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SECURE MAN

A Healthy Body Powers A Healthy Mind


HAYNES Haynes Publishing Group is the world’s market leader in the producing and selling of car and motorcycle repair manuals. Every vehicle manual is based on our experience of the vehicle being stripped down and rebuilt in our workshops. This approach, reflecting care and attention to detail, is an important part of all our publications. We publish many other DIY titles and books about motor sport, vehicles and transport in general. Haynes Publishing, Sparkford, Yeovil, Somerset BA22 7JJ, England

www.haynes.co.uk

MEN’S HEALTH FORUM The Men’s Health Forum’s man manuals contain easy-to-read information on a wide range of men’s health subjects. Founded in 1994, the MHF is the independent voice for the health and wellbeing of men and boys in England and Wales. Our goal is the best possible physical and mental health and wellbeing for all men and boys. Men’s Health Forum, 32-36 Loman Street, London SE1 0EH Registered charity number 1087375 Company limited by guarantee number 4142349 – England

020 7922 7908 • www.menshealthforum.org.uk

BIRMINGHAM & SOLIHULL MENTAL HEALTH Birmingham and Solihull Mental Health NHS Foundation Trust provides mental health care to those people living in Birmingham and Solihull experiencing mental health problems. Full details on page 34.

A full list of references is available at: menshealthforum.org.uk/MMreferences The MHF encourages your feedback at: menshealthforum.org.uk/MMfeedback

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CONTENTS What’s The Point? How To Be Good To Your Heart You Are What You Eat TOP EATING TIPS How To Get Active TOP EXERCISE TIPS How To Handle Your Tackle Safer Sex How To Quit Smoking YOUR MENTAL HEALTH MEDS How Dangerous Is The Sun? Things To Keep An Eye On Under The Weather Who Can Help?

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ONE MAN IN FIVE DIES BEFORE HE’S OLD ENOUGH TO RETIRE… Developed in partnership with Birmingham and Solihull Mental Health NHS Foundation Trust • Based on the Men’s Health Forum’s Man Manual • Written by Jim Pollard with additional text by Dr Nick Tarrant and Dr Rebekah Bourne • Tips generated with the men from Reaside Clinic, Longbridge • Edited by Jim Pollard • Cartoons by John Byrne • Thanks to the Advisory Board led by Dr Rebekah Bourne for Birmingham and Solihull Mental Health NHS Foundation Trust and Dr John Chisholm for the Men’s Health Forum and all those who helped with the booklet • Full photo and illustration credits page 35 • Published: February 2018 • Revision date new content: February 2020. The Man Manual, Secure Man © Men’s Health Forum All rights reserved. You must not reproduce or transmit any part of this booklet in any form or in any way without written permission from the Men’s Health Forum. This includes photocopying or scanning it. Printed in the UK. ISBN: 978-0-85761-015-7

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MEN’S HEALTH MADE EASY WHAT’S THE POINT? There are thousands of health books. Most of them make a simple subject complicated. The human body, like the best technology, works out of the box. Understand it, use it sensibly and it’ll last for years. But there’s one difference between your body and your new technology or car. If your body breaks down, you can’t go out and get a new one (although your partner might) so it makes sense to do some basic maintenance. We can tell you what you need to know in 36 easy-to-read pages. Scientists reckon that with one careful owner, the male body could run for 100, even 120 years. But it doesn’t work out like that. One man in five will die before he reaches 65, two in five before the age of 75. Sometimes it’s bad luck - an unavoidable accident or something in your genes - but often premature death is down to stuff we can all do something about very easily. We’re not talking anything dramatic - just a few little changes that will make life easier and more fun. This booklet will show you how.

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SMALL CHANGES - BIG DIFFERENCES Take the big killers: cancer, heart disease and lung diseases (or chronic obstructive pulmonary disease - COPD). Most of us will run into at least one of these at some time but there’s a lot you can do to delay them, avoid them and even live with them. Today, a record 2.5 million people are living with cancer in the UK. As many people now survive the disease as die from it. But Cancer Research UK also reckons that in the last five years a further 600,000 or more cases of cancer could have been avoided with the sort of changes we’re talking about in this booklet. It’s similar with heart disease. Deaths from heart attacks halved in the decade to 2012. But it’s still men who are dying prematurely. Three-quarters of those who die from heart disease under 75 are men.

FAST ACTION - QUICK RECOVERY So how do you increase your survival chances? Simple: catch it early. That means that if you are worried about anything, get it checked. If you’re offered screening or check-ups, go for it. Reading this booklet and making a few little changes can seriously My complex improve your odds. There is more diabetes is the on all these topics on our direct result of website. not going to the GP.

DO THE MATHS: DO YOU DO THESE? > NOT SMOKE

> DRINK FEWER THAN 14 UNITS OF ALCOHOL A WEEK

> EAT 5 FRUIT & VEG A DAY > TAKE AT LEAST HALF AN HOUR EXERCISE A DAY Research shows that doing all four adds about 14 years to your life. That’s time to see your grandchild grow up (or three World Cups!)

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HOW TO BE GOOD TO YOUR HEART KNOW YOUR HISTORY You can get a good idea of the hand you’ve been dealt by knowing your history. Many health problems run in families: heart disease, cancer, strokes, depression, mental health challenges. Find out if your parents, grandparents, aunts and uncles have had any of these illnesses, especially if they died young. Make sure your GP knows your family health history.

