Men are much less likely than women to seek medical attention when they’re not feeling well. The question is: why? Why are men more prone to skipping the screenings and check-ups that could potentially add years to their lives?
During Men's Health Month in June, host, Jonathan Fialkow, M.D. brought together a panel of Baptist Health experts to answer some frequently asked questions about men's health - from heart and prostate issues to misconceptions about testosterone treatments.
His guests were:
· Michael Swartzon, M.D., a primary care sports medicine physician at Miami Orthopedics and Sports Medicine Institute
· Ahmed Eldefrawy, M.D., a urologic oncologist at Miami Cancer Institute
· Elliott Elias, M.D., medical director of structural imaging at Miami Cardiac and Vascular Institute.
Men are much less likely than women to seek medical attention when they’re not feeling well. The question is: why? Why are men more prone to skipping the screenings and check-ups that could potentially add years to their lives?
During Men's Health Month in June, host, Jonathan Fialkow, M.D. brought together a panel of Baptist Health experts to answer some frequently asked questions about men's health - from heart and prostate issues to misconceptions about testosterone treatments.
His guests were:
· Michael Swartzon, M.D., a primary care sports medicine physician at Miami Orthopedics and Sports Medicine Institute
· Ahmed Eldefrawy, M.D., a urologic oncologist at Miami Cancer Institute
· Elliott Elias, M.D., medical director of structural imaging at Miami Cardiac and Vascular Institute.
BAPTIST HEALTHTALK PODCAST – WHY DON’T MEN GO TO THE DOCTOR?
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 am a preventative cardiologist and lipidologist at Miami Cardiac & Vascular Institute, where I am also Chief of Cardiology at Baptist Hospital and the Chief Population Health Officer at Baptist Health.
It's probably no surprise to hear that, on average, men pay less attention to their health than women. Men certainly are much less likely to seek medical attention when they’re not feeling well. The question is: why? Why are men more prone to skipping the screenings and check-ups that could potentially add years to their lives?
Since June is Men’s Health Month, in the latest episode of Baptist Health’s Resource Live program we brought together a panel of experts to talk about steps men can take to get healthier.
My guests were:
· Dr. Michael Swartzon, a primary care sports medicine physician at the Miami Orthopedics and Sports Medicine Institute
· Dr. Ahmed Eldefrawy, a urologic oncologist at Miami Cancer Institute
· And Dr. Elliott Elias, medical director of structural imaging at Miami Cardiac and Vascular Institute.
Let’s hear what they had to say….
DR. FIALKOW: So, Michael, let let's have you kick it off. We know that many men do put off going to the doctor as long as possible. They don't think of themselves as having medical issues whether it's denial or, you know, the macho component, but sometimes it's even when they're having symptoms. Why, why do you think, and are there any studies that show why men are less likely to go to a doctor both for preventative services or even when they may start having any complaints?
DR. SWARTZON: You know, for the most part, men very much like to go about their daily lives and not disrupt their routine taking off of work to going to see a doctor is simply not something that they typically would wanna do. And it's been my experience that most of the time, it's either a severe problem or their wife brings them in. And it's really a, you kinda nailed it before. I think some of it is cultural and some of it is just upbringing.
DR. FIALKOW: So Michael, so do you see in your, in your practice and you know, in primary care within Miami, Miami Orthopedics & Sports Medicine, do you see men coming to you that it's kind of like, "Dude what took you so long?" Or, you know, "Why'd you wait so long?" that you actually seen that in your practice?
DR. SWARTZON: Basically people will come to me when all the things that they could try at home had failed and they're limited with either their activities at work or their activities for other weekend warrior or their tennis. And they're really not interested in stopping what they're doing. And so it's really only when the problem becomes severe that they're limited that they show up.
DR. FIALKOW: Appreciate that. Elliot, cardiology standpoint, but again, this is, this is general, you know, again we said, men tend to avoid going to the doctor. They can sometimes ignore unusual symptoms that you might look at and say, "Hey, you know why are you ignoring that?" What, what are the kinds of things that men should be aware of? Even those that feel relatively well that might negatively impact their health as they get older.
DR. ELIAS: Yeah. So as cardiologists, our favorite types of medicine practice is preventative medicine. So for those patients that haven't reached us in clinic we try to identify for them those risk factors that are both modifiable and non-modifiable for coronary artery disease. So the typical ones that we focus on are high blood pressure, cholesterol, obesity, physical inactivity, diabetes. And we always of course know that we wanna encourage everyone to, to promote further healthy lifestyle such as not smoking and limit their alcohol abuse.
