If you're prone to yo-yo dieting, have knees that creak and groan when you try to jump out of bed, suspect you might be home to a burgeoning ulcer, and harbor a gut-wrenching sense that cancer will mow you down before your time, then read on. Your distress is shared by many mid-lifers; some of whom recently voiced these health concerns on a umdnj Baby Boomer Survey.
Statistics show that those who make it to 55 probably will live into their 80s, but boomers will not go quietly into a torpid old age. Doan's pills and Philip's Milk of Magnesia will not be their constant companions. they silently "nurse" an ulcer or sip Geritol to bolster their anemic blood. Unlike their predecessors, they expect to be hale, hardy and lovely right up until the end.
Boomers rage at arthritic joints, rant about the extra seven pounds they're carrying, rave at advice to limit their hot pepper consumption, and roar about the cancer-causing toxins seeping into their air and water. Many will jump onto the World Wide Web to search for data related to their ills before they consult a physician. This is a generation that moves fast and expects quick results. They will certainly not greet old age sitting down.
Above all else members of the 34 to 50 group believe in the power of information, so HealthState hereby offers them the wisdom of some experts on their common concerns.
The Once and Future Dieter
It's a truism that if dieting were easy, a large and profitable industry would go bust. Weight Watchers would become emaciated. Hundreds of trade books would be yanked off the shelves. And numerous magazines would be skinnier by far.
"There's a lot more to dieting than food intake and activity level," states Diana DeCosimo, MD, director of the Women's Wellness Center at UMDNJ-New Jersey Medical School's Doctors Office Center. She names genetics and metabolism as important components, as well as cultural and ethnic norms.
"One culture's fat may be another's average," she says. "Or one culture's idea of prosperity may include adding a few pounds. Have you ever heard the expression 'You could afford to gain some weight?'"
DeCosimo observes that fast food;and lots of it; is a baby boomer tradition. Hamburgers, pizza, fried chicken, Dunkin' Donuts and milkshakes have been an integral part of our great American culture for the last three decades.
Weight gain in the middle years; - when metabolism and athletic activity both tend to slow down;is not uncommon. What is rare is the boomer who, faced with such temptation, can take the pounds off and stay svelte.
"Many people need assistance to lose weight," says DeCosimo, "but few doctors have the time to provide it." She repeats the tale of one patient who asked her physician for help in starting a diet and was told just to push herself away from the table. That attitude is not uncommon, she says.
Dieters who hope for a magic bullet will be disappointed if they consult with DeCosimo. "Dieting is a lot of work and involves a lot of steps," she states. "It's not so different from planning to quit smoking or drinking." She calls her approach "holistic."
DeCosimo asks every would-be dieter: "What have you done before? What worked for you in the past? Why did you fail? How much structure do you require? Do you need the support of a group? Will you put forth the time, effort and money to reach your goals?"
She says the easy part is figuring out how many calories the individual should be taking in. "Many overweight people greatly underestimate what they eat," she explains, "and initially need the shock value of measuring and weighing everything that goes into their mouths."
Increasing one's activity level is among her recommendations -; ideally to 30 minutes every day of the week. She sees dieters back in her office within one month, she says, because most people need the motivation of answering to someone else. "It's too hard to do by yourself," she comments.
Much of her advice to patients comes from the heart; - she is engaged in her own life-long battle to keep the pounds off. These are her top tips:
DeCosimo will only prescribe diet pills such as phen-fen (a combination of phentermine and fenfluramine) as an adjunct for dieters who will continue under a doctor's care, work at limiting food consumption, incorporate exercise into their daily routines, and have no heart or lung problems.
"You still need to relearn how to eat," she says. "Dieting is eating."
In conclusion she advises: "Aim for a reasonable weight for your age and frame. Don't court failure by trying to return to the body you inhabited in fourth grade."
The Hip Bone's Connected to the Thigh Bone, the Thigh Bone's Connected to the Knee Bone
It's those connectors that often pain mid-lifers ... just think of the tin man with his rusty links. Kirk Hillman, supervisor of outpatient physical therapy at the medical school's Doctors Office Center, would have had some pointed questions for that creaky gent: "When do those joints act up? In the mornings? After exercise? When the seasons change? When it rains?" The answers provide all-important clues when you're in the business of relieving such complaints, he says.
