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National Men's Health Week a Chance to Take Stock

By Dr. David C. Pate, News and Community
June 10, 2013

It’s National Men’s Health Week, and Father’s Day Sunday. Us dads always need new ties! 

Most importantly, we need our health. A lot of people count on us. I have asked Dr. Steve Montamat to share what men need to know about health – and what we need everyone else to nag us about! His contribution follows. Please read this and forward the  link to the men in your life.

I’ve been a general internist at St. Luke’s for nearly 20 years. Yet when I think about men’s health, the first impression that comes to mind is decidedly nonclinical.

It’s that the middle-aged man in my exam room for the first time sits there looking like he just got sent to the principal’s office. 

He usually says something like, “Doc, my wife has been after me to get a physical exam for years, and I finally decided to come in.” 

My hope is that by the end of our visit, my new patient feels that the visit was fairly benign, and that he now has a plan for maintaining his health that allows him to live his life successfully.

It’s troublesome, and it concerns me. Men use less medical services than women, and women’s needs for obstetrical or gynecological care only partially account for the difference. 

Stoic behavior, social stigma, a sense of fatalism, and distrust of the medical system also contribute to the difference. Men’s irregular contact with doctors means they often do not receive any preventive care for potentially life-threatening conditions. More than one out of four men, a full 29 percent, say they wait “as long as possible” before seeking help when they feel sick or are in pain or concerned about their health.

Here, I’m focusing on health issues specific to men, but most disease and causes of death are not gender-specific. Simple actions can prevent you from enduring a miserable existence or suffering premature death, and allow you to live a full and vigorous life.

Here are my seven basics:

  • Don't smoke.
  • Eat a healthy diet.
  • Manage chronic conditions such as high cholesterol, high blood pressure, or diabetes.
  • Include physical activity in your daily routine.
  • Maintain a healthy weight.
  • Limit alcohol.
  • Manage stress.
And it’s with men in mind that I offer the following suggestions:

Periodic health visits

It’s a good idea for adults less than 50 years old without chronic conditions to make health maintenance visits every three years, and for adults 50 years and older to make annual visits. Most insurance plans now cover wellness checks.

Prevention

Specific to men are the following:

  • Cholesterol: Men age 35 years and older should be screened for lipid disorders, and men ages 20 to 35 years for lipid disorders if they are at increased risk for coronary heart disease.
  • Diabetes: Men with hypertension or high cholesterol also should be screened for diabetes.
  • Aspirin use: This is advised for men ages 45 to 79 years when the potential benefit due to a reduction in myocardial infarctions outweighs the potential harm due to an increase in gastrointestinal hemorrhage. Your healthcare provider can help you determine this.
  • Abdominal aortic aneurysm: This is a one-time screening for abdominal aortic aneurysm by ultrasonography in men ages 65 to 75 years who have ever smoked.
And here’s a screening that is not gender-specific but is noteworthy:
  • Colorectal cancer: Get a colorectal cancer screening test at age 50, or possibly earlier if there is a family history of the disease.
Accidents

The leading cause of death for men through age 44 is “unintentional injuries.” Heart disease and cancer take center stage at age 45 and older. 

Motor vehicle accidents account for the majority of accidental deaths in younger adult years for men.  These accidental deaths are usually preventable. Don’t drive when you feel sleepy. Don’t drink alcohol and drive. Wear your seatbelt.

Testicular cancer

While routine screening exams for testicular cancer are not recommended, men should certainly report any notable lumps or bumps in their testicles. This cancer is curable in the vast majority of cases, but only accounts for 1 percent of cancer in men.

Prostate cancer

Detecting and treating prostate cancer in men is a vitally important aspect of men’s health. Aside from non-melanoma skin cancer, prostate cancer is the most common cancer among men in the United States.

Although screening for prostate cancer with PSA can reduce mortality from prostate cancer, there remain important concerns that the benefits of screening may be outweighed by the potential harm to quality of life, including the risk for overdiagnosis, in instances where the cancer would not have caused illness or death, and treatment complications, mainly loss of urinary control and impotence. 

This is still controversial among the medical professional community. The most important intervention is informed decision-making in conjunction with your primary care provider or specialist. It is recommended that these discussions begin at age 50 in average-risk white men and at age 40 to 45 in black men, men with a positive family history, and men who are known or likely to have the BRCA1 mutation. Men who are at increased risk of prostate cancer because of race or family history may be more likely to benefit from screening.

Sexual health

This is another area where men may not seek attention because of pride or fear.

There are countless advertisements now for “low T.” A low level of the male hormone testosterone can result in unwanted symptoms, such as decreased libido, energy, or mood. Measuring a morning testosterone level can detect a low level, but many other factors can lead to these symptoms as well. 

If treatment for testosterone deficiency is needed, there are a variety of ways to administer testosterone that can be discussed with your healthcare provider. 

Erectile dysfunction is another well publicized disorder with available treatment options, but might also indicate a workup for illness that may be associated with this condition, such as cardiovascular disease. Again, talk to your doctor.

Suicide

While depression is more prevalent in women, men commit suicide at four times the rate of women.  Screening for depression and suicide risk requires that men have access to a trusted healthcare provider, which can allow an intimate and honest conversation to occur. Dr. Leslie Nona’s recent blog entry goes into more specifics about how suicidal behavior can be addressed to prevent tragic loss to our families and community.

Takeaways

Establishing a relationship with a primary care provider can help you navigate all of these health issues.  Make sure that discussions with your provider are based on your personal health goals. If you are 30, it may be to run your first marathon. If you are 50, it may be to stay healthy enough to go hunting in the fall.  And if you are 80, it may be to stay fit enough to get another ski season under your belt or travel to a grandchild’s graduation. 

For all men, whatever the goal may be, optimizing health to enjoy life events is worth getting sent to the “principal’s” office!

An excellent general resource on men’s health issues can be found at the Centers for Disease Control and Prevention website at http://www.cdc.gov/men/. For more information on men’s health from St. Luke’s Healthy U, go to http://www.stlukesonline.org/healthyu/news.php


About The Author

David C. Pate, M.D., J.D., is president and CEO of St. Luke's Health System, based in Boise, Idaho. Dr. Pate joined the System in 2009. He received his medical degree from Baylor College of Medicine in Houston and his law degree from the University of Houston Law Center.