Men’s Health: Dr. Valerian Discusses How to Make the Most of Your Annual Check-ups

Vicki:

Welcome to an HMC HealthWorks podcast. I’m Vicki Putnam. Today we’re joined by Dr. Chris Valerian who’s the National Medical Director and Program Consultant for HMC HealthWorks. Dr. Valerian went to New York College of Osteopathic Medicine. He did his post-grad work in Family Medicine at Duke University. Chris, thank you for joining us today.

Chris:

My pleasure Vicki.

Vicki:

I wanted to talk to you today because June is Men’s Health Awareness month and men die approximately five years younger than women and die at higher rates from heart disease, cancer, unintentional injuries, stroke, lung disease, diabetes, pneumonia, suicide, kidney disease, and Alzheimer’s disease. I know that sounded like a long list, but all of that is true and it impacts their ability to be involved fathers and supportive partners and also be engaged in their communities. What I wanted to talk to you today is many of these diseases can be prevented and there are steps men can take to avoid them just by knowing the symptoms and having regular checkups by their healthcare provider.

Vicki:

I was wondering if you could talk to me about that because I know the last time we talked was we were in the thick of the COVID pandemic and we were talking about that, and I know that because of the pandemic, a lot of people got behind in their appointments due to COVID. I wanted to have you talk to us about what men should do to make the most out of their appointments, and also about your thoughts on them getting back and getting caught up in those appointments.

Chris:

Sure Vicki. You’re right. That is quite a list that you rattled off there, but it is absolutely a 100% true as well. Some of it is genetic. It has to do with hormone balance and whatnot in men versus women. However, like you mentioned, that the vast majority of the diseases, especially the chronic diseases on the list that you mentioned, are preventable with regular health checkups and with men being aware of their health status. As you mentioned, the pandemic has certainly thrown all of us for quite a loop. Now that we’re kind of at the tail end of it and coming out of it, there’s actually been a lot of data to support the idea that people have not been going for their preventive service exams and their screenings over the last 12 to 18 months.

Chris:

There’s obvious reasons for that, safety and risk and others. There’s been a lot of public service messages recently you may have seen on the news or on the TV, or even hear on the radio that it’s okay to start getting your screenings again, that go to your doctor, go to your healthcare provider and start to get your routine screenings that you may have been putting off for the last year because of the pandemic, that it’s time to get back on board with that.

Vicki:

Yeah, that makes sense. I have heard that in public service announcements so that’s good that people are getting the information on all sides. One thing I wanted to ask you about is tell me what can men do to make the most out of their appointments once they make them with their providers?

Chris:

Sure. Obviously first step is make your appointment, make the call or go online through your portal and sign up. Taking the first step is the hardest one, right. But after that, you do want to be prepared and you do want to make the most of your time, as you mentioned. Some of the things you should do would be review your family history. If you’re not familiar with your relatives’ health history, then ask some questions and find out what have people died of? What are people taking medication for? Important. Find out what you think you may be due for, or even what vaccines you may be due for. Especially with today’s day and age, you want to keep up on all your vaccines, not just the COVID vaccine, which by the way everybody should be getting and just put a pitch in for that.

Vicki:

Yeah. Good point.

Chris:

If you’re like me, I need to write things down. Bring your list with you, right. Make a list of your health history, make a list of any of the issues that you may be having and bring that with you. I can tell you as a practicing provider, people that come in prepared for the visit, I have a much better experience than me fishing, right. If I have to go digging and asking a million questions, it’s a lot less productive than when you come in and say, “Hey, I had these five things I want to talk about today.” That’s important. Finally, review any symptoms that you may be having, or if you already have a chronic make sure, your blood sugar’s been, what’s your latest A1C. If you have COPD, how have you been doing with your medications? Have you had any grieving episodes? Things like that. Again, sort of really take a few minutes just to think through it and don’t just make it a passive experience.

