14 junho 2011
Whenever I get sick, I have a conversation with my wife, Rachelle, that goes like this:
Her: “How are you doing?”
Her: “Are you sure?”
She just doesn’t trust me when I tell her nothing is wrong—a lack of faith she claims dates to an illness early in our marriage. “You wouldn’t take aspirin because you wanted to see how high your temperature could go,” she recalls. “It was the stupidest reason you ever gave me for not taking care of yourself.”
It wasn’t the last time I put off going for an exam. Recently, a blotchy growth on my hairline went unchecked until its increasing size, nudges from Rachelle and “eww”s from my teenage daughter finally compelled me to see my doctor. It turned out to be an easily treated benign lesion—but the doc made it clear to me that it could have been cancer and really should’ve been checked sooner.
Like a lot of men, I have a thing about doctors. I’m not against them— I just figure medical care is for other guys. “Men like to think they’re indestructible,” says Alan Shindel, MD, codirector of the Men’s Health Program in the department of urology at the University of California, Davis.
We’re not total idiots about health, though. For example, men are more likely than women to get screened for colorectal cancer, and we understand it’s wise to get checked for serious conditions like heart disease and prostate cancer. It’s the out-of-nowhere aches, pains and oddball growths that we tend to blow off. One survey found that a quarter of men who were sick or in pain would wait as long as possible to see a doctor, and 17 percent would wait at least a week.
I finally went to the doctor about the spot on my scalp after I did some online research to assess the odds that it was something serious—and wasn’t reassured by what I read. Men like to be rational. Giving him the facts—as scary as they may be—may turn on a logic switch that makes it difficult to defend dodging his doctor.
Experts agree that not every symptom warrants a trip to the doctor, but some seemingly minor signs shouldn’t be toyed with (in men or women). We asked physicians to tell us the most serious symptoms that often go ignored—and why they shouldn’t be.
1. Feeling Tongue-Tied
He’s thinking: I’m having a senior moment.
But it could be: A stroke. When a clot, injury, narrow blood vessel or other problem restricts blood flow to the brain, the result can be a TIA—a transient ischemic attack, which impairs brain function and can make speech difficult. It’s different from the tip-of-the-tongue reaching for an elusive word. “He might find that words can’t come out at all, or he’ll speak words that are different from the ones he intended or mumble things that don’t make sense,” says Steven Kaplan, MD, director of the Iris Cantor Men’s Health Center now under construction at NewYork–Presbyterian Hospital in New York City. Such symptoms warrant an immediate call to the doctor or trip to the ER. Mini-strokes usually last a few minutes and symptoms typically disappear within an hour, but having a TIA means you’re at immediate risk of a more massive stroke. Men have a slightly higher risk of TIAs than women, and risks go up with age, especially after 55. Photo: Stockbyte
2. Shortness of Breath
He’s thinking: I’m really out of shape.
But it could be: An impending heart attack. Shortness of breath with exertion such as walking up a flight of stairs could be a sign that the heart muscle isn’t getting enough oxygen—a hallmark of coronary heart disease, which men age 55 and over are at an increased risk for.
“Any condition that makes breathing a struggle, including asthma and allergies, is exacerbated by exertion,” Dr. Shindel says. “But if shortness of breath seems to be getting worse each time, we worry about the heart.” Breathing that’s labored and doesn’t improve warrants a call to 911. An electrocardiogram or EKG (which measures the electrical activity of your heart), a sonogram or ultrasound of the heart, and chest X-rays can help diagnose or rule out a heart problem. Photo: Jupiterimages
3. Persistent Pain On One side of the Abdomen
He’s thinking: I probably pulled a muscle.
But it could be: A kidney stone or tumor. One-sided pain that goes away probably is a side stitch or pulled muscle and nothing to worry about. “But if a dull ache is persistent, it should be evaluated by a physician,” says Dr. Kaplan. “It could be many things, but a tumor is one of the first possibilities we consider.” An ache from a tumor won’t likely move around, and may get better if he takes an over-the-counter pain reliever—but will keep coming back. “Any abdominal pain that doesn’t resolve within three days deserves to be checked out.”
Sharp, excruciating pain that hits suddenly and doesn’t improve within an hour warrants a trip to the ER. “If it’s a kidney stone, the pain will radiate from a specific point and can be intense enough to make you vomit,” Dr. Kaplan says. “I’ve had one myself, and it’s so horrible it makes you want to die.” The problem could also be appendicitis, a perforated ulcer or a hernia, so it’s important to get checked out. Photo: Shutterstock
4. Toilet-Time Blood
He’s thinking: Must be something I ate.
