| name | chronic-care |
| description | Comprehensive chronic disease and nodule management. Supports hypertension, diabetes, cardiovascular disease, thyroid nodule (TI-RADS), breast nodule (BI-RADS), lung nodule (Fleischner guidelines), chronic prostatitis (NIH-CPSI), and chronic allergic conditions. Provides condition-specific monitoring, complication screening, personalized targets, and evidence-based lifestyle recommendations. Triggers on: hypertension, diabetes, high blood pressure, high blood sugar, thyroid nodule, breast nodule, lung nodule, prostatitis, prostate, chronic condition, disease management. |
| allowed-tools | ["bash","glob","read"] |
| version | 1.0.0 |
Chronic Care — Your Chronic Condition & Nodule Companion
Specialized skill for managing chronic diseases and nodules with personalized care plans, complication prevention, and evidence-based targets.
📋 Supported Conditions
Cardiometabolic Conditions
- Hypertension (all stages per ACC/AHA 2017)
- Diabetes Type 1 & 2 (ADA Standards of Care)
- Prediabetes / Insulin Resistance
- Cardiovascular Disease (secondary prevention)
- Heart Failure (stable, NYHA I-II)
- Chronic Kidney Disease (stage 1-3)
Nodule Management (NEW)
- Thyroid Nodule (TI-RADS classification, ACR guidelines)
- Breast Nodule (BI-RADS classification, ACR guidelines)
- Lung Nodule (Fleischner Society guidelines)
Urological Conditions
- Chronic Prostatitis (NIH-CPSI scoring)
- Benign Prostatic Hyperplasia (IPSS scoring)
Allergic Conditions
- Allergic Rhinitis (seasonal/perennial)
- Food Allergies (IgE-mediated)
- Eczema / Atopic Dermatitis
🫀 Hypertension Management
BP Classification (ACC/AHA 2017)
| Category | Systolic | Diastolic | Action |
|---|
| Normal | <120 | <80 | Maintain healthy lifestyle |
| Elevated | 120-129 | <80 | Lifestyle modifications |
| Stage 1 | 130-139 | 80-89 | Lifestyle + consider medication |
| Stage 2 | ≥140 | ≥90 | Medication + lifestyle |
| Crisis | ≥180 | ≥120 | Emergency evaluation |
Target BP by Risk Profile
| Risk Category | Target BP |
|---|
| Low CV risk (<10%) | <140/90 mmHg |
| Moderate risk (10-20%) | <130/80 mmHg |
| High risk (>20%) | <130/80 mmHg |
| Diabetes + HTN | <130/80 mmHg |
| CKD + HTN | <130/80 mmHg |
| Elderly (≥65) | <130/80 mmHg (if tolerated) |
Monitoring Schedule
| Parameter | Frequency | Target |
|---|
| Home BP | 2x/day (morning/evening) | <130/80 mmHg |
| Weight | Weekly | Stable |
| Sodium intake | Daily log | <2300 mg/day |
| Exercise | Weekly log | 150 min/week moderate |
| Medication adherence | Daily | >90% |
Lifestyle Recommendations
DASH Diet Components:
- Vegetables: 4-5 servings/day
- Fruits: 4-5 servings/day
- Whole grains: 6-8 servings/day
- Low-fat dairy: 2-3 servings/day
- Lean protein: ≤6 servings/day
- Sodium: <2300 mg/day (ideal <1500 mg)
Exercise Prescription:
- Aerobic: 150 min/week moderate OR 75 min/week vigorous
- Resistance: 2-3 days/week
- Flexibility: Daily stretching
🩸 Diabetes Management
Glucose Targets (ADA Standards)
| Population | Fasting BG | Post-Meal BG | HbA1c |
|---|
| Most adults | 80-130 mg/dL | <180 mg/dL | <7.0% |
| Pregnancy | <95 mg/dL | <140 mg/dL | <6.5% |
| Elderly/frail | 90-150 mg/dL | <200 mg/dL | <8.0% |
| High hypo risk | 100-180 mg/dL | <200 mg/dL | <7.5% |
Time-in-Range (CGM Metrics)
| Range | Target | Clinical Significance |
|---|
| 70-180 mg/dL | >70% | Time in target range |
| <70 mg/dL | <4% | Hypoglycemia |
| <54 mg/dL | <1% | Severe hypoglycemia |
| >180 mg/dL | <25% | Hyperglycemia |
| >250 mg/dL | <5% | Severe hyperglycemia |
Complication Screening Schedule
| Complication | Screening Test | Frequency |
|---|
| Retinopathy | Dilated eye exam | Annually |
| Nephropathy | UACR + eGFR | Annually |
| Neuropathy | Monofilament test | Annually |
| CVD | BP, lipids, ECG | Each visit / Annually |
| Foot ulcers | Comprehensive foot exam | Annually (high risk: quarterly) |
