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Nurturing Your Aging Body and Mind

Men, Take Note The life expectancy in the United States today is 78, and it's projected to steadily climb. Although the stage is set for a longer act for many of us, aging bodies and minds are susceptible to a string of diseases and ailments that, unfortunately, often play a starring role in our later years. On the bright side, prevention education-including more awareness about the necessity of regular exercise and good food choices, combined with regular physical exams-plus better screening methods means that we have more control than ever of how our life story plays out. Pulse spoke with South Bay physicians about some of the most common ailments of our aging population, how to recognize symptoms, get screened sooner and get on with life if diagnosed.

Men Take Note

PROSTATE CANCER

More than half of men in their 60s and as many as 90% in their 70s have symptoms of an enlarged prostate, or BPH. According to the Prostate Health Guide, 230,000 men are diagnosed with prostate cancer, and about 30,000 will die of it, making it the second leading cancer killer for men.

Cary Nelson, MD, a family practitioner with South Bay Family Medical Group in Torrance, said the rate of diagnosis is increasing, but this is largely due to better screening and earlier symptom recognition. "We are able to test for BPH sooner and remove the prostate if necessary, improving quality of life and getting men back to their regular level of activity."

Causes: A first-degree relative with prostate cancer (father or brother) increases risk. Genetics, aging and a poor diet contribute.

Symptoms: Slow urinary stream. Frequent, difficult urination. Blood in the urine, while less likely, can occur.

Screening: At 40, get a blood PSA test, and if that is normal, get a digital rectal exam at 50, provided there is no first-degree relative with prostate cancer. (Otherwise, start exams sooner.) The normal prostate is about the size of a walnut, but it's one of the few organs in the body that continues to grow. The prostate is stimulated by testosterone, and as men age, it can grow to the size of a lemon. A biopsy is the tell-all for prostate cancer, and if it's detected, the prostate can be removed. The 10-year survival rate when caught early is about 93%.

Prevention: It's in the screening. "Be diligent about your annual physicals and your PSA test," Dr. Nelson says. Also maintain a healthy diet and weight.

If Diagnosed: Depending on the stage of the cancer, the age and health of the patient, there are surgical and other treatment options.

HYPERTENSION

According to the Centers for Disease Control and Prevention, one in three Americans is living with hypertension or high blood pressure, which leads to an increased risk of heart disease, stroke and congestive heart failure. Dr. Nelson says that although hypertension affects both men and women, he commonly sees it in men, who typically are not as diligent about annual physicals.

Causes: Poor diet, lack of exercise and genetics contribute. However, occasionally an otherwise healthy person can have it. In fact, most of us will have high blood pressure if we live long enough, as the sensors that regulate it eventually wear out.

Symptoms: One-third of us have high blood pressure and don't know it, since symptoms rarely surface unless it's extremely high.

Screening: The best way to detect high blood pressure is to have it checked. Ideal is 120/80. An elevated blood pressure of 121 to 139/81 to 89 signals pre-hypertension, while 140/90 and higher notes hypertension.

Prevention: The heart is a muscle, and Dr. Nelson reminds us that we have to exercise it for best results. Sweat 30 minutes a day and maintain a normal weight by sticking to a low-fat, low-salt diet with proportionate carbs and lean protein. Men should follow a 1,500 to 2,200 average calorie count per day and consume at least 30 grams of fiber. Get a physical each year, especially if you're over 50. If hypertension runs in your family, get screened earlier.

If Diagnosed: "Make immediate lifestyle changes-each day should consist of whole grains and fruits and vegetables, as well as adequate cardio," Dr. Nelson says. Consult the American Heart Association's recommended diet plan for more information. aha.org

HEART DISEASE

The number one cause of death in America is heart disease, claiming a life every 33 seconds. And while a common belief is that heart disease is only a man's disease, 8.6 million women die from it each year, according to The Heart Foundation.

Causes: "The Western diet is so high in processed foods and saturated fats," Dr. Nelson says. "Obesity, diabetes and high cholesterol are major contributors, as is family history and, of course, a sedentary lifestyle." Sleep apnea also plays a big role, as proper sleep is paramount to good health. Smoking tends to increase risk.

Symptoms: Chest pain, trouble breathing during physical activity, dizziness.
Screening: At 40, get blood work and a blood pressure check. Starting at 50, do this annually and have an EKG.

Prevention: Don't smoke. Maintain a healthy diet and weight. Get at least 30 minutes of cardio a day. Be diligent with annual check-ups.

If Diagnosed: Lifestyle changes are necessary (see Prevention, above). Consult with your doctor.

