• November 30, 2020

MEDICAL MATTERS: Two Balls and Two Strikes - Odessa American: Health

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MEDICAL MATTERS: Two Balls and Two Strikes

Dr. Sari Nabulsi, MD, MBA, FAAP, is senior Vice President CMO/CMIO at Medical Center Health System

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Posted: Sunday, November 24, 2019 4:00 am

Sorry this isn’t your typical sports story with a line score, but now that I have your attention, I have some important information to share with you. It’s ‘Movember’, and besides shaggy facial hair, it brings awareness and support for testicular cancer, prostate cancer and suicide.

So, if it’s Men’s Health Awareness, you may be asking yourself, why is a female writing this article? Well, women have been saving men for centuries now. As a physician, I can tell you if it wasn’t for wives and girlfriends, I wouldn’t have any male patients. I’m sure that a couple hundred years ago a pilgrim wife told her pilgrim husband, “Thou hast a most foul spot on thy back! Get thee to the physician!” In all seriousness though, men are 24 percent less likely to have seen a physician within the last year.

The average life expectancy in the U.S. of men is 76.2 years, while for women it is 81 years. Approximately 12 percent of men over the age of 18 are in poor health. So, why is that? There are multiple factors, but there is a reluctance of men to admit they have a problem and need help, whether that is from an injury to mental health. We live in a society where men are expected to “suck it up” and not discuss any chinks in their armor. Admitting they have a problem is perceived as weakness. I’m not attacking masculinity, but not seeking routine health care is a detriment to both physical and mental health, and ultimately overall survival. So, how do we change that? As G.I. Joe always said, “Knowing is half the battle.”

Testicular cancer is the most commonly diagnosed cancer in young men. It can occur at any age, but it is more frequent from age 20 to 45. The average age of diagnosis in the U.S. is 33 years old. About 1 in every 250 men will be diagnosed with testicular cancer during their lifetime. Fortunately, there is a 95 percent five-year survival rate, even at advanced stages. As with all cancers, the earlier the diagnosis, the better the survival. Approximately 9,500 men will be diagnosed every year with around 400 deaths.

Risk factors for testicular cancer include family history (especially in a brother), history of undescended testicle (even surgically corrected), personal history of testicular cancer and white males. HIV infection also carries an increased risk of developing testicular cancer. Testicular cancer is rare in black men, but they are more likely to die from it if it develops. Treatment is mainly surgical removal of the affected testicle, but it may include chemotherapy and radiation depending on stage.

Having a single orchiectomy does not affect a man’s ability to have sex or conceive children. The main tool against testicular cancer is early diagnosis and treatment. Men should perform routine self-testicular exams, beginning in their teens and continuing throughout their life.

The best time to perform a testicular exam is either in the shower or just after getting out of the shower. The technique is simple: grasp each testicle between the thumb and fingers and gently roll it. You are looking for anything out of the ordinary for you: change in size or shape, a lump or tenderness. If you find anything, make an appointment with your doctor to get it checked out ASAP.

Prostate cancer is the second most common cause of cancer death in men (lung cancer is number one for both men and women). Approximately 1 in 9 men will be diagnosed with prostate cancer in their lifetime. The incidence of prostate cancer goes up with age, with the average age of diagnosis being 66.

Though there is a 98 percent five-year survival rate if discovered early, 88 men die of prostate cancer every day. There are approximately 175,000 new cases every year with over 30,000 deaths. Risk factors for prostate cancer include family history, obesity, diet high in saturated fats and high testosterone levels (including testosterone replacement therapy). Black men have a 74 percent higher rate of prostate cancer than other races and the death rate is twice as high.

There is a link to the BRCA and HER2 genes causing prostate cancer and men with that history should begin screening at age 40. For most men, we recommend beginning screening at age 50 with a PSA (prostate-specific antigen) level. The PSA has faced a lot of controversy recently, but it is still a good test for screening for prostate cancer.

The trend of the PSA is more important because the PSA typically doubles when prostate cancer is present. We recommend men with a family history of prostate cancer and black men begin screening at age 45. Signs and symptoms of prostate cancer are often the same as symptoms of enlargement of the prostate (BPH, or benign prostatic hypertrophy).

These symptoms include increased frequency of urination at night (nocturia), decreased force of the urine stream, pain with urination, having to strain to begin the stream, erectile dysfunction, painful ejaculation, blood in the urine or sperm and pain/stiffness in your lower back, hips or upper thighs. Treatment options vary from surgery (prostatectomy) to chemotherapy, radiation, hormone therapy and even just surveillance.

Suicide is the 10th leading cause of death in the U.S. and 11th in Texas. Texas ranks 40th in the nation in suicide rate per 100,000 people. Unfortunately, it’s not that we have less suicides but more people. There were about 1.4 million suicide attempts in the U.S. in 2017 and 47,000 deaths (almost 3,800 in Texas). Men are three and a half more likely to die from suicide than women, though women attempt suicide more often.

The main reason for this difference is men choose more deadly methods of suicide, mainly firearms. There are 129 suicides per day, and in Texas one person dies every two hours from suicide. White males account for almost 70 percent of suicide deaths, with middle-aged white men (45-54) having the highest rate. Men account for 75 of suicides in the U.S. Worldwide, a man dies every minute by suicide.

The VA released a report in September that 17 veterans die every day from suicide. This does not include active duty suicides, reservists or service members who did not have overseas duty (which explains the reduction from the oft quoted 22/day numbers). It’s still too high, no matter how you cook the numbers.

In conclusion, find yourself a good doctor that you trust and see them regularly. Don’t be afraid to speak up and seek help when something is wrong. Stay in contact with your friends and family members and talk with them. Know the facts and be aware of your own body. We women want you guys around for the long haul—even if you do hog the remote control.

Odessa, TX

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