Men's Health Month

In general, men are less healthy than women. They have more heart disease, chronic liver disease, alcoholism, kidney stones, bladder cancer and other chronic illnesses. And their life expectancy is shorter.
 
Each year in June we observe Men’s Health Month to raise awareness about mens’ health issues – and to encourage men to make take their health seriously  In this episode, host, Jonathan Fialkow, M.D., speaks with Baptist Health experts about the crisis in men's health.

Guests:
Gillian Generoso, M.D., internal medicine physician with Baptist Health Primary Care
Ahmed Eldefrawy, M.D., urologic oncologist at Miami Cancer Institute
Jason Perry, M.D., sports medicine physician with Baptist Health Orthopedic Care

Transcript

Announcer:
At Baptist Health, South Florida, it's our mission to care for you when you're injured or sick. And help you stay healthy and fit. Welcome to the Baptist Healthtalk Podcast where our respected experts bring you timely, practical health and wellness information to improve your family's quality of life.

Dr. Fialkow:
Welcome Baptist Healthtalk Podcast listeners. I'm your host, Dr. Jonathan Fialkow. I'm a preventative cardiologist and lipidologist at Baptist Health's Miami Cardiac and Vascular Institute, where I'm also Chief of Cardiology at Baptist Hospital and Chief Population Health Officer at Baptist Health. According to information from the US Centers for Disease Control, in general, men are less healthy than women. Men have more heart disease, chronic liver disease, alcoholism, kidney stones, bladder cancer, and other chronic illnesses. And their life expectancy is shorter. So what could be done about this? Each year in June, we observe Men's Health Month to raise awareness about men's health issues, and to encourage men to take their health seriously for their own sakes, and for their loved ones.

Dr. Fialkow:
I had the pleasure of hosting a recent episode of Baptist Health Resource Live Program that looked into this issue. It was a great discussion with experts, including Dr. Gillian Generoso, who's an internal medicine physician with Baptist Health Primary Care, Dr. Ahmed Eldefrawy, a urologic oncologist at Miami Cancer Institute, and Dr. Jason Perry, a sports medicine physician with Baptist Health Orthopedic Care. Let's hear what they had to say. Gillian, let's kick it off with you. Generally speaking, it's said that men tend to pay less attention to their health than women. What are some of the health issues that are unique to men? When you have a man in your practice, in your office, what are the kind of things you think about, or we have to realize are specific to men that need to be addressed?

Dr. Generoso:
Actually, a national survey showed that men tend to visit doctors less, in general. They also tend to have less wellness visits per year. They also tend to get less flu and pneumonia vaccines. So despite that, coronary artery disease remains the leading cause of death in men. And interestingly, strokes tend to occur at younger ages in men compared to women. Now the survey also reports that there are higher rates of smoking and alcohol use in men. So, that's really interesting. And then, of course, the issues that are very specific to men are things like prostate cancer, testicular cancer, and low testosterone.

Dr. Fialkow:
So as part of a medical visit, do you review all those things routinely with a male patient?

Dr. Generoso:
Yes. So it depends on their age. There are age appropriate screening measures. So typical things I do at a wellness visit is definitely look at their blood pressure, their weight. I review their lifestyle like smoking, exercise, alcohol use. And then, we also do screening tests. So, that would be labs. So screening for high cholesterol. And if you're age 55 and over, a prostate screening would be appropriate. Colorectal screening.

Dr. Fialkow:
So Ahmed, turning that over to you. It's a good segue. When we talk about screening tests, these are tests that you don't do because a person's coming in with a complaint. These are things we generally do just to see if there's early evidence of something that could be managed before it becomes severe. Gillian mentioned a few. But where do you see the greatest value in screening tests in men? Most men, as we're all saying, don't go to the doctor routinely. Where do we get the biggest benefit from screenings in men?

Dr. Eldefrawy:
So for example, one thing Gillian pointed out is prostate cancer. So in general, after the age of 55, it's recommended to get a PSA test, as well as a rectal exam to early detect prostate cancer. At this age, as 55 is a general age for that entire population. But patients with family history of prostate cancer, or African Americans who tend to have more aggressive prostate cancer. Sometime we test them or screen for prostate cancer earlier. As early as 45 or 50. So prostate cancer is a very slow growing cancer, very curable. And if it's not curable, it's very, very treatable in early detection. With early detection, no one should actually die from prostate cancer.