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TUNE YOUR ENGINE Tune your engine by using the right fuels. The heart needs: >> fresh air >> a balanced diet >> a healthy weight >> regular exercise and >> a relaxed attitude. Heart disease is caused when the arteries that pump your blood get damaged with gunk called plaque. This makes the arteries harden and narrow. The main causes are: >> smoking

The health check was simple - less than twenty minutes.

>> high blood pressure >> high cholesterol >> diabetes >> lack of exercise >> being overweight >> family history.

This booklet will help you with all these. For more on the heart-friendly diet, see page 8. For more on exercise and weight, see page 12.

GET A CHECK-UP If you’re in hospital, make sure you have the regular physical health check on offer. In the community, see your GP to get your blood pressure and cholesterol levels checked. If you’re over 40 in England, ask your GP for a free NHS Health Check which will estimate your risk of getting heart disease. Here’s a little incentive to look after your heart: everything that is good for your heart is good for your penis. Clear, unblocked arteries mean firm, durable erections. For more on erection problems (an early warning sign for heart disease), see page 15.

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YOU ARE WHAT YOU EAT Eating better comes with a lot of advantages. It can help you: >> keep a healthy weight >> avoid high blood pressure, high cholesterol, heart disease, stroke, diabetes and some cancers >> exercise better >> work better >> concentrate better >> feel better >> have better sex. It may even save you money.

CURBING CRAVINGS Your medication may well increase appetite and cravings, but these can be beaten if you try these ideas. Eat more slowly so you (and your body) both notice what you’re actually eating. This way, you’re less likely to eat more than you need and more likely to choose a balanced diet. Go for a walk (even a short one) after your meal - it reduces the rise in blood sugar and fat levels. If you crave something sweet, distract yourself. Exercise will do this best - a walk or run - as it will also burn off the effects of stress and curb the cravings - but anything that keeps you absorbed will help. If you can’t get away, drink water or herbal tea. Are you really hungry? Often we think we want a snack but we’re just thirsty.

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THE GREAT PLATE Regular meals help balance swings in your blood sugar levels and reduce swings in mood (grumpiness) and tiredness. Start with a decent breakfast then for main meals fill: >> HALF your plate with salad or vegetables, >> one QUARTER with protein (eg lean meat, fish, eggs, beans) and >> one QUARTER with starchy carbs (eg brown rice, wholewheat pasta, quinoa, baked potato, noodles). Aim for your 5 fruit and veg portions a day (only one can be juice or smoothie) and make sure you get some dairy (milk, cheese, yoghurt) to keep calcium levels up and bones strong. Watch out when life changes. When you leave home or hospital, move house or job, end or begin relationships, it’s easy to forget about what you’re eating. I really enjoy cooking now that I know what I’m doing.

There’s more on this topic in the Men’s Health Forum’s man manual Eat. Drink. Don’t Diet.

IS LOW FAT REALLY BETTER? If you choose lower-fat, lower-calorie or lower-sugar versions of foods you eat regularly such as mayonnaise, salad dressings, yoghurt or milk, check labels carefully. Whatever is taken out is usually replaced with something else so low-sugar may be high-fat and low-fat may be high-sugar.

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TOP EATING TIPS Looking for simple pointers to healthier eating? >> Try to have a good breakfast to start the day right. >> Eat mindfully. Sit down and chew each mouthful thoroughly and slowly. >> Don’t eat while distracted by TV, phone surfing or reading. >> Don’t eat because you’re bored. Find something else to do. >> C hoose healthy snacks between meals such as fresh fruit and unsalted nuts. (If you have to eat early in the evening there may be 12 hours or more until breakfast so plan snacks carefully. Fruit or nuts can beat the blood sugar slump.) >> Plate smart. You’ll get a better idea of what you’re eating if you fill your plate just once. >> Top up with water. It’s the best rehydration fluid when exercising (and free) >> Smart food substitutions make healthy eating easy and painless. >> Keep a food diary - write down everything you eat and drink from the moment you wake until you go to bed. Accounting for everything that passes your lips helps you make healthier choices and reduce random snacking. An easier option is just to record sugar. >> Read labels. Food nutrition labels help you make healthier choices such as cutting back on salt, sugar and calories. >> Enjoy all the foods you like but in moderation. If they are full of fat or sugar, simply eat less of them and/or find some healthier options that taste just as good. Try to plan what you’ll eat for a full week so you can plan for – and look forward to – the treats like take-aways. >> Encourage your visitors to bring healthy snacks (fruit and nuts rather than cake and crisps) as gifts – well, most of the time. >> Watch out that going out on leave doesn’t lead to less healthy behaviour such as heavy eating or smoking.

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HOW TO BEAT DIABETES Diabetes is caused by a lack of insulin, the hormone produced by the pancreas that helps the body’s cells turn the glucose in the blood into energy. There are two main types. Type 1 diabetes is unpreventable. It occurs when the body can’t produce any insulin. People with type 1 will always need to take insulin to manage their condition. Type 2 diabetes occurs when the body doesn’t make enough some insulin or cannot use that which it does make. This is often linked with being overweight and is preventable in some cases. Type 1 is usually diagnosed in children, type 2 in adults over 40. (In South Asian and African-Caribbean people, type 2 often appears after the age of 25). However, both types can be diagnosed in all types of people at all ages. There are children of seven with type 2 and men in their 40s diagnosed with type 1. Undiagnosed diabetes can kill. There are currently over 2.5 million people with diabetes in the UK (about 90% of them have type 2). But there are at least half a million people with diabetes who don’t know they have the condition. Men aged 35-54 are almost twice as likely to have diabetes as women of the same age. Don’t think diabetes is not serious. Make sure you know the symptoms. If you have them, ask your doctor to test for diabetes.

