Your Health

Half-century health primer

7 things to discuss with your doctor when you turn 50

7 things to discuss with your doctor when you turn 50

Winnipeg Health Region
Wave, November / December 2012

If you've recently turned 50 - or are about to hit the half-century mark - it's entirely likely the spring chicken feeling that has fuelled your lifestyle over the last five decades is losing a bit of its lustre.

As much as we'd all like to think we're forever young, sometimes the old bones - the aches and pains - have something else to say about the state of your body.

It's also likely your doctor will have something to say about your overall health, too.

"Fifty is the magic age," says Dr. Jamie Boyd, Medical Director for family medicine at the Winnipeg Health Region. "It has been sort of notoriously picked as a time for a wide variety of screening tests and other sorts of physical exams to check for chronic diseases."

Although it is just a number, most 50-year-olds know at least one peer who has already suffered heart disease or battled cancer. And at 50 and onward, we're increasingly at risk of finding ourselves in a similar situation. Boyd says the simple fact is humans are more likely to fall ill as they age.

Yet awareness and prevention are two very good weapons in the fight against the ravages of age and disease.

And at the front lines is your family physician, who will focus on a number of potential trouble spots. Here's a look at a few of the health issues you should be discussing with your doctor.

An apple a day keeps . . .

First and foremost, good health begins by taking good care of ourselves. This means eating right and exercising regularly. It's a platitude, but this advice is among the best prescriptions a doctor can write, Boyd says.

Eating a balanced diet that's high in fresh fruits and vegetables and low in salt, saturated fats and processed sugars has been shown to help prevent many cancers, cardiovascular disease, osteoporosis, dementia and Type 2 diabetes. It's also been shown to help reverse some of the effects of these illnesses for individuals who suffer from them, he says.

But many people, once they reach 50, are still living in the past when it comes to their lifestyle.

"They overeat and over-drink or oversmoke and they think they can get away with it like they're 19 years old. But if you're doing it from when you're 19 until you're 50, it's going to catch up with you," he says. "The real issue is everything in moderation."

That includes alcohol. If you're having more than two drinks a day as a male or one drink a day as a woman, you're at increased risk of a whole host of illnesses, including stroke, heart attack and a number of cancers.

"The odd time you have a few more is not a bad thing." But it's important to remember that you're 50, not 20 or 30, and all those bad habits will likely catch up to you - especially smoking.

"The big thing I always preach to patients about smoking is not everybody that smokes gets lung cancer, but if you smoke and you have heart disease in your family, you're in trouble," he says.

Many smokers may hem and haw about whether they should give up that "old friend" and, in fact, many eventually do. But it's often after the damage has been done.

"The most effective way for people to stop smoking is when they're in intensive care after a heart attack," Boyd says. "But everything's out of the barn by then."

Another problem with smoking and eating poorly is they usually go hand-in-hand with a lack of physical activity.

"The more we read and learn about exercise and its value at any age, regardless of medical condition, it makes a huge difference in outcomes," he says.

It actually wouldn't be overstating things to say that regular exercise is a "fountain of youth," and most people simply aren't taking enough sips to stay forever young. The latest data shows that if you want to maintain optimal health, you need at least 150 minutes a week of moderate to strenuous exercise, he says.

"That's considered to be the minimum for maintaining a good level of fitness, but any exercise - even just walking up the stairs instead of taking the elevators - is beneficial."

Checking for the silent killers

High blood pressure and cholesterol are often called silent killers. You don't know you have them unless you're tested. Yet what you don't know about them is hazardous to your health.

High cholesterol and blood pressure are two leading indicators of cardiovascular disease. And once we enter our 50s, we're at an increasingly elevated risk of heart attack and stroke, especially if we also have both these traits. But high blood pressure can also be a sign of Type 2 diabetes and kidney problems.

"There is a huge percentage of people with hypertension, and Type 2 diabetes is an epidemic across Canada," Boyd says.

Eating well, regular exercise, not smoking and moderate alcohol consumption all reduce the risk of high blood pressure, high cholesterol and Type 2 diabetes.

The problem is, most of us don't realize the connection until we're age 50 and up - after we're diagnosed, Boyd says.

"If you've been eating fast food for 30 years, smoking and overdoing it with alcohol, then you're likely going to have heart trouble earlier than most people, for example."

