Life with Chronic Conditions: Some Things I Just Can’t Do

Having my wrist in a cast due to a fracture has been a humbling experience, and a real eye opener as to just how clueless people can be.

While driving to New York City for Thanksgiving, three times I had to tell my husband that I couldn’t do certain things, like eat a snack while driving, as I only had one hand. People see me struggling to do something, and do they jump in to help? Often not. Some just stare and even  say, “Gee, it’s amazing you can do that.”

Fortunately at Thanksgiving Dinner I was seated between two people who totally got it and made it possible for me to eat without stressing about how I was going to pass dishes or try to get food on my plate.

 My take home from this Thanksgiving is that I have much to be thankful for, including not having a major injury as a result of my accident, but I’m saddened to see how indifferent people are about helping the people around them.

“Call me if you need anything” isn’t the correct response when someone is ill or injured

Three weeks ago I broke my wrist. While many have offered well wishes and a speedy recovery, others said “let me know if there is anything I can do.” Only a few people responded with meals, which quite frankly are hard to prepare when your arm is in a cast, and were much appreciated by me and my family.

So here’s the thing, most people aren’t going to call you for help. For those of you saying, “but I don’t know what they need, “ or “they’re very private and I don’t want to intrude,” be aware that when you are dealing with an acute injury or illness, you don ‘t know what you need.

If someone’s situation is well beyond their normal, and enough to require help, there are plenty of ways to do so without intruding.

The smallest of gestures can make all the difference. A card with a gift certificate for gas or a local eatery/grocery store is always helpful as people need to eat and there are going to be plenty of times where driving is needed. If the person lives in the city and doesn’t drive, Uber offers gift certificates.

If I need help, I’ll be calling those who have demonstrated concern by having made a meal or offered concrete ways they can help-e.g. I’ll be by Tuesday to stack your wood unless that’s a bad time for you.

Instead of elaborating, below are links from previous posts that outline the ways you can be helpful, not intrusive, and make a difference when people need it most.

How to Respond When Someone is Ill or Injured

How to Be Around Someone Who is Ill or Injured

How to Help Those Who Are Injured, Ill, Grieving or in Need of Comfort

Journal Watch November 2019

PAIN

Does weather really affect our experience of pain?Scientists in the United Kingdom have released the findings of a new study that exposes a link between chronic pain and humid, windy days with low atmospheric pressure. Digital Medicine

Opioids Offer Only Minor Pain Relief for People with Osteoarthritis: A new study reports that opioids only provide small benefits in pain management for people with osteoarthritis. Researchers say techniques such as heat, ice, and exercise can be more effective than opioids. Experts also suggest that people with osteoarthritis can use the “inner pharmacy” in their brain to ease pain. ACR/ARP Annual Meeting

COMPLEMENTARY & ALTERNATIVE MEDICINE

Preliminary medical marijuana research shows promise in lessening opioid: Medical marijuana shows early promise to lessen opioid use and potential abuse, suggests a systematic review of published studies being presented at the ANESTHESIOLOGY® 2019 annual meeting. However, much more rigorous scientific research must be done to determine if there truly are pain relief benefits to medical marijuana that can ease chronic pain and outweigh potential risks.

Metacognitive therapy may prevent depression relapse: Ending the cycle of negative thought rumination is the premise of a depression treatment called metacognitive therapy. New findings suggest that it may be more beneficial in stopping depression relapse than other more commonly used methods. Frontiers in Psychology

 

Cannabinoid use for mental health conditions lacks evidence: New research concludes that there is not enough evidence to justify the use of medicinal cannabinoids to improve mental health. The Lancet Psychiatry

Could cannabis use help avert depression in PTSD? Data collected in a national mental health survey found that those with PTSD who reported not using cannabis in the last 12 months were considerably more likely to experience severe depression and thinking suicidal thoughts than those who said that they had used the substance. Journal of Psychopharmacology.

