Don’t dismiss niggles as sign of ageing

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old people morguefile smaller morguefile.com 'There's a great long list of things that people put down to getting older.'

London - Postwoman Lynn Hill used to pride herself on her ability to keep up with younger colleagues. She’d previously been in the RAF and says: “I’d always been physically fit, and even though I was a 5ft 4in mum-of-one, I held my own with the 6ft 4in lads of 20 to 30.”

However, when she reached her mid-40s, her energy levels started to flag.

“Whereas before I’d get up at 4.30am, go on my rounds, get home at 2.30pm and do housework, I was really struggling to stay on top of my chores,” says Lynn, 50, who lives with husband Graham, 47, a farmer, and their son Andrew, ten.

“I needed a nap most afternoons, but I just thought: ‘That’s it — I’m getting on.’ “

Tiredness wasn’t her only problem. She also needed the loo more often.

“I never felt as if I’d emptied my bladder properly,” says Lynn. “It started after I had surgery for a prolapsed womb in 2012. I mentioned it to the staff but they said my pelvic floor muscles were weak due to my age and the fact my son had been a 9lb baby.”

In fact, her complaints were nothing to do with her age: Lynn had a tumour on her ovary that was pressing on her bladder.

For 18 months she lived with the symptoms — and then a more urgent need to open her bowels — until one day in March 2012, she felt so exhausted doing her rounds, she had to sit down. A colleague encouraged her to go to her GP, who sent her to A&E. A scan revealed the pineapple-sized tumour.

“The doctors said they were 95 percent sure it was malignant, and suddenly my world caved in,” says Lynn. “My first thought was: ‘How do I tell my husband and my son?’ He was only eight at the time. My parents were with me and my dad cried in front of me for the first time ever.”

The cancer had spread to her spleen, lungs and fatty tissues. Lynn underwent surgery to remove the ovarian cancer, then had chemotherapy and the drug Avastin, which effectively starves tumours of their blood supply.

“I am free of cancer now but doctors have told me it will come back — it could be in two years or 20,” says Lynn. “Had it been less advanced when discovered, there would have been every chance I would have lived to a grand old age and died of something completely different.”

Putting up with symptoms as just a sign of old age is a common problem, says Dr Laurence Buckman, a GP in North London.

“There’s a great long list of things that people put down to getting older,” he says. “For example, they often think getting gradually more breathless is just a result of age and being less fit, but it can be a sign of heart problems.

“Women sometimes think night sweats are the menopause, but in very, very rare cases they can be a sign of a virus, Hodgkin’s disease or TB. If you have two or three vague symptoms, it’s time to visit your GP.”

So what are the symptoms to watch for — and what do you not need to worry about? Here, the experts explain …

 

GOING TO THE LOO MORE OFTEN

What’s normal: As women reach the menopause — on average around 51 — oestrogen levels drop, making the bladder and surrounding muscles less flexible. Oestrogen helps produce collagen, the protein that makes skin and tissue elastic.

Men also become more prone to a weaker bladder from around 50 as their prostate, the gland that sits at the neck of the bladder, tends to grow with age.

“By 50 to 60, a significant number of men have an enlarged prostate, which interferes with the flow of urine, so the bladder compensates by making a man go in smaller quantities more frequently,” says Zaki Almallah, a consultant urologist at the Birmingham Bladder Clinic.

With age we also produce less of the antidiuretic hormone that acts on the kidneys to cut urine production at night and ensure sleep.

“After 50, going to the loo eight times or so during the day and even getting up once at night is normal,” says Mr Almallah. “As long as your urge to go isn’t affecting your quality of life, and your urine is a pale straw colour, there’s no reason to worry.”

What’s NOT normal: If you have an increased need for the loo and blood in your urine, see your GP, as this can indicate bladder cancer. Most cases are in the over-40s.

Needing to go to the loo more than twice at night if you’re a man and experiencing a weaker flow or urgency can be a sign of an enlarged prostate or prostate cancer.

If women have a poor stream of urine, this can be a sign of prolapse, where the bladder, womb or bowel has dropped out of place and is obstructing the flow. “If caught early, pelvic floor exercises can strengthen the muscles to help support the prolapse,” says Mr Almallah. “If left, it may worsen, and surgery may be the only option.”

Going to the loo more often but passing less urine each time can be a sign of chronic kidney disease, affecting one in five men and one in four women between 65 and 74.

It can be treated early with medication. But in rare cases needing the loo much more can be a sign of advanced ovarian cancer.

 

ASKING PEOPLE TO SPEAK UP

What’s normal: Hearing deteriorates from 25, but the decline is more marked from 60, says George Murty, consultant ear, nose and throat surgeon at University Hospitals Leicester. It’s caused by the decline in hair cells in the inner ear and nerve fibres in the hearing nerve.

“Higher frequencies fall off more quickly than the lower frequencies, so some people find it harder to hear female voices as they get older,” explains Mr Murty. Consonants are situated in the higher frequencies, so you may struggle to hear these, too.

“People often speak more loudly to someone older, but they’d do better to pronounce words more clearly and emphasise the consonants.”

What’s NOT normal: Age-related hearing loss should affect both ears equally. If it affects only one ear, seek medical help, as it could be a virus or bacterial infection.

Or the tiny blood vessels may have spasmed or become blocked, disrupting blood supply to the inner ear, says Mr Murty. These are treated with steroids and antibiotics to improve blood supply.

If hearing loss on one side is gradual, there are several possible causes, including a benign growth on the hearing nerve, glue ear — where the middle ear becomes filled with fluid — or a cholesteatoma, an abnormal collection of skin cells in the inner ear. This can be removed surgically.

