medications stop working, and you’ll have to switch. You’ll need to adjust to changes in your body as you age. And researchers are looking for new diabetes medicines and ways to treat it.

    High Blood Pressure

    Understanding High Blood Pressure

    High blood pressure (Hypertension) is a chronic cardiovascular disease in which the pressure or tension in the arteries is increased. Frequently known as the “silent killer”,  it has no symptoms and can go undetected for years. Thus, severely damaging your tissues and vital organs. Hypertension makes the heart work harder to pump blood to your tissues and organs. Eventually, causing enlargement and scarring of the heart. The arteries also begin to harden if the pressure is not controlled. This will cause your overworked heart not to function normally by pumping and transporting blood through these arteries. The damage to the heart and arteries can result in heart disease, kidney disease, the hardening of the arteries, eye damage, and the most common complication, stroke. High blood pressure can be caused by a number of factors including your genes, existing disease, and lifestyle.

    Causes of High Blood Pressure

    There are two types of high blood pressure.

    Primary (Essential) Hypertension

    For most adults, there’s no identifiable cause of high blood pressure. This type of high blood pressure, called primary (essential) hypertension, develops gradually over many years.

    Secondary Hypertension

    Some people have high blood pressure caused by an underlying condition. This type of high blood pressure, called secondary hypertension, appears suddenly and causes higher blood pressure than primary hypertension.

    Various conditions and medications can lead to secondary hypertension, including:
    • Obstructive sleep apnea
    • Kidney problems
    • Adrenal gland tumors
    • Thyroid problems
    • Certain defects you’re born with (congenital) in blood vessels
    • Certain medications, such as birth control pills, cold remedies, decongestants, over-the-counter pain relievers and some prescription drugs
    • Illegal drugs, such as cocaine and amphetamines

    Signs & Symptoms of High Blood Pressure

    High blood pressure is known as a “silent killer” chronic disease. High blood pressure is an illness that commonly shows no symptoms. It may take months or years for the condition to reach severe levels. Even at severe levels, the symptoms of high blood pressure can still be linked to other conditions.

    Symptoms of High blood pressure can include the following and require immediate medical attention:

    • Headaches (most commonly pain that starts from the back of the head until the top)
    • Shortness of breath
    • Nose-bleeding
    • Dizziness
    • Chest pain
    • Visual changes
    • Blood in the urine

    These symptoms do not occur in everyone with high blood pressure, and waiting for a symptom to appear could be fatal.

    Complications of High Blood Pressure

    Because high blood pressure, or hypertension, is often a silent condition, it can cause severe damage to your body for years without showing any symptoms. Untreated high blood pressure, may result in serious and even fatal complications.

    Complications of high blood pressure include the following:

    • Heart attack or stroke.
    • Hardening and thickening of the arteries (atherosclerosis), which can lead to a heart attack, stroke or other complications.
    • Aneurysm.
    • Heart failure
    • Weakened and narrowed blood vessels in your kidneys.
    • Thickened, narrowed or torn blood vessels in the eyes. This can result in vision loss.
    • Metabolic syndrome. This syndrome is a cluster of disorders of your body’s metabolism, including increased waist circumference, high triglycerides, low high-density lipoprotein (HDL) cholesterol, the “good” cholesterol, high blood pressure and high insulin levels. These conditions make you more likely to develop diabetes, heart disease and stroke.
    • Trouble with memory or understanding.
    • Dementia

    High blood pressure makes arteries harder, tighter, and less elastic making it easy for fats to deposit in your arteries and block blood flow. This damage can lead to increased blood pressure, blockages, and eventually, heart attack and stroke.

    Chronic Disease Management for High Blood Pressure

    High blood pressure, or Hypertension can lead to many serious health conditions, such as heart attack, heart failure, stroke, and kidney disease. Early treatment of high blood pressure is essential to preventing these and other problems from occurring in the future.

    Lifestyle Change

    Changing your lifestyle can go a long way toward controlling this chronic disease. Your doctor may recommend you make lifestyle changes including:

    • Eating a heart-healthy diet with less salt
    • Getting regular physical activity
    • Maintaining a healthy weight or losing weight if you’re overweight or obese
    • Limiting the amount of alcohol you drink

    But sometimes lifestyle changes aren’t enough. In addition to diet and exercise, your doctor may recommend medication to lower your blood pressure.

    Your blood pressure treatment goal depends on how healthy you are.


    There are several different medications that can help treat high blood pressure. These are drugs called antihypertensive, and are divided into individual categories.

    With so many options available, finding the best one for you may take some time and patience. We will work with you to find the best treatment plan for management of your chronic disease. This treatment plan may include one or more of the following medications.


    Beta-blockers make your heart beat slower and with less force. This reduces the amount of blood pumped through your arteries with each beat, which lowers blood pressure. It also blocks certain hormones in your body that can raise your blood pressure.


    High sodium levels and excess fluid in your body can increase blood pressure. Diuretics, also called water pills, help your kidneys remove excess sodium from your body. As the sodium leaves, extra fluid in your bloodstream moves into your urine, which helps lower your blood pressure.

