Irish men can be complex and full of contradictions regarding their health. The facts speak for themselves: Irish men die, on average, at least five years younger then Irish women, often from medical conditions and complications that are preventable. At the moment there is an explosion of diabetes and obesity-related conditions, with complications of heart disease and stroke just around the corner. Irish men have high rates of bowel and prostate cancer, while stress-related illnesses are on the increase.
In the same breath, we know that Irish men are less likely to access healthcare than women. They will often stick their heads in the sand or kid themselves that they are too busy. In my opinion, most Irish men do care about their health, but at times there seems to be an ‘if it ain’t broke don’t fix it’ mentality. This is the wrong attitude. It is a dangerous assumption to make about your health. Many important health conditions, such as high blood pressure, high cholesterol levels and even diabetes, can remain silent with no symptoms for many years. So you may have health problems for a long time and still feel perfectly well. This is an important point because prevention and early detection are better than cure. If these conditions are detected at an early stage they can be treated and difficult long-term complications can be prevented. We can kid ourselves into thinking that because we feel fine our health must also be fine.
While feeling well is a great place to be at and a good start to better health, it should compliment rather then replace the need for a sensible approach to your long-term health plan. To a large extent your future health is in your own hands. Develop good health habits now and they can gift you a lifetime of better health in return. These habits include a healthy diet, focusing on positive healthy food choices: plenty of wholegrains, pulses, fruits, vegetables and oily fish. Keep an eye on your weight and especially your waist (belly fat). Get plenty of exercise. If you smoke cigarettes, stop. Break bad habits. Have a healthy respect for alcohol; while it can be a good servant it is a very bad master. Mind your mental health and watch your stress levels. Don’t let what’s important to you, including family, friends, hobbies and health, be squeezed too much. Educate and inform yourself about important men’s health issues. Have the courage to take control of your own health. Be confident enough to go to the doctor when you feel ill or are concerned about some health issue. Think of your body as being like your car; it too needs its regular NCT.
Prevention Is Better than Cure
You get your car serviced every 20,000 miles, indeed older cars now have to be NCT-tested to ensure their road worthiness. Yet we often fail to apply these minimal basic standards of car welfare to our own bodies and health.
As a family doctor with an interest in men’s health I feel that a regular maintenance check or wellness check for men would be a valuable part of every man’s health programme. We know that for many reasons men are often ‘too busy’ to go to the doctor and when they do it is often only after being prodded into action by their partner. So a proper preventative wellness check allows the opportunity and, more importantly, the time to look at the following:
- Your current symptoms, if any
- Your past medical history, including a history of any illnesses and operations, vaccination history, a history of any supplements or over-the-counter vitamins, etc., a history of any allergies, and a critical look at your family history, particularly regarding any potentially inherited diseases such as diabetes, heart disease, bowel cancer, kidney stones and haemochromatosis
- A lifestyle questionnaire, including your exercise habits, diet, alcohol intake and how you deal with stress.
- A physical examination, including body mass index, abdominal circumference, blood pressure, a general examination of your heart, lungs, abdominal area, back and legs, skin surveillance and looking at moles, and an examination of urine
- Make sure you know about any inherited conditions in your family or family illnesses that have a genetic component. There may be specific screening programmes that you can avail of. For example, colonoscopy for polyps, which can lead to bowel cancer, or eye tests to screen for glaucoma (high blood pressure of the eyes). Remember that information and knowledge allow you to make informed decisions for your better health.
As a general rule of thumb I recommend a good check-up for men at the following intervals:
- Every five years for men in their twenties
- Every two to three years for men in their thirties
- Every one to two years for men in their forties
- Over yearly for men in their fifties
Blood tests that may be carried out at these examinations include the following:
- A full blood count – this tests for anaemia (low iron) and the number of white cells (the army that fights infection) in the blood. It also checks the platelet level (the clotting ability of the blood).
- Fasting blood sugar – this tests for diabetes or the likelihood of developing diabetes.
- Lipid profile – this tests the total cholesterol, as well as the LDL (bad) cholesterol, HDL (good) cholesterol and triglyceride (blood fat) levels (see Chapter 6 for a discussion on cholesterol).
- Liver function – this tests the function of the liver.
- Renal function – this checks the kidneys as well as the amount of sodium and potassium in the blood.
- Thyroid – this tests the functioning of the thyroid gland.
- Serum ferritin – this tests the amount of iron stores in the blood.
- Uric acid – this is a screening test for gout.
- PSA – this can be a marker of prostate function (see Chapter 8 for further information on this).
Useful Vaccinations for Men to Consider
- Flu vaccine – recommended annually for men aged over 50 and younger men who have chest problems such as asthma, heart problems, kidney problems, diabetes or a weakened immune system.
- Pneumococcal vaccine – this can provide good protection against the most common type of pneumonia found in the community.
- Hepatitis B vaccine – this protects against the hepatitis B virus, which can be transmitted through body fluids, including via cuts from sports injuries.
- Tetanus vaccine – this protects against tetanus, which can be caused by dirty cuts.