Cannabis may be linked to strokes and heart rhythm disturbances in young people: Frequent cannabis (marijuana) use among young people was linked to an increased risk of stroke and people diagnosed with cannabis use disorder were more likely to be hospitalized for heart rhythm disturbances (arrhythmias), according to two new preliminary studies to be presented at the American Heart Association's Scientific Sessions 2019. In addition, the study linking cannabis use disorder to an increased risk of stroke (Oral Presentation 333) will be published in Stroke

Could a combination of psychedelics and meditation treat depression?: Mixing mindfulness meditation  with a well-known hallucinogen, psilocybin, may make for a new form of therapy that could aid those with depression, according to a new study. Scientific Reports

Yoga, Running, and Other Workouts Can Combat Depressive Episodes:  A new study suggests that incorporating more physical activity — whether high-intensity dance, aerobic, or machines to more low-intensity yoga or walks — for 4 hours per week (or approximately 35 minutes per day) can help decrease the chances of depressive episodes by 17 percent. Depression and Anxiety

After Legalization, Marijuana Addiction Is on the Rise: A new study finds that addiction has gone up among young people who live in states where recreational cannabis is legal, although it still remains low overall. Experts are learning more about how heavy cannabis use can take a toll on health. JAMA Psychiatry

Listening to music while driving may help calm the heart: Driving can be very stressful, particularly if you are stuck in heavy traffic or are an inexperienced driver, and this stress will eventually take its toll on the heart. However, researchers now confirm that there is a simple fix for this problem: listening to the right music while driving. Complementary Therapies in Medicine

FDA ACTION

• Approved Trikafta the first triple combination therapy to treat cystic fibrosis in patients over 12.

• Issued a new statement to present two major steps they are taking to protect the public from the potentially harmful effects of products labeled as "homeopathic."

• Announced that the tobacco pouches, sold by a Swedish company, are now officially classified as reduced risk products. It is the first time that U.S. health regulators have characterized a type of smokeless tobacco to be less harmful than cigarettes. However, the FDA cautioned that all tobacco products, including the pouches, pose risk.

• Approved Reblozyl (luspatercept–aamt) for the treatment of anemia (lack of red blood cells) in adult patients with beta thalassemia who require regular red blood cell (RBC) transfusions.

• Sent warning letter to Dollar Tree over certain over the counter drugs

PREVENTION: Exercise

Better Executive Function in Older Adults: Even short bouts of moderate-to-vigorous physical activity appear to have cognitive benefits for middle-age adults and walking more total steps each day is related to better executive function in older adults, according to new research studies published by the Alzheimer's Association's family of journals. The study authors report 10 to 21 minutes per day of moderate to vigorous activity related to better thinking and planning skills for middle-age adults and 10-minutes per day was associated with better verbal memory. For older adults, the total amount of physical activity rather than the intensity was associated with maintaining cognition. 

Being physically active can lower older adults' risk for dying: Low levels of physical activity are associated with higher risks of death, no matter what a person's level of health. Overall, physical activity was important for avoiding early death in older men and women. Journal of the American Geriatrics Society

Quality over quantity! Interval walking training improves fitness and health in elderly individuals: It's not how much you walk, but how intensely you do so for a minimum amount of time to get positive results. This finding may be welcome news for those who want to save time and get the most out of their workout. Interval Walking Training is the method of walking at 70% of the walker's maximum capacity for 3 minutes, then at 40% of their capacity for the next 3 minutes. This is continued for 5 or more sets. 

Increased exercise over the age of 60 reduces risk of heart disease and stroke: People over the age of 60 should do more exercise not less in order to prevent heart disease and stroke, according to findings from a study of over 1.1 million elderly people published in the European Heart Journal . The link between levels of physical activity and risk of cardiovascular disease in older people held true even for those with disabilities and chronic conditions such as high blood pressure, high cholesterol levels and type 2 diabetes.

Even Small Amount of Running Decreases Risk of Death by Nearly 30%: New research published in the British Journal of Sports Medicine finds running any amount at all is associated with a significantly reduced chance of dying from any cause. Any amount of running is associated with a 27 percent lower risk of death from all causes for men and women when compared with no running at all. Running was also associated with a 30 percent lower risk of death from CVD and an impressive 23 percent reduced risk of dying from cancer. However, researchers found no evidence that increasing time spent exercising was associated with any further reduction in the risk of death from any cause. Most surprising is that even running less than once per week, for under an hour and at less than 6 miles per hour still conferred improved health and longevity, according to researchers.