WHAT ARE THE SYMPTOMS OF DIABETES? >> feeling very thirsty >> peeing more often, especially at night >> feeling very tired >> weight loss and loss of muscle >> itching (around the penis or vagina) or frequent episodes of thrush >> cuts or wounds heal more slowly >> blurred vision (caused by the lens of the eye becoming dry)

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HOW TO GET ACTIVE

Don’t underestimate it. If exercise were a drug, we’d all want to take it. Exercise boosts physical and mental wellbeing and helps you live longer. Scientists now reckon being inactive is even more of a health risk than being overweight. People who do regular physical activity have a 35% lower risk of heart disease and stroke and a 50% lower risk of diabetes and of bowel cancer. Regular exercisers also have a far lower risk of osteoarthritis and hip fracture. Best of all, exercise feels good. It boosts feel-good chemicals that raise self-esteem and helps sleep and concentration. I feel great Regular exercisers have a after exercise. 30% lower risk of It’s a natural depression and of dementia. high.

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WHAT DOES ‘REGULAR PHYSICAL ACTIVITY’ MEAN? To get the full benefit, the NHS reckons you need 150 minutes a week of moderate-intensity aerobic exercise. This means exercise that makes you slightly breathless - fast walking, cycling, jogging, mowing the lawn, swimming, playing sport. The statistics on page 12 about the benefits of exercise are based on these sorts of exercise levels. And, if your exercise goal is to lose weight, you probably need to do more than this. But - and it’s a very big but - anything is better than nothing. Try walking. Walking reduces the risk of heart disease by a third. The further and faster you walk the better but even walking just 5-6 miles a week at a very slow pace (2 miles per hour) will help reduce risk. Little and often is fine. Get a pedometer to count your steps. If you want a target, aim for 10,000 steps a day. Stretching and strengthening muscle is also important. Again, this doesn’t have to be vigorous. Yoga is fine.

NEED TO LOSE WEIGHT? Being overweight increases your risk of heart disease, stroke, diabetes and some types of cancer. Next year in England and Wales alone around 50,000 deaths will be down to excess weight. So get the tape measure out. As a man, you have a: >> HIGHER risk of health problems if your waist size is more than 94cm (37 inches) and an >> EVEN HIGHER risk if your waist size is more than 102cm (40 inches)

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TOP EXERCISE TIPS Looking for simple pointers to easier exercising?

>> Try to build exercise into your everyday life. Walk as much as you can. >> Find out what classes are on. Join a club or team. Use the shared facilities. Exercise is more fun when you do it together. You can also compete against friends or other wards. >> Try all the exercise options and find out which one works best for you. You may be surprised. Many men, for example, have found yoga very helpful for strength, mobility and generally feeling better. >> Count your steps with a pedometer and/or measure your exercise area. >> Take full advantage of your fresh air time. >> When on leave, try to walk rather than take transport. Perhaps ask for longer leave to do this. Think about what you do on leave – can you get some exercise? >> Use the stairs not the lift. >> You don’t need a proper gym to exercise. Exercise anywhere where there’s a bit of space, inside or outside. Woodwork, manual work and gardening are good forms of exercise. Walk and talk. >> And there’s plenty you can do without equipment in your room: weights, shadow boxing, press-ups, jogging. Watch DVDs for ideas. >> If you haven’t exercised for a while, make sure you avoid injury (see below).

I HAVEN’T EXERCISED FOR YEARS. Take it easy. Often new exercisers find that their heart and lungs rise to the challenge quicker than the skeleton and muscles. Result: they get injured (and give up). When you start over, the only thing you really need to focus on is not getting injured. Warm up properly, build up slowly and don’t do more today than you will be able to do tomorrow. So start with a nice walk.

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HOW TO HANDLE YOUR TACKLE The Men’s Health Forum get asked more questions about the male tackle than anything else. This is what men usually want to know.

IS MY PENIS TOO SMALL? Limp penises come in all shapes and sizes but, when erect, they’re pretty much the same. Not that it matters: the vagina can expand or contract to take anything from a tampon to a baby. Genuine problems that might stop you enjoying sex or taking a piss are rare and usually picked up when you’re a baby. If you’ve passed that stage you’re probably good to go. Trying to enlarge your penis is expensive, probably dangerous and almost certainly won’t work. Don’t. All surgery has risks. You only have one knob and it cannot be replaced.

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I CAN’T GET AN ERECTION Erectile dysfunction (ED) affects most men at some time (about 1 in 10 of us at any given moment). Often the cause is physical: >> diabetes >> blocked arteries (see page 6 on the heart) >> drinking too much >> drug/medication side-effects (see page 27) >> spinal cord injury >> prostate or other surgery in this area. Sometimes the cause is psychological: >> relationship problems or sexual boredom >> tiredness, stress, depression or anxiety >> sexual identity problem. >> not being interested due to circumstances (being in hospital or prison) If you can’t get an erection with your partner but can when masturbating or during the night, there’s a good chance your ED has psychological causes (in your mind). There are many treatments available. See your GP. They treat ED everyday. Also talk to your mental health team, especially if you are worried it may be your medication causing it. They are used to talking about this too and there are things that can be done to help.