Sick Day Management
When Ill (fever, vomiting, infection):
- Monitor glucose every 2-4 hours
- Check ketones if glucose >250 mg/dL
- Continue basal insulin (may need correction doses)
- Stay hydrated (sugar-free fluids)
- Contact doctor if:
- Glucose >300 mg/dL despite corrections
- Moderate/large ketones
- Unable to keep fluids down
- Fever >38.5°C for >24 hours
🦋 Thyroid Nodule Management
TI-RADS Classification (ACR 2017)
| TI-RADS Level | Points | Malignancy Risk | Management |
|---|
| TR1 | 0 | <2% | Benign, no FNA |
| TR2 | 2 | <2% | Not suspicious, no FNA |
| TR3 | 3 | ~5% | Follow-up if ≥2.5cm, FNA if ≥2.5cm |
| TR4 | 4-6 | 5-20% | Follow-up if ≥1.5cm, FNA if ≥1cm |
| TR5 | ≥7 | >20% | Follow-up if ≥1cm, FNA if ≥1cm |
Ultrasound Features (Point System)
| Feature | 0 Points | 1 Point | 2 Points | 3 Points |
|---|
| Composition | Cystic | Spongiform | Mixed | Solid |
| Echogenicity | Anechoic | Hyperechoic | Isoechoic | Hypoechoic |
| Shape | - | - | Wider-than-tall | Taller-than-wide |
| Margin | Smooth | - | Ill-defined | Extrathyroidal |
| Echogenic Foci | None | Large | Punctate | - |
Follow-Up Schedule
| TI-RADS | Size | Initial Follow-up | Ongoing |
|---|
| TR3 | <2.5cm | 1 year | Every 1-2 years if stable |
| TR3 | ≥2.5cm | Consider FNA | - |
| TR4 | <1.5cm | 1 year | Every 1-2 years if stable |
| TR4 | ≥1.5cm | Consider FNA | - |
| TR5 | <1cm | 1 year | Annual for up to 5 years |
| TR5 | ≥1cm | FNA recommended | - |
Growth Definition
Significant Growth:
- ≥20% increase in two dimensions, OR
- ≥50% increase in volume, OR
- New suspicious features
Action for Growth:
- Upgrade TI-RADS category
- Consider FNA if not previously done
- Shorten follow-up interval
Patient Education
Reassurance Points:
- 90-95% of thyroid nodules are benign
- TR3 has <5% malignancy risk
- Most nodules don't require surgery
- Regular follow-up is key
When to Seek Care:
- Rapid nodule growth
- Hoarseness or voice changes
- Difficulty swallowing
- Neck lymph node enlargement
🎗️ Breast Nodule Management
BI-RADS Classification (ACR)
| BI-RADS | Malignancy Risk | Management |
|---|
| 0 | Incomplete | Additional imaging needed |
| 1 | 0% | Negative, routine screening |
| 2 | 0% | Benign, routine screening |
| 3 | <2% | Probably benign, 6-month follow-up |
| 4A | 2-10% | Low suspicion, biopsy consideration |
| 4B | 10-50% | Moderate suspicion, biopsy recommended |
| 4C | 50-95% | High suspicion, biopsy strongly recommended |
| 5 | >95% | Highly suggestive of malignancy |
| 6 | 100% | Known biopsy-proven malignancy |
Imaging Modality by Age
| Age | Primary Modality | Additional |
|---|
| <30 | Ultrasound | MRI if high risk |
| 30-39 | Ultrasound + Mammogram | - |
| ≥40 | Mammogram + Ultrasound | MRI if dense breasts |
Follow-Up Schedule
| BI-RADS | Follow-up | Duration |
|---|
| 1-2 | Routine screening | Annual (age ≥40) |
| 3 | 6, 12, 24 months | If stable at 2 years → routine |
| 4A-C | Biopsy | Within 2-4 weeks |
| 5 | Biopsy + Oncology | Immediate |
Cyclical Breast Changes
Fibrocystic Changes (Common, Benign):
- Timing: Worsens before menstruation
- Symptoms: Lumpiness, tenderness, bilateral
- Management: Supportive bra, reduce caffeine, OTC pain relief
When to Evaluate:
- New lump persisting after menses
- Dominant mass (different from surrounding tissue)
- Nipple discharge (especially bloody)
- Skin changes (dimpling, redness)
Patient Education
Self-Awareness (not formal self-exam):
- Know your normal breast texture
- Report new, persistent changes
- Don't panic—most lumps are benign
Risk Reduction:
- Maintain healthy weight
- Limit alcohol (<1 drink/day)
- Regular exercise
- Breastfeeding (if possible)
🫁 Lung Nodule Management
Fleischner Society Guidelines (2017)
Solid Nodules
| Nodule Size | Low Risk Patient | High Risk Patient |
|---|
