Boston Public Health Commission
VOL. 4 • NO. 10
© June 2010
Men’s health: regular checkups vital first step
enry Jenkins has come a long way. Like most men, he went to a doctor only if it were an emergency. And one evening four years ago, he was having an emergency. All the years of ignoring his health came crashing down as he fell off his couch and landed on the floor. He was having a stroke. Fortunately, his friend heard the thud and called 911. But even then, his health was not his first thought. “When they were taking me in the ambulance, all I could think of is how soon I could have a cigarette and a beer,” he remembered. All of that changed after the stroke. Jenkins is now 72 and is amazed that he could live so long without going to a doctor on a regular basis. “It almost cost me my life,” he said. For a variety of reasons, men have a different attitude about their health, and an aversion to making — and keeping — regular medical appointments is just one of them. Those attitudes are in part the reason that men — particularly black men — are suffering and dying at higher rates than any other demographic group. In 2007, the death rate in black men in Massachusetts exceeded that in black females by more than 30 percent in all but a few illnesses. Black men die from cancer and heart disease at a rate more than 60 percent higher than that of black women. Even when matching males against males, the picture is bleak. Black men die from diabetes, kidney failure and HIV at two to fives times the rate of white men. Homicide is another factor. Black males are murdered 11 times more frequently than white men. These figures explain why life expectancy for black men continues to lag behind white men and women. While white women in Massachusetts are expected to live until the age of 83, life expectancy of black men is almost nine years shorter.
Dr. Jean Bonhomme, founder of the National Black Men’s Health Network, places a lot of the blame on the men themselves. Not going to the doctor is ingrained in men — sucking it up is instilled in young boys when they are in pain. “Society has a great admiration for pain without complaint,” said Bonhomme. “Males have an expectation that if something hurts, don’t bother with it. It will go away by itself.” Typically, men enter the health care system when their prostate kicks up, but that takes 40 to 50 years. It doesn’t take that long for cardiovascular problems to emerge — and often silently. That’s why “feeling fine” is not a reliable measure of good health. Ironically, some men begin to suffer from the very condition that concerns them the most — erectile dysfunction (ED). Although there are many causes for ED — stress, depression, and certain diseases — one of the biggest causes is carHenry Jenkins is smiling, but admits his past behavior is no laughing matter. diovascular disease. Men with untreated Because Jenkins refused to go for regular checkups, his high blood pressure and high blood pressure, diabetes, clogged arteries — the very conditions that would cholesterol went undetected. Jenkins suffered a stroke almost four years ago. be assessed and treated at regular doctor visits — can interfere with normal sexual had one doctor, and according to Jenkins, men saw him only functions. Add smoking, excessive alcohol use, obesity and when they had cut themselves and required stitches. lack of exercise to the mix, and it’s a wonder that men can “We had our own remedies for colds and stomach aches,” perform at all. Jenkins readily admits that he was more of the rule rather he said. “I think I went to the doctor’s office only about five times in my life and it was never to see what was going on inthan the exception. He grew up in a small town in Louisiana, and going to the doctor was not part of the culture. The town Jenkins, continued to page 4
Taking health to the streets Wayne Lloyd walks the talk — literally — when it comes to healthy living
loyd doesn’t need any prodding to take care of himself. The 45-year-old physical education teacher was taught from an early age about the importance of health care and regular doctor’s visits. His career path kept him on the straight and narrow. Lloyd studied health and physical education in college, and unlike many men who ignore their health for several years following graduation, he instead established a relationship with Dr. J. Jacques Carter, an internist at Beth Israel Deaconess Medical Center. It’s a good thing he did. Lloyd has high blood pressure, which was found during one of his physicals. It is well controlled with medication. Lloyd said he was glad he started his screenings several years ago. “Over a long period of time, it [high blood pressure] catches up to you,” he said. Uncontrolled high blood pressure is one of the leading causes of stroke and heart attack.
Lloyd has a healthy lifestyle. “I’ve exercised all my life,” he said. “I run 15 to 20 miles a week.” It does not end there. He tries to instill these values in his students at Mattahunt Elementary School in Mattapan. “Children are excited about health,” he said. “They ask a ton of questions.” Each year his students literally “jump” for good health. They take part in the American Heart Association’s (AHA) “Jump Rope for Heart,” an educational event that combines exercise with fund-raising. “The kids love it,” he said. “The money is donated to the AHA for research in heart disease and stroke.” Lloyd expresses concern for the health of the kids after they leave elementary school. He knows all too well that as kids age, their concern for health can wane. “Once they reach middle school, I only hope someone can continue to teach them good health habits,” he said. George Dixon has assumed that mantle.