Staying Active During Heart Attack Recovery Can Decrease Risk of Death by 30%: Regular physical activity is good for everyone, even those who’ve had a heart attack. A brisk walk for 30 minutes a day may help decrease the risk of death by nearly 30 percent. American Heart Association Scientific Sessions

Exercise levels predict lifespan better than smoking, medical history: Wearable activity trackers may pave the way for a better method to predict short term death risk, suggests a new study, which found that exercise data was more accurate than other risk factors, such as smoking and medical history. The researchers found that total daily physical activity was the strongest mortality predictor. Age came second, followed by time spent performing moderate to vigorous physical exercise.

The Journal of Gerontology: Medical Sciences

Physical Activity After Cancer Diagnosis Improves Survival: Findings seen among postmenopausal breast cancer patients regardless of activity level prediagnosis. Breast Cancer Research

PREVENTION: Diet/Nutrition

Plant-based foods and Mediterranean diet associated with healthy gut microbiome: A study presented at UEG Week 2019 has shown that specific foods (including legumes, bread, fish, nuts and wine) could provide protection for the gut, by helping bacteria with anti-inflammatory properties to thrive.

 

Food beneficial for a healthy gut: New research finds an association between healthy bacterial compositions and certain dietary patterns and food groups. What is more, the findings suggest that "diet is likely to become a significant and serious line of treatment" for conditions such as Crohn's disease, ulcerative colitis, and irritable bowel syndrome. The study found that "a diet characterized by nuts, fruits, greater vegetable and legume intake than animal protein, combined with moderate consumption of animal derived foods like fish, lean meat, poultry, fermented low fat dairy, and red wine, and a lower intake of red meat, processed meat and sweets, is beneficially associated with the gut ecosystem." UEG

Soft drinks found to be the crucial link between obesity and tooth wear: A new study finds that being overweight or obese is  associated with having tooth wear. Significantly, increased consumption of sugary soft drinks may be a leading cause of the erosion of tooth enamel and dentine in obese patients. Clinical Oral Investigations

High fiber, yogurt diet associated with lower lung cancer risk: The benefits of a diet high in fiber and yogurt have already been established for cardiovascular disease and gastrointestinal cancer. The new findings based on an analysis of data from studies involving 1.4 million adults in the United States, Europe and Asia suggest this diet may also protect against lung cancer. JAMA Oncology

 

Ultra-Processed Foods — Like Chips and Soda — Could Be Terrible for Your Heart: A recent study from the Centers for Disease Control and Prevention showed a link between consuming ultra processed foods and a decrease in heart health. Packaged chips, cookies, and sodas are all considered ultra-processed.  This type of food generally lacks the fiber and nutrients of whole, unprocessed foods. CDC

Evening eating linked to poorer heart health for women: Women who consumed a higher proportion of their daily calories later in the evening (after 6pm) were more likely to be at greater risk for cardiovascular disease than women who did not. American Heart Association's Scientific Sessions

PREVENTION: Supplements

Vitamin D and Omega 3 supplements do not reduce risk of systemic inflammation: While many consumers take supplements with the intention of lowering their inflammation and preventing disease, an analysis of the VITamin D and OmegA-3 TriaL (VITAL) by investigators at Brigham and Women's Hospital indicates that neither vitamin D nor omega-3s were effective at reducing systemic inflammation. Clinical Chemistry

Vitamin D, Omega-3 Do Not Benefit Kidney Health in T2DM: Supplementation with vitamin D₃ or omega-3 fatty acids does not result in a significant difference in change in estimated glomerular filtration rate (eGFR) at five years versus placebo among adults with type 2 diabetes, according to a study published online Nov. 8 in the Journal of the American Medical Association.

Is Kratom Safe? New Study Links Substance to Liver Health Issues: As a plant-based supplement named kratom increases in popularity, the full picture of its potential benefits and harms is still becoming clear. The increase in interest is because of its use as a possible treatment for opiod withdrawl as other issues. Researchers say kratom may cause severe liver injury in some people. American Association for the Study of Liver Disease.

 PREVENTION: Other

Douching linked to dangerous chemicals in blood: Doctors generally advise women against vaginal douching, warning that this practice can upset the delicate balance of vaginal flora and increase the risk of infection. Now, a new study also shows that douching has associations with a higher blood concentration of harmful chemicals. Journal of Women's Health

Hearing Loss in Women Associated with Dementia: A new study in Alzheimer's & Dementia: The Journal of the Alzheimer's Association reports that recent progression of hearing loss in women is associated with a higher risk of perceived concerns about thinking memory. Previous studies have found similar associations in men, but this is the first such finding in women. Hearing loss is common, increases with age, and has been found to be associated with poor cognitive performance. 