Women, Take Note

Women Take Note

URINARY INCONTINENCE

Involuntary leakage of urine, or urinary incontinence, affects up to 30% of women and one in three women over age 60; it affects men too, but only up to 3%, reports the Mayo Clinic.

Bahar Zadeh, MD, a family practitioner of the Torrance Memorial Physician Network, says, "Because a lot of people are reluctant to initiate a discussion with their doctor, the condition often remains undetected and undertreated."

Causes/Symptoms: There are two common types of incontinence: stress and urge incontinence. Stress refers to leakage of urine with a cough, sneeze or laugh-often a problem with women who've gone through childbirth or menopause. Urge incontinence, or overactive bladder, refers to loss of urine with a sensation of urgency, urinary frequency (normal is considered to be about eight times per 24 hours) and nighttime urination.

Screening: There are currently no screening guidelines, but Dr. Zadeh encourages keeping a bladder diary-a record of how much urine you make and how frequently you go. Also make a note of how much fluid you drink and what activities cause a leakage. Take it to your doctor's visit to help with an accurate diagnosis.

Prevention: Risk may be decreased by practicing Kegel exercises, which help strengthen the muscles that aid in controlling urine loss. Also maintain a healthy weight, eat more fiber and don't smoke.

If Diagnosed: Surgical procedures are available, which offer the highest cure rate for stress incontinence. Treatment for urge incontinence and overactive bladder should start with elimination of foods and drinks that can trigger symptoms (think caffeine, alcohol, spicy foods, acidic foods or beverages). Bladder training is another approach and involves using the bathroom on a schedule while you are awake and using strategies to control sudden urges-such as using Kegel exercises. Other treatments are available.

OSTEOPOROSIS

Osteoporosis is characterized by low bone mass, which is associated with reduced bone strength and an increased risk of fractures. The National Osteoporosis Foundation says this disease occurs most commonly in postmenopausal women and affects more than 55% of the population age 50 and over.

Causes: Risk factors for osteoporotic fractures include advanced age, a previous fracture, long-term prednisone use, low body weight, family history of hip fracture, smoking, excessive alcohol and confirmed diagnosis of rheumatoid arthritis.

Symptoms: Stooped posture, loss of height, fractures that occur more easily than they should.

Screening: "The goal of screening is to identify those at increased risk of sustaining a fracture and who would benefit from intervention to minimize fracture risk," says Dr. Zadeh. A bone density or DXA test screens for bone loss. Recommended for women 65+ and for men 70+, unless there's a family history or you have smoked or taken prednisone. For screenings: torrancememorial.org/Osteoporosis
Prevention: Adults should get 1,200 mg of calcium (through diet and supplements) plus 1,000 IUs (international units) of vitamin D per day, in addition to regular exercise including weight-bearing and muscle-building exercises.

If Diagnosed: There are several widely prescribed medications.

BREAST CANCER

The American Cancer Society (ACS) reports that an estimated 230,480 American women will be diagnosed with breast cancer this year, and 39,520 will die from the disease. About 1% of males are diagnosed with breast cancer, occurring mostly in men 60 to 70 years old. Fortunately, when found early, breast cancer is curable.

Fe Inocentes, MD, a family practitioner at the Family Medicine Center of Torrance, says it's never too early to pay attention to and really get to know your body. "I tell my patients at 19 and 20, who are coming in for their first pap smear, to get familiar with their breasts, because in years to come, if something is off or abnormal, they'll know it."

Causes: Family history is one factor, but lifestyle choices-obesity, heavy drinking, etc.-are also believed to play a role. Otherwise healthy women are also diagnosed; researchers don't know all the causes.

Symptoms: Vary widely, from lumps to swelling to skin changes, and many breast cancers have no obvious symptoms.

Screening: Mammography is the most effective tool. When it comes to family history, the screening guidelines change. For example, if your mother had breast cancer at 47, doctors would recommend you start having mammograms 10 years before that and continue until you are 85.

Prevention: Make a yearly mammogram, starting at 40, part of your annual physical. Conduct regular self-breast exams, preferably after your period when hormones are quieter, Dr. Inocentes says. Limit alcohol intake, exercise and eat right.

If Diagnosed: A variety of treatments and surgical options exist.

Aliments That Concern Us All

Robert Glazer, MD, a family practitioner of the Torrance Memorial Physician Network, says, "Mild issues with memory recall as people age do not constitute dementia; the diagnosis requires more global dysfunction at work, home and socially."