But his responsibility is even greater. Forget about Mohammed and the mountain. George Dixon has an even more difficult mission: convincing black men to take control of their personal health. Dixon, 50, knows all too well that men — and black men in particular — shun doctors and go only under extreme circumstances, thereby increasing their risk of a myriad of illnesses, including stroke, heart disease and cancer. He also knows that failure to get the appropriate screenings early in life can result in permanent and severe disability. And worse — premature death. By all accounts, Dixon is not your typical male. His work with doctors and hospitals made him realize and appreciate the necessity of regular and timely visits to the doctor. But his parents had a hand as well. Growing up, his family doctor lived just a block away and actually made house calls. As an adult he was fortunate Dixon, continued to page 4 PHOTO BY ERNESTO ARROYO
Get a checkup! Be a man
It’s true, isn’t it? Men are raised to be fearless in scary situations. Run into a burning building to rescue a child? Check. Join the armed forces to defend the country? Check. Race down the Southeast Expressway straddling a motorcycle as dark clouds prepare to dump six inches of rain? Check. Call the doctor to schedule an exam? Hang on, wait, nope, not happening this year. Or next year. And maybe not even the year after that. According to a 2009 U.S. health report, men are 80 percent less likely than women to have a go-to source for medical care. Not surprisingly, men ages 18 to 44 are 70 percent less likely to visit a doctor. Now there’s
5 Health Tips for Stronger, Healthier Men
A visit to the doctor needn’t be the first — or only — step you take toward better health. Prove to yourself and your loved ones you’re a strong man of action by following the five stayhealthy tips below. 1. Lift weights. Eye-popping muscles aren’t the only reason to lift weights. While it’s nice to show off a summertime sixpack — the kind that ripples below your ribs, that is — strong bones are an equally important gain. Osteoporosis, a condition that makes bones increasingly fragile, affects more than two million men. In fact, after men reach 50, one in four suffers an osteoporosis-related bone fracture. Annually, 80,000 men break a hip bone and one-third die within a year of ensuing health complications from the disease. Weight lifting, resistance training and other exercises like stairclimbing, walking and running that push the body to
a scary situation considering the fact that the death rate from heart disease is 50 percent higher in males and men die of chronic liver disease at twice the rate of women. What makes guys shy off when it comes to scheduling health appointments? One hurdle can be access to care, notes a national report on quality and disparities in health care. African American and Hispanic men are roughly 10 percent less likely than white men to have a primary care provider. Yet that’s not the full story. Waiting rooms that look more feminine than masculine are a turn-off. Soft-focus wall colors and magazine selections make plenty of men feel out of place. Familiarity matters, too. While women
work against gravity help keep bones strong if you aim for at least two strengthening bouts per week engaging all the major muscles — arms, legs, chest, back and abs. So, too, does getting enough calcium and vitamin D, not smoking, drinking only in moderation and taking bonestrengthening medications if prescribed.
2. Go low on your stats. We know, we know. The players currently slugging it out at Fenway Park are all about pushing statistics into the stratosphere. But when it comes to blood pressure, keeping that vital stat low helps protect you against heart disease, kidney disease and stroke among other ailments. Other numbers that should stay low to boost your health are your blood glucose (diabetes), total cholesterol and LDL (bad) cholesterol. One exception is HDL (good) cholesterol, where higher numbers are better. When you do see a doctor— and you certainly should! — ask if your blood pressure and cholesterol stats fall within a normal range (below 120/80 mm Hg for blood pressure and less than 200 mg/dL for total cholesterol). Exercising regularly, eating right, losing weight if necessary, not smoking, drinking alcohol
are encouraged to come in for regular health checks during child bearing years for Pap smears, birth control and prenatal care, men often get a pass unless health problems crop up. On top of all this comes the warrior syndrome. “Men often downplay pain or worrisome symptoms and actively avoid potentially embarrassing tests or questions,” says Dr. Jan Cook, medical director for Blue Cross Blue Shield of Massachusetts. “Nothing short of an all-out emergency will persuade many men to have a much-belated checkup. However, seeing a doctor regularly and having appropriate tests can actually head off a serious illness before it becomes an emergency.” only in moderation and taking medication if prescribed, all help bring down blood pressure and keep your cholesterol stats in balance.