Dr. Fialkow:
What other type of screenings would you say would be relatively important for them?

Dr. Eldefrawy:
Other screening for mainly for testicular cancer is the self exam for young adult like teenagers and early twenties. And the self exam that's done once monthly is very, very important for detect testicular cancer. And compared to prostate cancer, testicular cancer is very, very aggressive cancer, very fast to growing. But the good side is it's very curable. Just the fact that it's very fast to growing makes it very sensitive to chemotherapy. And it's a very curable disease, even when spread.

Dr. Fialkow:
When you see men with testicular cancer, what's the usual presentation? Do most come in because they've done self-exam, and they noticed something? Is it picked up on a primary care exam? What's the trigger or pathway that most men come in with? What is testicular cancer?

Dr. Eldefrawy:
The first thing they tell me that they notice something growing on the testicle. And it's more often, it's ignored first. But as that thing keeps the growing, then they come seek medical attention. But what I see that they see it growing for at least a few weeks, sometimes up to a few years before they come to see me.

Dr. Fialkow:
Okay.

Dr. Eldefrawy:
And the thing also, they ignore it. One of the reasons they ignore it. It's painless, and testicular cancer is always painless, even on spread.

Dr. Fialkow:
So, just to put some minds at ease, what's the work-up of testicular cancer? Because that might prevent some men from getting checked out. What do you do if it's suspicious?

Dr. Eldefrawy:
If it's suspicious, I would first get an ultrasound to see, distinguish that there's an actual solid mass coming off that testicular tissue. And if it is in fact, like it is concerning for testicular cancer, then I would do blood markers, blood tests, to check for tumor markers that can distinguish the different types of testicular cancer. Then after that, I would obtain some imaging studies like a CT scan of the chest, abdomen, and pelvis to see if it has spread beyond the testicle.

Dr. Fialkow:
Gillian, back to you. We'll get to you Jason, soon enough. But Gillian, we talk about men not wanting to go to the doctor. And I see it and live it. Too tired, too busy. There's always a reason to delay things. But we know how important it is, both for preventive purposes and to get things checked out. What kind of tips would you recommend for either an individual or more often a loved one to say, "We want you to get checked out," or "How come you haven't gone to a doctor?" Any type of recommendations you would have to encourage men to get themselves checked out for regular medical visits?

Dr. Generoso:
So it's funny you say that because you don't know how many times I've had a man come into my office, and I'm like, "Hey, so what's your reason for the visit?" And he's like, "The reason I'm here is because my wife sent me here." So it's really funny. A lot of times men seek care because they're encouraged by their loved ones. So it depends. Right? So someone might just need a gentle reminder. Others might need a little bit more of a nudge, like, "Hey, I know this great doctor." And then still others, they might need a little more than a nudge. And then, the partner might go, "Hey, I think it's time for a checkup, and I made this appointment for you." So it makes it easy for someone to go in when they're a little bit more proactive. Not that everybody needs that. But...

Dr. Fialkow:
So obviously, be supportive and give them a little bit of a nudge if necessary. And what's the proper first exposure to medical care? I mean, we clearly expect primary care to be that foot in the door, so to speak, for a man to get a medical checkup now.

Dr. Generoso:
Right? So primary care addresses just general issues. It's general practitioner. So if you have a symptom, or you just want a general checkup, it would start with a primary physician.

Dr. Fialkow:
All right, Jason. It's your turn. We know personally it's hard for men to open up and talk about certain things. There's the ego, and the machismo, and whatnot. But in your experiences and you're dealing with fairly active men and others with conditions. What tools do you use to get men to open up about the conversation that might otherwise be important for you to assess their medical condition? But they might not be comfortable to talk about.

Dr. Perry:
Well that's a great question. I'm typically seeing people for problems that they're very comfortable talking about with bones, and joints, and injuries, and people wanting to stay active. But I think in general, this comes down to the environment in the office, in the clinic. Establishing good rapport with your patients. Having very good bedside manner. Getting to know your patients. Being friendly. Not feeling that the visit is rushed.

