The secret to living well with a chronic illness is to remove any obstacles to self-management.

Your doctor gives you expert advice and prescribes treatments. Insurance helps pay for your care. The right treatment can control symptoms or complications.

But nearly every physician will agree: When it comes to managing diabetes, asthma, or any other chronic illness, the patient has the most critical role—little else matters if you don’t keep up your end of the bargain.

“Having a chronic condition means you’re probably going to have to live with it for the rest of your life,” explains Kate Lorig, R.N., Dr.P.H., director of the Patient Education Research Center at Stanford School of Medicine in Stanford, Calif., and coauthor of Living a Healthy Life with Chronic Conditions. “You have a choice in how you manage it—you can be proactive and assertive, or you can do nothing and let the chips fall where they may.”

These suggestions can limit the obstacles in your path.

Make Your Voice Heard
“If the doctor recommends a treatment you don’t want to do, you need to talk about it right there and then,” Lorig stresses.

Negotiate what’s important to you. The unwanted treatment might be a medication you dislike or a regimen that conflicts with your daily routine.

Lorig herself has an illness that requires her to receive an intravenous infusion every two weeks, which can interfere with her heavy travel schedule.

“I asked my doctor if it was essential to get these every two weeks,” she explains. “He said ‘No, there’s a 10- to 21-day window.’ If I hadn’t asked, I would never have known.”

Safeguard Your Lifestyle
What’s most important to you? Maybe it’s tinkering with your car or keeping your house tidy. If the treatment plan will interfere, ask your doctor how you can revise the plan or the activity so you can keep doing the things you love.

Lorig recently met with a patient who has severe neurological problems due to illness. The woman loves to ski, so she found a ski clinic for people with physical challenges. If you love to play bridge but arthritis is keeping you from holding the cards, you can get a card holder. There’s almost always a way you can adapt.

Keep Up Your Activities
If you have diabetes, for example, you can comfortably eat out with friends or family while still maintaining your healthy eating plan. The solution is to be open about your challenges—and ask for understanding and support.

Get Past Depression
Being depressed is one of the main reasons people with chronic illness don’t stick with their treatment.

“Understand that you may have a good reason to feel bad—no matter what your illness, it will be lifechanging,” Lorig says. “You may feel overwhelmed.”

However, just because you have a reason doesn’t mean you can’t do something about it. Just as you would treat diabetes, treat depression.

To limit negative emotions, try to stay active in life. Focus on helping others. Learn relaxation techniques.

Importantly, ask for help if you need it. Proven treatments can help break the cycle of depression.

“If you’re feeling blue, having a hard time sleeping or getting out of bed, or your appetite is huge or nonexistent, it’s worth talking to your doctor. It’s not a weakness to consult your doctor about depression,” Lorig insists. “In fact, asking for help shows strength.”

Learn About Your Illness
You can begin by visiting a reputable Web site, such as the American Diabetes Association (www.diabetes.org), the Arthritis Foundation (www.arthritis.org), or the Asthma and Allergy Foundation of America (www.aafa.org).

Better yet, join a class that teaches how to deal with your specific condition or with chronic illness in general. Ask your health care provider if there are any classes in your area. Or call your local Administration on Aging—many now offer self-management programs for chronic diseases.

“You might even want to join an online group for your condition,” says Lorig. “There’s a lot of patient wisdom out there on how you can live with heart disease, diabetes, and so on.”

Stay Active
If you’ve been sedentary, start slowly with what you can do now. Can you walk a block without your symptoms being worse when you finish than before you started? Take baby steps at first. Eventually, try to get 20 to 30 minutes a day of exercise three or four days a week.

Most important, Lorig adds, “stay in close communication with your health care providers—and stick up for yourself. Chronic illness is a tough thing to deal with, but with a little persistence, almost everyone can learn self-management skills.”

Chronic Illness Resources

• American Medical Association Guide to Preventing and Treating Heart Disease: Essential Information You and Your Family Need to Know About Having a Healthy Heart by Martin S. Lipsky, M.D., Wiley, 2008, $25.95.
• Harvard Medical School Guide to Lowering Your Blood Pressure by Aggie Casey, R.N., M.S., and Herbert Benson, M.D., McGraw-Hill, 2005, $14.95.
• The Blood Pressure Book: How to Get It Down and Keep It Down by Stephen P. Fortmann, M.D., and Prudence E. Breitrose, Bull Publishing, 2006, $14.95.
• Living Well with Arthritis: A Sourcebook for Understanding and Managing Your Arthritis by Dianne Mosher, M.D., Howard Stein, M.D., and Gunnar Kraag, M.D., Penguin Global, 2007, $24.
• 28 Days to Diabetes Control, How to Lower Your Blood Sugar, Improve Your Health, and Reduce Your Risk of Diabetes Complications by Lance Porter, M. Evans and Co., 2004, $14.95.
• The Asthma Sourcebook by Francis V. Adams, M.D., McGraw-Hill, 2006, $16.95.
• The Pain Survival Guide: How to Reclaim Your Life by Dennis C. Turk, Ph.D., and Winter Frits, Ph.D., American Psychological Association, 2005, $19.95.

Polly Turner spoke with Kate Lorig, R.N., Dr.P.H., professor of medicine and director of the Patient Education Research Center at Stanford School of Medicine in Stanford, Calif., and coauthor of Living a Healthy Life with Chronic Conditions: Self-Management of Heart Disease, Fatigue, Arthritis, Worry, Diabetes, Frustration, Asthma, Pain, Emphysema, and Others, Bull Publishing, 2006, $18.95.

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