Wider social network may help women live longer: Women who were more socially integrated at age 60 were living longer and more likely to reach 85 or older. Social integration includes the number of people someone has in their network, and the frequency of their interactions with this network through varied activities. For example, having a spouse or partner, several close friends or relatives, and regularly participating in religious and non-religious activities are indicators of high social integration. For health and longevity, it’s generally understood that the higher the social integration, the better. Gerontology

Noise a Risk Factor for High Blood Pressure: A recent study investigated the relationship between occupational noise-induced hearing loss and blood pressure. The authors conclude that chronic noise exposure increases the risk of hypertension. Plos One

New Guidelines Issued for Colorectal Cancer Tests: Earlier Is Better: The American College of Physicians has issued new guidelines on colorectal screening for those 50-75. They recommend a fecal test every 2 years with the possible addition of a colonoscopy or flexible sigmoidoscopy every decade. Annals of Internal Medicine

Local vehicle exhaust may raise stroke risk: Even in environments with low air pollution, long term exposure to traffic exhaust near people's homes may heighten their risk of stroke, according to a new study from Sweden. The culprit appears to be a fine particle air pollutant called black carbon. Environmental Health Perspectives

E-Cigarettes May Be Worse for Your Heart Than Traditional Cigarettes: A new study concludes that e-cigarettes tend to decrease blood flow to the heart. A second study states that e-cigarettes negatively affect heart-related issues, such as cholesterol and glucose levels, more than traditional tobacco cigarettes. Scientific Sessions 2019

Wearable tracker study links insufficient sleep to biological aging and cardiovascular disease risk: Getting a good night's sleep is important and insufficient sleep has been linked to poor health in many studies. Analysing data collected from wearable trackers, researchers from the SingHealth Duke-NUS Institute of Precision Medicine (PRISM) and the National Heart Centre Singapore (NHCS) recently demonstrated that chronic sleep deprivation is associated with increased cardiovascular disease risk markers and accelerated biological aging. Their findings have been published in the journal Communications Biology

Deep sleep can rewire the anxious brain:A sleepless night can trigger up to a 30 percent rise in emotional stress levels, new study shows. Researchers have found that the type of sleep most apt to calm and reset the anxious brain is deep sleep, also known as non-rapid eye movement (NREM) slow-wave sleep, a state in which neural oscillations become highly synchronized, and heart rates and blood pressure drop. Nature Human Behaviour

Strong link found between level of depression and heart disease, stroke: The severity of a person's depression may increase their odds of having heart disease or stroke, according to preliminary research to be presented at the American Heart Association's Scientific Sessions

Psychological stress may increase risk for a serious cardiovascular event in women with heart disease: The way women with heart disease respond to psychological stress puts them at increased risk for heart attacks and other cardiovascular events, yet the same doesn't appear to be true for men, according to preliminary research. American Heart Association's Scientific Sessions 2019

Weight-reduction surgery may prevent strokes, lengthen lives: Obese patients who undergo weight-reduction surgery live longer and are less likely to experience a clot-caused stroke than those who do not, according to preliminary research to be presented at the American Heart Association's Scientific Sessions 2019

 

Flu shots help prevent illness, death in heart disease patients: An annual flu vaccination is inexpensive, easy and proven to prevent illness and death in people with heart disease, however, almost 1 in 3 patients skip the flu shot. American Heart Association's Scientific Sessions 2019

TREATMENT

Statins May Not Be Necessary for People with Lower Heart Disease Risk: Statins — including cholesterol-lowering medications such as Lipitor, Mevacor, Crestor, and Zocor — may not be as helpful as once believed for people in low to moderate risk categories, according to a new studyTrusted Source from the United Kingdom. Researchers concluded that statins as primary prevention against heart disease “may be an example of low value care and, in some cases, represent a waste of healthcare resources.” the side effects of the cholesterol-lowering medications may outweigh the benefits from the drugs for some people. Experts say diet and exercise are among the alternatives to taking statins to keep cholesterol in check.