 

FEELING BREATHLESS

What’s normal: Breathlessness is a common problem with age and is often linked to becoming less active and a sign the heart and lungs are not distributing enough oxygen around the body. “Becoming breathless on exertion is normal if you have reduced your activity levels,” says Dr Sundip Patel, a consultant cardiologist at London Bridge Hospital.

What’s NOT normal: Feeling increasingly breathless, not just when exerting yourself, and being unsteady on your feet could be a sign of heart failure — when the organ is not pumping blood efficiently. It could also suggest a leaky heart valve blocking blood.

Another possible cause is “silent” angina, that causes breathlessness (on mild exertion) and unusual tiredness, but not the pain on exertion that typically characterises angina.

Silent angina tends to affect the over-50s, says Dr Patel. Angina occurs when blood vessels to the heart are partially blocked.

“If you become breathless doing minimal effort activities and feel wiped out doing something you could do without great effort six months ago, that’s a cause for concern.”

Heart failure can prove fatal without treatment such as beta blockers and ACE inhibitors that lower blood pressure, reducing strain on the heart. Medication such as glyceryl trinitrate which relaxes blood vessels, can help with angina.

 

YOUR VOICE SOUNDS WEAKER

What’s normal: The vocal cords — folds of elastic muscle that stretch across the larynx — can slacken with age, and many people notice their voice gradually becoming weaker from about 60. Women’s voices may deepen after the menopause, possibly an effect on the vocal cords of the lack of oestrogen.

What’s NOT normal: A rapid drop in the strength of your voice over a period of months could be down to polyps or a cyst on the vocal cord, or paralysis of the vocal cords due to a virus. Or it could be the first sign of lung cancer pressing on the nerve supplying vocal cord muscles. Polyps and cysts can be treated with surgery.

 

HAVING HEART PALPITATIONS

What’s normal: All ages experience heart palpitations — fluttering sensations in the chest. It is a brief off-beat, often caused by stress, not enough sleep or drinking too much coffee, rather than a heart problem, says Dr Patel.

What’s NOT normal: If your heart is fluttering or beating strangely, and you have other symptoms, such as feeling very tired and faint, it could be a heart block — a disruption to the electrical signal making it beat. Five to 10 per cent of over-70s have this, and while it causes no problems for some, for others it can be life-threatening and require a pacemaker.

 

LIKING STRONGER SCENTS

What’s normal: People typically favour ever-stronger perfumes with age. “Your sense of smell starts gradually dropping off, from about 55,” says Mr Murty. This could be down to the loss of nerve endings in the nose or declining levels of mucus, which keeps odours in the nose.

What’s NOT normal: A rapid loss of sense of smell — within months — is often caused by nasal polyps, small swellings in the lining of the nose.

“These aren’t dangerous and can be corrected,” says Mr Murty.

Cancer in the nose lining and sinuses, although very rare, can also affect smell.

 

GENERAL ACHES AND PAINS

What’s normal: Odd twinges after 40 are normal and not necessarily arthritis. “Joints don’t always deteriorate with age”, says Professor Philip Conaghan, a musculoskeletal expert at Leeds University. However, we lose muscle bulk as we get older, so the joints become less well supported, leading to pain.

What’s NOT normal: Stiffness lasting more than an hour in the morning that eases during the day can indicate rheumatoid arthritis. This affects more women than men, and starts between 30 and 50.

The affected joint may look hot, red and be painful. It is caused by the immune system attacking the joints. Medication can stop the inflammation damaging the joints.

If, as well as back pain, you get muscular weakness in your legs and feet and any loss of bowel or bladder control, the nerves operating the muscles are being squeezed, risking long-term damage, and you may need surgery, says Dr Mike Platt, a pain specialist for Imperial College Health NHS Trust.

“Prolonged pain bad enough to wake you at night, especially if associated with weight loss, can be sign of secondary bone cancer,” adds Professor Conaghan.

 

FORGETTING WHY YOU WENT UPSTAIRS

What’s normal: Can’t remember why you went upstairs? Forgotten where you left your car? Often it is a normal part of ageing, says Robert Howard, professor of old-age psychiatry at King’s College, London. “Our memory declines from our late 20s,” he says.

“One theory is we may produce less of a key protein as we age. However, sometimes you may struggle to remember something simply because you are doing too much at once and you aren’t giving it your full attention.”

What’s NOT normal: While people often think not being able to remember the past means they have dementia, it’s not necessarily the case.

“Alzheimer’s disease — the most common form of dementia — involves a profound disturbance to recent memories,” says Professor Howard. For instance, forgetting what you did that morning or what somebody’s just told you.

 

STRUGGLING TO READ THE NEWSPAPER?

What’s normal: Over-40s can find it harder to read things closer to them due to presbyopia, changes to the lens making it harder to focus up close.

It is also common to see floaters, small particles of protein in the vitreous — the jelly-like substance between the lens at the front of the eye and the retina at the back.

As you age, the vitreous becomes more liquid, and protein strands in it can break away. These are harmless, but float across the vision.

What’s NOT normal: The vitreous can pull away from the back of the eye altogether, causing a sudden shower offloaters.

“People experiencing this should be examined, as in two percent of cases, as the vitreous pulls away it can cause a slight tear to the retina,” says James Ball, a consultant eye surgeon from Optegra Eye Hospital in Yorkshire. ‘Without treatment you may suffer irreversible blindness.’

Blurred or double vision can be a sign of giant cell arteritis — when blood vessels to the head and neck inflame, interrupting blood flow to the eyes, leading to blindness.

Other danger signs include seeing straight lines as wiggles. This may be wet macular degeneration, a leading cause of vision impairment in the UK. - Daily Mail

 

Additional reporting: DIANA PILKINGTON.

* Ovarian Cancer Action: ovarian.org.uk.

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