| <6mm | No routine follow-up | Optional CT at 12 months |
| 6-8mm | CT at 6-12 months | CT at 6-12 months, then 18-24 months |
| >8mm | Consider 3-month CT, PET, or biopsy | Consider 3-month CT, PET, or biopsy |
Subsolid Nodules
| Type | Size | Management |
|---|
| Pure GGN | <6mm | No routine follow-up |
| Pure GGN | ≥6mm | CT at 6-12 months, then every 2 years until 5 years |
| Part-solid | ≥6mm | CT at 3-6 months, then annual for 5 years |
Risk Stratification
Low Risk:
- Minimal or no smoking history
- Age <50 years
- No family history of lung cancer
- No other risk factors
High Risk:
- Significant smoking history (≥20 pack-years)
- Age ≥50 years
- Family history of lung cancer
- Occupational exposures (asbestos, radon)
- Personal history of cancer
Growth Assessment
Significant Growth:
- ≥2mm increase in diameter
- Doubling time 20-400 days (concerning for malignancy)
- New solid component in subsolid nodule
Action for Growth:
- Shorten follow-up interval
- Consider PET-CT
- Biopsy or surgical consultation
Smoking Cessation (Critical)
5 A's Approach:
- Ask about tobacco use
- Advise to quit
- Assess readiness to quit
- Assist with quit attempt
- Arrange follow-up
Pharmacotherapy Options:
- Nicotine replacement therapy (patch, gum, lozenge)
- Varenicline (Chantix)
- Bupropion (Zyban)
Patient Education
Reassurance:
- Most small nodules (<6mm) are benign
- Even larger nodules often represent old infections
- Follow-up is essential but don't panic
Warning Signs:
- Persistent cough
- Coughing up blood
- Chest pain
- Unexplained weight loss
- Shortness of breath
🚹 Chronic Prostatitis Management
NIH-CPSI Scoring System
Domains:
- Pain (0-9 points)
- Perineal, testicular, suprapubic, low back pain
- Pain during/after ejaculation
- Urinary (0-6 points)
- Incomplete emptying
- Frequency
- Quality of Life (0-12 points)
- Symptom impact
- Life satisfaction
- Worry about symptoms
Total Score: 0-43
| Severity | Score Range |
|---|
| Mild | 1-9 |
| Moderate | 10-18 |
| Severe | 19-43 |
Classification (NIH)
| Category | Name | WBC in EPS | Culture |
|---|
| I | Acute Bacterial | Positive | Positive |
| II | Chronic Bacterial | Positive | Positive |
| IIIA | Inflammatory CPPS | Positive | Negative |
| IIIB | Non-inflammatory CPPS | Negative | Negative |
| IV | Asymptomatic | Positive | Negative |
CPPS = Chronic Pelvic Pain Syndrome
Treatment Approach by Category
Category II (Chronic Bacterial):
- Antibiotics: 4-6 weeks (fluoroquinolone or TMP-SMX)
- Alpha-blocker if voiding symptoms
- Anti-inflammatory for pain
Category III (CPPS - Most Common):
- Multimodal approach (UPOINT system):
- Urinary: Alpha-blockers (tamsulosin)
- Psychosocial: Stress management, CBT
- Organ-specific: Quercetin, pollen extract
- Infection: Trial antibiotics (if never tried)
- Neurologic: Neuropathic pain agents (gabapentin, amitriptyline)
- Tenderness: Pelvic floor physical therapy
Lifestyle Recommendations
Dietary Modifications:
- Limit: Alcohol, caffeine, spicy foods, acidic foods
- Increase: Water (2-3L/day), omega-3 fatty acids
- Consider: Anti-inflammatory diet
Physical Measures:
- Warm sitz baths (15-20 min, 1-2x/day)
- Avoid prolonged sitting (use cushion)
- Regular exercise (avoid cycling if worsens symptoms)
- Pelvic floor relaxation exercises
Stress Management:
- Mindfulness meditation
- Deep breathing exercises
- Cognitive behavioral therapy
- Regular sleep schedule
Monitoring Schedule
| Parameter | Frequency |
|---|
| NIH-CPSI score | Every 4-6 weeks |
| Urinalysis | Every 3 months |
| PSA (if age ≥50) | Annually |
| Post-void residual | If voiding symptoms worsen |
When to Refer to Urology
- NIH-CPSI ≥20 despite conservative management
- Recurrent urinary tract infections
- Elevated PSA or abnormal DRE
- Hematuria
- Suspected abscess
- Consideration for procedural interventions
🤧 Allergy Management
Allergic Rhinitis Classification
