“Changes in clinical stability must be investigated with the doctor to understand whether they are due to an actual worsening of the disease that requires non-deferrable tests or not”, underlines Dr. Bonetti
Not only Covid-19: despite the pandemic from coronavirus and the lockdown, the chronic diseases, on all cardiovascular diseases, diabetes and chronic respiratory disease, they have not abandoned those who suffer from it. With the risk, however, that these people, in this particular period, miss the necessary checks. But what are the controls that should not be neglected? And when, instead, can it be postponed to the end of the emergency? “In this period, the difficulties of following the chronic pathology in a timely manner accumulate and accentuate, problems that have dragged on over the years. The medical indication of the checks unfortunately clashes with the concrete possibility of making these investigations and concluding them in a reasonable time, due to the suffering of health services offering, which goes beyond the Covid emergency situation “: this is clearly stated by Dr. Fulvio Bonetti, general practitioner in Barlassina (Monza-Brianza).
What are the pathologies that must be followed despite the Covid emergency?
“There are three types of situations to deal with: chronic pathology, acute pathology and chronic exacerbated pathology. In addition to these there is also the problem of oncological follow-up, another important situation “.
What do we mean by chronic diseases?
“We are talking about diabetes, chronic obstructive pulmonary disease (chronic bronchitis), cardiovascular diseases, both cardiological and neurological such as ischemic heart disease, hypertension or stroke, but also liver diseases and others that can become chronic, degenerative neurological diseases such as dementia and cognitive deficits of vascular origin. All those who suffer from it must maintain a close relationship with the family doctor and plan checks and therapies with him that must be done relatively quickly and those that can be postponed “.
When is control necessary without delay?
“As far as these chronic pathologies are concerned, checks must be made without doubt when there is a condition of clinical instability, a decompensation of the disease. In the case of diabetes, for example, this occurs when the blood sugar rises alarmingly despite therapy or symptoms that have recently arisen in an unusual way. In these cases, the family doctor can, in some situations, recover the compensation by acting on drugs and lifestyle. In other cases it must necessarily refer to specialist consultations for assessments. In general for these pathologies the instability is clinical: ‘it is evident that the patient is not well’ ”.
So if there are no perceptible changes, can tests and checks be postponed?
“Exact. The changes in clinical stability should not be underestimated, which should instead be investigated with the doctor to understand whether they are due to an actual worsening of the disease that requires non-deferrable tests or not “.
Speaking instead of acute and chronic exacerbated diseases, which ones does it refer to and how should they be approached in a period like the one we are experiencing?
“The acute pathology (for example biliary or renal colic) has two stages: the acute one of urgency or emergency, in which it is necessary to go directly to the emergency room for checks or to the doctor of the continuity assistance service (former medical guard) for temporary therapy, or that in which the family doctor himself establishes the importance of the clinical picture and, consequently, the treatment. The case of chronic diseases exacerbated on the other hand, it concerns patients who suddenly become unstable and have a flare-up of the disease, such as uncontrolled hypertension or acute chronic bronchitis. Especially in this period of Covid, greater monitoring is good in the case of respiratory disease to ascertain that it is precisely an exacerbation of chronic bronchitis and not Covid-19. In these cases, clinical instability often occurs suddenly, and therefore a more rapid intervention is necessary ”.
How much do age and familiarity factors affect these pathologies?
“It depends on the pathology. In the case of hypertension, for example, they are both very important factors. In general, familiarity with pathologies always has an implication. In the case of hypertension, the age factor is important as the younger the patient is, at an unusual age for the onset of hypertension, the more important it is to clarify the causes of the same, which may also depend on a secondary underlying disease. To clarify if I have hypertension in my twenties this is unusual and more tests must be made to find out the cause. If I have hypertension at the age of 50 and I am also familiar with it, it is likely that this hypertension is primary, not due to other pathologies “.
What exactly is meant by familiarity? What degrees of relationship is it about?
“It is meant by recurrence of the same disease in relatives who are usually first degree: parents or siblings. In the case of oncological pathologies it is good to investigate the same pathologies also in grandparents and uncles, widening the spectrum of familiarity. And if there are several relatives who have had the same pathology then the greater risk can be considered and the genetic investigation is widening “.
What are the values that should alarm at the level of cholesterol, blood pressure, glycated hemoglobin?
“On pressure in general, if the hypertensive patient is elderly it is sufficient for him to remain on values of 140-80, for a young person in therapy on values of 120-80. For what concern diabetes, the measurement of glycemia alone is less important, even if fasting values above 150 mg / dl show uncontrolled diabetes. Most important is the glycated hemoglobin: it should be around 6, even 6-7 in the elderly, values above 8% show controlled diabetes. Regarding the cholesterol, the lower the better. In general, the total cholesterol should be below 200 mg / dl, the so-called bad LDL below 120 (but if you have ischemic heart disease or angina or diabetes itself it must be as low as possible), the so-called good HDL at least above 40, but the higher the better. Unfortunately, HDL values cannot be corrected with drugs, but only with lifestyle. A tip is to walk briskly at least half an hour for at least two or three times a week and follow an ad hoc diet “.
Read also: Diabetes and Covid-19, the primary: “The risks come from blood sugar and weight”
Are there any therapies that absolutely must not be forgotten?
“It is very important to remind people who are on anticoagulant therapy to do the recommended checks, without ever forgetting them. Anticoagulant therapy is very effective but has its risks that should not be underestimated “.
Read also: Diet to prevent diabetes
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23 November 2020 (change November 23, 2020 | 18:26)
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