DR. FIALKOW: So those are the, the big things that would be part of just the general checkup and things that a man should be aware of to determine are they at risk for medical problems. And I think it's important to point out of the ones you mentioned, high cholesterol and high blood pressure don't produce symptoms. So, people will not know if they have those medical conditions, unless they get checked out, whether it's they check their own blood pressure or have someone check it or get blood tests to look at their cholesterol. So that's great information.
Michael, let's kick it back to you regarding exercise. Couple of things I think your expertise can bring to this this conversation in terms of not just what would be recommendations for exercise for men, especially as we get older, but what can a man expect from their ability to exercise? I see it a little bit, because a lot of times when men amends conditioning decreases over time they may think it's a cardiac condition. What, what would you recommend in terms of general statements regarding exercise and men? And then secondly, what can one expect as they age regarding their exercise ability and performance?
DR. SWARTZON: These are very, very important questions or topics. Exercise is a very key ingredient in how we move forward and prevent cardiovascular and other issues that men have. Men will get frustrated just like women as they age. Things just won't work exactly same way. Aging process is very difficult. It's very individualized, but overall, most people will notice that their muscles belcome a little weaker, their body becomes a little tighter. And so the, the warm up and cool down period becomes a little bit longer to have the same to maintain the same flexibility and strength. There's articles all the time that are coming out. The main guideline that we use from the American College of Sports Medicine is 150 minutes a week of cardiovascular exercises and 150 minutes a week of resistance training. This is very important for men. You worry about blood pressure. You worry about erectile dysfunction. You worry about being able to sustain in your life. If you don't use it, you'll, you will lose it and it'll be so much harder later. And there's constantly show studies that show that the middle-age is such an important time for you to engage in moderate exercise activity.
DR. FIALKOW: I think that's great information and all the points you made are, are are really critical for anyone, but certainly for a man. Can you speak a little bit, you you just mentioned, if you don't use it, you lose it. Can you speak a little bit and again just in the expectations such that, you know a 20 year old athletic person who might get away from exercise a few weeks can kind of get back into it. If someone's gonna either start exercising or they got away from it and got back into it as they get older, both precautions and expectations in terms of age-related conditioning, can you speak to that a little bit?
DR. SWARTZON: Yeah. So this is a kind of fallacy that if as you get older, you have to have you have to be weaker and you have to be smaller. That's not necessarily true. You can maintain a lot of your cardiovascular fitness level and a lot of your strength. You see a lot of marathon runners are older and you develop that kind of veteran savvy. And so really becomes not only physical, but mental. You need to create the time and vary your routine to continue to exercise. And you make to pick up an injury or two on the way, which may mean you need to adapt. And instead of high-impact long distance running, you switch to cycling or swimming. You have back problems. Maybe you need to do some Pilates. So shortly you need to be open to varying your routine, but you have to keep pushing. If you don't overload the system, you'll you won't continue to maintain what you have.
DR. FIALKOW: I love that last comment and, and concept. How, how often do I see and again, I'm sure you see it even more, you know a man middle aged, a little bit older, might've had their routine fairly fit and they hurt their knee. They stop exercise and they gain weight and they say, oh but I couldn't exercise anymore. I hurt my knee. And I'm like, well, there's lots of other things you can do that, you know, might will spare your knee and whatnot. So adapt, find out, you know, what your body can handle age-related. I think it was a great recommendations. And I think people should recognize that.
DR. SWARTZON: And don't forget to adjust your diet as you're exercising less, right? Because the snowball effect that I see is people have a minor injury, go rest, then they gain weight. Then their knee or hip will hurt more. And then they exercise less and they gain more weight. And then all of a sudden you used to be a very active person and now you're not. And it's very hard to, to, you know, go back the other way.
DR. FIALKOW: I love these comments you're making. I appreciate this dialogue. It's very true. You can't exercise your way out of a bad diet. If someone has a certain level of age and nutrition and fitness, and they're a certain weight you break that you take a variable out like they're not exercising, they gain weight. They can't just resume the exercising it back where they are. They have to alter their diet appropriately.
DR. SWARTZON: Absolutely.
DR. FIALKOW: So, so great, great advice. Elliot, let's turn it back to heart disease. Obviously all these con these components are very much related. You mentioned the risk factors, the things that someone may look at or be told, hey you have this, it could lead to this problem. Let's look at it. What can, what can men do to stay on top of their heart health? Exercise of course and, you know, as as Michael mentioned, is, is extremely important. What other things would we be recommending to men as part of their general health in avoiding heart disease?
DR. ELIAS: Yeah. So again, as, as we talked about modifiable risk factors, exercise is great, diet again, is comes to the forefront on lowering cholesterol even for diabetes is ideal and even stress and ways to decompress I think is something that's a big risk factor that we don't always see. And it's difficult to think about but if you don't have time to, to release stress and and whether it's work or other issues that are going on, then the blood pressure creeps out. And so of course, we'd always like to treat something without medication. And that's something that I think goes on under the radar.