Saw my GP. Got my sex life back. It was that simple.

Don’t buy drugs privately. Life-threatening problems like heart disease and diabetes can cause ED and you need to rule these out. What’s more, drugs sold online are often not what they claim to be and can be dangerous fakes (see page 33).

MY ERECTION WON’T GO DOWN If an erection lasts more than four hours, it could be a condition called priapism. See a doctor right away. Untreated priapism can be dangerous leading to, for example, permanent erection problems.

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MY PENIS IS SORE, RED OR ITCHY A red, sore penis head could be balanitis. This occurs in uncircumcised men who don’t wash their dicks. Your GP can treat it and advise on prevention. After unprotected sex, it could be a sexuallytransmitted infection (STI).

I CUM/COME TOO QUICKLY Premature ejaculation (PE) is very common. It’s usually caused by stress or anxiety. The good news is PE can nearly always be treated. There are techniques to try yourself - see the Men’s Health Forum website - or your GP can prescribe.

MY FORESKIN IS TOO TIGHT Frequent, careful, lubricated masturbation can help. (Honest.) Your GP can also advise on creams and stretching techniques. A last resort is full or partial circumcision but that comes with risks.

THERE’S BLOOD IN MY SEMEN/URINE It’s probably nothing but could be a symptom of something more serious like a prostate problem so see your GP. For semen, go if you get blood twice. For urine, once.

THE HOLE IN MY PENIS IS IN THE WRONG PLACE If you’re not pissing out of the end of your penis you may have undiagnosed hypospadias. It can be treated, improving both peeing and sexual function. Your GP can refer you to a urology specialist.

MY ERECTION IS BENT Some bend is normal but if it’s so bent that it makes sex uncomfortable, it could be a condition called Peyronie’s. Ask your GP about it.

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IS IT OK TO MASTURBATE? Yes. Ejaculation is a need like food and drink. It may also reduce the risk of prostate cancer or a tight foreskin. Three health warnings: >> You only have one penis so be careful what you stick it in. >> Anything pleasurable can be addictive. >> Porn is unrealistic, often makes women sexual objects and can spoil your relationships with real women.

I’VE LOST INTEREST IN SEX Your interest in sex (libido) is a complicated mix of emotions and hormones. Ups and downs with time and age are normal. But libido can also be reduced by: >> tiredness, stress, depression and/or relationship problems >> the side-effects of drink or drugs (including legal drugs such as anti-depressants and blood pressure medication) >> hormonal changes (as men age, levels of testosterone go down) >> medical conditions such as heart disease or diabetes. If prolonged loss of libido concerns you, see your GP.

HOW WILL MEDS AFFECT MY SEX LIFE? Lots of things can affect your sex life, like physical illness, substance use and mental health conditions. Your meds can also affect it. Meds can lower sex drive and make it more difficult to get an erection. You may cum too soon (premature ejaculation) or take longer. Or not even cum at all even though you have an orgasm. Cum can go back into your bladder and make your piss cloudy. It sounds bad, but it’s not dangerous. Very rarely you might get a hard-on that won’t go down (priapism). This is rare and only seen with some medications. If it happens you will need to go to A&E. If your medication causes you any problems with your sex life, tell your doctor. There may be other meds you can take that won’t cause the problem.

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If you’re thinking of becoming a dad, you might wonder if your meds will affect this. Some antidepressants can affect your sperm quality or the count. If you are concerned, talk to your doctor. Some antipsychotics can cause an increase in a hormone called prolactin. In some people this might affect the way sperm is made. A blood test can be done to check your prolactin level if you are worried.

I HAVE PAIN/A LUMP IN MY TESTICLES Testicular cancer is rare. True, it is the most common cancer in younger men but this is because cancer is so rare in young people. You can check your testicles monthly in a warm bath or while having a shower. Hold the scrotum in the palm of your hand and feel the difference between the testicles. One is probably larger and lying lower, which is completely normal. Examine each one in turn, and then compare them with each other. They should be smooth. Check for any lumps or swellings. (Remember that the epididymis which carries sperm to the penis and lies along the top and back of the testis normally feels bumpy.) If you notice a lump in your balls, see your GP immediately. Testicular cancer can be treated very successfully if caught early on.

CAN YOU GET PENIS CANCER? Yes. But it’s very rare. If you have a lump or sore, see your GP or sexual health clinic.

WHAT IS THE PROSTATE? Only men have a prostate gland. It’s round and about the size of a golf ball. It is in the pelvis, against the base of the bladder. The prostate surrounds the urethra – the tube that runs from your bladder down inside your penis to the outside (you urinate through it). Imagine the prostate as a fat rubber washer around a bit of tubing. It grows to adult size during puberty. In most men, it also begins to grow again in early middle age, which can cause problems which are quite common.