Dr. Perry:
I think your patients really just need to know that you care. And if they feel that you care, they're going to be more willing to open up about things that may be more sensitive. I think oftentimes as physicians, we have an agenda. Things that we want to talk to the patients about. Things that we want to address with their health. But we need to allow time to listen to patients and hear their concerns, and address them with empathy and compassion. And I think at the end of the day if you don't feel like a patient is opening up about something, we just really need to ask specific questions and not be shy.

Dr. Fialkow:
I think that's well said. Give them that comfort level. Take the stigma away. I mean, Gillian, you mentioned early on alcohol abuse, and substance abuse, and how you have those sensitive conversations. I think in our space, dealing with obesity. I always laugh in the cardiology space with erectile dysfunction. And I always try to diffuse it by asking my patients about it, making them comfortable with it. But whenever we get a call about the patient wants a refill. But only wants to talk to you. We know it's a Viagra refill. So we always say, "No. No. It's we establish with it. It's a normal medical condition. You can talk to anyone about it." Anything you guys, Gillian, or Ahmed, you want to add about that? What do you use in your relationships with men to get them to feel comfortable in opening up about things that might otherwise be difficult for them? Ahmed, any thoughts on that? Especially in your [crosstalk 00:11:10].

Dr. Eldefrawy:
Yeah. Yeah. I think the main thing for me is to try and let the patient know that it's not just you, or this is your problem. Let them know that it's a common problem. I see it all the time. I think patients feel embarrassed sometimes opening up about something. They feel they are the only ones who have it. They are the only ones who have the problem. But they don't realize no one walks around, talk about their problems. Erectile dysfunction, for example. But here I see it all the time. So it's a lot more common than people think. And I think if they know that they will open up more about it.

Dr. Fialkow:
So, following up on let's say some of the specifics that men may deal with that might be difficult to... Not difficult, but might take a little extra work to kind of address. Ahmed, speak a little bit about stress. And everyone has stress. It's not unique to men. Men may internalize a little bit better. Again, it goes back to that macho type of, I can take care of my own problems. Any thoughts that you have, or any experiences regarding how to address stress related aspects of a man's health?

Dr. Eldefrawy:
I try to encourage patient to open up more to family and friends and about their illness. And also, I also offer them to communicate with other patients who had the same problem. Maybe sometimes if they communicate with other patients with a similar problem, and they get treated, and they are doing well. That will be relieve their stress. And almost all my cancer patients, I offer them to enroll into the survivorship program. And I got a very positive feedback and psychological and emotional relief after going through this program. And seeing others talking and seeing other patients of their similar condition.

Dr. Fialkow:
So it's certainly something that should be part of a discussion a man should have. Or a doctor should have with a male patient. And Gillian, an extension of that to some degree is, again, going back to the pushbacks, et cetera, would be mental health issues. And specifically we talk about anxiety, depression, or even worse things. So in your assessment, do you sense there's a problem? And then you tease it out? Or do you kind of address it in everyone just to see if there's an underlying component? Give us a little bit how you address those difficult behavioral health, mental health type conditions and may experience.

Dr. Generoso:
Sure. So actually in my practice, we administer what we call a PHQ, which is a depression screening tool. So we kind of standardize that for all visits. So you don't have to feel the pressure of bringing it up yourself. We do kind of screen you for it. And of course, patients come to me with such symptoms. And a lot of times they have never talked about it with anybody else because there's that stigma. Or they grew up in a family where mental issues were kind of poopooed. So I talk to them about it. I talk to through them about it. I explain what depression or anxiety how it presents, and how it's treated. And then really when it becomes an issue is when their functioning is affected. Are your symptoms affecting your relationships at home? Or with your friends? Or at work? Are you getting into more arguments? Is your productivity affected? If that's the case, then you might have something more than just stress or the blues. It might be something that will need more to be addressed.

Dr. Fialkow:
I think that's something to call out. So it's one thing to say, someone has some depressive episodes, or going through a down period of time, or nervous about something. That's not always pathological. Right? In other words, it's not like I shouldn't talk about it, because they're going to think I'm sick. The conversation, as you said, is there are different levels? Different components? Maybe it's natural, or it'll pass. Is that fair to say? I mean, is that part of your assessment?

Dr. Generoso:
Right? So I generally ask about the duration of their symptoms. If it's something that's going on daily for a more than a few weeks. Like maybe a month or two months. And it's really affecting their functioning that I think that needs to be addressed.

