Wednesday, March 21, 2018

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Take care of Your Health, Man!

Written by  Suzanne Ramsey


Prevention is the key

In a filing cabinet at my house, there’s a 2-inch-thick manila folder labeled “Suzanne Medical” that contains documentation from a decade or so of medical appointments — mammograms, annual physicals, that time I thought I had a gallstone, you name it.

And my husband’s file? What file?

It’s no secret that men are known for not seeking medical help until a limb is dangling or they’re bleeding to death or both. But like women, they’re not immune to health problems. In fact, WebMD reports that “of the 15 leading causes of death, men lead women in all of them except Alzheimer’s disease, which many men don’t live long enough to develop.”

So why the aversion to the physician’s office? Joel Silverman, MD, chairman of Virginia Commonwealth University Medical Center's Department of Psychiatry, has some insight.

“When your self-image and the expectations of others are that you are strong, in charge, invincible, then you do not ask for help,” Dr. Silverman says. “Why would you need it? This, of course, is paradoxical because the strongest, most successful people do surround themselves with smart, strong people who help them succeed.”

So, for all the wannabe Supermen out there, OurHealth talked with area physicians about health conditions that commonly affect men and how to prevent them. Here’s what they had to say.

Lung cancer

The American Cancer Society estimates about 115,610 men will be diagnosed with lung cancer in 2015, and 1 in 13 men will be diagnosed with the disease during his lifetime. These numbers include smokers and nonsmokers, although a smoker’s risk is much higher than a nonsmoker’s.

As for risk factors, physicians say smoking is most often to blame.

“The primary risk factor for the development of lung cancer is cigarette smoking, and that accounts for approximately 90 percent of all lung cancers,” says Attique Samdani, MD, a board-certified medical oncologist with the Virginia Cancer Institute. “Other factors include radiation therapy and environmental factors, including exposure to second-hand smoke, asbestos, radon and ionizing radiation. The role of dietary and genetic factors is not well established but may have some impact.”

What is ionizing radiation?

Ionizing radiation can damage living tissue by disrupting and destroying individual cells at the molecular level. All types of nuclear radiation — X-rays, gamma rays and beta rays — are potentially ionizing. Sound waves physically vibrate the material they pass through but do not ionize it.

Source: Gale Encyclopedia of Medicine

Symptoms of lung cancer include things one might expect, such as coughing up blood or a chronic cough, for example, but other indications aren’t so straightforward.

“Cough is present in 50 to 70 percent of lung cancer patients at presentation,” Dr. Samdani says. “Hemoptysis [blood in sputum], chest pain and shortness of breath are present in approximately 25 to 40 percent of patients with lung cancer at the time of diagnosis.

“Lung cancer can spread to any part of the body," Dr. Samdani continues. “Therefore, patients can present with headache, vomiting and seizures if there is involvement of the brain, and bone pain with bony involvement.”

Recognizing the symptoms and heeding them could mean the different between life and death. “The majority of patients with lung cancer have advanced disease at clinical presentation. Overall survival decreases significantly with advanced-stage disease and for those who have poor performance and weight loss.” says Dr. Samdani.

The American Cancer Society estimates that 86,380 men will die of lung cancer in 2015.


Heart disease and stroke

Heart disease is the leading cause of death for men in the United States. According to the Centers for Disease Control and Prevention, heart disease killed 307,225 men in 2009, which translates to 1 in 4 male deaths. The CDC reports that 70 to 80 percent of sudden cardiac events occur in men.

Despite these numbers, Antonio Abbate, MD, a cardiologist with the VCU Pauley Heart Center, says the risk of heart disease is underrated.

“I think one of the major problems is underestimating the risk of heart disease,” he says. “We are frightened about many things that are highly unlikely to occur — a terrorist attack, for example — but we don’t fear enough the No. 1 killer in the United States: heart disease. The risk is high.”

Among the risk factors for heart disease, Dr. Abbate lists genetics, an unhealthy diet, alcohol and drug use, stress, lack of exercise, diabetes, high blood pressure, high cholesterol and generally not taking care of oneself.