Causes: Genetic, lifestyle and environmental factors are believed to be at play, although researchers don't fully understand exact causes.

Symptoms: Alzheimer's damages and kills brain cells, leading to significant brain shrinkage. Symptoms start with forgetfulness, mild confusion and difficulty organizing thoughts. Impacted over time are speaking, writing, judgment and problem-solving skills.

Screening: If the patient, family or doctor suspects a decline in abilities, the clinician will question impairment not only in recall but in reasoning, language, behavior, personality changes and functioning in "activities of daily living." If there is a rapid decline, it's necessary to rule out an acute illness as a cause. According to Dr. Glazer, there are a variety of effective screening tools for Alzheimer's. One is the clock drawing test; others are the verbal fluency test and the mini-mental state test.

Prevention: More research is needed, but it's believed that controlling blood pressure and hypertension, getting regular exercise, taking omega-3 fatty acids (fish oil, for example) and cognitive engagement are important. "I really stress the latter, as seniors can sometimes become isolated and withdrawn," Dr. Glazer says. "I recommend crossword puzzles, reading the newspaper and regular interaction with others. The term 'use it or lose it' applies to the brain as well."

If Diagnosed: There are several FDA-approved drugs on the market, but the effectiveness of these products is modest, Dr. Glazer says, and may not be beneficial in the long term. Engaging family members and caregivers about the disease and referral to support groups is critical.

VISION LOSS

There are many types of vision problems that surface as we age-cataracts, macular degeneration and glaucoma among them. But the most common, and one that will affect all of us at some point, is presbyopia, a normal loss of the lens' ability to focus. This age-related visual change begins around 40 when it's harder to read up-close.

Causes: A wide variety of diseases, disorders and conditions cause vision loss, along with aging.

Symptoms: Presbyopia-blurred vision when reading up-close. Macular degeneration-clarity is lost, making it difficult to see details, but shapes can be made out. Cataract disease-commonly seen in people 70 and over, where the lens becomes cloudy opaque. Glaucoma-gradual loss of peripheral vision and sometimes tunnel vision.

Screening: Annual vision test. A result of 20/40 and above should lead to a visit to an ophthalmologist for a formal eye exam where the pupils are dilated for an in-depth view.
Prevention: Dr. Nelson encourages eating a balanced diet of foods that are rich in color-particularly those with beta-carotene (orange peppers, carrots). Vitamin D is an important element as well. Proper eyewear should be used without fail. "Wear sunglasses with polarized lenses outside and never look directly into sun," Dr. Nelson says.

If Diagnosed: Treatments vary greatly, depending on the cause.

DIABETES

More than 25 million Americans (8.3% of us) are living with diabetes, according to the American Diabetes Association (ADA). Of those 65 and older, 26.9% are affected. The disease affects slightly more men than women, although studies show that as people approach 60, the incidence rate is fairly equal. The ADA reports that diabetes causes more deaths each year than breast cancer and AIDS combined.

Eduardo Anorga, MD, a family practitioner at Madison Park Family Medical Group in Redondo Beach, says, "Diabetes affects all of your medium and small arteries that go to a lot of important places in the body, like the brain, eyes, heart, kidneys, legs and feet. As a result of diabetes and high blood sugar, the patient can get eye, heart, kidney and vascular disease due to the blockage of these organs."

Dr. Anorga says he is seeing an increased incidence rate of diabetes. "Part of this is due to earlier recognition and diagnosis, but part of it is that we are a more sedentary population."

Causes: Both type 1 and type 2 diabetes are linked to genetics; type 2 is also linked to lifestyle. Being overweight increases the risk for type 2.

Symptoms: Type 1 symptoms include extreme thirst, excessive urination, unusual weight loss and fatigue. Type 2 symptoms are the same but can also include blurred vision, slow-to-heal cuts or bruises, tingling in the hands and feet and frequent infections.

Screening: Routine screening beginning at 45, unless the patient is overweight or obese, has a family history of diabetes or has high blood pressure, high cholesterol or heart disease.

Diabetes is primarily detected through blood work via a fasting blood sugar. A result of below 126 is desired; normal range is 80 to 100.

Prevention: Stay away from white foods, Dr. Anorga says. White rice, bread, pasta, potatoes, cereals, white flour and sugar are not your best friends. Consider substitutes of whole grain bread and pasta, brown rice, etc. Also, limit carb intake to one serving per meal.

If Diagnosed: Your doctor will help determine the right treatment for you, as well as advice on keeping glucose levels in check, administering insulin (if advised), and helping you maintain diet and an appropriate exercise regimen.

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