Furthermore, diabetes often leads to heart disease and increased risk of stroke as well as kidney failure. In fact, your family doctor may start checking out your kidneys at around age 50, too, Boyd says.

"They're doing tests called the EGFR, or estimated glomerular filtration rate."

It measures the level of creatinine, a waste byproduct of the body.

"The test determines the function of the kidneys, and we really start testing between 50 and 55 in men and women who are at risk because they've had diabetes or hypertension for years."

Check-ups for women

Age 50 and up is the breast cancer danger zone.

Although some women are diagnosed with the disease before that age, some even in their 20s and 30s, the risk increases with age. And the halfcentury mark has largely become the point at which most women receive a mammogram.

This X-ray of the breast tissue was at one time given to most women a decade earlier, but it's found to be more effective at 50 - often after menopause.

"We don't recommend it for women less than 50 years of age unless there's a strong family history of breast cancer at an earlier age," Boyd says.

"That's because the density of the breast tissue increases with age so the screening works better, whereas it's not as useful in young women because of the density of the breast tissue when they're premenopausal."

Women should also continue with pap smears and other checks for signs of cervical cancer. "It starts at a much younger age, but it's a screening test that needs to be continued," he says. "Some women will think that because they're past the child-bearing age they don't need a pap smear anymore, but that's not true."

Regular pelvic exams - every two years - are recommended to check for not just cervical cancer, but also uterine and ovarian cancers because the risk of both these cancers increases with age. Exams should be done until between ages 65 and 74, as well as check-ups for breast cancer. And pay special attention to postmenopausal bleeding.

"If they haven't had a period for about a year, and then they suddenly get bleeding, this is not normal and needs to be investigated," he says. "It could be something else other than cancer, but you really need to ask your doctor."

Check-ups for men

At age 50, prostate cancer is certainly on the radar for most men, but they shouldn't expect their doctor to necessarily start screening them for the disease unless there's a family history of early diagnosis.

The PSA test checks for elevated levels of a protein called prostate-specific antigen, which is produced by the prostate and is alone a poor indicator of cancer. At one time, it was considered a good way to screen all men for prostate cancer. But researchers have found that positive results can lead to unneccessary medical actions.

"Once you do a PSA, and it comes back elevated, you end up having to do a transrectal ultrasound and at the same time, you have to do multiple biopsies, which are very traumatic to the patient," Boyd says.

"You may or may not find a tumour, but you'll produce a lot of scar tissue on the prostate, which will inevitably end up having repeat PSA-elevated readings in the future, which will be hard to interpret."

The fact is most men will get prostate cancer at some point past age 50, but it's unlikely the disease will prove fatal. In most cases, it's slow-growing, and aggressive treatment can do more harm than good.

"Today, there are a lot of other less invasive treatments available - as opposed to surgery, which causes impotence and incontinence," he says. "When you start doing screening with a PSA and end up with an abnormal result, then you end up putting the patient through a lot of unnecessary grief." Still, some testing is needed, but it's fairly basic: a digital rectal exam. The doctor inserts a finger into the rectum to check to see if the prostate is enlarged or has a hard nodule that could be an indication of malignant growth.

An enlarged prostate, however, is a common occurrence with age and not a sign of cancer either.

"If the patient had a whole bunch of symptoms that are suggestive of a screening test - getting up at night to urinate several times, losing control of the bladder, going to the toilet yet not being able to do so - then, you may consider doing a PSA and further tests."

In those instances, testing is no longer considered "screening."

"We call it 'case finding,'" he says. "A patient who has these symptoms suggesting there is a prostate problem and, as physicians, our job is to find out why."

Eyes, ears and mouth

It's easy to become pre-occupied with high blood pressure, screening for cancer and all those other major health concerns - so much so that even family doctors can overlook some of the basics: our eyesight, hearing and oral health.

But make no mistake. These are important concerns. Take hearing and eyesight, for example.

"Those are two things that, as people age into their 60s and 70s, are key indicators that they will do well health-wise," Boyd says.

Checking in on hearing and eyesight at age 50 is a good way to assess just how much or how little both faculties are declining.

Most people actually lose a lot of hearing at an early age - the result of listening to their music at high volume.

"This is going to be a major problem in the years to come," he says.

Furthermore, an eye exam from an ophthalmologist or optometrist can help diagnose potential health problems like high blood pressure and diabetes.

