Chronic illness

Chronic illness

Asthma

Reassure adolescents that a diagnosis of asthma does not adversely affect adult educational attainment, employment prospects, housing or social class.

Diabetes

Reminders:

  • Encouraging independence is crucial to good diabetic control and a responsible adult attitude to diabetes.
  • Education and information are all important. Membership of the Diabetic Association can be useful.
  • The advent of pen administration of insulin (drug that lowers the level of sugar in the blood) has greatly aided compliance, as adolescents do not need to carry around bottles and syringes.
  • Adolescents may prefer a drug regime of a medium or long acting insulin in the evening to provide continuous control, supplemented by short acting insulin before meals. This mimics insulin produced by the body and may produce better blood sugar control. It also allows a more flexible lifestyle that may suit active adolescents.
  • It is useful to check that the adolescent knows what a ‘hypo’ (when blood sugar drops) feels like and what to do if they feel it coming on.
  • Adolescents who have been diabetic for more than five years should have annual eye examination and tests on their kidneys.

Ketoacidosis (a dangerous complication of diabetes that occurs when fat is not broken down properly in the body) is a major problem in young insulin dependent diabetics (those who need insulin rather than diet only to control the level of sugar in their blood). It occurs more often in people under 30 years of age than in any other age group. Ketoacidosis is the major cause of death in people with insulin dependent diabetes under the age of 20.

A Scottish study of people presenting with ketoacidosis compared the clinical characteristics of young adults less than 25 years of age to older patients. Poor blood sugar control was the most common cause of ketoacidosis in young people rather than precipitating infection, which was the case in older adults.

Errors administering insulin or problems with manipulation of dose was the cause in half of the young adult cases studied. The absence of underlying disease in many young patients suggests incorrect insulin use as the major cause of ketoacidosis in this age group.

Cystic Fibrosis

A once fatal condition, cystic fibrosis is now a life-limiting disease. Average survival is now in to the fourth decade in developed countries. Sexual and reproductive health is increasingly an issue for young people with cystic fibrosis. Male infertility, due to abnormal development of the reproductive tract, has been established for over 30 years. However, the presumption of female infertility for a similar reason has been found to be incorrect and there are increasing numbers of pregnancies in women with cystic fibrosis.

Adolescent cystics need to be given space to discuss their developing sexuality with discussion about the impact of probable male infertility and possible female infertility. Advances in infertility treatments offer hope for the future. Adolescents need to be encouraged to make a realistic appraisal of their situation.

Cancer

Adolescent cancers are rare, with an annual incidence in Western Europe among 13-19 year olds of 140-150 cases per million. This results in about 100 new adolescent cancers in Ireland each year.

The most common cancers in order of frequency are; cancer of the lymphoid tissue (lymphoma), tumours of the central nervous system, acute leukaemias, bone and soft tissue cancer, malignant melanoma (a type of skin cancer), and thyroid cancer.

The overall incidence of cancer is stable but testicular cancer, malignant melanoma, other skin cancers and thyroid cancer have become more common, with ovarian cancer becoming less common.

A diagnosis of cancer will be devastating for a person and their family at any age but when that patient is an adolescent, adapting to the effects of the disease and its treatment, may be particularly hard.

They may experience:

  • Loss of personal control.
  • Changes in social relationships.
  • Prolonged absences from school, college, or a first job.
  • Uncertainty about the future.

These issues arise at a time when the adolescent will be attempting to create an identity separate to their family and yet are heavily dependent upon them.

The outlook for adolescent cancers is improving all the time. In general, other than late effects and specific complications of treatment, survivors are well, employable and indistinguishable from their peers. This may need to be emphasised to the adolescent after the initial diagnosis of cancer.

Headache

Recurrent headache with no obvious cause is common in adolescents. Some families express their tension and stresses as headache and the adolescent may mimic this pattern. An explanation, following a full examination, may be enough to reassure the teenager who may worry that they have a brain tumour. Enquiry into possible stresses both at home and school may be useful.

Migraine may develop for the first time at puberty and in girls it may be worse during the menstrual period. The combined oral contraceptive pill may make migraine worse.

If a headache is persistent or worsening the adolescent should be referred immediately to their doctor.

Chest pain

Recurrent chest pain is a feature of adolescents rather than children and is often associated with fears about heart disease and cancer.

Any teenager that complains of apparently odd symptoms or stress related symptoms may wish to discuss other issues but may not have the confidence to do so. It is useful to ask a ‘is there anything else that might be bothering you?’ type of question.

Sexuality

All adolescents find aspects of sexuality confusing, embarrassing or worrying. But those with chronic illness face additional stresses. These may include:

  • Questionable fertility in survivors of cancer.
  • The difficulties of negotiating intimate relationships in teenagers with significant body scars or physical anomalies such as colostomies.
  • How to tell a future partner of an infectious disease, eg. HIV in a haemophiliac.
  • Those with cerebral palsy or are regular wheelchair users.
  • The difficulties of informing a partner of future infertility as in Turner’s syndrome or cystic fibrosis.
  • Adolescents may seek to deny they have problems in this area and will need sensitive counselling to assist them in leading as normal a life as possible.

Remember:

As a parent or guardian, do not focus only on the management of the disease - deal with the whole person first. Quality is as important as length of life.

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