“Most men would never use low-grade gasoline for their car or give their dog bad food,” he says, “but they’ll poison themselves with fast and junk food.”

As for ways to avoid heart disease, Dr. Abbate recommends dealing with risk factors — “Tackle them hard,” he says — and recognizing and reacting to symptoms. According to the CDC, half the men who die suddenly of coronary heart disease have demonstrated no previous symptoms, but there are symptoms to watch out for.

“Chest pain, pressure and discomfort are typically symptoms,” Dr. Abbate says, adding that men also need to be aware of pain in the arm, jaw or back. “Other symptoms that are very important are shortness of breath, fatigue, tiredness and dizziness. Remember that risk factors are usually silent, so get checked.”

Heart disease also puts men at risk for stroke.

“Risk factors for stroke are divided into those an individual can control and those he cannot,” says Stacey Epps, MD, a neurologist with Bon Secours Neurology Clinic. “Men are already at a higher risk for stroke than females. In addition to gender, those that cannot be controlled are age (higher risk with advancing age), race (African Americans are at higher risk), and family history of stroke. We tell folks to be aware of these risk factors, but they cannot be changed.”

Risk factors that men might have some control over include smoking, high blood pressure, high cholesterol, diabetes, an unhealthy diet and excessive alcohol consumption. A daily aspirin regimen might reduce heart attack and stroke risk, but Dr. Epps says this approach is not appropriate for everyone. "Speak with your doctor about whether you should take a daily aspirin. Never start an aspirin regimen without speaking to your doctor first.”

Dr. Epps also recommends regular checkups with your physician and knowing the warning signs and symptoms of stroke. Recognizing symptoms quickly is very important, he says, because 1.9 million brain cells are lost every minute during a stroke, and some treatments are dependent on quick reaction time.

“Stroke symptoms typically come on without warning,” Dr. Epps explains. “Never ignore symptoms suspicious for stroke. There are treatments available, but one still has to get to the hospital as soon as [symptoms] are recognized in order to be eligible for treatment.

“The sooner a stroke is treated, the better the potential outcomes," he says. "The passing of time could make some patients ineligible for some treatments. Strokes typically don’t cause pain and therefore people will tend to ignore the symptoms.”

BE FAST to recognize stroke

The acronym BE FAST is a good way to remember stroke symptoms.

B — Balance difficulty.

E — Eye trouble (double vision, losing vision, etc.).

F — Face (drooping of a side of the face).

A — Arm (weakness/numbness of arm, leg or side of body).

S — Speech (difficulty with speaking or understanding speech or written words).

T — Time. Time is critical. If you suspect you or someone you are with is having a stroke, call 911 immediately for transport to the nearest certified stroke center. No matter the location, stroke treatment begins with emergency medical services. EMS will quickly identify a potential stroke in progress and call ahead to the hospital emergency department. This advance warning allows the emergency department and other staff to be ready and waiting to expedite treatment.

Source: Stacey Epps, MD 

Depression and suicide

While women are more likely to report a suicide attempt, men are more likely to succeed in killing themselves. This is according to the CDC, which reports that men are about four times more likely than women to die from suicide. Men represent more than 79 percent of all U.S. suicides.

As for why an estimated 40,000 people — about 31,600 of them men — kill themselves each year in the U.S., the online support group reports that untreated depression is the No. 1 cause of suicide. But why so many men?

“There are many factors, including that women ask for help with their depression and other things more readily than men,” VCU’s Dr. Silverman says. “Men employ more lethal methods, like firearms, whereas women tend to employ less lethal methods, like overdose.

According to Dr. Silverman, “Men are more likely to have substance abuse problems, which worsen their depression and make them impulsive. Some men have poor levels of social support, which is a protective factor against suicide. Men may be more vulnerable to the depressing effects of job loss.”

Among the risk factors, he says, are lack of social support, alcohol and drug abuse, job loss and genetics.

“We know that mental illnesses, like many other illnesses, have their risk increased by genetic factors,” he says. “A family history of depression is an important predictor.”

Warning signs of depression


Poor mood.