3. Walk it off. Real men don’t walk? Then pick another way to get regular exercise. Set your sights on accumulating two and a half hours of moderate activity a week. This strengthens heart, lungs and bones while helping you stay trimmer and happier. Playing football, basketball, soccer and other sports counts toward your daily or weekly total. Lifting weights at least twice a week should be added to your aerobic exercises. Still not convinced? In a longterm study of nearly 32,000 men, those who engaged in exercise three to five hours a week beat sedentary men in sexual well-being because they were 30 percent less likely to suffer erectile dysfunction. If you’re looking for additional ideas, browse free online workouts posted by the American Council on Exercise (http://www.acefit ness.org/exerciselibrary/default.aspx).
4. Quit it. The American Cancer Society reports that smoking is responsible for almost one in five deaths. If you smoke or use tobacco products, it’s the right time to quit. Cancer is the second leading cause of death, topped only by heart disease — in men, as well as women. Overall, smoking cigarettes prompts roughly one in three cancer deaths and contributes to heart disease, emphysema and other lung diseases, stroke, and, according to some studies, impotence. It harms practically every organ in the body, interfering with breathing, everyday activities, tasks and enjoyment. Second-hand smoke can make children and others around you sick, too. If you’re ready to quit — even if you’re just starting to wonder about it — the Blue Cross Blue Shield program Living Healthy, Smoke Free can help. Or try the four-step plan described on the Massachusetts Department of Public Health Web site.
5. Pick up the phone. Then call your primary care doctor to find out if you’re due for a physical exam or screening tests that may help you avoid serious health problems further down the road. If you don’t have a doctor, you can find one on the Blue Cross Blue Shield Web site (see “Find a doctor, dentist, or hospital” at www.bcbsma.com), or through another health insurance plan or a local clinic.
Men’s Health Summit 2010 When: Saturday, July 10th Where: Roxbury YMCA Time: 10 am – 2:30 pm Sponsor: Whittier Street Health Center Call 617-989-3028 to register
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Questions & Answers 1. Men are advised to have an exam for prostate cancer by the age of 50. Are there other screenings they should have before then? All men should have routine medical screenings well before the age of 50. Blood pressure check, body measurements (height and weight), cholesterol and Jean J. Alves, M.D. diabetes tests and testicular Internist examination are the most Bowdoin Street Health Center important ones. Along with prostate cancer screening, at age 50 men should also be screened for colorectal cancer. 2. Why do some men with diabetes and other medical conditions experience erectile dysfunction? Diabetes and other medical conditions such as high blood pressure are well known to cause damages to blood vessels and nerves which are essential to achieve and maintain erection in men. Aging, neurovascular disease, smoking, excess consumption of alcohol and certain medications can also cause erectile dysfunction. 3. Why do men tend to ignore health symptoms rather than go to the doctor? Unfortunately, many men react with a “macho” attitude when experiencing health symptoms. A common mistake made by men is that all symptoms will self resolve and that a visit to the doctor is unnecessary. It is important for all men to discuss health symptoms with their provider, particularly if symptoms are persistent or recurrent. A simple history and exam along with appropriate tests in a doctor’s office can make a great difference. 4. If a man says he “feels good,” does that mean he does not need to see a doctor? No. Regular check ups with a doctor are an important part of all men’s health maintenance. Some diseases may not cause symptoms and men may be falsely “feeling good” while harboring serious ailments. High blood pressure, a very common illness, and some cancers are common examples.
Testosterone is a sex hormone that makes men men. It is responsible for their sex drive, sperm production, body hair, muscle mass and bone density. Men gradually lose testosterone over time especially after the age of 40. Other causes of loss are injuries, infections and hormonal disorders. Some men have no symptoms or fail to recognize them. When symptoms impair quality of life, low testosterone can be evaluated and treated, often by an endocrinologist, a doctor who specializes in disorders of hormones.