But it could be: A kidney stone or bladder cancer if blood is in urine; colon cancer if blood is in stools. Bright red spots on tissue after wiping are likely from hemorrhoids. But blood in stools that have become narrower and thinner than usual (like the width of a pencil) could be a sign of cancer. Black, tarry stools might also indicate stomach bleeding from an ulcer. His doctor will likely examine the GI tract via a colonoscopy or upper endoscopy to nail down the problem.
Blood in urine may show up as a subtle pink hue, but he shouldn’t dismiss minuscule amounts or chalk it up to eating beets. “You’d have to eat a whole lot for that to happen,” says Mark Pochapin, MD, director of the Jay Monahan Center for Gastrointestinal Health at NewYork–Presbyterian Hospital/Weill Cornell Medical Center in New York City. Assume any reddish color is blood: One drop can turn the bowl pink. “Even microscopic amounts are a warning,” says Martin Miner, MD, codirector of the Men’s Health Center at The Miriam Hospital and clinical associate professor at the Warren Alpert Medical School of Brown University in Providence, Rhode Island. “If he can actually see red color, he should definitely be evaluated.” Photo: iStockphoto
5. Trouble Down Below
He’s thinking: There’s a pill for this.
But it could be: An early warning of cardiovascular disease. “The latest studies find that men in their 40s and 50s with erectile dysfunction may be two to five years away from a cardiovascular event like a heart attack,” Dr. Miner says. A recent study at the Mayo Clinic found that men who had ED in their 40s were 50 times more likely to have heart trouble down the road than men who didn’t. The artery leading to the penis is about half the diameter of the one feeding the heart, so experts think that restricted blood flow from atherosclerosis shows up early down below. An EKG or stress test can identify cardiac problems and a Doppler ultrasound (usually from a urologist) can test blood flow in penile blood vessels.
“The first sign of ED is usually trouble maintaining an erection during sex or not having normal morning erections,” Dr. Miner says. The good news is that the onset of ED, if it’s caused by cardiovascular disease, suggests your man may have a window of opportunity to treat heart disease before it becomes a serious problem. Photo: Jim Arbogast/Thinkstock
6. Daytime Fatigue
He’s thinking: I should go to sleep earlier.
But it could be: Obstructive sleep apnea. Spending more time in bed won’t help if fatigue is due to this condition, in which the airway narrows or is blocked during sleep, cutting off breathing and disrupting slumber five to 30 times an hour. “Everyone has a night here and there when he doesn’t sleep well. But if the fatigue doesn’t go away even when he can catch up on rest, sleep apnea could be putting him at risk for health problems such as heart attack, arrhythmias, stroke or even heart failure,” Dr. Shindel says. A sign he’s chronically tired: falling asleep while doing activities during waking hours. “It’s not normal to fall asleep during usual waking hours just because you’re in a dark room,” Dr. Shindel says. Sleep apnea is especially common in overweight men and heavy snorers, but can be treated with breathing devices such as a CPAP (continuous positive airway pressure), an apparatus that you wear at night to keep airways open. Losing weight and surgery to widen the airway can also help. Photo: Stockbyte
7. Constant Grumpiness
He’s thinking: I’m just under a lot of stress at work.
But it could be: Depression. Feeling cranky and low because of work hassles or difficult times is normal, but it should dissipate within a few days. With clinical depression, downbeat irritability lasts weeks at a time. “It’s different from run-of-the-mill blues and time for him to talk to his doctor if you’re saying to him, ‘You haven’t been acting like the person I think you really are for weeks’ or he’s lost interest in activities he used to enjoy or isn’t performing at work,” Dr. Shindel says.
Talk therapy and antidepressant medication are the options his doctor will likely suggest first. But if he has symptoms such as fatigue, low sex drive and loss of muscle mass, Dr. Shindel advises getting a blood test for low testosterone, which is sometimes the root cause of depression, especially in men over 40. Testosterone replacement in the form of gel, skin patches or injections can reverse the symptoms, but he should first talk to his doctor carefully about his medical history and the potential risks of testosterone therapy. Photo: Ditigal Vision
8. Frequent Urination
He’s thinking: I’m drinking too much coffee.
But it could be: Type 2 diabetes or an enlarged prostate. It might be the coffee—when he’s actually drinking it. But if he often gets up to go twice or more during the night, his body could be trying to get rid of excess blood sugar that’s built up because it can’t get into cells—the problem that defines diabetes. He should first try adjusting what or when he drinks at night to see if that leads to fewer wee-hour trips to the bathroom. “If he still urinates more than he did a month ago, he should get his blood sugar checked, especially if he also has increased thirst, another red flag for diabetes,” Dr. Miner says. Diabetes can usually be controlled with changes in diet and exercise, often combined with medication.
