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Staying Healthy As You Age

In February 2008, our guest expert in Le Club's Ask the Expert segment was France Farley, a nurse practitioner at Montfort Hospital in Ottawa.

France specializes in the area of rehabilitation at Montfort, where many of her clients are older women.

France graduated from the Nursing Science program at the Collège de l'Outaouais in 1991. She subsequently completed a BA in Nursing Science at the Université du Québec in Hull in 1994. She also holds a certificate in project management from the Université de Québec and a certificate in critical care from the Cité Collégiale.

Since 1991 France has worked at Montfort Hospital in different roles (bedside nurse, nurse manager, nurse educator).

She has been working as a nurse practitioner since she received her Nurse Practitioner diploma in primary health care from the University of Ottawa in 2007.

France has extensive experience in the area of emergency health care and services for seniors. She also did humanitarian missions in Africa with a team from the Alliance de santé communautaire Canada-Afrique.

Here are France’s answers to your questions on Staying Healthy As You Age:

Q: I am 48 years old and I have just discovered a lump near the bottom of my left breast. I have made an appointment to see my doctor later in February. I went to see my doctor last year with a similar problem. He told me it would go away by itself. I felt a small lump in the past but now it is the size of a dime. Why didn’t he investigate this problem the first time?


A: Unfortunately, I can’t answer for your doctor. I can however tell you this: a breast lump is not always synonymous with cancer, although cancer is also a possibility. Many women develop lumps on their breasts, and they are often benign. This problem is frequently observed in young women and is known as fibrocystic breasts.

Sometimes, the breast milk ducts are compressed or blocked and a lump will form. I believe you did the right thing by booking an appointment with your doctor to have your lump checked. All breasts lumps merit particular attention.

Editor’s note: Fibrocystic breasts refer to lumpy, thickened tender areas in the breast. You may notice increasing lumpiness and tenderness in your breasts as the levels of your reproductive hormones fluctuate during your menstrual cycle and as you approach menopause.  Cysts are fluid-filled sacs caused by dilated ducts.  Fibroadenomas are round, firm, rubbery masses that arise from excess growth of glandular and connective tissue.

 


Q:  Hi. I was diagnosed with blood clots in 2003. My legs make them and they don't know why. They have run all the tests. So, I'm taking warfarin for the rest of my life. I've heard that this can cause damage to the kidneys. Is this true, and is there an alternative?

A: Warfarin, which is most often prescribed under the name Coumadin, is the long-term drug of choice for people like you who repeatedly develop venous thrombosis (blood clots). This drug is safe for the kidneys, and the dose does not need to be adjusted according to renal (kidney) function. For you, the most important thing is to have regular bloodwork done in order to maintain therapeutic drug levels on a daily basis. Currently, there is no alternative for people like yourself who must take warfarin for the rest of their lives.

 



Q:
How can I prolong my menstrual periods as long as possible after my childbearing years?  I'm 46 and have breast cancer. I need to know what foods/supplements/protocols will balance my estrogen and allow me to keep my cycle as long as possible.

A: Unfortunately, there is no pill, supplement or anything else that will help you extend your menstrual periods. In some specific circumstances, it’s possible to give hormones to restore menstruation in post-menopausal women. I would not recommend that for you, however because you already have breast cancer.

Editor’s note: Always check with your physician before taking any herbal or natural supplement.

 


Q: What preventive measures can I take to avoid getting cancer and cardiovascular illness?

A: The following lifestyle and dietary changes may reduce the risk of both cancer and cardiovascular disease:

  • Eat healthily (follow the Canada Food Guide)
  • Avoid fried foods, saturated fats and candy
  • Exercise regularly for at least 30 minutes, five to seven times per week
  • Limit use of salt in all forms
  • Do not smoke or take recreational drugs
  • Drink alcohol only in moderation
  • Maintain a healthy body weight
  • Keep your blood pressure and lipid profile (cholesterol) within normal limits
  • Sometimes, taking 80 mg of aspirin is beneficial for those over 50 depending on their risk factors, but this should be done only if recommended by a doctor

Editor’s note: Oral contraceptives may also increase your risk of cancer or heart disease. Check with your doctor.

 


Q: My kids seem to be sick quite often during the fall and winter. How can I avoid catching these annoying bugs that circulate at this time of year? Also, how can I keep my energy level high so that I can have fun with my kids? I noticed that my energy level started to drop after age 40.