| Type | Timing | Common Triggers |
|---|
| Seasonal | Spring/Fall | Tree pollen, grass, ragweed |
| Perennial | Year-round | Dust mites, pet dander, mold |
| Occupational | Work days | Chemicals, dust, latex |
ARIA Classification
| Severity | Sleep | Daily Activities | Symptoms |
|---|
| Mild | Normal | Normal | Bother some |
| Moderate-Severe | Disturbed | Impaired | Troublesome |
Stepwise Treatment (ARIA Guidelines)
Step 1 (Mild Intermittent):
- Oral antihistamine (cetirizine, loratadine, fexofenadine)
- Avoid triggers
Step 2 (Moderate-Severe or Persistent):
- Intranasal corticosteroid (fluticasone, mometasone)
- Continue oral antihistamine
Step 3 (Refractory):
- Add intranasal antihistamine (azelastine)
- Consider combination spray (steroid + antihistamine)
- Allergen immunotherapy consideration
Step 4 (Severe Refractory):
- Allergy testing and immunotherapy
- Biologic agents (omalizumab for severe cases)
Preemptive Treatment
For Seasonal Allergies:
- Start intranasal steroid 1-2 weeks BEFORE pollen season
- Continue daily throughout season
- Add oral antihistamine for breakthrough symptoms
Trigger Avoidance
Pollen:
- Keep windows closed during high pollen days
- Shower and change clothes after being outdoors
- Use HEPA air filter
- Check pollen count forecasts
Dust Mites:
- Encase mattress and pillows
- Wash bedding weekly in hot water (>55°C)
- Remove carpets from bedroom
- Maintain humidity <50%
Pet Dander:
- Keep pets out of bedroom
- HEPA air filter
- Wash hands after pet contact
- Consider rehoming if severe
Food Allergy Management
Common Triggers:
- Milk, eggs, peanuts, tree nuts
- Soy, wheat, fish, shellfish
Management:
- Strict avoidance
- Read food labels carefully
- Carry epinephrine auto-injector (if anaphylaxis risk)
- Wear medical alert bracelet
Emergency Action Plan:
- Recognize symptoms (hives, swelling, difficulty breathing)
- Administer epinephrine immediately
- Call emergency services
- Lie down with legs elevated
- Second dose if no improvement in 5-10 minutes
🔗 Cross-Domain Correlation Analysis
Hypertension Correlations
| Factor | Correlation | Recommendation |
|---|
| Sodium intake | r = 0.6-0.7 (positive) | Reduce to <2300 mg/day |
| Exercise frequency | r = -0.5 to -0.7 (negative) | 150 min/week moderate |
| Sleep quality | r = -0.6 to -0.7 (negative) | Prioritize 7-8 hours |
| Stress level | r = 0.4-0.6 (positive) | Daily meditation 10 min |
| Alcohol intake | r = 0.4-0.5 (positive) | Limit to ≤2 drinks/day |
| Potassium intake | r = -0.4 to -0.5 (negative) | Increase potassium-rich foods |
Diabetes Correlations
| Factor | Correlation | Recommendation |
|---|
| Carb intake | r = 0.6-0.7 (positive) | Control refined carbs |
| Post-meal exercise | r = -0.5 to -0.6 (negative) | 15-30 min walk after meals |
| Medication adherence | r = 0.7-0.8 (positive) | Set reminders, pill organizer |
| Fiber intake | r = -0.4 to -0.5 (negative) | 25-30g fiber/day |
| Sleep duration | r = -0.4 to -0.5 (negative) | 7-8 hours sleep |
| Stress level | r = 0.5-0.6 (positive) | Stress management techniques |
Nodule-Specific Correlations
Thyroid Nodule:
| Factor | Correlation | Recommendation |
|---|
| Iodine intake | U-shaped | 150 mcg/day (not too little, not too much) |
| TSH level | r = 0.5 (positive) | Monitor TSH every 6-12 months |
| Cancer anxiety | r = 0.6 (positive) | Reassurance: TR3 <5% risk |
Breast Nodule:
| Factor | Correlation | Recommendation |
|---|
| Cycle phase | Cyclical | Track timing; many are fibrocystic changes |
| Caffeine | r = 0.3 (positive) | Consider reduction if symptomatic |
Lung Nodule:
| Factor | Correlation | Recommendation |
|---|
| Smoking history | r = 0.6-0.8 (positive) | Critical: Smoking cessation |
| Nodule growth | Variable | Follow Fleischner guidelines |
📊 Output Format
Every chronic care consultation produces:
# [Condition] Management Report
**Date**: YYYY-MM-DD
**Condition**: [Hypertension / Diabetes / Thyroid Nodule / etc.]
---
## 🚨 Risk Assessment
**Current Status**: [Controlled / Needs Attention / Urgent]
**Risk Level**: 🟢 Low / 🟡 Medium / 🔴 High
**Key Concerns**:
- [Concern 1]
- [Concern 2]
---
## 📈 Current Metrics
| Parameter | Current | Target | Status |
|-----------|---------|--------|--------|
| [Parameter 1] | [Value] | [Target] | ✅/⚠️/❌ |
| [Parameter 2] | [Value] | [Target] | ✅/⚠️/❌ |
---
## 🔗 Correlation Insights
### [Factor A] ↔ [Condition]
**Correlation**: r = [value] ([Strength])
**What this means**: [Interpretation]
**Action**: [Specific recommendation]
---
## 📋 Action Plan
### Today
- [ ] [Action 1]
- [ ] [Action 2]
### This Week
- [ ] [Action 3]
- [ ] [Action 4]
### This Month
- [ ] [Follow-up test/appointment]
- [ ] [Goal]
---
## 📅 Follow-Up Schedule
| Test/Visit | Due Date | Status |
|------------|----------|--------|
| [Test 1] | YYYY-MM-DD | Due/Completed |
| [Test 2] | YYYY-MM-DD | Due/Completed |
---
## ⚠️ When to Seek Immediate Care
- [Red flag symptom 1]
- [Red flag symptom 2]
- [Red flag symptom 3]
---
## 📚 Patient Education
[Condition-specific education points]
---
**Disclaimer**: This analysis is based on your provided health data and is for informational purposes only. It does not replace professional medical diagnosis or treatment. Always consult your healthcare provider for medical concerns.
🛡️ Safety Boundaries
✅ Can Do
- Track and trend condition-specific metrics
- Provide evidence-based lifestyle recommendations
- Remind about follow-up schedules per guidelines
- Explain classification systems (TI-RADS, BI-RADS, etc.)
- Correlate lifestyle factors with condition control
- Generate action plans
❌ Cannot Do
- Diagnose conditions
- Prescribe or adjust medications
- Order diagnostic tests
- Interpret biopsy results
- Replace specialist consultation
- Predict malignancy
🚨 Emergency Triggers
Hypertension Crisis:
- BP ≥180/120 mmHg → Seek emergency care
Diabetes Emergency:
- Glucose >300 mg/dL with symptoms → Urgent care
- Glucose <50 mg/dL → Immediate treatment
Nodule Red Flags:
- Rapid growth
- New neurological symptoms
- Unexplained weight loss
- Night sweats
🔗 Cross-References
| Skill | Relationship |
|---|
| musculoskeletal-care | Osteoporosis bone density management, fracture risk assessment |
| fitness-coach | Exercise prescription for chronic conditions |
| medication-manager | Medication adherence tracking |
| nutrition-advisor | DASH diet, diabetic diet, calcium/Vitamin D |
| vital-monitor | BP, glucose trend tracking |
| preventive-care | Screening schedules |
📚 References
Clinical Guidelines
- Hypertension: ACC/AHA 2017 Guidelines
- Diabetes: ADA Standards of Care 2026
- Thyroid Nodules: ACR TI-RADS 2017
- Breast Imaging: ACR BI-RADS Atlas 5th Edition
- Lung Nodules: Fleischner Society Guidelines 2017
- Prostatitis: NIH-CPSI, EAU Guidelines
- Allergic Rhinitis: ARIA Guidelines 2025
Risk Calculators
- ASCVD Risk Calculator
- Framingham Risk Score
- CHA2DS2-VASc Score (if applicable)
Version: v2.0
Created: March 2026
Maintainer: Family Doctor Team
