Monday, April 6, 2015

Focus on Men’s Health

by: Jack L. Zaremba, M.D. Internal Medicine at TRINITY MEDICAL CLINICS at Trussville

Although we are focusing on men's health issues, this topic is also for the ladies in their lives who often are instrumental in noting men's problems and encouraging them to seek medical evaluation. Also a wife's participation in healthy behaviors has been shown to improve the outcome of both partners.

There are obvious differences between men and women not just with respect to their relative risk of certain diseases but with their participation in periodic health screenings. Women, perhaps due to their role in child bearing and nurturing, are more likely to participate in periodic health examinations than men. Men, on the other hand, may have an attitude that if it's not broken, don't fix it. Some men may give more attention to the preventive maintenance of their trucks, boats and lawn mowers than their own body. Men would not fail to give attention to a check engine light but they may have a tendency to continue to drive on ignoring certain health warning signs.

Certain medical conditions could be detected earlier and have more effective treatment if men would take advantage of periodic health examinations and preventive medicine screenings, as appropriate to their age and risk factors. Delay can lead to serious difficulties or even disaster. The emphasis now is not just to cure disease but to try to prevent its occurrence or to mitigate its consequences. This is the case where an ounce of prevention may be worth a pound of cure. Men should consider a periodic examination every 1 to 3 years starting at about age 18-25 and then yearly after age 50 depending on risk factors.

Let's turn our attention to some of the mile markers on a man's road of health. Consider these as guidelines, and for further direction I would encourage discussions with your physician. Men at age 18 to 24 could focus on accident prevention, seat belt usage, tobacco abstinence, alcohol moderation and incorporating healthy life styles such as aerobic exercise for approximately 150 minutes per week, weight reduction to a BMI of Iess than 25, decreasing waist circumference and a heathy diet. This may reduce premature cardiovascular related deaths by up to 40%. Also, perform screening for hypertension which is the most common chronic disease. The goal is to keep the systolic pressure less than 140 mm and the diastolic less than 89 mm.

Screening for testicular cancer by monthly self-exams is prudent, particularly if there is a history of undescended testes as a child.

Promote skin health through avoidance of UV light exposure and the use of sun screen is appropriate at any age However, those with a positive family history of melanoma should be cautious and have their skin checked - particularly those areas that are not sun exposed.

At age 25 - 44 consider screening for fasting lipid profile to achieve a target LDL (bad cholesterol) lower than 100 and HDL (good cholesterol) higher than 40 as well as triglycerides less than 150. Diabetes Mellitus Type 2 can have a prolonged asymptomatic period before one develops weight loss with frequency of urination and thirst. Those at higher risk have one positive family history of diabetes as well as those with Metabolic Syndrome consisting of hypertension, dyslipidemia, increased triglycerides and central obesity. We can't affect our age or family history but we can improve our diet, exercise and weight reduction.

At age 40-45 consider having a prostate evaluation depending on symptoms, age and family history. It is said that there are two types of men. One type has prostate problems and the other type will develop prostate problems if he lives long enough. Benign prostate hypertrophy is the enlargement of the prostate gland that may cause symptoms of urinary frequency and urgency, as well as hesitancy and nocturia. A Digital Rectal Examination can evaluate size and consistency of the prostate. Interventions include diet modification to reduce caffeine and alcohol and treatment with medications such as alpha blockers.

At age 45-64, having a prostate cancer screen to include a Prostate Specific Antigen (PSA) and a complementary digital rectal examination is prudent for men with a first degree relative with prostate cancer and also African American men who are at higher risk. It is important to know your risk and to know your PSA number - particularly when your PSA number is elevated. The natural history of prostate cancer is variable. Early detection may have a beneficial effect on treatment, although there is conflicting data on mortality from prostate cancer and PSA screening. Know your risk and consult with your physician if you are over 70 years of age.

At age 50 it is time for men to perform a "gut” check. A screening colonoscopy is recommended. This could be performed earlier if there is a family history of colon cancer or symptoms. Colon cancer is preventable if detected early by colonoscopy.

A periodic chest X-ray and pulmonary function test for smokers may be indicated depending upon their risk. Cardiovascular screening may be indicated depending on symptoms, age and risk factors. An ophthalmological exam, at about age 50, for glaucoma followed by yearly exams thereafter is recommended.

Erectile Dysfunction can have multifactorial causes. Encourage life style changes such as weight loss, regular exercise, moderate alcohol consumption, correct any sleep disorders and rule out organic causes, as well as medication side effects, stress and psychogenic causes. Treatment with oral Phosphodiesterase 5 inhibitors can be effective. However, they can affect blood pressure and should not be used with nitroglycerine. Those with cardiovascular disorders should check to see if they are “safe” for sex using these medications.

Low testerone level - or low T- can often be seen in direct consumer marketing. Low T can be related to delayed sexual development, Kleinfelter's Syndrome, sexual dysfunction, infertility, decreased muscle mass, obesity, bone fractures, depressed mood and decreased stamina. Yet, many of these symptoms are non-specific and could be related to other causes. An association between two things does not mean that one causes the other. Age related decrease in testerone may begin in the 40s. One must document the early morning low T level in the presence of symptoms and in the absence of other causes. There is increasing interest in normalizing low T levels through testerone replacement therapy. Many studies indicate the normalization of low T levels can promote cardiovascular health, decrease obesity, improve glycemic control, and improve libido, lean muscle mass and quality of life. Recently a study indicated that testerone replacement may increase the risk of cardiovascular events. However, this study is inconclusive. Therefore, you should discuss the risks and benefits of testosterone replacement therapy with your physician. Treatment should be accompanied by surveillance of PSA, HCT, OSA symptoms as well as risk of DVT

At age 65, consider screening for Abdominal Aortic Aneurysm particularly for men who are, or have a history of, smoking.

Consider recommended immunizations for disease prevention such as Influenza, Pneumococcal, Shingles Vaccine and Tdap.

There are some warning signs or red flags that could alert us to potential problems ahead.

These include:

• Vision changes in one or both eyes

• Oral lesions or sores that don't heal particularly in smokers or smokeless tobacco users

• Hoarseness that is persistent

• Difficulty swallowing

• Chronic cough

• Chest pain or Dyspnea on exertion or atypical exertional pain such as in the arm or jaw

• Unusual bleeding such as nose bleeds

• Change in bowel or bladder function or blood in the stool or urine

• Chronic indigestion

• Lumps on the body or breasts (male breast cancer is relatively rare but does occur)

• Change in the color, size or shape of a wart or mole

• Confusion, difficulty with speech, vision or use of an arm or leg could be a symptom of impending

• Sleep disturbance such as excessive snoring or apneic pauses in breathing- particularly in a man
whose neck size is greater than 17 and/or BMI greater than 30

• Consider family CPR training to intervene early and save lives in a cardiac arrest situation. The life saved may be yours.

• Also attention to disaster preparedness and dangerous weather preparation.

Perhaps two-thirds of our ailments could be related to our life style. The foundation for health is healthy habits of diet, exercise and weight reduction as well as optimizing our lipid profile and reversing other risk factors. Know your risks and change your direction accordingly, as well as participate in appropriate periodic medical health screening examinations.

Here’s looking forward to your life's road being long and healthy.

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