FMT is effective in IBS, but having a 'super-donor' is essential, new study finds: The results of a large, randomised, double-blind, placebo-controlled study have confirmed that faecal microbiota transplantation (FMT) using a single 'super-donor' is an effective and well tolerated treatment for irritable bowel syndrome (IBS), producing high rates of clinical response and marked symptom improvements. The study reported, which involved a large cohort of patients with various subtypes of IBS, used several enhanced methodologies, and highlighted the importance of donor selection for optimising the effectiveness of FMT as a treatment for IBS. UEG Week

The Placebo Effect Works And You Can Catch It From Your Doctor: A new study, published in Nature Human Behavior, finds that patients can pick up on subtle facial cues from doctors that reveal the doctor's belief in how effective a treatment will be. And that can have a real impact on the patient's treatment outcome.

The Most Prescribed Blood Pressure Med May Not Work as Well as Diuretics: A new multinational observational study finds that Ace Inhibitors the most popular first-line treatment for high blood pressure, may be less effective for initial treatment and carries greater side effects than an older treatment that’s been available for decades. The findings indicate that patients who were first prescribed thiazide diuretics rather than ACE inhibitors had 15 percent fewer heart attacks, strokes, and hospitalizations for heart failure. Those who began their treatment with thiazides also experienced fewer side effects.

 

Why Taking Blood Pressure Meds at Bedtime May Be More Effective: New research suggests that taking your blood pressure medication at bedtime may more effectively reduce your risk of illness or death due to heart and blood vessel disease. European Heart Journal

Testosterone Therapy Tied to Increase in Short-Term VTE Risk: For men with and without hypogonadism, testosterone therapy is associated with an increased short-term risk for venous thromboembolism (VTE), according to a study published online Nov. 11 in JAMA Internal Medicine.

Regular use of prescription drugs for pain and sleep increases frailty risk by 95 percent: Frailty consists of deficits in a variety of functional measures, and is a reliable predictor of loss of independence, increased use of health care resources, and mortality. The possible implications of current research findings are especially serious given that it is common for older Americans to use two or more prescription drugs at the same time and many of these prescription drugs are for pain and sleep, including analgesics and sedatives. Journal of the American Geriatric Society

OTHER

Rates of IBD Including Crohn’s Disease Are 3 Times Higher Than Realized: There are 3 times as many people living with inflammatory bowel disease (IBD) than previously estimated, according to new research presented Sunday at United European Gastroenterology (UEG) Week. Not only do more people have IBD, they’re also at greater risk of developing colorectal cancer (CRC), according to the research. https://www.healthline.com/health-news/ibd-rates-may-be-three-times-higher-than-realized

Study finds functional medicine model is associated with improvements in health-related Quality of Life: In the first retrospective cohort study of the functional medicine model, Cleveland Clinic researchers found that functional medicine was associated with improvements in health-related quality of life. Researchers believe that reasons for the improvements in health-related quality of life shown in the functional medicine patients include differences in the functional medicine model itself, the types of patients seeking functional medicine, and treatment adherence or belief in the model of care. Future prospective studies are needed to examine the functional medicine model of care and long-term outcomes.  JAMA Network Open

Seriously ill Medicare beneficiaries can face considerable financial hardship: Despite high beneficiary satisfaction with Medicare overall, a new national survey led by researchers from Harvard T.H. Chan School of Public Health, Harvard Business School, and colleagues finds that its coverage gaps may cause considerable financial distress for the most seriously ill patients. About half reported a significant problem paying medical bills, with prescription drugs posing the most hardship.

Smartwatch App Shows Promise for Identifying Atrial Fibrillation: For participants without atrial fibrillation, use of a smartwatch application (app) can identify irregular pulse, which may indicate atrial fibrillation with high positive predictive value, according to a study published in the Nov. 14 issue of the New England Journal of Medicine.

High-Risk Surgical Patients Benefit From Teaching Hospitals: Better outcomes per cost seen for general and vascular surgery, but not orthopedic surgery. Annals of Surgery.

Take a Break: Gratitude Scavenger Hunt

Life with Chronic Conditions: Simplifying to Create a Sustainable and Sane Holiday Season

With Halloween behind us, holiday preparations are underway, particularly in a place like Vermont, where it’s dark and cold. We welcome anything that breaks up the gray of “stick season.” Also, many put their trees up Thanksgiving weekend, some as it’s the last family gathering before people head south for the worst of winter. In short, while this may seem like an unusual post for the beginning of November, it provides ample time for you to consider implementing some of the suggestions.