Vicki:

Yeah. That makes sense. I know that anytime I’ve been prepared when I go to my physician, when I come out, I know that the outcomes were better. I walked away with clear action steps. The other thing I wanted to ask you about is I had mentioned earlier that statistically men don’t typically live as long as women. I wanted to know if you could talk to us a little bit about what some of those factors are that might contribute to that.

Chris:

Sure, absolutely. As I mentioned, some of it is genetic. Women because of higher levels of estrogen, all else being equal, will have longer lifespans than men just genetically. However, that doesn’t mean that we can’t level the playing field a little bit from our habits and our perspective. One of the biggest things is smoking. Men tend to smoke more than women. That contributes to some of the statistics that you had mentioned. Alcohol is another. Again, excessive alcohol use in men is more prevalent than women. That’s another contributing factor. I hate to admit this, but my fellow men tend to make more risky choices or unhealthy choices than women. Again, I put myself in some of that same category. Women tend to be more likely to go to the doctor than a man as well.

Chris:

A lot of times you’ll have the female of the house will actually make the appointment for the men and kind of coerce them into going. Men are just not making those decisions on their own. I think men are more reluctant to admit they may have an issue, whether it’s related to mental health issue or sleeping issues or chronic disease or symptoms they may be having. We just historically kind of bury it a little more deeply than women tend to do. I think if you take all of those factors in aggregate, that’s what drives a lot of these statistics around women living longer than men.

Vicki:

Yeah. That makes sense. I liked that you brought up about women sometimes giving them the nudge to do the appointments. Even though this is Men’s Health Month, I also think that it’s Women’s Health Month so that they can support the men in their life and give them the nudge and just acknowledge those things that you’re doing it out of love. That’s what’s really important. The other thing is we were talking about in the beginning about for me like the biggest ones, changes, possibly in your lifestyle that can help with these particular diseases. How could men lower their risk for type 2 diabetes, heart disease and cancer? Are there some small steps they can take that will result in some bigger changes so it doesn’t seem so overwhelming to make those changes?

Chris:

Sure, absolutely. You’ve kind of hit the big three for men right off the bat there, diabetes, heart disease, and cancer. Those are certainly the leading causes of illness and death in men. Anything you can do to sort of start down a healthier road would be helpful. Some simple things you can do if you smoke, you want to stop smoking, right. That’s pretty obvious. Even if you do smoke, cut back a little bit, if you’re a pack a day, try to get down to half a pack and then maybe take a walk. You don’t have to run a marathon day one, but maybe instead of watching that sitcom, maybe take a half hour walk with your loved one or your family or friend or whatever.

Chris:

That’s one thing. As far as diet goes, again, you’re not going to go from eating Big Macs to salads in day one, but maybe instead of a fast food, you could substitute a homemade meal. There’s a lot of data to support that people that eat at home actually have healthier lifestyles than people that eat out. Think about that. Maybe do substitute a healthier choice if you are out instead of the fries, you may have fruit or salad instead. Those are some sort of easy, simple things. Probably the biggest one and we all struggle with this is to not drink your calories. I don’t know if you’ve ever heard that statement before.

Vicki:

I have.

Chris:

Soft drinks and sodas. Juices even have a lot of calories and a lot of sugar. Substitute either a diet drink, or even water. Most of us as Americans don’t drink enough water a day. You should actually be striving for a gallon of water a day, if you can believe it. I know I struggle with that and I’m sure most of us do as well, but that is the recommendation.

Vicki:

Those are really great tips. In terms of the hydration and water, I did fill a gallon jug just to see one day because I had read that and had also been told that by my primary care provider. I have to say, even though it seems like a lot, when I spread it out through the day and into the evening, I did feel much better the next day, subsequent days where I was doing it. I mean, it made it easier to do when I realized how much better I felt. That was [crosstalk 00:10:47]

Chris:

Absolutely. Real quick story on something like that. My brother-in-law has a water bottle that has markings on it that basically are motivational messages for how much water to drink for a day. Actually if you fill it three times, I think it’s a gallon a day. I’m not promoting one product over another, but there may be some creative motivational things out there if you do some Google searching.