Dr. Fialkow:
Jason, let's turn over to you again. I think a really important topic, which we probably do a whole Facebook live about. And that's exercise and the importance of being active, staying active. Talk a little bit about, again from a focus of men's health, why is it important to stay active? How can we motivate people? It's always, our days are full, we're tired. What's your experience regarding... Well, first educate us regarding the benefits of staying active and exercise. And then how we can motivate men to become active? Who may not be as active as we'd like.

Dr. Perry:
Yeah. That's great. Obviously, I'm seeing people for orthopedic related issues. And I'm talking about activity with every single one of my patients. And I think at the surface level. Or what most people recognize is exercise is helpful for things like weight loss, things like decreasing body fat, or improving lean muscle mass. But the benefits extend well beyond those things. And the laundry list is huge. But some of those would include things like improved cardiac health, decreasing the risk of heart attack, stroke, improving things like blood pressure. Raising our good cholesterol while decreasing our bad cholesterol. Prevention of type two diabetes, or in somebody that has type two diabetes, perhaps eliminating it or improving our blood sugar control on a day to day basis. As we just mentioned mental health. I think exercise has been shown to be very helpful with mental health and reducing the risk of both depression and anxiety.

Dr. Perry:
Regular exercise can help improve our sleep, improve our balance, prevent falls, prevent fractures by improving our bone density. It's been shown to help with brain health, memory. There's tons of things. One that I see commonly is reducing pain in joints of patients that have arthritis. In terms of motivating. I think motivating patients to exercise can be thought of like motivating patients to do other things like quitting smoking. Where as like that list in itself is motivating. But as a provider, we know that we can't force our patients to be active. And we can't get everybody to be active the way we want. But I think that regularly at each visit, we should be assessing our patients' physical activity levels, assessing their willingness to be active if they aren't already active. And then from there, we really need to help our patients set some goals. And those goals need to be realistic. And then, provide them with real life ways to meet those goals. And that could be physical therapy, or even something like an exercise prescription.

Dr. Fialkow:
So another follow-up to that. Again, I mention to the viewers how important this is. If someone's going to start an exercise routine, and whether they do on their own, or with an exercise prescription, or following something. Would there be any kind of warning signs that should make them say, "Wait a minute. I better get checked out." And a follow-up to that is avoiding traumas and stuff. Are there certain things you would go through with them as a motivator? But also just a pay attention type of thing?

Dr. Perry:
Definitely. There are definitely things that you should see your primary care doctor or cardiologist before you get started in an exercise program. Certainly, people that haven't exercised in a long time, have any type of chest pain, shortness of breath, dizziness at rest, or with light levels of activity should be evaluated by a physician before engaging in a program. Those with a history of heart disease, or arrhythmias, or kidney disease. These might be patients that want to just discuss with their primary care providers or their specialists, who they follow with, for some guidance on what they can and can't do.

Dr. Fialkow:
So I think obviously there's a common sense component, and kind of follow your body. And if you're feeling something's not right, get it checked out, and make sure it's not a sign of something. So this has been a great conversation. We clearly didn't talk about the importance of diet and various other things which we know are very important in the interest of time. But there certainly don't... The viewers should not use what we're talking about as exclusive of anything else. Gillian, hopefully not putting you on the spot. Belly fat. Can you speak a little bit about the significance of the people, men more commonly who actually gain weight in the belly as opposed to other parts of their body?

Dr. Generoso:
Waste circumference is, or central obesity where the fat is mainly around the abdomen. That's associated with obesity related disease like hypertension, diabetes. And then, also links to cardiovascular disease. So, that's one way we look at that.

Dr. Fialkow:
Yeah. I mean, I appreciate that. I always say when I lecture and whatever. When the belly is the first part of the body that comes into my exam room, I know it's someone who we're going to have to have a significant talk about health and improvement in avoiding diabetes and heart disease and all those other things.

Dr. Fialkow:
To our listeners. If you have a comment or suggestion for future topic, please email us at baptisthealthtalk@baptisthealth.net. That's baptisthealthtalk@baptisthealth.net. We'd love to hear from you. Thanks for listening and stay safe.

Speaker 1:
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