DR. FIALKOW: Elliot I'm gonna put you on the spot a little bit, which, which, which I've certainly done in the past. Let's talk about the coronary calcium score a little bit, coronary calcium score. It's an incredibly safe and inexpensive and easy to attain test which gives us a lot of information, but it certainly fraught with a lot of inappropriate use or people getting wrong information from it a little bit, you know, the coronary calcium test was actually developed by radiologists in the Baptist Health system, you know going back over a decade ago
DR. ELIAS: A calcium score is a powerful tool that we use for risk stratification in our asymptomatic patients. Now, I think a lot of confusion lies in the fact where you would think that if you've got a score, then you would know how much blockage you have in your arteries. But really what we're focusing on is the amount of calcium in our arteries. Now we know that calcium is a marker of coronary atherosclerosis, which predisposes you to heart disease. And so what we do with the score is quantify that amount of calcium and based on the amount of robust data that we've had over the last 20 years, we're able to risk stratify our patients based on their age, sex and even ethnicity. And then we combine those with some of the other risk factors that we mentioned and then we're able to appropriately classify them as either low, intermediate or high-risk. And I think it's a great tool that allows us to give a patient-centered treatment approach with a high amount of weight behind our treatment plans.
DR. FIALKOW: Well said, the calcium score helps guide the clinician as to what's your risk of a cardiac event so we can appropriately lower the risk. It's not an indicator of blockage, or, you know you're gonna have a heart attack in the near future. I remember when calcium scores first came out people were getting them and they'd get a score and they'd run to the emergency room thinking, you know it was something really bad, it's just a, it's just a risk predictor. Who should not get a calcium score? Again, you know, I've seen people that bypass surgery and they come in and say, should I get a calcium score? The calcium score is meant to tell me, what's your chance of having coronary disease that can lead to a cardiac event. Well, you had bypass surgery. Kinda think we know you have coronary disease. So, so where, you know, can you speak to maybe where it doesn't help and maybe second point of that, what if the castle score is zero? What's the power of that, that score of zero?
DR. ELIAS: Sure. So I'll answer your second question first. I had a patient recently, and his father and uncle actually died prematurely of coronary disease, which is before the age of 55. And he was considering, actually he wasn't considering he already put himself on a Statin medication. Now granted his uncle and father smoked a lot and drank wine, which we know are modifiable risk factors for coronary disease, but we decided to get him a calcium score. And the calcium score was zero. And while he was on that medication, before the calcium score he was having a lot of myalgias or muscle pain. And based on that calcium score, we made a joint decision to take him off that medication. So in short, to answer your, your question of what is the power of zero for a calcium score, we know that there's no proven benefit to treatment when a calcium score is zero.
DR. FIALKOW: And we repeat it in four to five years. So it's a moving target.
DR. ELIAS: Yes.
DR. FIALKOW: Ahmed, switching, switching gears a little bit again. These are the things that we as men have to deal with and certainly our, our, our, our count, counterparts outside of this call have to deal with. You mentioned that prostate, colorectal, lung, skin cancers, very prominent in men. Let's talk a little bit about, you know, the prostate. What is it? What does it do? What are the symptoms or signs a man may have that should warrant them getting a follow-up regarding to any prostate problems. You mentioned screening with PSA's I think you said 50. When should men start thinking of relating a symptom to it?
DR. ELDEFRAWY: So the prostate is a gland. Its location is between the bladder and the urethra, so at exactly the trigone between the bladder and the urethra. And the urethra, actually runs through the prostate in the middle of the prostate. The purpose of the prostate gland is to free fluid that provided for the semen, for the sperms to determine for help survive the journey to the urethra. That's the only, only benefit for the prostate. So it's beneficial for the young men. One, two main issues about the prostate and the problem can arise from the prostate in men. One is enlarged prostate in avoiding problems from the prostate, which at condition when the central part of the gland grows, and until today no one knows why this part starts to grow with age. Men usually start to experience symptoms with week stream , having to start coronation and having to wake up at night to urinate. And this is a benign condition, it's not cancer. It's just the prostate being larger and middle of the that prostate gland it kinda narrow the stream and put some pressure. And for that there are treatments, there are medication we try and if they fail we resort to the surgery if the symptoms are bothersome to the patient. If there mild symptoms and doesn't bother frequently, then do not do any treatment. That's for the denying problem.
DR. FIALKOW: So I think I just, again, I'll let you finish but I got people are there's prostate cancer, which is a particular abnormality, as you mentioned and the PSA blood test and the digital exam, we are talking about much more common prostate related concerns that might men experience, which is not cancer related. So I just wanted to clarify that as you go on. So I'm sorry. Continue. Yes.
