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Special Section: Preventive Care for Male Baby Boomers

May 18, 2011

Men over 40 and your partners,

These posts will always give you the straight facts, without fluff, and without making you bite on medical terminology granite. This essay is worth a 5-10 minute read as it was digested from hundreds of pages of up-to-date information. It does not cover medical emergencies, which will be covered in future posts. Write comments and ask questions!

NOTHING BUT THE FACTS: A PREVENTIVE CARE OVERVIEW

You will likely lower your blood pressure by switching to a better diet. The DASH Diet — Dietary Approaches to Stop Hypertension –is five servings of fruits and vegetables, with fiber, whole-grain foods, low-fat dairy, fish, poultry, and nuts. You should eat no more than one serving of red meat a week, and minimize saturated fats and sweets. In addition, the American Heart Association recommends eating less than 1,500 milligrams of sodium per day.

Diets to lower blood pressure are also good for the heart and for diabetes. They often control calories, resulting in weight loss to reduce obesity. Processed foods contribute up to 75% of your sodium intake. Canned soups and lunch meats are prime suspects. Try to check food labels and menus carefully. You will hear this constantly: Eat a healthier diet with more fruit and veggies, fish, and whole grains.  You’ll be rewarded by getting more energy and a better quality of life. You can buy an inexpensive blood pressure monitor to keep at home.  Taking your own blood pressure regularly is a good idea for a baseline.  Anxiety can produce falsely high readings.

For men with a high risk of stroke, doctors often recommend medications to lower the risk. Anti-platelet medicines, including aspirin, or anti-clotting drugs, such as warfarin, may be needed to help ward off stroke in some patients.

The fasting blood lipid panel tells you your levels of total cholesterol: LDL “bad” cholesterol, HDL “good” cholesterol, and triglycerides (blood fat). The results tell you and your doctor a lot about what you need to do to reduce your risk of heart disease, stroke, and diabetes. Men over 40 (and some younger men) need regular cholesterol testing. Lifestyle changes and medications can reduce cholesterol and lower your risk of cardiovascular disease.

Prostate cancer screenings may include both a digital rectal exam (DRE) and a prostate specific antigen (PSA) blood test. While experts disagree on the usefulness of the PSA screening test, a recent study showed that a rapidly rising PSA could signal more aggressive cancer.  Screening should begin at 50 for average-risk men, and 45 for men at high risk, including African-Americans, and at 40 for men with a strong family history of prostate cancer.  10-6-11 the news is out! PSAs dont work. If your doctor orders a PSA, tell him to go look it up.

Men over 50 should have a colonoscopy for colorectal screening. Early colon cancer can be literally “nipped in the bud.” Recommendations for smoking, diet and exercise will lower your risk for most cancers.

Guidelines from the AHA state that if you drink alcohol, you should limit the amount to no more than two drinks a day for men under 65 or one a day for those older. They define a drink as one 12-ounce beer, four ounces of wine, 1.5 ounces of 80-proof spirits, or one ounce of 100-proof spirits. In fact, recent studies associate such moderate alcohol intake with lowered incidence of coronary artery disease. Alcohol intake above that amount should be monitored by your doctor. He may order periodic blood tests to check liver function or perform other indicated tests. (Also see post “Another Glass of Wine?”)

The use of alcohol is very individual. Some have no tolerance due to lack of the enzyme that metabolizes it. Others can safely imbibe more. Alcoholism takes a toll mentally and physically, and contributes to early death by injuries, malnutrition, and other medical problems.

“Exercise and maintain a healthy weight” is much easier said than done, but regular exercise helps lower your blood pressure, control diabetes, reduce obesity, and lower the risk for other health problems. Adults should get about 150 minutes of moderate-intensity exercise every week. That could include walking, bicycling, dancing, and swimming. Muscle-strengthening activities are recommended at least two days a week and should work the major muscle groups. Physical exercise also lessens the risk of impotence. (See the post “Which of these do NOT Count as Exercise”)

If it applies, quit smoking.  If you continue to smoke, you risk at least fifteen different conditions that cause chronic illness or death. Smoking causes lung cancer, but also be aware of how severely the quality of one’s life is compromised in other ways. When you toss the smokes, your risk of heart disease goes down within weeks after quitting. Within a year, your risk is cut by half. After 10 years of living smoke-free, it’s as if you never smoked at all (Nieca Goldberg, MD, cardiologist at New York University).

When found early, diabetes can be controlled and complications can be avoided with diet, exercise, weight loss, and medications. This can help prevent complications such as vision loss and impotence. A fasting plasma glucose (blood sugar) test is most often used to screen for diabetes.  The A1C test (or hemoglobin A1C), which tells how well your body has controlled blood sugar for the past 3 months.  It’s useful because daily fluctuations in glucose can be all over the map.  Healthy men should have one of these tests every three years starting at age 45. If you have a higher risk, including high cholesterol or blood pressure, testing earlier and more frequently is advised.

Irreversible vision loss can occur before people with glaucoma notice any symptoms. A case in point is Kirby Puckett, a baseball “Hall-of-Famer” whose career was cut short by glaucoma.  Screening tests look for abnormally high pressure within the eye to diagnose the condition before damage to the optic nerve. Eye tests for glaucoma are based on age and personal risk:  40-54: Every 1-3 years. 55-64: Every 1-2 years. 65 up: Every 6-12 months. You may need earlier, more frequent screening, if you fall into a high risk group.

Help prevent melanomas and other skin cancers by using sunscreen with an SPF of 15 or higher on all exposed areas, and for extended outdoor activities use one that is water-resistant. The American Cancer Society recommends screening for skin cancer by regular skin self-exams to check for any changes in marks on your skin including shape, color, and size. A skin exam by a knowledgable health professional should be part of a routine checkup.

Some physical age-related changes, such as prostate enlargement or testicular atrophy, are not preventable. Getting treatment for health disorders (such as high blood pressure and diabetes) that lead to changes in urinary and sexual health may prevent later problems with urinary and sexual function.

Changes in sexual response are most often related to factors other than simple aging. Older men are more likely to have good sex if they have continued to have sexual activity during middle age.Men who have sex with more than one partner, or have a partner who has other partners, need periodic screening for HIV and STDs. The partner should also be screened. Condoms or restriction to oral sex do not guarantee against disease transmission.

The best way to prevent influenza is by getting a flu vaccination each year. Hand-washing and avoiding others with the flu also may help. Transmission is by touching recently contaminated skin or surfaces, or getting sprayed by coughs and sneezes.

Getting the right screening test at the right time is one of the most important things a man can do for his health. Screenings find diseases early, before you have symptoms, when they’re easier to treat. All screening exams and tests should be provided or coordinated by a primary care doctor who can see the “big picture” of a patient’s health.

Men have a very functional view of their bodies and tend to see health care as a one way street (i.e. “Just fix it, doc”). Their partner’s support and influence on a man’s health behaviors is important, and partners can act as motivators for healthy behaviors. Encouraging men to make more effective use of preventive health services is an important way of improving their health.

If the cost of a checkup is holding you back, you may have more options than you think. Federally funded health centers allow patients to pay what they can. County clinics or local hospitals should provide low-cost services or give information about clinics that accept sliding scale payments. Call your local health department for leads.

References:

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