Possible Symptoms Decrease in sex drive Erectile dysfunction Low sperm count Enlarged breasts Mood changes Reduced muscle bulk and strength Increased body fat
Decreased bone density Osteoporosis Fatigue, decreased energy Sleep disturbances Depression Trouble concentrating or remembering things Hot flashes
5. Do men experience “male menopause?” It is unclear and frequently debated if, in fact, men experience “male menopause.” Menopause is the result of hormonal changes. In women there is a complete lack of production usually between the ages 45 and 55. In men there is a gradual decrease in hormonal (testosterone) production that may account for symptoms attributed to “male menopause.” These symptoms may include generalized fatigue and weakness, sexual dysfunction, depression, mood swings, increase in fat and loss of bone density. 6. Osteoporosis is often considered a woman’s disease. Do men get osteoporosis as well? Unfortunately, many men view osteoporosis as a disease unique to women. After age 50, 6 percent of all men will suffer fractures related to osteoporosis. It is important to recognize and treat men with osteoporosis to prevent fractures and improve physical mobility and independence. A decrease in testosterone, a hormone, is a contributing factor to osteoporosis. 7. Why is depression in men often not recognized? Because of macho attitude, men usually deny signs of depression. It is common for men to ignore symptoms such as lack of sleep, fatigue, weight loss, decreased appetite, sexual problems and emotional changes. It is very important to promptly diagnose and treat depression. In the U.S. men account for 75 to 80 percent of all suicides related to untreated depression. 8. How does a man know if he has low testosterone? Testosterone usually declines gradually after age 40. Men with lower than normal levels may experience fatigue, decreased sexual function, sleep disturbances and mood swings. A simple test done at the doctor’s office will be able to determine testosterone level. 9. At what age should men be examined for testicular cancer? Although rare, testicular cancer is the most common cancer in men between the ages of 15 and 35. All men should have a testicular exam done by their physician during their annual exam, and learn how to perform it as well. 10. If men do not follow a healthy eating plan, can vitamin and mineral supplements make up for the nutritional deficit? A healthy diet is crucially important to keep the body functioning well. A healthy eating plan of a variety of fruits and vegetables, whole grains, lean meats and healthy fats is recommended for everyone. If for any reasons, particularly elderly men are not able to keep a healthy diet, vitamins and mineral supplements may be prescribed to achieve adequate nutritional balance.
The information presented in BE HEALTHY is for educational purposes only, and is not intended to take the place of consultation with your private physician. We recommend that you take advantage of screenings appropriate to your age, sex, and risk factors and make timely visits to your primary care physician.
BE Healthy • http://behealthy.baystatebanner.com 3
Jenkins, continued from page 1 side my body.” And like most men, Jenkins had a simple fatalistic reason. “If there was anything wrong with me,” he explained, “just let it happen.” But Jenkins took his short-sighted behavior to an extreme. When his friend scheduled yearly physicals for him, Jenkins would calmly sit in the waiting room for a while — and then catch the bus back home without actually ever seeing his doctor. Jenkins now blames himself. “It was me,” he said. “Going to the doctor was something I decided I didn’t want to do. I was afraid.” Jenkins is not alone. In a recent survey sponsored by the American Academy of Family Physicians, more than 1,100 men
J. Jacques Carter, M.D., M.P.H. Assistant Professor of Medicine Harvard Medical School Beth Israel Deaconess Medical Center talked about their attitudes on their personal health. What they found was not surprising. But one pattern emerged — the answers are tempered by age. The older men get, the more likely they are to seek the care of doctors. Men between the ages of 18 and 34 tend to consider themselves healthy — thus denying the need for a doctor’s visit. They also tend to wait as long as possible to see if they get better on their own, are less likely to have a blood cholesterol test and have a fear of knowing if something is wrong. By the time men reach 55 years old, their views are completely different. They tend to seek medical advice as soon as possible, are more likely to have had a recent cholesterol test (89 percent), do not consider themselves particularly healthy and do not fear what the doctor may find. There are many reasons for men’s be-
havior and fingers can be pointed in several directions — even at the medical profession. For starters, there is no counterpart to gynecologists, doctors specially trained in the female reproductive system. While services for women and children and specific diagnoses abound, men are hard pressed to find programs geared to them alone. Even treatment of the elderly gets more play than male-designated care. And what does receive an inordinate amount of attention — sexual performance — is not exactly a fatal condition. In fact, of the top 20 leading causes of death in men, the lack of sexual prowess is not one of them. Dr. J. Jacques Carter, an internist at Beth Israel Deaconess Medical Center, is extremely blunt. “There’s more to men’s health than prostate cancer and Viagra,” he says. Not all is lost. Over the years, Carter has seen a change in attitudes. Although most of his male patients are between 45 and 55 years old, he says he sees a significant number of thirtysomething men. “You want to get them early,” he said. “You don’t need to see them every year, but you want to get a baseline.” The trick, Carter explains, is to establish a strong and trusting relationship with his patients. “They won’t come back if they don’t like what you say,” he said. He’s also learned the art of bargaining. If he can get a patient to do at least one of the four suggestions he makes, he’s partly there. Jenkins has made a remarkable recovery. Though he still wears a short-leg brace to support his right ankle and he uses a cane to walk outside, his speech has improved and he is slowly gaining strength in his right arm. He now attends the Rogerson Communities Adult Day Health Program three times a week where he spends several hours in the exercise room. In hindsight, Jenkins marvels at his past behavior, but admits, “The stroke is the best thing that has happened to me.” He has no problems going to the doctor now. “Every six months I go for a physical,” he said. He takes his medications faithfully. And his fear of doctors has disappeared — just like his smoking habit. “Now if anything is wrong with me, I go to my doctor right away. If it’s on the weekend, I go to the emergency room.” But more than anything else, Jenkins wants people to learn from — and not repeat — his experience. He’s become a preacher of sorts. He says he stops people in the street — complete strangers — to warn them of the dangers of not going to the doctor or not getting screened. For Jenkins, it’s personal. ”I don’t want others to go through what I went through,” he says.