A: It’s certainly true that as we age, we lose a bit of energy. Be sure to get enough sleep, manage stress, eat three healthy meals a day (with healthy snacks in between) and exercise. It’s important to exercise even when you’re tired because physical activity gives us energy, as strange as that may sound.

Children and viruses are fast friends. Everything finds its way from their hands to their mouths and on to the toys, glasses and utensils they share with each other. This is made worse by the close quarters winter imposes on us: children play inside more often than outside and the windows are always closed.

Therefore, you have to be patient and adopt good personal hygiene such as washing your hands frequently, washing toys if possible, throwing dirty tissues in the bin right away and avoiding as much contact as possible with people who are grappling with a virus.

 



Q:
I am 52 years old and in poor health. I have suffered with sciatica for about 20 years and fell and hurt my back two years ago. Now I have carpal tunnel syndrome and have gained 30 pounds. I stopped smoking two years ago hoping to improve my health but without success. I feel like I am no longer myself, but just an illness.

Please help, because I would like things to improve as I age. Thanks very much.

A: First of all, congratulations on quitting smoking. You have done something very good for your health. Your back pain and sciatic nerve problem are chronic now. Losing weight would be a great help. It’s not easy to do, but I advise you not only to follow a healthy diet, but also to get some exercise, such as walking or swimming. These two activities would be less painful for your back and legs.

Often, by reducing portion sizes, fried foods and desserts and excess starches (pasta, bread potatoes), as well as drinking adequate water throughout the day, weight loss can be achieved. Of course, motivation is probably the most important factor for success.

Carpal tunnel problems usually occur because of repetitive movements. It’s possible to have minor surgery to correct the problem if there are symptoms, but if the causal motion is not modified, the carpal tunnel problem could return.

Editor’s note: Seek advice from a physiotherapist in the management of pain from your sciatica and for guided exercises. Consultation with a registered dietitan is advised for helping with weight loss and providing motivation. For the carpal tunnel syndrome, seek physiotherapy or a hand therapist for guidance of management of symptoms before considering surgery.

 


Q: Type 2 diabetes runs in my family. A few of my aunts and my grandmother got the disease as they approached middle age, despite having a relatively healthy lifestyle. What steps can I take to prevent the onset of this disease? Although I watch my diet, I’ve noticed that I am craving carbs recently and I do less exercise than when I was younger.


A: Diabetes is a disease that’s spreading rapidly. The number of people affected continues to rise, especially among the young. We know that obesity (especially abdominal) is a risk factor, and you are already paying attention by eating healthily. Exercise is certainly helpful but maintaining a healthy weight is the most important thing. You can’t however do anything about your family history. To prevent diabetes, put all the odds in your favour by continuing to watch your diet and exercise regularly (30 minutes, five times per week). I must tell you that it’s a myth that eating too much sugar and other carbs causes diabetes.

Editor’s note: Eating regular well balanced meals and snacks throughout the day may decrease food cravings.

 


Q: I have a teenage daughter and am a little concerned about her diet. She doesn't eat a lot of junk food but tends to favour carbohydrates (noodles, rice and starch) over fruits and vegetables. She is involved in sports now so being overweight is not an issue. But because she is of stocky build I think that as she gets older the starches are going to catch up with her.

How can I convince her that eating fruits and vegetables now will help her maintain a healthy weight as she gets older?

A:A healthy diet today is no guarantee of a healthy weight in the future. You are right, however, adopting good eating habits when you’re young can make it easier to maintain them as you get older.

Teenagers often need reminders about healthy eating practices. Your daughter already avoids junk food, which is a plus And if she manages to burn the calories she takes in, she should be all right. Carbohydrates are often the preferred food choice of teenagers, and your daughter is no different. In fact, carbohydrates or starches are an important source of energy in our diets. Encourage the use of whole grain breads, pasta and rice, as these are more nutritious choices. Why not try reviewing with her the recommendations in the Canada Food Guide for each category?

 


Q: Hello. I am in my mid 40s and I am trying to get back into exercise. However, my knees hurt whenever I do most forms of cardio. I have been to a physiotherapist who has given me specific exercises to do, and it seems to help a little. But I am worried. If I have significant knee pain already at my age, does this mean I am headed for arthritis in the next few years? What can I do to prevent this from happening? Is more exercise the answer, or will this put too much wear and tear on the joints?

A: I think the exercises the physiotherapist recommended should be good for you. Often the knees are the first joints to feel the effects of excessive weight and wear and tear. Therefore, exercise is necessary and rarely causes damage to the joint if done properly.