Vicki:

Wow. That’s a great idea. The other thing I wanted to ask you about too which is not just a problem with men, it’s throughout our whole society, is that the health consequences of being overweight. I mean, we just know from the ’50s to now, people are carrying a lot more weight and carrying extra fat can lead to some more serious health consequences. Talk to me about carrying the extra weight and what are the types of things that can cause you to not be well from carrying that extra weight.

Chris:

Sure, absolutely. As you mentioned, being overweight is actually an epidemic in this country right now. There’s studies that showed that about 2/3 of Americans are what’s considered medically overweight, which is obviously of epidemic proportions. BMI is the measure that a lot of people use and you’ll see that everywhere, your doctor probably talk about it. You can buy a scale that helps you measure your BMI. BMI alone is not that great an indicator, it’s certainly one of the tools, but it tends to underestimate the obesity factor. What we found is a better measure, a simple measure is waist size, waist circumference. Just get a tape measure and measure your waist. In men, it’s been found that men that have a waist size of 36 inches or less are 50% more likely to be healthy later on in life.

Chris:

The other way to look at that is if you have over a 36 inch waist as a man, you are 50% more likely to have a chronic health condition in the next 10 years. I know we’re on men here, but just the number for women by the way it’s 32 inches. A waist size of 32 inches or less is what you strive for from a health perspective and a health risk perspective. Having said that though, once you determine are you overweight or are you not overweight? Obviously being overweight, even moderately overweight can lead to cardiovascular disease, specifically heart disease and stroke, type 2 diabetes, and even some cancers are more prevalent in obesity. The reason for that really is visceral fat. As we age, we get that sort of little extra around the middle and that little extra around the middle is called visceral fat. That is the unhealthy fat. That is what kind of leads to a lot of these chronic health conditions.

Vicki:

Yeah. It’s interesting going back to what we were just talking about a few minutes before this about just some small changes where you were talking about swapping out like salad for fries, or taking a walk. I know with my own husband, who’s actually in very good health and he was fairly healthy when I first met him, but definitely much healthier now. Lot of it was doing a great job of starting to keep up with his doctor’s appointments, doing walks, and also like he’ll take the stairs instead of taking an elevator, just those small things. That really helped him just lose some weight and put him at a really ideal weight just from the small changes. Just from like losing 10 or 15 pounds, his health just skyrocketed and he did it over several years.

Vicki:

It’s not like an instant thing. I’m glad that you mentioned that losing that little bit of weight can really make a difference and change somebody’s waist circumference. The last thing I’d like to close out with is I know one thing that we always hear from doctors and we see it in medical newsletters and hear a lot about it is prostate cancer in men. What I wanted to ask you, if you could briefly tell us a little bit about prostate cancer, maybe what some of the symptoms are, and if there’s a certain age that men start getting checked and just give us a background on that. Because I think we all hear about it but we’d really know all the ins and outs of it.

Chris:

Sure, absolutely. Prostate cancer is the most common male cancer. People think of it as the sort of breast cancer equivalent in men, right. Everybody talks about breast cancer in women and in men it’s sort of prostate cancer. The prevalence of prostate cancer really starts to show at age 50 and above. They say, if you live long enough, a male that lives over a hundred has over 90% chance of having prostate cancer at that age, believe it or not. It’s definitely something that you should be aware of and be checked for. One of the easiest ways to be checked for it, again like we’ve been talking about, is keeping your regular annual doctor’s visits because there’s blood tests that could be done as well as physical exam findings that can help detect early prostate cancer.

Chris:

The good news is on prostate cancers, if you detect it early, it is many times curable. It is something that you really can prevent if you’re vigilant about it and take the appropriate actions. What should you be concerned about from a symptom perspective? It’s pretty non-specific, there’s several things that can mimic it, but the general symptoms to look out for are the need to urinate frequently, especially if you have to get up at night more than previously. As we age, the prostate tends to grow anyway, which many men as they age tend to get up, if they were not getting up at all in the middle of the night, they tend up to get up once. But if you find yourself getting up two or three or four times at night, that’s something to take note about. Difficulty in starting to urinate or stopping at the end, sort of dribbling as they call it.

