Though we’re all human and have in common a good percentage of the same DNA, there are some definite differences between the sexes when it comes to health issues. Verne Maree gets some solid, manly advice on men’s health from our all-male panel of doctors.
In most parts of the world, men tend to be in worse health than women are. Studies show that men are nearly twice as likely as women to die from the types of cancers that affect both sexes; they’re also more than 50 percent more likely to develop those cancers, and they have poorer survival rates. That’s no wonder, really, as they tend to follow less healthy lifestyles. They’re more likely to smoke, and more men than women drink to excess.
So, what’s to be done to get the male species off the endangered list? Let’s find out how to improve men’s health.
#1 Your Cancer-Savvy Buddy
Surgical oncologist DR DENNIS LIM, who specialises in thyroid, head and neck, parotid and melanoma surgery, feels that men should pay more attention to their health than they generally tend to do.
In the course of his work, including at Singapore’s National Cancer Centre, Dr Lim has seen many men who could have benefited from being more aware of the various causes of cancer, how to protect themselves from cancer, what to watch for, and essential cancer screenings that could save their lives.
So I asked him, if he had the opportunity to advise his best buddy on how to avoid dying from cancer, what would he say to him? Describing his approach as comprehensive and holistic, Dr Lim is quick to emphasise that the thoughts he’s about to share are not all necessarily mainstream. Instead, they’re more general in nature, based on his personal life experience and his own interpretation of data.
On diet … Diet is a big part of determining the state of your immune system, he says. Your immune system determines not only the likelihood of your getting cancer, but also your response to treatment if you do have cancer – so, it is of prime concern.
“For most of us who work in an office and whose work is not physical, the issue is excessive calories. So I tell my friends to cut out carbohydrates at dinner and to eat earlier in the evening so that their food has a longer time to digest. Also, I suggest setting aside two or three days a week for fasting, or eating only light meals, so as to stimulate the production of various beneficial liver enzymes.”
As to exactly what a man should eat, there’s no need to follow faddish diets that exclude one or more food groups. “Humans evolved to be omnivores, so a mixed and varied diet is key.”
On stress management…
Stress is the most challenging aspect of the life of today’s citydweller, he reckons, and mobile devices are a major culprit. Not only do they blur the traditional work-rest divide, they can also interfere with us getting proper rest and sleep. So, how does Dr Lim handle his own stress?
“My plan is simple – half-an-hour off every day, a half-day off every week, and a full week off every quarter.” What does “off” mean? “It means complete me-time and minimal decisionmaking. Examples include reading a chapter of a book along with enjoying a cup of coffee; taking a long bicycle ride on a Sunday morning; and relaxing on an island for a week.”
On sun protection…
For him, sun protection means avoiding the midday sun, and using hats, caps and other sun-blocking garments, especially for sports. “Unlike creams and lotions, they don’t wash off, and there’s no danger of them getting into your eyes.”
On screening and early intervention for males…
Colonoscopy is an essential and highly effective screening for colorectal cancer, he says. For males at risk of lung cancer, he recommends low-dose computer tomography (CT), which uses x-ray technology to scan the lungs. “Any recent symptoms – like painless lumps that appear to be growing, a chronic cough, or a change in appetite or bowel habits – needs to be looked at. A consultation with a general practitioner would be the place to start.” What is not known widely, he adds, is that most solid cancer can be cured if detected early. The key is to be informed about the symptoms and signs of cancer and to be vigilant. “Importantly, most solid cancer can be treated with surgery alone if it’s detected early. If it’s in an advanced stage, the treatment regime is more complex.”
What’s new and encouraging…
Targeted immunotherapy, he says, is a completely new arm in the treatment for cancer in addition to the well-established triad of surgery, radiotherapy and chemotherapy.
#2 Colon Cancer Screening
With colon cancer being the third most common cancer in the world, and men having a higher lifetime risk than women, this is an essential health screening for men’s health, warns DR SUJIT SINGH GILL. Statistics show that one out of every 26 men will develop this dreaded disease.
Though serious, he says, colon cancer is unique in having an easily detected precancerous phase that is highly treatable. Colon cancers typically start out as a non-cancerous polyp (a small growth on the inner lining of the colon) that mutates over time (five to 10 years) to become a cancerous tumour. If these polyps are removed, cancer is avoided.
What is colonoscopy?