You may have to replace your knees later in life if the pain becomes immobilizing. Joint pain is often a sign of arthritis as you suggest, but stopping exercise would likely only make the situation worse. Choose low-intensity exercises and avoid jumping and sudden, jerking movements.

 


Q: My mother and grandfather both had Alzheimer disease and I am terrified of getting it as well. As I get older I find I am getting more absent-minded. Can that be a normal part of aging? What types of things should I do to keep my brain healthy? Are there any special foods I should eat (or avoid), supplements I should take or blood tests I should have?

A: Genetics play an undeniable role in Alzheimer disease. Still, only a small percentage of cases are associated with the particular genes that cause the hereditary form of the disease. It’s possible that there is a genetic link in the majority of cases. However, your risk of developing Alzheimer’s is only slightly higher if a member of your family has suffered or is suffering from the disease. Some decrease in memory is a normal part of getting older as is a lack of concentration or attention. There are warning signs of the disease, such as lapses of memory that interfere with daily activities, difficulty executing familiar tasks, disorientation of time and place and language problems, etc.

Studies conducted on certain supplements, such as vitamin E, have been inconclusive. Eat healthily, stay physically active, maintain a healthy weight and put your memory to work. Play memory or card games or do crosswords. Take a different route when you drive to the grocery store. Write your name with your less dominant hand, etc. No single blood test can lead to a diagnosis of this disease. The diagnosis is usually made through a systematic assessment that seeks to eliminate all other possible causes. A reliable clinical history, physical exam, cognitive tests and other tests such as blood work, CT and MRI may all be used to point to the likelihood of Alzheimer disease.

 


Q: I feel a little frivolous asking this question, but as I get older I am starting to really see wrinkles and sagging skin. I am actually considering Botox or some laser treatments perhaps. What are some of the risks? I was also thinking of trying some of the drugstore remedies first, but am skeptical. I know they have made advances in these products in the last few years, but do any of them actually make a noticeable difference – or is it just marketing? Some of them are so expensive, and I wouldn't know where to start. Are there certain ingredients I should look for, or avoid? Thank you.

A: You should never be embarrassed to ask questions. They are all important. Unfortunately, I don’t have a lot of knowledge in this area. As far as creams are concerned, I’m skeptical as well and am not sure about how effective they are. With Botox injections there is a risk of an allergic reaction or cellulitis at the injection site, and I am unsure of the long-term effects. I encourage you to visit Health Canada’s website because warnings have been issued.

Editor’s note: Botox injections use bacteria injected in the skin to minimize wrinkles. It is a temporary solution, lasting up to six months. Possible side effects may include flu-like symptoms, headache and upset stomach. The risk of distant toxin spread has also been reported in Europe. Before considering any kind of cosmetic treatments, discuss with your physician the benefits and risks.

 


Q: I am 67 and have high blood pressure. I'm on four medications and still can't get the systolic (upper) pressure down to normal. It usually ranges from 140 to as high as 175. Meanwhile, my diastolic pressure is usually fine, between 65 and 80.

One doctor says this is ok. Another says it's worth any side effects to get the systolic pressure down. I already have a number of side effects from the drugs, but I'm afraid of getting a stroke. I don't know how to make this decision. What factors do you think are most important?

A: 140 isn’t so bad but 175 is too high. You need to try and keep your blood pressure below 130/80 if you have diabetes or kidney problems and below 140/90 for everyone else. Yes, there are long-term risks for the vascular system that supplies blood to the brain, heart, kidneys, eyes, etc. On average, people take two or three medications to control their blood pressure.

I would also say that putting up with side effects is better than facing the risks associated with an elevated systolic pressure, although I do not know what side effects your are experiencing. Perhaps changing the time you take your pills could help. Your fear of having a stroke is very understandable. So, in addition to taking your pills, I urge you to adopt the following behavioural changes as well:

  • Do not smoke or use any tobacco products
  • Reduce excess weight
  • Do 30 to 60 minutes of moderate exercise, five days to seven per week
  • Limit your salt consumption
  • Limit your alcohol consumption
  • Choose vegetables and fruit, and low fat foods. Limit canned foods, fast foods or foods that are bought prepared.
  • Eat foods containing sufficient levels of potassium, calcium and magnesium
  • Avoid foods that are high in fat and cholesterol
  • Try relaxation techniques

 

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