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There are two possible causes of an enlarged prostate: benign prostate hyperplasia (BPH) – a benign (non-cancerous) enlargement of the prostate gland common in men over 50 – and prostate cancer. The symptoms are very similar and are usually related to problems urinating, such as the following: >> A constant need to urinate, especially at night

Other symptoms can include: >> Lower back pain

>> Rushing to the toilet

>> Pain in your pelvis, hips or thighs

>> Difficulty starting to urinate

>> Erection problems

>> Difficulty urinating

>> Blood in the urine – this is rare

>> Taking a long time urinating

>> Pain when you ejaculate

>> Having a weak flow of urine

>> Pain in your penis or testicles.

>> Feeling bladder has not emptied >> Dribbling after finishing urinating >> Pain or discomfort when urinating.

Remember that these symptoms can also be caused by problems which are nothing to do with prostate cancer. If you are concerned, see your doctor.

TELL ME MORE ABOUT BPH BPH rarely causes symptoms before you’re 40, but more than half of men in their 60s and as many as 90% in their 70s and 80s have some BPH symptoms. As the prostate enlarges, tissue layers surrounding it prevent it from growing evenly, and pressure then squashes the urethra like a clamp on a garden hose. As a result, the bladder wall becomes thicker and irritated, shrinking even when it contains small amounts of urine, causing you to urinate more often. The bladder will eventually weaken and lose the ability to empty itself, trapping urine inside. The urethra becoming narrower and the bladder not emptying completely cause many of the problems linked with BPH. Some men with very enlarged prostates might not suffer while others with less enlarged prostates can have more problems. The problem can be treated with drugs or by surgically removing the enlarged part of the prostate. There is a small risk that either treatment may cause erectile dysfunction (being unable to get and keep an erection). You can speak to your doctor about this.

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SAFER SEX COULD I HAVE AN STI? Sexually-transmitted infections (STIs) can be caught through vaginal, oral or anal sex. Or skin-to-skin contact. Some STIs are increasing rapidly. Common symptoms include: >> a yellow discharge from your penis >> swollen tender testicles >> irritation of your penis >> pain when peeing.

Your GP can help. Or for something more anonymous, try a specialist sexual health clinic. Many STIs can be treated if caught early, usually with antibiotics. Some STIs such as chlamydia may not have any symptoms while the only signs of HIV and hepatitis may be a short flu-like illness. All are serious diseases. So get yourself tested if you’ve had unsafe sex. The best way to I like avoid an STI is through safer sex. condoms now I use them properly. You last longer. Assuming you don’t want to stop sex with other people altogether, it’s about using condoms. These prevent pregnancy and help prevent most STIs.

WHAT’S SAFER SEX?

Other forms of contraception - like the pill - may stop pregnancy but not STIs. So it’s as simple as this: if you don’t know someone else’s sexual history, use a condom - whatever sort of sex you’re having. If a condom breaks, NHS Choices can direct you to the nearest emergency contraception service.

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WHAT ABOUT HIV? HIV lives in the blood and in some body fluids. To get HIV, one of these fluids from someone with HIV has to get into your blood: >> cum and precum >> vaginal fluids, including menstrual blood >> breast milk >> anal mucus (found inside your arse) >> blood. It’s possible to have HIV without knowing it. Most men experience some symptoms around two to six weeks after infection (such as a sore throat, fever, body aches or rash). These symptoms are common to other illnesses and many people do not realise they could be a sign of HIV infection. If left untreated, HIV attacks the body’s immune system, leaving it vulnerable to infections we would normally fight off. There is no cure but, if you are diagnosed with HIV and treated, you should have a normal life expectancy. Sex without condoms is the most likely way for gay men to become infected with HIV.

YOU CAN’T GET HIV FROM: >> kissing >> spitting >> being bitten >> contact with unbroken, healthy skin >> being sneezed on >> sharing baths, towels or cutlery >> using the same toilets and swimming pools >> mouth-to-mouth resuscitation >> animals or insects like mosquitoes.

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The more HIV someone has in their bodily fluids, the more infectious they are, and the more likely they are to have serious health problems. HIV treatment lowers the levels of HIV in the body and can make the carrier less infectious, but it won’t get rid of the virus completely. If you think you’ve been exposed to HIV, go to your local sexual health clinic or A&E as soon as possible, preferably within 48 hours. They will be able to prescribe you with a course of anti-HIV medication which may prevent you from becoming infected with HIV. HIV isn’t a death sentence, and many people with HIV live long and healthy lives with the right care. But that doesn’t mean it’s trivial.

WHAT IS HEPATITIS? Like HIV, the only signs of hepatitis — a blood-borne liver disease — may be a short flu-like illness. There are three sexually-transmitted forms of hepatitis (hep): A, B and C. There are vaccines for Hep A and B. These will usually clear up on their own (although you should seek advice just in case yours doesn’t). Less common but potentially more serious is Hep C. There is no vaccine and it won’t clear up on its own. All of these activities can transmit hepatitis: >> unprotected sex >> rimming >> fingering >> sharing toys >> fisting >> group sex >> sex without condoms >> sharing needles or drug straws.