Colonoscopy is the technique whereby a fibre-optic tube inserted into the colon is able to detect polyps and remove them during a single session. It is performed under light sedation so the patient does not experience any pain or discomfort. It typically takes 15 to 20 minutes and is done as day surgery.
Who should be screened?
Though current guidelines recommend screening for colon cancer from the age of 50, doctors are seeing a rapid increase in this disease in men aged from 35 to 49 years old. However, anyone with symptoms attributable to the colon should see their doctor for assessment, says Dr Gill. “Typical symptoms to look out for are blood in stools, recent-onset constipation or diarrhoea, or a feeling of incomplete evacuation after bowel movement.”
#3 Pre-diabetes – A Clarion Call!
Be happy that there’s such a thing as pre-diabetes. Not that you’d be expected to do the dance of joy on receiving the diagnosis – but you can rejoice in knowing that there’s a lot you can do to get yourself off the predictable road to full-blown Type 2 diabetes, says cardiologist DR ROHIT KHURANA.
In the US, for example, an estimated one third of adults is prediabetic. The condition puts you at increased risk for cardiovascular diseases, and that’s why monitoring for prediabetes is such an integral part of heart and vascular disease risk assessment, he says. The condition is diagnosed by a simple “pinprick” fasting blood sample test, or by a more formal glucose tolerance test.
What exactly is pre-diabetes – and how serious is it?
Pre-diabetes is defined by blood sugar levels being higher than normal, but lower than the threshold for Type 2 diabetes. And it’s precisely that increased blood glucose that’s the villain here: apart from increasing the risk of clotting, it damages blood vessels of all types and sizes throughout the body, from tiny capillaries in your fingers and toes to the large blood vessels in your heart and other major organs.
You’ll have no symptoms, says Dr Khurana, but about a third of pre-diabetics will progress to being diabetic and dependent on medication. What’s more, the adverse health consequences of being diabetic include “an increased risk of vascular complications, such as heart disease, stroke, and eye and kidney damage”. In fact, studies show that a man with diabetes is twice as likely to have heart disease as his peers.
What can a pre-diabetic man do to reverse the condition?
Take steps to get your weight under control, says the doctor. He advocates reducing calorie intake through healthy dietary habits that include avoiding sweetened beverages, eating less fat and limiting alcohol intake.
If being overweight makes you more prone to prediabetes and diabetes, so does being sedentary. Fortunately, many studies have shown that lifestyle intervention in the areas of diet, weight loss and regular physical activity significantly reduces the progression from prediabetes to Type 2 diabetes.
Lifestyle changes need to be sustainable, and also tailored to each individual’s daily demands and constraints – such as working schedule, physical capabilities and budgetary limitations. “Support from family and friends is invaluable at this time,” he says. “And to help you monitor your various lifestyle changes, wearable health tracking devices and mobile apps can assist in keeping you motivated.”
What about medication?
“It can be considered,” he says, “usually after a trial of intensive lifestyle intervention.” The drug most usually prescribed is one that reduces the amount of glucose that the liver makes, can also lower insulin resistance, and is regarded as being safe in the long term.
Any other advice?
“If you’re diagnosed with pre-diabetes, I recommend that you undergo screening for other modifiable cardiovascular risk factors, such as hypertension and cholesterol profile,” says Dr Khurana.
It goes almost without saying that smokers should quit the habit; apart from its other nasty effects, smoking further impairs glucose metabolism, insulin sensitivity and secretion. Finally, he concludes, you should follow up regularly with your physician to monitor your levels not only of glucose, but of glycated haemoglobin; the useful HbA1c test demonstrates how well your prediabetes is being controlled.
#4 Weak At The Knees?
Yes, we women like our men weak at the knees – but only in the figurative sense. A man with knee pain is a miserable creature. Consultant radiologist DR KENNETH SHEAH of Orthopaedic & Hand MRI tells us more about this men’s health issue.
Not only middle-aged and older men are prone to problematic knees. In fact, studies show an ongoing rise in the incidence of young, active men with damaged and painful knee joints. The knee is a hinged joint that allows us to move and to bear weight, explains Dr Sheah; many injuries to the knee occur when compression, twisting or side forces are applied to it.
