A recent survey by Forbes Health found that when it comes to New Year’s resolutions, “improved fitness” is often so high on the list that it even outranks “improved finances.” A lot of us want to look and feel better even more than we want money. But achieving those goals can require different paths in your 30s, 40s and 50s, says Lidya Bal, a primary-care physician with a family health specialty at Stamford Health.
“In their 20s, people think everything is fine and they don’t have to go to the doctor, but in their 30s, people start coming in,” Bal says. “The 40s, you get these patients that will say, ‘I haven’t been to a doctor in a long time, but now I’m 40.’ They get anxious.” And by the time people reach their 50s, she says, problems might be harder to address. “Let’s say you have a patient in their 40s, and their bloodwork came back with high cholesterol. They can work on that with diet and exercise,” Bal says. “But in their 50s, we start to talk about medication.”
Here’s a look at common challenges people encounter in each of the three decades, and what experts advise to address those concerns.
PANEL OF EXPERTS
Dr. Mario Gioia
Cardiologist at Stamford Health
Dr. Lidya Bal
Primary-care physician at Stamford Health
Dr. Darlene Negbenebor
Gastroenterologist at Stamford Health
Dr. Spencer Richlin
Reproductive endocrinology and infertility specialist at Illume
Site manager of HSS Sports Rehab
Bal says many patients in their 30s want to discuss family planning. General health and weight are also concerns, but thirtysomethings start to get serious about having (or not having) children.
She refers a lot of those patients to Illume Fertility, which has offices in Stamford and other locations. Spencer Richlin, a reproductive endocrinology and infertility specialist at Illume, says he routinely sees people in their 30s who are opposite-sex couples, same-sex couples, single moms-to-be and women who want to freeze their eggs for future use, along with men who want reproductive health checks. “They want to be proactive,” Richlin says. “Maybe they’re in their early 30s and they want to know how their sperm count is. They want to know about their reproductive potential before they even try. We’ll check a woman’s ovarian reserve to see how good the ovaries are.”
Richlin’s biggest advice is to be as healthy as you can be prior to a pregnancy. Illume has nutritionists, yoga and acupuncture available for anyone who wants to work on overall health before attempting to conceive. “Let’s say you have pre-diabetes. You really could have fought it off with diet and exercise, but you’re not in the greatest shape—well, guess what? Being pregnant is going to set you up to be a straight diabetic,” Richlin says. “It’s the same with things like hypertension. Maybe you still have time to get your blood pressure down.”
His recommendations for eating healthier include yogurt, walnuts, almonds, proteins, vegetables and fruits, “not fast foods and sugary foods.” And, he recommends adding in a fun form of exercise, like cycling or walking. Cut down on drinking and smoking, and work on sleeping better.
“The other thing that’s very out there is freezing eggs,” Richlin says. “People are coming in between the ages of 31 and 34, and they’re doing in vitro and freezing their eggs. If they ever need to use them down the road, [the eggs] act like they were at the younger age.”
BREAST & COLON SCREENING
During the 40s, Bal says, it’s usually time for screenings to catch breast and colon cancer. In some cases, screenings also start for prostate cancer, she says: “If you’re high risk with a family history, we’re now starting with males in their mid- to late 40s.”
The thought of a colonoscopy scares many 40 year olds, Bal says. “They get this look—they know they must prep the night before. It’s a procedure that requires you to lose a day of work and you need to find somebody to drive you to the appointment. And, yet, the procedure is close to 100 percent in detecting cancer in the colon.”
Darlene Negbenebor, a gastroenterologist with Stamford Health, says what doctors are looking for in a colonoscopy is not actually cancer. “We’re looking for polyps, which are pre-cancerous legions that, over many years, will turn into cancer,” she says. The polyps are removed during the colonoscopy, a procedure that is easiest when the polyps are still small. Usually, Negbenebor says, the whole process can be completed in a single visit. “It has evolved quite a bit from when we started doing colonoscopies,” she says. “It’s a small-volume prep: one dose the night before, one dose the morning of the procedure. The taste hasn’t gotten much better, but the volume that you have to drink has improved.”
