Dr. Kevin Most: Encourage the men in your family to visit the doctor
Be sure to tune in Wednesday June 26th at 6:40AM for Facebook Live segment with Dr. Kevin Most!
Well Father’s Day was a week ago and many feel that is enough pampering for the fathers and perhaps it is time now to start nagging them about health related screening issues. We know that men are terrible patients, they are usually compliant but getting them to the doctor is often like getting a dog to the vet. Once they know where they are headed they look for any reason or excuse to cancel or postpone the appointment. Startegic nagging has been shown to increase compliance. Nagging is a science and must be used at the right time with the right message.
Men are not as indestructible as they think they are and they need nagging from kids, spouses and significant others to stay on track for their health screening. It should not be seen as nagging but instead should be considered persistent encouragement. I am sure there are many men listening now that will say, “if I had not been encouraged to do ………, I would have found out about this condition earlier, when treatment would have been easier”
So if the nagging is going to start, let’s make sure we know what to encourage. Every male over the age of 35 should know some simple numbers and know when they were checked last. Simple things like blood pressure, cholesterol and weight/ BMI should be known and monitored on a regular basis. Each of these can contribute to Heart Disease the number one killer in men. Over 500,000 men die each year from Heart Disease and controlling your blood pressure, weight and cholesterol can lower your risk.
It is one thing to know the key numbers but as a team you should do something about it. As far as weight, well we are not going to get any taller, so the only option is to lose weight. Nagging him to lose weight can be a losing battle, for this you need a different strategy. For many men the concept of a grocery store is foreign, they open the refrigerator or cabinets and food is present, so they eat. A good strategy for weight loss is to control what they eat, how they eat and how much they eat. So, choosing healthy foods and eliminating bad foods is often in control of the individual shopping. Men will eat carrots if that is all they have to choose, but given a choice between chips and carrots, chips win. Smart shopping and food preparation can help with weight control as we know we are not going to get any taller for our weight.
A combination of diet and exercise is best to achieve this. Now there are many diets out there to choose from but in the ideal world we would look at a diet that is good for cardiovascular health for men. If High Blood pressure is an issue, Probably the best is the DASH diet. DASH stands for Dietary Approach to Stop Hypertension. This diet looks at lowering sodium in your diet while eating foods rich in nutrients that lower blood pressure like potassium and calcium. Hiding the salt shaker will work, as men will not get up to look for the salt shaker if food is in front of them. The unique thing with the Dash diet is it also is great in preventing osteoporosis, cancer, heart disease, stroke and diabetes, all other concerns we will discuss.
If high cholesterol is the issue then the Mediterranean diet may be the best. This diet will not only help you lose weight but it will also help lower the bad cholesterol known as LDL. This diet incorporates the healthy eating habits noted in the Mediterranean area and includes olive oil and red wine. When we look at the incidence of heart disease in the countries where this diet is commonplace the rates are significantly lower than in the US. This diet emphasizes eating mainly plant based foods, whole grains and nuts. It replaces butter with olive or canola oil. It stays away from salt and instead seasons food with herbs and spices. It limits red meat and encourages fish and chicken.
The exercise side can be a bit more challenging, however a simple request for a walk after dinner, is a great start. Trying to push them into Pilates and Yoga have been known to backfire, as men have selective hearing and may hear Pie and Lattes, and Yogurt which would not get you to the goal of increase exercise. Explaining to him that exercise will prevent bone loss and decrease the risk of osteoporosis. This will decrease the chance of either of you falling and sustaining a hip fracture
So we know that heart disease is the number one killer in men, if you know your numbers, the change to one of the diets above may help to lower the chance of heart disease.
If we lower the chance of heart disease with diet and exercise, what else do we need to focus on? Cancer is the number 2 cause of death in men. Now some are obvious, if there is a smoking history, attempt to get him to quit, encourage him to quit and give him acknowledgement as he quits. The nagging can also be rule setting, telling him no smoking in the house is one thing but no smoking within 150 feet of the house will push him to the neighbor’s yard and may deter him. We still have over 150,000 deaths a year due to lung cancer with over 90% caused by smoking. Now we do have screening for lung cancer that is covered by most insurance companies. The recommendation is that if you are over the age of 55, have a 30-pack year history of smoking, and currently smoke or have quit within the past 15 years that a low dose CT is performed looking for early signs of lung cancer that can be treated with a good chance of cure.
Colon Cancer- now most patients do not enjoy the prep or test for colon cancer, so they will do everything they can to postpone it. The story of Eddie Olczyk can be used as a nagging technique for colonoscopy. Most men in the Midwest know Eddie’s story and his fight with colon cancer. This is a great way to bring up the consideration for a colonoscopy, you can play ignorance, such as “Did you know Eddie Olczyk had colon cancer diagnosed before he turned 50?, you should make sure to schedule yours as Eddie is in better shape than you are” .