If he’s also feeling like he can’t empty his bladder completely and/or is having a slow or weak stream, dribbling and having trouble getting urine flow started, the problem may be a growing prostate. This small gland surrounds the tube that carries urine out of the bladder, so an increase in size can put the squeeze on urine flow—a common problem in middle-aged and older men. (In men under 50, symptoms could be due to a urinary tract infection.)
Though painless, an enlarged prostate can eventually get worse and lead to acute urinary retention, where he suddenly can’t urinate at all, which is an emergency that often leads to surgery. Treatment ranges from exercises to strengthen muscles in the pelvic floor to medications that relieve symptoms or shrink the prostate. Prostate cancer is also a possibility, especially for men over 50, and if the doctor suspects that, he’ll do a rectal exam and draw blood to check PSA (prostate-specific antigen) levels; higher-than-normal results may indicate prostate enlargement, an infection or cancer. Photo: Thinkstock
9. Yellowish Skin
He’s thinking: What yellow skin?
But it could be: Liver trouble. Yellow skin, or jaundice, suggests the liver isn’t functioning right. Possible causes in adults include liver disease, gallstones, pancreatic cancer or a viral hepatitis infection, which causes swelling of the liver.
“Hepatitis A isn’t a disease people think of, but it’s a virus found in contaminated shellfish and can be passed on by people who prepare food and don’t wash their hands,” Dr. Pochapin says. In fact, hepatitis A is one of the most common infectious diseases that’s preventable with a vaccine— worth considering for anyone who hasn’t been inoculated. Symptoms like jaundice, fever, upset stomach and fatigue usually show up within two to six weeks of exposure and get better on their own with a few weeks of rest. (And the virus doesn’t stay in your body after that.) But have him check in with his doctor, who’ll most likely want to run some tests to figure out exactly what’s going on. Photo: Jupiterimages
10. A New Spot—Mole, Freckle, Red Patch— On the Skin
He’s thinking: It’ll go away.
But it could be: Skin cancer or seborrheic keratoses— warty, waxy benign lesions that become more common in middle age. Any time a new skin growth appears or an existing one changes in size, color or shape, he should see a doctor. Be especially concerned if a spot or mole gets darker, bleeds, itches or feels irritated—all of which are possible signs of skin cancer, according to the American Academy of Dermatology. The differences in appearance between a benign growth and skin cancer—especially melanoma, the deadliest type—can be subtle. So your physician may want to take a biopsy to make a definite ID.
I know all this from firsthand experience— and when I understood what the dangers may have been, I was glad I saw my doctor. After all, nobody’s indestructible forever. Photo: Jupiterimages
Why he doesn’t want to go to the doctor…and how to get him there
Every woman has that man in her life— her father, husband, brother, boyfriend, friend—who just won’t go to the doctor. Indeed, research shows that men are 24 percent less likely to have seen a physician in the past year than women.
Perhaps it’s no coincidence that men are more likely to be hospitalized for a preventable condition than women. What drives their avoidance? Research shows that it has a lot to do with men wanting to feel, well, manly. A study of 1,000 men found that those who have a more traditional view of masculinity—thinking that a “real” man doesn’t complain about pain, for example—were half as likely to get preventive care as those who didn’t agree with such stereotypes.
And let me tell you what else is going on: denial. Many people use it as a coping mechanism to deal with fear. So he’s probably thinking something like: “If I ignore this, it will go away” or “I don’t like needles and being prodded, so I’d rather just skip it” or “It’s either nothing or something too scary to know about, so I don’t want to go.”
So how can you help your man see the doctor? Talk to him about it. Sit down and have a chat, telling him that getting regular checkups is the best way to catch any potential illness before it becomes harder to treat and possibly life-threatening. Emphasize how important it is for him to be there—and healthy—for his family. Research shows this is the strongest motivator for men to see the doctor, probably because it appeals to their traditional sense of what their roles are. To help him address a symptom, the best dialogue I can suggest is something along the lines of: Let’s agree to tell each other when we’re feeling or seeing something that’s unusual or new for us—no matter how embarrassing—so we can help each other figure out what to do. I’m going to tell you if I have a stomach, gynecological or other issue and get it taken care of so I can stay healthy for you, and I want you to do the same for me.
Asking him to go to the doctor, and, if need be, arranging the visit shows that you’re taking his health (and symptoms) seriously, which can propel him to as well. It also helps remove the stigma he may feel about asking for help. Beforehand, help him organize his questions and concerns in writing and, if he’d like, be there with pen and paper in hand (or send him with a tape recorder) so you can both discuss the doctor’s responses later. When people are anxious, they often don’t hear or process the information they’re given in the moment. Don’t worry about being overbearing: A little nagging can go a long way in helping him protect his health. Photo: Shutterstock