 

For people with chronic conditions, the holidays can be a challenging time not only financially but also the excess of the 4 Fs (food, family, feelings and fun.) The following post has been designed to help create a sustainable, meaningful and over all sane holiday.

I’ve been writing this blog for 10 years, so it’s no surprise that I have various posts on dealing with the holidays.  Please find links to previous years tips and tricks at the end of this post.

 

As you go about planning your holiday, consider what can be recycled and re purposed post-holiday, as well as giving gifts that are meaningful, sustainable and affordable.  As always, when possible, shop locally.

CONSIDER THE FOLLOWING

GIFTS:  Now’s the time to think about simplifying the “Gift-Go-Round:” Among family members, or friends, draw names so you only purchase for one adult. While some gifts must be purchased brand new, others can be gently used, obtained from local thrifts stores, as well as made. Focus on sustainable giving.

• Before purchasing an item, ask yourself the following questions: Can I afford this? Will they use it and how often? Is it something that it is reflective of them and their tastes and interests? Are their allergies or health concerns to consider? Is it something they need or want?

• For children, consider donating to a college fund or purchasing a savings bond and picking up a gently used toy for “something under the tree.”

• Gift certificates for experiences such as a massage; a class at a local art or music school or even a community college; spa services; choice food items from a local store or gift certificates to various eateries.

• Give your time such as teaching grandad how to use the Internet or Smart Phone; lawn care; cooking; a booklet with redeemable coupons for services, such as child care, window washing etc.

• Antiques and collectibles: These don’t have to be new. It could be something you already have or something you find at a flea market or thrift store

• Gifts from nature: Be it a selection of beach glass, or a piece of Chaga from a birch tree, there are treasures in nature that many will appreciate.

• Gifts from the kitchen, particularly savory items during this very “sweet time” are often welcomed. Check out “How to Pickle Anything (No Canning Necessary)  for a wide variety of pickled veggies.

• Forced bulbs (paper whites narcissus, amaryllis and hyacinth) can be blooming or  set up to bloom in January. It’s the perfect gift for the flower lover. Learn more at How to Force Bulbs Indoors.

• Donations to local charities, including condition specific organizations.

• Look for gifts made of recycled materials and that are battery free.

• Re gifting is fine. Think of it as the object finding it’s rightful home. 

• Specific gifts for those affected by Chronic Conditions:

-       Gifts that Aid in Healing

-       Unique Gifts for Caregivers

-       Unique Gifts for Hospital Patients

-       Christmas/Holiday Gifts for Hospital Patients

-       Holiday Gifts When Chronic Disease is an Issue

THINK RECYCLABLE

• Real Christmas trees. A live potted tree can be used for years and planted outside when it becomes too large. Many communities now have free chipping service for trees. This is useful since the chips are used as mulch for municipal landscaping or sold at low cost to gardeners. This chipped material makes an excellent mulch for your shrub beds and garden pathways.

• Plain wrapping paper (a little tape is okay) along with plain cards and cardboard boxes can be recycled. Consider alternative wrapping methods such as newspapers, cloth gift bags etc. More and more sheets and pillow cases are packaged in fabric bags that are perfect for gift giving. Check out Gift Wrapping Alternatives

• Avoid anything with metallic, glitter or velvety flocking, Styrofoam, as well as bows, ribbons and anything stringy is a single use item. Make more sustainable choices and avoid these type of items.

• Make “To/From” tags from previous year’s holiday cards.

LOWER THE IMPACT OF HOLIDAY LIGHTING

• Reduce the size of outdoor lighting displays and use mini lights. There are now solar LED strings

• Use LED Lights for house and tree as they use up to 95% less energy than larger traditional holiday bulbs. They also last much longer and if a light burns out, the rest remain on.

• Use a timer so lights are turned off when no one is around

Other Holiday Posts

• Coping with Holiday Stress 

• Holiday Loneliness

• Opting Out of Black Friday-Options 2015

• Traditions: Don’t let them overwhelm your holiday

• Holiday songs can be good reminders for people with chronic conditions 

And since the holidays mean more stuff coming in, consider decluttering when you can. Check out The Kon Mari Method for Tidying When Affected by a Chronic Condition  and Life with Chronic Conditions: Staying Tidy/Alternatives to Retail therapy.