So, who needs to be screened and how often do they need to be screened? Recently the American Cancer Society shifted the age of initial screening from 50 to 45. This shift has come as we are seeing an increase in colon cancer in younger patients who have no known risk factors. The beauty of colon cancer is that it is often a slow growing cancer so the interval timing for an individual with a normal colonoscopy may be scheduled for their next test in 10 years. Individuals who have cancerous polyps noted or precancerous polyps may have that timeline shortened to a few years. Colonoscopy is not only a diagnostic tool, but it also can be used to treat colon cancer as the doctor can remove polyps with cancer as they do the exam.
Colon Cancer is the 2nd leading cause of cancer death in men and women. We will have close to 150,000 new cases of colon cancer next year. The sad thing is that 1 in 3 individuals are not up to date with colon cancer screening. Individuals who do not want to have a colonoscopy have another option as a screening test. You may have seen ads for Cologuard, this is a simple test that takes a sample of your stool and looks for genetic cancer markers. Now this is a very popular test, but you need to be aware that this test does not find precancerous lesions, cannot be used to remove cancer polyps, also if you have a positive Cologuard, you will need to have a colonoscopy.
Prostate Cancer- we all probably know of an individual that has been diagnosed and treated for prostate cancer, it is the most common form of cancer in men besides skin cancer. In the United States we will see over 175,000 new cases of prostate cancer this year. Now we all have probably have heard the confusion around the blood test for prostate cancer, should it be done regularly? How often should it be done? What test level is concerning, what change is concerning, when should we stop testing? Each of these questions seems to have multiple answers as many doctors follow their historic pattern of screening which is often more aggressive than the current US task force recommendations. Currently the recommendation is for individuals between the ages of 55 to 69 to undergo PSA testing periodically. The timing of the tests should be discussed with your primary physician as we are finding that a discussion covering the risks and benefits of the testing. We wish the testing was more specific and accurate as results of this test may trigger procedures that in fact may not be needed. A change in results of a PSA may result in a biopsy or treatment that may have side effects. The big message here is that men need to be aware of the incidence of prostate cancer and have a discussion with their doctor. Nagging him to get in for this important discussion may be key to his health.
Diabetes is a disease that is exploding in numbers in the US. Would you believe we have 30 million adults with diabetes in the US, 95% are individuals with Type 2 diabetes. This is the type of diabetes we see in adults and in individuals who are obese. We know that diabetes plays a big role and increases the risk in many other illnesses and cancers, including heart disease, kidney disease, blindness and sexual dysfunction. Early identification as well as treatment of diabetes can minimize the risk that we see with uncontrolled diabetes. Now the nag is pretty simple here. Wait until he says something nice, you follow up with” Thank You, that is so sweet, speaking of sweet, what was your last glucose reading”
This may open up the possibility now for a discussion on diabetes and how it is important to have your blood sugar checked as Type 2 Diabetes is a silent disease that is doing damage every day it is out of control.
Immunizations – now this nagging can be done as example or threat. Example is obviously the easiest. This would be that when you are going in for your flu shot you drag him along for his flu shot as well. This can be used each year for flu shots. If you can do the same for Shingles and Pneumonia shots that is best as his compliance is actually verified with your compliance. If the leading by example does not work, studies have shown the threat of non-compassion or treatment can be effective as well. When he hears you will not cater to him when he gets flu or shingles, that may push him to get the shot as we realize that there is no way a man can care for himself when ill. Taking Tylenol can be much more complex than thought in males that are ill, and the skills needed to work the stove or microwave are mysteriously lost when sick. Just the threat of the loss of this support for an illness that could have been prevented with a simple immunization may push them to receive the vaccinations needed.
On March 6th of this year, Alex Trabek shared with the world that he was suffering from Stage 4 Pancreatic cancer. Stage 4 cancer means that the cancer is not just limited to the pancreas and that it has spread to the other parts or organs in the body. It is not unusual to have this cancer diagnosed at this stage as the symptoms are often subtle or nondescript until it reaches other organs and causes symptoms that require investigation. Remember we still do not have a blood test or any screening test to diagnose pancreatic cancer sooner. This is a terrible form of cancer, patients diagnosed with Stage 4 pancreatic cancer have a 3% chance of being alive 5 years after the diagnosis.
When it is found at this stage, surgery is not an option and the patient must work with chemotherapy for treatment. This is one of the most deadly forms of cancer and one that continues to frustrate the medical community. It is often diagnosed at a late stage and in many cases surgery is not an option.
With this grim diagnosis and statistics that are not promising, it is great to hear that Alex Trabek is doing well with his treatment. Mr. Trabek was diagnosed 4 months ago, now remember when diagnosed at Stage 4 the median survival is 3-6 months. He appears to be responding well to chemotherapy and is sharing with us that he is thought to be in “near remission”. Doctors treating him are amazed and are saying his response to the chemo is unheard of. Scans have shown that his tumors have shrunk by 50%. We know there are some patients who respond well to chemotherapy and every patient is unique.