Most common are joint pains that are worse in the mornings, Hillman states, and they can have diverse causes;arthritic conditions related to muscle stiffness and lack of flexibility, awkward sleeping positions, being overweight, and lack of cardiovascular and muscular conditioning. The remedy in many cases, says Hillman, is exercise: "The resiliency of the system is reduced when it's not exercised."
Sleep deprivation or broken sleep can also do damage. "If you wake up and you're still exhausted, if you tossed and turned all night, if you fell into bed at midnight and tried to hop out at 5:30, your muscles probably did not have a chance to rejuvenate," he observes.
For those whose creaks and groans seem to worsen with the change of seasons, Hillman points to such activities as raking leaves, shoveling snow, gardening and mowing. "Each of these uses different muscle groups," he says. "If you haven't done any pre-season conditioning, your back may be doing extra work because your arms and legs are not up to it. Then your back will go out. Your whole system may be stressed because your muscles are not flexible."
The physical therapist says boomers should expect some muscle pain and joint stiffness when starting a new activity. They can also look forward to longer recoveries from injuries and overuse, and greater sensitivity to temperature changes.
Hillman points out that some mid-lifers have neglected their bodies for decades and it's this lack of conditioning that's catching up with them, resulting in loss of range of motion and flexibility, and declining endurance. The normal aging process, old injuries that sometimes act up and stressful schedules also contribute until an oft-repeated movement;such as lifting the laundry basket -; which you've done for 20 years one day knocks you for a loop. "Your body has lost some of its great potential to accommodate," he says.
So what should you do to avoid tin man syndrome? Do an aerobic activity for 20 to 30 minutes each day, Hillman counsels. Even 15 minutes will help. Add flexibility exercises;such as stretching the muscles of the legs and trunk;before beginning major activities, such as digging your garden or moving your furniture. Watch your weight.
"Give your muscles and joints the chance to rejuvenate," advises
the physical therapist. "The body does its own healing. We're just
here to facilitate that process."
When Did Swigging Mylanta Become Part of the Daily Routine?
So you thought you could compete in the Great American Chili-Eating Contest forever. Now you can barely swallow three mouthfuls of the hot stuff before your stomach starts churning. Should you add worry to the mix bubbling around in your gut?
"If you can identify what food is causing the trouble, simply cut it out of your diet," says Bruce W. Trotman, MD, professor of medicine at New Jersey Medical School. Some of the common culprits are chocolate, spicy foods, particularly hot sauce, milk and milk products. Medications can also cause stomach upset.
But in this era of self-medication; - when relief with Mylanta, Pepsid AC and Axid AR is indeed just a swallow away; there's a real chance that a more serious problem could be overlooked. "If you're suffering more than once a week, seek professional help," he advises.
The real concern is that many GI conditions will respond to an array of drugs that reduce or neutralize acid, he explains, but symptoms such as nausea, heartburn, pain, fever and vomiting need a diagnosis.
For instance, the identification of the microbe H. pylori as the cause of 90 percent of duodenal ulcers and 80 percent of gastric ulcers "changed our whole thinking about stomach disease," Trotman states. "Roughly 96 percent of those treated with antibiotics are free of ulcer disease after two weeks, and the ulcer generally does not recur. Those who are treated with other medications have a 90 percent recurrence rate."
In the United States about 5 percent of the population is infected with H. pylori, but in many countries, infection rates run as high as 100 percent by adulthood. "Immigrants to this country who are infected with this microbe may not be getting treatment because they are asymptomatic," he says.
Gastroesophageal reflux disease;which occurs when an open valve allows hydrochloric acid from the stomach to back up into the esophagus;is also a real possibility in this age group. The most common symptom is heartburn. Not only can it produce ulceration of the esophagus, but it sometimes causes asthma when material from the stomach gets into the lungs, Trotman says. The most common treatments are antacids, or drugs such as Tagamet or Zantac, which actually block acid production.
The incidence of gallstones peaks in the 20s and again in the 40s and 50s, he states: "You should suspect this condition if you have pain that recurs and radiates to the back and shoulder blades about 45 minutes after eating, or during the night." Nausea, vomiting, fever and jaundice are other symptoms. Laparoscopic removal is sometimes necessary, but patients are often able to go home the same day, the physician states. There are some situations when laparoscopy can not be used, he notes.