Compression forces occur when the femur is forced against the tibia. This can result in a fracture of the overloaded tibia. The severity of the fracture is worse with higher loads – falling from a greater height, for example. Compression of the knee also occurs when we put on weight, he says. This increases the load on the joint, affecting the medial meniscus and the weight-bearing cartilage of the medial joint. “Once cartilage on the medial knee wears out, the attrition will be transferred to the outer (lateral) part, marking the start of more advanced osteoarthritis.”
Twisting forces usually occur in sports. “In football, for example, for a player with one foot planted on the ground to change direction is already subjecting that knee to torque,” says Dr Sheah. “Another player colliding into him can stress the ligaments, causing tears of the menisci, the cruciate ligaments and the medial collateral ligament.”
This pattern of injury even has a name – “O’Donoghue’s unhappy triad” (or “terrible triad”), courtesy of the American orthopaedic surgeon who first noted it in 1950. In addition, other supporting structures on the back of the knee can be damaged – and this has implications for rehabilitation after the injury, and a risk of re-injury.
Side forces can be directed from in-to-out (varus) or from outto-in (valgus). These cause damage to the collateral ligaments that support the sides of the knee. “Once the collateral ligaments are torn, the knee buckles more easily, which accelerates degeneration and leads to joint dysfunction and pain.”
Finally, anterior knee pain (in the front of the knee) is very common, especially in young to middle-aged runners. According to Dr Sheah, it can be caused by any of a range of injuries, including “patellar tendonitis, quadriceps tendonitis, and patellar maltracking with patellofemoral cartilage disruption”.
Different treatment options are available for the various injuries, so it’s important to identify exactly which structure is responsible for your pain. For example, cartilage ulcers may need arthroscopic repair, whereas tendinitis may be treated with physiotherapy.
Here’s where MRI or magnetic resonance imaging is so useful, he concludes: “The MRI scan is a great non-invasive way to investigate the knee joint, as it visualises soft tissue injuries so well. Tissues that are evaluated with MRI include the menisci, which support the joint surfaces and reduce impact together with cartilage; cruciate ligaments, the major restraints that prevent knee-buckling; collateral ligaments that support the sides of the knee; and of course the cartilage and underlying bones.”
From it, your doctor can tell which of the structures are injured and to what extent, and plan your treatment accordingly.
“MRI costs have been reduced since the technology was introduced two decades ago. You can speak to your doctor to consider an MRI of the knee. There are established ‘appropriateness criteria’ published by professional radiology societies that recommend the correct type of medical imaging.”
Does the idea of having to keep still in a narrow tunnel bring on claustrophobia? Knee injuries are often good candidates for compact MRI diagnostic imaging, available at private medical facility MRI Center for the Extremities. This technology allows knees, ankles, feet, elbows, wrists or hands to be scanned in isolation, instead of involving the whole body
#5 You’re So Vein…
Or are you? It’s a common misconception that varicose veins are merely a cosmetic problem, says DR SUJIT SINGH GILL.
Though that is the case with some patients, he adds, for many it is not. Varicose veins cause heaviness in the legs, aching calves, night cramps, burning pain and restless legs. If untreated, a proportion go on to develop chronic venous insufficiency (CVI), a condition where sufferers develop long-standing ulcers in the legs that are notoriously difficult to treat.
Another misconception is that they’re mainly a woman’s problem, not a men’s health issue. In fact, 25 percent of the population suffer to some degree from those swollen, bulging and tortuous veins that occur mainly on the legs, and the ratio is about two men to every three women.
Causes and Treatment
“The cause of varicose veins is a malfunctioning of valves within the leg veins,” says Dr Gill. Fortunately, the location of these malfunctioning valves can easily be determined with an ultrasound scan, done by a vascular specialist during your consultation. This maps out the veins that need treatment.
Nowadays, he explains, treatment is in the form of minimally invasive ablation, or closure, of the diseased veins, performed either with local anaesthesia or with light sedation. How does that work? “A catheter is inserted into the vein under ultrasound guidance, and then activated to cause constriction and closure of the vein. The catheter is then removed.”
The good news is that there’s no need for hospitalisation. “You’ll be able to walk out of the clinic soon after the procedure. What’s more, the results are good and the risk of complications is very low.
OUR MEDICAL PANEL
Dr Rohit Khurana The Harley Street Heart and Vascular Centre
• #02-38/41 Annexe Block, Gleneagles Hospital, 6A Napier Road | 6472 3703
• #07-41 Mount Elizabeth Novena Specialist Centre, 38 Irrawaddy Road | 6694 0050 | harleystreet.sg
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