Reduced energy.

Crying spells.

Feelings of hopelessness and helplessness.

Changes in appetite.

Loss of sexual energy.

Thoughts of suicide or thoughts that life just isn’t worth it.

Source: Joel Silverman, MD

To avoid depression, Dr. Silverman recommends a healthy lifestyle, including a good balance of play and work. Substances such as alcohol should be used in moderation; having friends and exercising regularly are also important.

“Lastly, when depression starts, recognize that it is an illness and seek diagnosis and treatment from an experienced professional,” says Dr. Silverman.

Fortunately, there are a variety of treatment options for depression, everything from medication and psychotherapy to yoga, meditation and exercise.

“There are many effective treatments for depression,” Dr. Silverman says, “but patients must realize that they are dose-dependent, which means you have to have enough of the treatment in order for it to be effective. Penicillin may be the best drug for your pneumonia, but if you don’t take enough for long enough, it won’t work. There are effective medications and psychological treatments. Each works, and often both together work better than either alone.”

The problem, however, can be getting men to seek treatment.

“Men often feel shame and reluctance to seek help and would rather just suffer, which is not a smart strategy,” says Dr. Silverman. “The strongest people recognize their problems and get help. Most of us get a lot of help in our lives. We don’t grow our own food, make our own cars or do our own legal work, etc. Seeing the doctor makes sense.”


According to the 2014 National Diabetes Statistics Report, more than 29 million people — more than 9 percent of U.S. adults — have diabetes, a disease caused by having too much glucose, or sugar, in the blood. Of these, 15.5 million are men.

Most cases of diabetes are Type 2 — what used to be called adult-onset diabetes — which has been linked to being overweight or obese. Physicians say improved diet and exercise habits can go a long way in the fight against diabetes.

“You can do plenty to help avoid or delay the development of diabetes with simply a healthier diet and plenty of physical activity,” says Stephen P. Crossland, MD, a wound care specialist at the Chippenham Hospital Wound Healing Center and Diabetic Limb Salvage Program. “It has been shown that 90 percent of cases of Type 2 diabetes could be prevented or significantly delayed through healthier diet, physical activity and weight loss, when needed.”

Warning signs of diabetes

Increased thirst.

Increased hunger (especially after eating).

Dry mouth.

Frequent urination or urine infections.

Unexplained weight loss (even though you are eating and feel hungry).

Fatigue (weak, tired feeling).

Blurred vision.


Source: WebMD

Diabetes risk factors

Overweight or obese.

Sedentary lifestyle.

Diet high in sugar and refined carbohydrates and low in fiber and whole grains.

History of Type 2 diabetes in your immediate family (mother, father, sister, brother).

Risk increases with age.

Ethnicity – increased risk for African-Americans, Native American, Alaska Natives, Asian-Americans and Pacific-Islanders.

Source: Stephen Crossland, MD

If diagnosed with Type 2 diabetes, Dr. Crossland says there are numerous treatment options, among them, lifestyle changes, diet and exercise; oral medications; insulin, inhaled and/or injected; and new drugs that work in combination with insulin to improve blood sugar.

Skin cancer

Studies have shown that men are at higher risk than women for getting skin cancer.

“Statistics from 2008 showed that 35,000 American men would develop the deadliest form of skin cancer, melanoma, compared to 27,000 women,” says Jean Calhoun, MD, a dermatologist with Dominion Dermatology. A recent study showed incidence rates for men to be more than five times greater than they were 30 years ago, according to Dr. Calhoun.

Why more men than women? According to Melissa King, MD, a board-certified dermatologist with Richmond Dermatology & Laser Specialists, men are not genetically or inherently more likely to get skin cancer, but they are less likely to use sunscreen and don’t get the added sun protection from makeup, which often is the case with women.

Dr. King says that men are most commonly affected on the face, especially the nose and ears. "Ears stick out of baseball caps and most people don’t think to apply sunscreen there. Also, scalps of older men, due to hair thinning and hair loss. Third is the backs of hands and forearms. A very interesting and important fact is that statistically there are more skin cancers on the left side of the face, left hand and left forearm because sun comes through the car window.”