Is there any tie-in between stress and stomach problems? "It's possible that your GI tract can represent ongoing
problems with life," the gastroenterologist says. He also warns that aspirin as well as Advil, Tylenol, Alleve;all non-steroidal anti-inflammatory drugs;destroy the gut and should not be taken casually. He says even one aspirin a day can cause damage.
In conclusion, Trotman advises everyone over 50 to have regular screening for colorectal cancer, or if there is a family or personal history of problems, to start at 45. For anyone experiencing rectal bleeding, he says it's imperative to get checked immediately, even if you have a history of hemorrhoids.
Polyps are a sign of unrestricted growth in the colon, he explains, and cautions minority groups;whom he says have a higher incidence of this cancer and greater disease severity; to be particularly watchful.
Fear of Cancer or When Did Every Twinge Become an Incipient Tumor?
So why do so many baby boomers suffer anxiety over this disease when they give heart problems barely a nod? Since statistics for this age group do not support such dread, the answer would seem to lie in the emotions.
"There is real grimness about a diagnosis of cancer," says Howard Leventhal, PhD, a Rutgers University health psychologist and researcher into the effects of emotional factors on health outcomes. "The stereotype is that cancer is not curable, not controllable and not preventable, and that it's painful, disfiguring and disabling. Many people think that's particularly true about breast cancer, which strikes this age group more than other cancers."
He says the perception of cardiac disease is quite different: "People feel that there are many things they can do to prevent and deal with it, and that when it hits, it will take them fast and without much pain. In general, heart disease is not thought of as being gene-related, although it often is."
Leventhal is conducting a longitudinal study;from 1991 to 1999;on more than 500 residents of a retirement community. Part of the research looks at how people appraise their own health and whether their appraisals are related to mortality.
One of the questions asked of study participants is: "What do you think you will die from?"
The researcher says that: Approximately 20 percent think heart disease will kill them and 20 percent think it will be cancer; 50 percent say they don't know or want to know; and 10 percent believe they will be victims of accidents.
When asked for some of his general findings about this group, Leventhal says: "The 50 percent who did not name a cause of death tend to be more optimistic.
"The 20 percent who named heart disease believe they will live longer than those who said cancer. And those who think they will die of heart disease believe that conserving energy will keep them well. They think they can act to prevent cardiac disorders, although many are not exercising;even though properly prescribed exercise regimens are protective against heart problems. They also have more friends and relatives with heart disease."
The psychologist says by contrast the people who believe cancer will do them in are more worried about death, have friends and relatives who have or have had cancer, think they have little control over the disease and believe they will die at a younger age.
"It seems that people's ideas about heart disease and cancer are inconsistent, a mixture of the rational and irrational, and a poor basis for taking effective, preventive The data from the longitudinal study also confirms what has been reported in several published studies, namely that self-assessments of health are good predictors of mortality after an individual's medical history and age are taken into account. However, women are less accurate predictors than men.
Leventhal explains: "The process of assessing health is a two-step affair. It begins with events that create emotional upset, such as illness for men and both illness and social problems for women. The emotional distress affects men's and women's self-assessments equally. But because a woman's upset reflects illness as well as social problems, both her health assessment and her prediction of mortality are less precise."
Leventhal is also co-investigator with Marvin Schwalb, PhD, professor of microbiology and molecular genetics at New Jersey Medical School, in a study on the issues surrounding genetic screening for mutations to the BRCA1 and BRCA2 genes, which have been definitively linked to familial breast and ovarian cancers. He says they are looking at two major questions: Do people understand genetic risk? (Most do not, he says.) And how do people respond behaviorally and emotionally once they are tested for the gene mutation and get negative or positive test results?
A third subset of the group includes women who come in for an initial interview but decide not to get tested. "This third group will also be followed long term to see what they will do about prevention," he says.
The study sample is not yet large enough to get a representative picture, Leventhal observes, "but my hunch is that women who decide not to test have more fears and anxieties than those who do."
He adds that few people volunteer to be part of a clinical study, but most people want information that can be determined only by such investigations. Perhaps the boomers will be the first generation to actively participate in this aspect of medicine's quest for knowledge.