Primary Care Physician
Dr. Orrange received her BA in Biology at the University of California, San Diego, and a Masters Degree in Health Sciences at the Johns Hopkins University School of Public Health. She received her MD from the USC Keck School of…
So THIS is 40… A Unisex Guide to What Happens From Head to Toe
Posted in Healthy Eating by Dr. Sharon Orrange on Dec 26, 2012
As you will see, your 40s are a “happy” time. The 40s also bring many new and interesting complaints affecting men and women alike. Here is your unisex top to bottom guide to medical issues that may sprout up in your forties.

- Hair loss. The 40s and hair are like oil and water. The most common cause of hair loss in men and women, androgenic alopecia, will leave half of white men with male pattern balding by the end of their 40s. Androgenic alopecia is an issue for men and women but the bright spot here is it looks like finasteride 1 mg (Propecia) for men and finasteride 5 mg for women may help with this “situation.” So ask your doctor about it.

- Mood. Depression and anxiety disorders are more prevalent in younger adults than older adults. The 40s tend to bring some relief from mood disorders that hit in your late teens and early 20s.

- Headaches: Your 40s bring good news for migraine sufferers as the number of folks affected by migraines drops at age 40. For women, this will take a small bump up again during perimenopause. Cluster headaches in men also decrease in frequency in your 40s. Good news for the head.


- Look around at 40 some-things in restaurants, they will be pulling out their new readers or holding a candle to the menu to read it. After the age of 40, you'll notice it's more difficult to focus on objects up close because of presbyopia -- a hardening of the lens inside your eye. You will compensate at first by holding your reading material far away but eventually you will need reading glasses, multifocal contact lenses, or multifocal eyeglasses.


- Gum disease (periodontal disease) is more common in your 40s and is an important cause of tooth loss, but also a risk factor for heart and lung disease. Forty year olds can swap stories about the dreaded deep cleaning of the gums - scaling and root planing - yes it’s like a beating with a wet hose but it has an important payoff.


- The 40s are pretty good in the lung department but here are some depressing facts: we make new alveoli until about age 20, after that the lungs begin to lose some of their tissues and our chest wall changes. Does this mean our lungs get weaker? Umm, yes they do.

- Changes in vital capacity occur with age, so by the time you are 40, forced vital capacity (FVC) decreases between 0.15 and 0.3 liters per decade. Interesting point here is that age-related changes in women decline less steeply.


- Think 40, as in 140. High blood pressure is defined as blood pressure greater than 140/90. The number of folks diagnosed with high blood pressure takes a huge jump at 40, with thirty percent of Americans aged 40-59 carrying a diagnosis of high blood pressure.

- Please remember here you will feel FINE even with high blood pressure and might not know it is there, which is why we still call it “the silent killer.” Pop in to a drug store or to your primary care doctor to check your pressure so you can start on meds or make lifestyle changes to lower it.

The Gut:

- Gallstones are more likely to occur when you are 40 and older. Pain in your right upper quadrant after eating a large or heavy meal is your warning sign.

- Gastro-esophageal reflux disease (GERD) also hits in your 40s and your tolerance for spicy foods will be much lower. Thai and Indian food won’t go down like it did in your 20s. Over the counter medications can help you out including omeprazole (Prilosec OTC,) Tagamet, and Zantac as examples.


- Age spots will pop up (literally) in your 40s. Seborrheic keratoses are age and sun related scaly tan - brown spots that may look like corn flakes (sorry for the food reference.) They do not have the potential to become skin cancer and can be left alone or lightened with freezing (liquid nitrogen.)

- Cherry angiomas may visit you in your 40s as bright cherry red small raised dots that are not cancerous.

- More sinister skin cancers: basal cells and squamous cell carcinomas will also start in your 40s so a once a year skin check with a dermatologist isn’t a bad idea.

The Back:

- Low back pain is the fifth most common cause of visits to the primary care doctor and you won’t escape your 40s without it. Back pain is a part of life but here is something to cling to: for patients with acute low back pain 75% to 90% report improvement within 1 month.

- Most low back pain in your 40s has a mechanical cause and the spine and/or surrounding structures are angry.

- Lumbar strain or sprain causing your low back pain can be further divided into 3 problem areas: degenerative disease (arthritis,) discs or facet joints.

- Conservative therapy (anti-inflammatories, home exercises, and physical therapy) is the way to go.

Hips and Knees:

- You are bored of hip and knee pain and so, most likely, is your doctor. Yes they will ache in your 40s and yes there are many causes but it is most likely degenerative changes in the joints (aka osteoarthritis.) Enough said.


- 20 year olds don’t have foot pain, 40 year olds do. Pain in the foot and ankle will bug you in your 40s.

- A staggering 11 muscles have tendons crossing the ankle, with 4 major ligaments providing the stability.

- Here are the repetitive strain injuries your 40 year old foot and ankle may teach you: 1. Pain in the metatarsals (the bones in your midfoot) causing pain in the ball of your foot. This is most common in the second toe. 2. Pain in your heel and sole when you set your foot down in the morning is most likely plantar fasciitis. 3. Two culprits for ankle pain in 40 somethings are Achilles tendonitis and Posterior tibialis tendonitis. For all of these anti-inflammatories, rest and ice, and physical therapy are a place to start. Chronic worsening pain needs a visit to a foot doctor.
Keep Calm and Forty on…

- Dr. O


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oh goody, it just gets worse.
By catsr  Jan 30, 2013
From the perspective of a 64 year old, I found this article quite refreshing.

I wasn't doing very well in my 40's, actually, until I had to give up chocolate. Then, after being off chocolate for 3 months, I started feeling at least 5 years younger. Just sayin'.
By Fern RL  Dec 29, 2012
This a really negative and depressing article. Why the hell would anyone want to read this except to hone in on negatives as they age?? Some of these probably don't even happen to all humans in there 40's. Articles like this just make people paranoid and fearful!
By azure111  Dec 26, 2012
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