What are common signs of skin cancer?

An enlarging bump or red scaly area that has gotten bigger.

A lesion that bleeds with minimal trauma.

A mole that changes color.

Source: Jean Calhoun, MD 

The Skin Cancer Foundation estimates melanoma will kill 6,640 men in 2015, but there are ways men can reduce their risk.

Dr. King recommends avoiding the sun between 10 a.m. and 2 p.m., when its rays are strongest, and opting for shade when possible. “Also, it’s possible to have car windows tinted for UV protection,” she says. “That’s very important, especially for people whose work requires them to be in the car a lot, sales people, etc.”

Physicians also say to avoid tanning beds, use sunscreen, and wear hats and clothing that have a sun-protective rating similar to the SPF in sunscreen.

“One survey showed 47 percent of men never use sunscreen, while only 34 percent of women said they never use sunscreen,” Dr. Calhoun says. “This also includes sun-protective clothing.”

Men also are more likely to put off going to the doctor.

“Men are more likely to be diagnosed at a more advanced stage,” Dr. Calhoun says. “They may seek medical advice later. Since men have a high incidence of skin cancer on their back, this may make it more difficult for them to spot.”

Prostate cancer and other urological issues

The American Cancer Society reports that other than skin cancer, prostate cancer is the most common cancer in American men. The organization estimates that 220,800 U.S. men will be diagnosed with prostate cancer in 2015, and about 27,540 men will die from the disease. Further, the ACS says that 1 in 7 men will be diagnosed with prostate cancer at some point in his life.

“Prostate cancer typically occurs as men age,” says Michael Franks, MD, a board-certified urologist with Virginia Urology. “There are genetic and environmental factors that play a role in developing prostate cancer. African-American men are at a higher risk, 1 in 4, of developing prostate cancer than Caucasian men, 1 in 6. There is no one factor that causes someone to develop prostate cancer.”

Unfortunately, physicians say there’s not much that can be done to avoid prostate cancer if one is genetically predisposed to it. Most men also don’t experience symptoms of prostate cancer unless the disease has progressed, Dr. Franks says, so knowing your family’s history of prostate cancer is imperative.

“Men that have a sibling or father that has had prostate cancer have a two or three times greater risk of developing prostate cancer,” he says, adding that men who have a family history or are African-American should have prostate-specific antigentesting and a rectal exam in their 40s. “This information can be invaluable should prostate cancer develop in the future.”

What is prostate-specific antigen testing?

Aprostate-specific antigen test measures the amount of prostate-specific antigenin the blood.PSAis released into a man's blood by hisprostategland — a small, walnut-shaped gland that produces the seminal fluid that nourishes and transports sperm. Healthy men have low amounts ofPSAin the blood, but the amount ofPSAin the blood normally increases as a man'sprostateenlarges with age.

Source: WebMD

Dr. Franks also recommends diet and exercise as important factors in managing inflammation in the body, which can play a part in developing prostate cancer. "We recommend that men eat a heart-healthy diet, avoid fatty foods and try to reduce stress. All play an important role in overall general health,” he says.

There are other conditions that should prompt a visit to the urologist as well, among them benign prostatic hyperplasia, commonly referred to as enlarged prostate.

What is benign prostatic hyperplasia?

Prostate gland enlargement is a common condition as men age. Also called benign prostatic hyperplasia (BPH), prostate gland enlargement can cause bothersome urinary symptoms. Untreated, prostate gland enlargement can block the flow of urine from the bladder and cause bladder, urinary tract or kidney problems.

Source: Mayo Clinic

“About half of the men over age 50 will have prostate enlargement,” Dr. Franks says. “Urinary symptoms, such as getting up frequently during the night to urinate or [having] a slow urine flow can be signs of BPH. Medications are available to help with BPH. We also offer laser treatments that allow men to urinate better.

“Bottom line is that a man’s urinary and sexual function can be indicators of various problems and therefore should not be ignored. As with any medical issue, it’s best to catch it early so it can be treated property.”