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HOW TO QUIT SMOKING We all know smoking is bad for your health and most smokers want to quit. Most hospitals are non-smoking but outside hospital it may be harder to stay off tobacco. Remember the benefits. Half of all smokers will be killed by the habit. Stopping smoking will almost certainly increase the length of your life and you will definitely: >> feel fitter and perform better (including in the bedroom); >> look and smell better; >> be able to taste good food and smell sweet smells again; >> be richer — a 20-a-day cigarette habit costs well over £1,000 a year; >> be doing everyone a favour — the smoking information organisation ASH (Action on Smoking and Health) estimates that several hundred people die every year from breathing others’ cigarette smoke. Remove the reminders of smoking, such as ash-trays and lighters and avoid places or situations where you’re tempted to smoke (eg. pubs or restaurants). Clean the house and clothes to get rid of the smell. Avoid other smokers. Choose a time which will work for you. Present yourself in your new environment as a non-smoker and then nobody will offer you a fag. Make a list of the reasons you are giving up. Put the money saved to one side.

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Ultimately, you will only succeed if you are really ready to quit. However, the following may help: >> Nicotine replacements such as gum, patches and vaping. >> Drinking water — drink throughout the day, especially when you’re craving. >> Exercise >> (Healthy) eating — chew on a carrot rather than chocolate bar. If you’re struggling join a support group or see a counsellor. Your GP may be able to prescribe some meds.

HOW TO BEAT BOWEL CANCER Bowel cancer is one of the most common types of cancer in the UK. There are 40,000 new cases every year. Nine in ten cases are in people over 60. You’re also at increased risk if you have a family history of the disease, smoke, drink, have a diet high in fat and low in fibre, are overweight and don’t exercise. Look out for: >> Bleeding from your back passage and/or blood in your stools (your crap) >> A change in bowel habit lasting for 3 weeks or more, especially to looser or runny stools >> Unexplained weight loss >> Extreme tiredness for no reason >> A pain or lump in your stomach area. If you’re aged 60-74, there is a screening programme for bowel cancer. Ask your GP about it.

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I got very very badly sunburnt in just half an hour.

HOW DANGEROUS IS THE SUN? It can be very dangerous. The number of people in hospital for skin cancer is increasing. What’s more, men are more likely to die from the disease than women. The main cause of skin cancer is the sun. If you have fair skin, light-coloured eyes or more moles, you’re at higher risk. Don’t avoid the sun. Being outside is good for you. But cover up. Wear a shirt rating. and hat. Choose sunscreen that is at least SPF 15+ and has a Keep an eye on your moles. You’re looking for changes to the ABCDE: A – asymmetry (both halves should look the same) B – border irregularity (it should be round) C – colour change (it should be tan - not red, black or white) D – diameter (it should be below 4mm) E – elevated (raised) or enlarged. Also watch for itchiness or bleeding. Any concerns, see your GP.

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YOUR MENTAL HEALTH MEDS The aim of your mental health meds is to help you feel better between the ears. But they can sometimes affect your physical health too. They can affect your sex life (see page 18) and other things too. Tiredness: This happens more with some meds, and will usually improve with time. Weight gain: Some meds may cause some people to put on weight. Your team will keep an eye on this but you can watch what you eat and try to stay active. Blood pressure: This can be linked to weight gain and is more of a problem as you get older. Again your team will keep an eye on your blood pressure. Fats (lipids): We know some meds may increase your levels of lipids. That’s why you should have blood tests before starting medication and at least every year afterwards. Again, watch what you’re eating and stay as active as you can. If these don’t help enough, your doctor may talk to you about meds like statins to help control the level of lipids. Blood sugar: Some meds can push up your blood sugar, which can lead to diabetes in some people. Again, your team will keep an eye on this. Let them know if you feel thirstier than normal, or need to piss more often, especially at night. Movement problems, ranging from a shake (tremor) and stiffness, feeling restless (akathisia) to muscle spasm (dystonia). These can usually be treated, either by changing the medication you’re on, or prescribing another drug to help. Body changes: In some people, if your meds increase the amount of the hormone prolactin, you might notice your chest gets bigger. Some people might get ‘moobs’. If this happens, tell your doctor. Your mental health team care about your physical health too. If you notice anything that you think might be caused by your meds, let your team know. They can talk to you about how you’re feeling and will try to help.

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THINGS TO KEEP AN EYE ON HOW DO I BEAT FLU? Flu occurs every year, usually in the winter. It’s a highly infectious and symptoms come on very quickly. As it is caused by a virus, antibiotics won’t treat it. Colds are much less serious and usually start gradually with a stuffy or runny nose and a sore throat. The most common flu symptoms are fever, chills, headache, aches and pains in the joints and muscles, and extreme tiredness. The flu virus is spread in tiny droplets of saliva in coughs and sneezes. If you breathe them in or touch a surface they’ve been on, you could catch it. Prevent the spread by covering your mouth and nose when you cough or sneeze and wash hands frequently or use hand gels to reduce the risk of picking up the virus.

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The best bet is to have the vaccination every year in the autumn before the flu season starts. This will protect you from the most common types of flu around at the time. The NHS advise anyone living in a hospital or other environment where they are in close contact with many others to consider having the vaccine. Flu can affect anyone but if you have a long-term health condition the effects of flu can make it worse even if the condition is well managed and you normally feel well.