Celebrate Men’s Health Week … and check yourself out! Condition
High blood pressure
At least every two years
Every five years
Type 2 diabetes
Every three years
Every one to ten years
*Frequency and starting age will differ by risk factors. For instance, if you have prostate cancer in your family, you will probably start screening at age 40 or 45. This schedule applies to asymptomatic persons. Follow your doctor’s recommendations once a diagnosis is confirmed.
Looking for services you can call your own? Men’s Health Program
Young Men’s Health Clinic
Whittier Street Health Center 617-989-3028
Boston Medical Center 617-414-5951
The Men’s Health League
Barron Center for Men’s Health
Cambridge Public Health Dept. 617-665-3677
Mount Auburn Hospital 617-499-5722
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How important are doctor’s visits to your overall health routine? Jerel Ferguson, 35 Customer Service Rep. Dorchester Very important. Because historically its been neglected. I’ve been going annually for the last 18 years. It’s beneficial to our survival.
Ian Cotterrell, 48 Property Manager Boston I’ll go to the doctor in a minute. If I’m not feeling well, it doesn’t take me long at all to make that call.
Master Heg Robinson, 67 Tai Chi/Qigong Master Roxbury It is the absolute, most valuable thing a human being can do. On a scale of one to ten, it’s a 10 ½ !
PHOTO BY ERNESTO ARROYO
In observance of American Stroke Month in May, the American Stroke Association teamed up with the Men’s Health League for the second Cambridge Barbershop Tour. George Dixon (left) a mentor in the League, discusses health information with Justin Wright.
Dixon, continued from page 1 enough to find a doctor who met his needs and has stayed with him for about 20 years. Fortunately, his numbers are good — no diabetes, nor prostate or colon cancer. His high blood pressure and high cholesterol are under control. But something was missing. Although Dixon was satisfied with his good lab report, he realized he needed to keep his numbers in line. He took a close look at himself and sadly came to the realization that the pounds have crept up and he was not the “strapping 160-pound guy” anymore. His wife put it a little more bluntly. “You have more different size clothes than anyone I’ve ever met,” she offered. A poster about the Men’s Health League (MHL) caught his attention and offered a solution to keep his health on track. The MHL is co-sponsored by the Cambridge Health Alliance, the Cambridge Family YMCA and the Margaret Fuller Neighborhood House, a community-based organization developed to help empower community residents. The program is an initiative to improve men’s health and link them to health care.
Men of color are particularly targeted. The poster was thought-provoking. “Whoa,” thought Dixon. It hit a chord. “I could never do this on my own.” Dixon joined and never looked back. He finished the 12-week wellness program that promotes routine screening, exercise and information on nutrition and risk factors for chronic diseases. The MHL is not the first program to educate people at risk to take control of their health. But it has a unique component that Dixon calls an intervention. It affords men the opportunity to discuss among themselves issues relating to health that they would not normally discuss elsewhere. “There’s a camaraderie,” said Dixon. “We break down barriers and provide a trusting environment. It’s intimidating to walk into an academic medical center and ask for help. Here we speak a common language and people have similar challenges.” He doesn’t worry about the major changes — it’s the little ones that add up. Dixon didn’t stop after his 12 weeks. He graduated. Now he’s the mentor, sallying forth to help men who stand where he once stood a while back.
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