- Travel vaccinations – these are important to remember if you are travelling to other parts of the world.
How To Get the Best from Your Doctor
The following tips may help you get the best from your doctor:
- Treat your doctor as a genuine partner in your healthcare. He or she is there to help you.
- Do not be afraid to ask for help if you are feeling down or stressed.
- Do not be embarrassed asking your doctor about issues you are worried about. He or she is there to help you and has seen and heard it all many times before.
- Do not be afraid to ask questions. The best patient is an informed patient.
- Let your doctor know you are interested in keeping yourself well. Ask about preventative health opportunities, including wellness programmes.
- Consider writing your main symptoms down before you see your doctor. Research has shown that sometimes in consultation we forget to tell or ask our doctor important things that could be bothering us.
- Make sure you understand the benefits and risk of any medication you are prescribed.
- Have a good understanding of your own family history and its relevant health implications. Make sure your doctor does too. Our own individual family history is very important in the context of a risk profile for many health conditions. Do not make assumptions that your doctor knows your father died from bowel cancer twenty years ago. Make sure your doctor is informed of this and that it is recorded prominently in your notes.
- Take some responsibility for the accuracy of your own medical records. Many medical records are now computerised, with specific sections that note drug allergies and past, and family history. Help your doctor to help you by sharing any relevant information.
- Take a balanced approach to any investigations. In the old days time was very important in the context of health, sickness and healing. Time was used both as a diagnostic tool to allow vague symptoms to evolve and as a therapeutic tool to allow symptoms to resolve and nature to take its course. Nowadays, with the advent of medical technology, high-tech scans are often only a fingertip away. While there is no doubt that modern technology has an invaluable role to play in healthcare, over-investigation can cause unnecessary anxiety. Some invasive diagnostic procedures can have risks and side effects of their own but there is a balance here between, on the one hand, the need to evaluate symptoms thoroughly, including appropriate investigation where needed, and, on the other hand, over-investigating everything. With the rise of defensive medicine there can be an extra perceived pressure on your doctor to organise more tests and more scans, so that ‘nothing is missed’. Your challenge is to be an informed and equal partner in this decision making. Help your doctor to help you to decide what is best for your long-term health.
- Focus on good communication. Be honest with your doctor and yourself. Learn to talk honestly and openly to your doctor about any worries or concerns you may have. Even if they are of a sensitive nature, your doctor is there to help you. Remember: not even the best doctors can read minds.
- Become proactive and informed on healthcare issues.
- If you are on several medications check out potential drug interactions. Make sure you inform your doctor about any supplements or herbal or over-the-counter medications you are taking. This is important because some of these can interact with prescribed medication.
- Stay informed about important developments in men’s health.
Why Some Men Do Not Follow Health Advice
Do you know the biggest reason as to why prescribed medication does not work? It is simply because people don't take the medication, or at least don’t take enough of it for long enough to produce the desired effect. This is a massive challenge for doctors, patients, healthcare and society in general. There is no doubt that many of us do not like taking pills or medication, particularly if we do not feel sick. I mean, how many of us have been prescribed a week’s course of an antibiotic for a sore throat and finished the course? I know many men, doctors included, might take them until they feel better and then stop the rest of the course. While this may not have many adverse consequences for your throat, apart from increasing the risk of drug resistance to antibiotics, the story can be different when you are looking at the management of many chronic conditions, including high blood pressure, diabetes and high cholesterol. With these conditions, taking medication daily is often essential to maintain wellness and to prevent complications such as heart attack and stroke, which remain among the biggest killers of Irish men.
How Common Is Non-Compliance?
Research has shown that only one in every three men will comply and take a course of medication to a degree sufficient enough to affect outcome. These men, in general, have a better understanding of their medical condition, as well as a better understanding of the need to take medication. Naturally they tend to have better outcomes. About one in three men tend to comply partly with the prescribed medication, in that they may take it for a few months or a year on and off, but not sufficiently frequently enough to prevent complications arising from their condition, and about one in every three men do not comply at all. This lack of compliance does not just apply to prescribed medication; it holds for lifestyle advice as well.
There are many reasons as to why Irish men may not comply with healthier advice and prescriptions:
- A man’s own health beliefs. We all have our own internal belief systems about health and illness, which are dependent partly on our experiences and upbringing. This is known as the health belief model. Using this model, we all tend to weigh up, on the one hand, our perceived seriousness of the medical condition concerned and how threatened or vulnerable we are to it and, on the other hand, the perceived benefits of doing nothing or of taking action.
- Our level of education is very important. Today, in twenty-first century Ireland, about 15 per cent of Irish men have literacy problems, which act as a huge barrier to informed decision making in the area of health. We are now in the information age where a huge amount of easily accessible evidence-based information is available on a wide range of topics.