SHOULD I GET MY SIGHT TESTED? See an optometrist if you are having difficulty focusing close-up or seeing long distance or have pain, headaches, blurred vision or see halos around lights. As we age, some deterioration in sight is normal. The basic eye test is cheaper than you think and is free in many cases or if ‘clinically necessary’. If you already wear glasses or contacts, you should have an eye test at least every couple of years. People over 40 and people from black or minority ethnic groups may need tests more frequently. (People from African-Caribbean backgrounds are at greater risk of glaucoma and diabetes and people from south Asian backgrounds at greater risk of diabetes.) If you use screens habitually as a significant part of your normal work, your employer should pay for a proper eye test and any glasses you might need for screen work. Always protect your eyes when working by using the right mask, shield or goggles.

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WHAT ABOUT HEARING? Hearing also deteriorates with age - 40% of those over 50 have some hearing loss. Look after your ears by wearing ear protectors when necessary and keeping volume down when using headphones or headsets. Wax build-up can also affect hearing. Warmed olive oil (yes, the cooking type) can loosen wax, or try drops from your pharmacist. If they don’t help, see your practice nurse.

DO I HAVE TO GO TO THE DENTIST? Yes - at least once a year. It could prevent a lot of pain and expense later on. You can reduce the risk considerably by brushing twice a day for two minutes at a time with toothpaste. (The NHS suggests fluoride toothpaste.) Brush all surfaces including the gums gently with an up-and-down motion. Flossing or interdental brushes can help you clean between the teeth. Cleaning gets rid of the bacteria (plaque) that cause tooth decay and gum disease. Mouth cancer is more common in men than women. Watch out for white or red patches, ulcers or lumps that do not clear up after two weeks, especially if you smoke and drink.

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REMEMBER…

Your mental health team also care about your physical health. In hospital, make sure you keep them informed about any problems you have or if you’re feeling under the weather. They will be able to support you in getting the right care.

UNDER THE WEATHER?

WHAT SHOULD I DO WHEN I’M ILL? For coughs, colds and other minor problems in hospital, see a doctor in your team who may be able to deal with the problem or will refer you to the GP. In the community, try your high-street pharmacist. In the community, the local general practice is the first point of contact for illness or personalised advice. Make sure you’re registered with one. It’s very easy. Choose one that is easy to get to from home or work. Check opening hours, the appointment system and what you can do online or by phone. General practices also provide information, vaccinations, clinics, healthchecks, blood tests and some simple operations.

WHAT ABOUT OUT OF HOURS? In hospital, let nursing staff know and they will be able to help you, there will always be a doctor available on call if you need one. If you need information out of hours in the community call 111. In an emergency, call 999 or go to the Accident and Emergency Department (A&E).

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WHAT’S AN EMERGENCY? Call 999 or go to A&E if the patient is: >> unconscious >> in a very confused state >> having fits that are not stopping >> having breathing difficulties >> having persistent, severe chest pain

The A&E staff were great. The four-hour wait wasn’t.

>> bleeding severely and you cannot stop it. You are wasting everybody’s time if you go to A&E and it is not an emergency.

WHAT OTHER SERVICES ARE IN THE COMMUNITY? Minor Injuries Units are a quicker, easier alternative to A&E for less serious injuries like sprains, breaks, minor burns and bites. There are also some Walk-In Centres which are open out of hours providing minor ailment and some minor injury services without an appointment. Sexual health clinics offer free confidential advice, testing and treatment for sexually-transmitted infections. There are also many other NHS services for, for example, stopping smoking, mental health problems and social care. You can find services near you on the Men’s Health Forum or NHS Choices websites. Another very useful source for help with minor health problems and advice on treatment and local services is your pharmacist. There’s one on most high streets. Just walk in. Many have a private area to talk if need be.

HOW DO I GET THE BEST OUT OF MY DOCTOR? GPs are generally available from around 8.30am to 6pm (or later). Calling at other times will put you in touch with an out-of-hours system. It’s always best to see your own doctor if possible, so unless your problem is urgent and cannot wait, you should make an appointment to be seen by your normal doctor. Practices now often offer a huge range of services such as minor surgery, skincare, chiropody and even diabetic clinics.

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To get the best from your doctor: >> Turn up. If you don’t keep an appointment you can cause huge frustration. >> Write down your symptoms before you see your doctor. It’s extremely easy to forget the most important things during the examination >> Doctors will ask questions such as: When did the problem start and how did it feel? Did anyone else suffer as well? Has this ever happened before? What have you done about it so far? Are you taking any medicine for it? >> You can ask questions too and don’t be afraid to ask your doctor to give more information or make something clear that you don’t understand >> Get to the point – if you have a lump or bump say so. Time is limited so make sure you raise serious problems not just the easy ones. Have your prescription explained, and ask whether you can buy any medicines from your chemist. Make sure you know what each medicine is for. Some medicines clash badly with alcohol and other drugs.

WHAT ABOUT THE INTERNET? Choose sites that display the NHS England Information Standard ‘Health and care information you can trust’ logo. (You can see the logo on page 2.) Be sceptical of social media and commercial sites without this. On overseas sites, the HONcode is a sign of quality. Sites like the Men’s Health Forum’s and NHS Choices provide lots of useful health information. But information is all it is. You need a doctor to diagnose.

WHAT ABOUT GETTING DRUGS ONLINE? If you have a prescription from a GP, many GPs and pharmacists can deal with these online.

I paid £130 for a product that didn’t work.

If you don’t have a prescription, get one. Don’t self-diagnose and buy drugs online. Many sites offering drugs without prescription are illegal. The drugs they sell may be useless or dangerous fakes. Fake drugs have been known to include pesticides, brick dust, paint and floorwax. Plus your credit card details may be stolen.