    ACE inhibitors

    Angiotensin is a chemical that causes blood vessels and artery walls to tighten and narrow. ACE (angiotensin converting enzyme) inhibitors prevent the body from producing as much of this chemical. This helps blood vessels relax and reduces blood pressure.

    Angiotensin II receptor blockers(ARBs)

    While ACE inhibitors aim to stop the creation of angiotensin, ARBs block angiotensin from binding with receptors. Without the chemical, blood vessels won’t tighten. This helps relax vessels and lower blood pressure.

    Calcium channel blockers

    These medications block some of the calcium from entering the cardiac muscles of your heart. This leads to less forceful heartbeats and a lower blood pressure. These medicines also work in the blood vessels, causing them to relax and further lowering blood pressure.

    Alpha-2 agonists

    Alpha-2 agonists change the nerve impulses that cause blood vessels to tighten. This helps blood vessels to relax, which reduces blood pressure.

    High Cholesterol

    Understanding High Cholesterol

    Cholesterol is a waxy substance that’s found in the fats (lipids) in your blood. While your body needs cholesterol to continue building healthy cells, having high cholesterol increases your risk of heart disease.

    When you have high cholesterol, you may develop fatty deposits in your blood vessels. Eventually, these deposits make it difficult for enough blood to flow through your arteries. Subsequently, your heart may not get as much oxygen-rich blood as it needs, increasing your risk of a heart attack. In addition, decreased blood flow to your brain can cause a stroke.

    High cholesterol can be inherited, but it’s often the result of unhealthy lifestyle choices, and thus preventable and treatable. A healthy diet, regular exercise, and sometimes medication can go a long way toward reducing this risks of this chronic disease.

    Signs & Symptoms of High Cholesterol

    High cholesterol typically doesn’t cause any symptoms. In most cases it only causes emergency events. For instance, a heart attack or stroke can result from the damage caused by high cholesterol.

    These emergencies typically don’t occur until high cholesterol leads to the formation of plaque in your arteries. Plaque from high cholesterol can narrow arteries so less blood can pass through. The formation of plaque changes the makeup of your arterial lining. This could lead to serious complications.

    A blood test is the only way to know if your cholesterol is too high. This means having a total blood cholesterol level above 240 milligrams per deciliter (mg/dL). Ask your doctor to give you a cholesterol test after you turn 20 years old. Then get your cholesterol rechecked every 4 to 6 years.


    Your doctor may also suggest you have your cholesterol checked more frequently if you have a family history of high cholesterol, or if you demonstrate the following risk factors:
    • have high blood pressure
    • are overweight
    • smoke

    Complications of High Cholesterol

    If left untreated, high cholesterol can cause plaque to build up in your arteries. Over time, this plaque can narrow your arteries. This condition is known as atherosclerosis.

    Atherosclerosis is a serious condition. It can limit the flow of blood through your arteries. Also, it raises your risk of developing dangerous blood clots.

    Atherosclerosis can result in many life-threatening complications, such as:
    • Stroke
    • Heart attack
    • Angina (chest pain)
    • High blood pressure
    • Peripheral vascular disease
    • Chronic kidney disease

    High cholesterol can also create a bile imbalance, raising your risk of gallstones.

    Chronic Disease Management for High Cholesterol

    High cholesterol can be lowered or prevented in two ways: through medication or with lifestyle changes. Healthcare providers may prescribe either of the two options or a mix of both to help treat your chronic disease.


    Statins are the most commonly prescribed medications for high cholesterol. They block your liver from producing more cholesterol.

    Examples of statins include:
    • Atorvastatin (Lipitor)
    • Fluvastatin (Lescol)
    • Rosuvastatin (Crestor)
    • Simvastatin (Zocor)
    Your doctor may also prescribe other medications to help your chronic disease, such as:
    • Niacin
    • Bile acid resins or sequestrants, such as colesevelem (Welchol), colestipol (Colestid), or cholestyramine (Prevalite)
    • Cholesterol absorption inhibitors, such as ezetimibe (Zetia)

    Some products contain a combination of drugs to help decrease your body’s absorption of cholesterol from foods and reduce your liver’s production of cholesterol. One example is a combination of Ezetimibe and Simvastatin (Vytorin).

    Lowering cholesterol through diet

    To help you achieve and maintain healthy cholesterol levels, our providers may recommend changes to your diet.

    For example, they may advise you to:
    • Limit your intake of foods that are high in cholesterol, saturated fats, and trans fats
    • Choose lean sources of protein, such as chicken, fish, and legumes
    • Eat a wide variety of high-fiber foods, such as fruits, vegetables, and whole grains
    • Opt for baked, broiled, steamed, grilled, and roasted foods instead of fried foods
    • Avoid fast food and junk food
    Foods that are high in cholesterol, saturated fats, or trans fats include:
    • Red meat, organ meats, egg yolks, and high-fat dairy products
    • Processed foods made with cocoa butter, palm oil, or coconut oil
    • Deep fried foods, such as potato chips, onion rings, and fried chicken
    • Certain baked goods, such as some cookies and muffins

    Eating fish and other foods that contain omega-3 fatty acids may also help lower your LDL levels. Salmon, mackerel, and herring are rich sources of omega-3s. Walnuts, almonds, ground flax seeds, and avocados also contain omega-3s.

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