DR. ELDEFRAWY: Yeah. The second problem...
DR. FIALKOW: You're dropping out a little, you're dropping out a little bit there. That's what I wanted to clarify. I didn't mean to...
DR. ELDEFRAWY: Okay. So the second problem that you need to address is the prostate cancer. And prostate cancer arise from the peripheral zone of the prostate. It means the outside part of the prostate. And like we said, one in six men can have prostate cancer. And you know, prostate cancer is not an aggressive kind of cancer, which can take many years to to spread or kill someone. And with that being said, it's very curable detected early. And being the most common cancer in men and the second most curable cancer in men, we try to detect prostate cancer as early as possible and cure it, if we detect it early.
DR. FIALKOW: So Michael, turning it back to you. This is actually a question I'm probably the most interested in the answer. And only because again receiving a lot of these questions as well, testosterone, Low T, lots of marketing stuff out there. So first place again, what is the, what does testosterone do, you know important for again, muscle bone mass, helps libido, stores fat. We, you can get into whatever level of detail you want regarding what testosterone does if you're comfortable. But the real question is what happens naturally to men's testosterone levels as we get older? And then when would it become a pathological condition where it should benefit from actually being treated or replaced? Can you speak a little bit about, you know what your experiences are regarding the testosterone?
DR. SWARTZON: You know, low T is certainly in fashion, right? I listen to sports talk radio, and every segment there's a commercial for it for someone, there's magazine articles. Here's what I'll say. Testosterone's a hormone that's really what gives you your manliness; there's no doubt about it. It peaks, you know, it starts shooting up at puberty, peaks kind of in your early adulthood and then starting at about 40, you lose one to 2% per year. So as you age, there there may be some symptoms that you notice such as decreased libido, decreased muscle mass. Most of these are normal part of aging, which you can correct with like I said, the exercise and other issues. Now here's where the problem lies. A lot of times people have issues that they'll blame on testosterone that are really a function of a chronic illness, stress, alcoholism, obesity, which all those things actually also reduce testosterone. So you have people going to the doctor asking for testosterone treatments thinking that's gonna solve their problem, when really there may be other factors at play that are more likely responsible for why they're feeling what they're feeling. Certainly it's a reasonable blood test to take, but and there's probably a million people on testosterone treatment, but it's not the easy solution. There's no shortcut, right? And so, as much as it may seem to be an easy way out there usually is another reason why you're having the erectile dysfunction and it's probably more diabetes and exercise related than your testosterone. Does that make sense?
DR. FIALKOW: Oh, it's phenomenal. I love it. I should record it and put it in our, in our, in our in our cardiovascular offices as well. You know, testosterone is a fat-soluble hormone it's made by the body. We gain weight in the belly, the testosterone we make it's partitioned to the belly. So it's not, we're not making it. It's, it's just being sucked up somewhere else. And you talk about these lifestyle things that will lower your testosterone. It's obviously better to improve those lifestyle issues and your testosterone will normalize than taking the supplement. But as a follow-up to that and it's a little controversial, so I recognize, you know, I'm putting you on a spot, if someone gets put on a testosterone replacement that really is not deficient testosterone it's secondary, their levels are low for other reasons, is there a danger to that?
DR. SWARTZON: There, there is. You know, certainly we, we had some guys talk earlier. Some of the physicians here talk about prostate cancer. More rarely, people have breast cancer. If you start taking testosterone, you could be hastening a problem that you're unaware of. Your red blood cell count could be much higher. You could develop sleep apnea. If you're thinking about becoming a father that could affect how you, you have children. If you have heart issues, it could affect that. And certainly there's there's issues with possible blood clots and other issues. So never a good idea to mess with a system that the body has going right. This is, the body knows its homeostasis or, or how to balance what levels you're at. The minute you start taking it by mouth or injecting it or patches or gels, you, you mess up your body's system and you there are risks for that.
DR. FIALKOW: I love it. People want the quick fix, you know, get a little older don't exercise as much, gain a little weight, drink a little more, oh let me take testosterone and it'll make it all better. And there's obviously consequences to it. And you guys were really awesome. I really can't tell you again. I always learn, I always love learning from our guests and hopefully our listeners got a lot of great information that they can use as well.
DR. FIALKOW: As we wrap up this episode, I’d like to encourage all our listeners to please take a moment to give this podcast a five-star rating on whichever platform you listen to us on. We’d love to hear your comments and suggestions for future topics. You can email us at Baptist Health Talk at baptisthealth.net. That's Baptist Health Talk at baptisthealth.net.
Thanks for listening and stay safe!
ANNOUNCER:
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