Perhaps even more importantly, you won’t get a diagnosis of your problem. Not being able to get an erection won’t kill you. But heart disease or diabetes (of which erection problems are a sign) can.

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BIRMINGHAM AND SOLIHULL MENTAL HEALTH NHS FOUNDATION TRUST Birmingham and Solihull Mental Health NHS Foundation Trust provides mental health care to those people living in Birmingham and Solihull experiencing mental health problems. Serving a culturally and socially-diverse population of over a million spread over 172 square miles, it is one of the largest mental health foundation trusts in the country. The Trust’s secure services provide inpatient services to just under 200 men in hospital and around 100 men in the community. Some of its specialised services are also available to those who live further afield. Look out for our Top Tips boxes in this booklet which were put together with some of the men under the care of the Trust. The secure services are a specialist part of the service which provides mental health care to men and women from the West Midlands area with mental health problems who are in contact with the criminal justice system or who need additional support to keep themselves or others safe. The Trust works to promote both the mental and physical health of the service users and this booklet is a part of that. The authors and the publisher have taken care to make sure that the advice given in this edition is correct at the time of publication. We advise you to read and understand the instructions and information included with all medicines and to carefully consider whether a treatment is worth taking. The authors and the publisher have no legal responsibility for the

results of treatments, misuse or overuse of the remedies in this book or their level of success in individual cases. The author and the publisher do not intend this book to be used instead of advice from a medical practitioner, which you should always get for any symptom or illness.

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WHO CAN HELP? Men’s Health Forum www.menshealthforum.org.uk Health information from the Men’s Health Forum

Domestic Violence Men’s Advice Line (for victims) 9-5 Mon-Fri  0808 801 0327 www.mensadviceline.org.uk

NHS Choices  Online ‘front door’ to NHS www.nhs.uk www.nhs.uk/livewell www.nhs.uk/change4life www.nhs.uk/oneyou/apps Call 111 (24 hour) for nonemergency medical advice. http://tinyurl.com/oohNHS for more on NHS out of hours.

Respect (for perpetrators) 9-5 Mon-Fri  0808 802 4040 www.respectphoneline.org.uk

Alcohol www.drinkaware.co.uk The NHS has a Drinks Tracker app. Or text Units to 64746 to access the NHS alcohol units calculator on any smartphone Alcoholic Anonymous 0800 9177 650 www.alcoholics-anonymous.co.uk British Dental Health Foundation www.dentalhealth.org Eye health www.rnib.org.uk/eye-health Macmillan Cancer Free helpline  0808 808 00 00 www.macmillan.org.uk

PHOTO CREDITS: Thanks to Sarah Taylor Silverwood 2017 commissioned by Midlands Arts Centre as part of BEDLAM festival. Photographs were completed by: G.M. A.T. and Anon plus

Health and Safety at work  www.hse.gov.uk Organ Donor Register www.organdonation.nhs.uk Mental Wellbeing www.mentalhealth.org.uk www.time-to-change.org.uk Sexual Health www.fpa.org.uk www.loversguide.com For free condoms locally, try: http://tinyurl.com/NHScondom Smoking  0800 022 4332 www.smokefree.nhs.uk Drink and drugs  Frank 0300 123 6600 www.talktofrank.com

Diabetes UK 9-7 Mon-Fri 0345 123 2399 www.diabetes.org.uk British Heart Foundation Heart helpline: 0300 330 3311 www.bhf.org.uk Back Care  0208 977 5474 www.backcare.org.uk Stroke Association Helpline 0303 303 3100 www.stroke.org.uk Gay, bisexual and transgender www.gmfa.org.uk HIV  Awareness, support & advice: 0808 802 1221 www.tht.org.uk FEELING DESPERATE? Samaritans  116 123 Emotional support 24/7 www.samaritans.org Calm  0800 58 58 58 www.thecalmzone.net

Prostate Cancer 0800 0748383 www.prostatecanceruk.org

P.B. for the line drawing, Thanks also to Craig Cloutier, Len Rizzi, D Sharon Pruit, Michael Coté, Timothy Takemoto, Brian Wright and chinesechef who were all kind enough to make their images

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available through the Creative Commons. (If this is not the case, please contact us.) Full credits, links and licences at: menshealthforum.org.uk/ MMreferences


SECURE MAN One careful owner? With a little care, the high-performance machine that is the male body will run smoothly for a lifetime with just basic maintenance and minimal need for spare parts. This easy-to-read handbook will show you how to fine tune your engine, choose the right fuel and keep your mind on the road ahead. We’ll explain the little changes that can make a big difference: > how to be good to your heart > how to get active > how to handle the ups and downs SECURE MAN also includes your personal TOOL-KIT: answers to all the frequently-asked questions on the male tackle. SECURE MAN: for a healthy body and healthy mind

Excellent. So easy to read and so simple to understand.

WARNING: Reading this booklet could seriously improve your health. ISBN: 978-0-85761-015-7 www.menshealthforum.org.uk

Secure Man  

A physical health handbook for men detained in secure units developed with Birmingham and Solihull Mental Health NHS Foundation Trust.

Secure Man  

A physical health handbook for men detained in secure units developed with Birmingham and Solihull Mental Health NHS Foundation Trust.