And when it comes to oral health, studies have shown that healthy teeth indicate good health in other parts of the body, like the heart. The same infectious bacteria that wreak havoc on our gums are the same germs that infect heart tissue, he says.

"And many studies have shown that there may indeed be a link between bad teeth and heart disease."

Furthermore, as we age we become more prone to infections, and our mouth is often an overlooked gateway to disease. It's as simple as this: An unattended infection in your gums and teeth can lead to a widespread, life-threatening infection in the rest of your body.

And generally, by age 50, bad oral hygiene really starts to catch up with us, so it's not just a good idea to see your family doctor regularly, but also your dentist, Boyd adds.

Health from the bottom up

Screening for colon cancer starts at age 50 and it's a test that will continue every two years until age 75.

Called a hemoculture test, it looks for "occult blood" in the stool. "This is blood that shouldn't be there and incorporated into the stool, which means there's been some bleeding somewhere in your bowel," Boyd says.

The test involves sampling stool for three consecutive days. If blood is found, a colonoscopy - inserting a snake-like device with a camera into the rectum - is required to search for possible signs of colon cancer. The colonoscopy looks for polyps, which are little mushroom-shaped growths in the colon. "They can bleed and can be benign, but they can become malignant," he says.

Once a polyp is found, doctors will biopsy it to test for cancer.

While it's standard practice to do hemoculture testing of stool at age 50 and up, individuals with a family history of early diagnosis of colon cancer or polyps are screened earlier.

"You usually try to do it three to five years before the first-degree relative developed cancer."

These tests certainly aren't the most convenient or pleasant of activities, but they're very necessary to our well-being, he says. Colon cancer is one of the most common forms of cancer in men and women, and it's the fourth leading cause of cancer death behind lung, stomach and liver cancers.

Check up from the neck up

It's unlikely that your family doctor will ask you about your relationship with your mother - a la Sigmund Freud - but he or she should be asking you a little bit about what's going on in your noggin once you reach 50.

Yet Boyd says many doctors may overlook mental health as a component of our overall well-being. So if your doctor fails to ask, it's up to you to ask for a head check-up. Even if you're feeling fine, it's still a good idea to discuss mental health going forward from age 50. "You can ask your doctor for a mini-mental status exam - an MMSE - and have it on file at 50 and then five or 10 years down the road, you can do it again and use the earlier one as a measure of brain health."

Depression and anxiety do tend to increase with age, he says. And in some instances, they can be an indicator of serious degenerative brain disease like Parkinson's or Alzheimer's disease. In fact, doctors do look for signs of these illnesses in their patients 50 years old and up.

Parkinson's disease sufferers often show symptoms in their late 40s to early 50s. These include hand tremors while at rest, such as shaky hands even while resting on a table.

Doctors also look for facies: tell-tale facial expressions - or more precisely, an inability to produce normal facial expressions - that often indicate a degenerative brain disease.

These diseases are relatively uncommon in our early 50s, but they certainly increase with age. About 770,000 Canadians suffer from dementia-related disease in Canada - the result of Alzheimer's and Parkinson's, among others.

And the number is expected to double in the next 18 years. Boyd says these are debilitating conditions that progress with age, often making it very difficult for sufferers to manage their own affairs.

For that reason, he also recommends that his patients think about advance care planning. "We need to able to talk about our advance care needs before we get into an acute situation in a hospital," Boyd says.

Advance planning includes developing a living will that addresses how you want to be cared for and a power of attorney so your affairs will be managed by someone you trust. It also addresses dealing with the end of our lives, such as a do-not-resuscitate order in the event of being kept alive on life support following brain death, with no chance of recovery.

These are difficult issues and while we can't predict the future, at least we can be prepared.

"Keep in mind, these plans can always be changed, but they're really an important thing to do and shouldn't be forgotten," he says. "You may not have needed to think about this earlier in life, but at age 50, it's much harder to avoid these issues - and when we do ignore them, we do so at our own and our loved ones' peril."

Joel Schlesinger is a Winnipeg writer.

Wave: November / December 2012

About Wave

Wave is published six times a year by the Winnipeg Health Region in cooperation with the Winnipeg Free Press. It is available at newsstands, hospitals and clinics throughout Winnipeg, as well as McNally Robinson Books.

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