And, she adds, most patients feel no pain during the procedure. Propofol is administered for conscious sedation. “It’s not the same as general anesthesia,” she says. “You’re in a relaxing sleep, you’re breathing on your own, and you can be awoken.”
If the colonoscopy reveals a condition such as diverticulosis, Negbenebor says, she usually advises lots of water and a high-fiber diet. That means green leafy foods and certain cereals. “The ones that are on the upper shelves, like Kashi, those are great,” she says. “Most people use generous bowls, so you’ll get about 20 grams in just your morning cereal. The goal is 25 to 35 grams a day for anyone with the issue of constipation.”
After the big 5-0, Bal says, it can be time to discuss medication for persistent conditions. Cardiovascular screenings come into play for plaque buildup that can lead to a heart attack or stroke, and some people experience arthritis. “People start to get back pain, knee pain, joint pain,” she says.
Mario Gioia, a cardiologist at Stamford Health, says his job is to discern whether a person is experiencing true cardiac pain or something else. “Things to look for if it’s cardiac chest pain or a heart attack is that it’s the sternum, right in the middle of the chest, and it feels like somebody is sitting on that part of the body,” Gioia says. “Sometimes it radiates to the left arm, the right arm, the back of the jaw, the neck. Sometimes there’s symptoms of nausea, sweating. Other characteristics can include exertional pain, because cardiac chest pain will get better with rest.”
Gioia says his team will do a checkup that includes not just symptoms, but also family history and other factors, to determine the risk of coronary disease. After that, decisions are made about testing, including outpatient procedures such as an EKG and a stress test. “If everything’s normal, that provides a ton of reassurance to the patient,” he says.
He’s also seeing more requests for a calcium score. “It’s a CAT scan that’s not covered by insurance. Depending on the state you live in, it’s $100 to $200 for a test that only lasts for a few minutes, but it looks at the calcium levels in the arteries that feed blood to the heart,” he says. “The test results enable a health care professional to estimate how much calcium is in there; the more you have, the more at risk you are of having a cardiac event over a 10-year period.”
If that risk is high, a statin medication might be prescribed. He calls statins “stroke-prevention pills” that are virtually risk-free. “There are some very rare side effects, maybe a little muscle soreness or GI upset, but the benefits far outweigh the risks,” he says.
Gioia’s heart-healthy food recommendations include a Mediterranean-style diet with “good fats” such as olive or canola oil, walnuts, fish, white meat without the skin, vegetables, legumes and fruits. “The less red meat, the better,” he says. “If somebody wants to have a burger now and then, that’s fine, but try to limit it to once a week at most.”
In terms of exercise, Gioia says, the key is at least 150 minutes a week of moderate cardiac exercise—about 30 to 45 minutes a day, four or five days a week. “For some people, walking is just enough,” he says. “Swimming is great. Biking is great. Running, jogging is obviously great. Even strength training is great.”
Matt Fedro, site manager of HSS Sports Rehab provided by Stamford Health in Greenwich, adds that it’s key for people to work out in ways that don’t cause additional problems. “The vast majority of injuries we see come back to the fact that somebody did too much too soon after doing too little for too long,” Fedro says.
He recommends outlining a plan, such as aiming to walk a certain number of steps each day, leading up to a certain number of miles each day. “A lot of people don’t get more than 2,000 steps a day,” Fedro says. “Good research shows that walking more decreases heart problems, cardiovascular problems and mortality.”
Or, he adds, try a fun form of exercise such as pickleball. “Find a way to gradually ease into it, maybe with a trainer or a coach to make sure you don’t do too much,” he says. “The best thing for any sort of arthritic condition is to do things with less impact on your joints. You may need a little more supervision, or some injections or medications to help with the pain, but it comes down to needing to get stronger. You need to move.”