Chris:

If those are symptoms that are new onset, that’s something to definitely see your doctor about. If you notice that the stream of the urine is weakened or interrupted, that would be something else to keep in mind. Of course, if there’s any pain or burning with urination, that’s not normal. Any erectile or ejaculatory issues may be related to prostate cancer and should be evaluated by a physician as well. What else? Certainly, if you see any blood in the urine, that’s something that should be evaluated. There’s many things that could cause that, but prostate cancer is one of them. Sort of non-specifically if there’s stiffness or pain in the lower back or hips that is new onset and just sort of out of the ordinary, not the usual aches and pains that we all get through life, those are some other reasons that you’d want to speak to your healthcare provider.

Vicki:

That makes sense. I’m glad that you just said not normal aches and pains, because it sounds like that pretty much not just with looking out for your health with prostate cancer, but men just should pay attention that if anything feels out of the ordinary, it’s different than it used to, go see the doctor, even if it’s not in the cycle of your regular physical or your screening, [crosstalk 00:18:23]. I was thinking that because I know a lot of times people think, “I’ll wait until my physical,” but really it’s better just to address something right away. Also, in talking about prostate cancer, can prostate cancer be prevented? Can men prevent it?

Chris:

It’s not a 100% preventable, but early detection, as I mentioned, is the way to go, because it can be cured if it’s detected early on. Again, just another reason that you should be going to your healthcare provider on an annual basis. Screening for prostate cancer for most men starts at age 50, by most recommendations, there are some situations, if you have a family history of prostate cancer, for example, or a close relative has prostate cancer, there’s reasons to start screening earlier than that. But again, you should talk to your healthcare provider about that, or men should talk to their healthcare provider about that. In general though, starting at age 50 men should start to be screened.

Vicki:

Yeah, that’s good to know. I want to ask you one other question before we close out, because we recently also had a Colon Cancer Awareness Month couple of months back. I know that’s a pretty severe cancer and if it’s not caught early, it can be very, very fatal. I was wondering, what would you say for most men, what would be the age to ask their primary care doctor about that screening? Or are there different factors that affect when someone should be screened like their age? I mean, is it different depending on your background or how does that work?

Chris:

Yep. Again, age 50 seems to be that magic age where we start to fall apart.

Vicki:

Lucky older adults.

Chris:

Yeah. I’m just there myself. Age 50 is the average age for a colon cancer screening in men as well. There are several ways to do it. You should talk to your physician or healthcare provider about what they recommend. The most common one is a colonoscopy, which is that where you drink that dreaded stuff the night before to sort of cleaned you out and then you get a light that looks into the colon. Direct visualization is what it’s called. That is sort of the gold standard, but there are some newer other technologies that are available as well. Again, that’s up to you to or the man to talk to his healthcare provider about. There are circumstances though, where you want to screen before age 50, just like I had mentioned in prostate cancer.

Chris:

If there’s a family history of prostate cancer, you may want to start earlier and there’s not a 100% agreement on what age is the right age to start. Some of the data will show age 40, some will say even earlier than that. Certain ethnic groups are at higher risk as well, and should start earlier as well. Again, I would speak to your healthcare provider because there’s not a 100% agreement on exactly what age it is. Depending on your individual circumstance, they may recommend earlier than age 51st for that as well.

Vicki:

Yeah. That makes sense, because they’re going to know you better because they’ve seen you for years, hopefully they’ve been seeing you for years and if they haven’t been get in with an appointment. Dr. Valerian, thank you so much for joining us today and we really appreciate it and hope that you’ll come back and talk with us again soon.

Chris:

Absolutely. It’s my pleasure. Anytime.