- The doctor–patient relationship itself is an integral part of good medical care. You need to trust your doctor, not too much, but enough to allow you to make the best decisions to help yourself in terms of your long-term health and well-being. In the old days, the doctor–patient relationship tended to be quite paternalistic, meaning the doctor assumed the all-knowledgeable father figure role in relation to the subservient child (the patient). Nowadays, the ideal doctor–patient relationship is thought to be a genuine partnership between you and your doctor. This implies freedom on your part to ask relevant questions, to be heard, to have your ideas, concerns and expectations understood and to be able to discuss things in an open manner. It also gives you the responsibility to act on the shared decisions that you and your doctor come to regarding your health and wellness.
Many people do not comply with medication because they may find it hard to take something several times a day, they may experience side effects, they may have concerns about side effects, potential addiction or dependency, or they may simply find it too expensive. On top of this a man may feel psychologically that his maleness, his manliness, his sense of strength and his invulnerability are threatened by the need to take small pills every day. If you have concerns about any medication prescribed, discuss them with your doctor or pharmacist. I do not think there has ever been a pill made that cannot cause some side effects. Some degree of risk-benefit balancing may have to be done. However, your doctor may be able to suggest more suitable alternatives in many cases.
The Pill-for-every-Ill Culture
If you feel unwell or are concerned about something, you should always see your doctor. However, sometimes the best thing your doctor can prescribe for you is simply good advice. At times the best pill may be no pill at all. For example, many sore throats and upper respiratory infections are caused by viruses, which do not respond to antibiotics and would tend to clear themselves in time, sometimes with the aid of simple over-the-counter remedies. There is evidence that antibiotics are often over-prescribed for sore throats. This can be due to the doctor’s perception of the patient’s expectation of a prescription, sometimes fuelled by real patient demand for this. So, before you get your next prescription for a sore throat or cough, it might be worth asking the following questions:
- Is this prescription really necessary?
- Can I get better without it?
- What are the benefits of taking this medicine?
- What is the risk of side effects?
- Why am I taking it?
- Are there alternatives?
If you can answer these questions you will have a much better understanding of the need, if any, to take medication. This will help to give you the knowledge, understanding and confidence needed to allow you to comply properly with the treatment given, leading to a better outcome for all.
Making a Change for Your Health
We are all essentially creatures of habit, so making a change is not easy. But making changes by developing newer, healthier habits can be the key to our long-term health and well-being. No matter how unfit you are, no matter how overweight you are, no matter how unhealthy your lifestyle has been up until now, it is never too late to make changes and, in terms of your health, there can be massive benefits just around the corner. I find the following tips useful when looking at positive health changes:
- Write out a balance sheet of all the pluses and minuses to your behaviour change. Get an A4 sheet of paper and draw a line down through the centre. Let’s take exercise as an example. On the left-hand side write down all the benefits you will have from taking more exercise. These may include immediate benefits such as feeling better and long-term benefits such as reducing your risk of heart disease and diabetes. On the right-hand side write your perceived negatives for taking more exercise. You should see that one side of the scale (hopefully the left side) far outweighs the other side. This then can act as a tipping point for taking action.
- It can be useful to organise specific strategies to deal with any negatives you may have for making a change. For example, if you feel that lack of time is a negative for taking more exercise then a useful strategy for overcoming this may be to keep an exercise diary over a seven-day period. This will allow you to slot in specific times on certain days for taking exercise. It also provides a useful tool for assessing accurately at the end of each week how much exercise you have taken, which can reinforce the good behaviour. It is important to reward yourself regularly for making a change. Finally, it is important to stay on track; do not get disillusioned or disheartened if you have the occasional slip. We are all human after all. It is what you do 90 per cent of the time that counts for long-term good health.
Challenges Going Forward
There is no doubt that there is an urgent need to advertise and promote men’s health in a positive way. Men have been the poor relation in terms of profile, media exposure, funding and lobby groups when it comes to men’s health issues. Women have been very proactive in terms of lobbying, quite rightly, for women’s health issues, including breast cancer screening and osteoporosis amongst others. These efforts are to be applauded.
However, there has not been the same exposure or drive for important men’s health issues, including prostate, bowel and testicular cancer, heart disease, diabetes and depression. The facts of these conditions speak for themselves. Male-specific health strategies must be adopted to try to help those men who haven’t been good at helping themselves.
Men’s health has a profound impact on all of us in society. It affects the children whose fathers are struck down with premature death or illness and the women whose husbands, fathers, sons and brothers are affected by ill health and premature death. This is not to mention the huge economic and social cost for society. Men’s health does indeed reflect the wealth of a nation. It affects all of us. As far as Irish men are concerned, your wealth really is your health. Treasure it!
Key Points
- Being an Irish male can be a health hazard.
- Don’t let the usual suspects of denial, fear, apathy or ‘being too busy’ prevent you from taking action.
- Take action and don’t become another statistic.
- The gift of better health is within your grasp.
- A healthy lifestyle, including a good diet, exercise and being able to de-stress, is a great way to start the journey to better health.
- Have the same respect for your body and mind as you have for your car – get a regular service.
- Prevention and early detection are better than cure – ‘a stitch in time saves nine.’
- Remember that your health is your wealth.