19 February 2024
By Maria Lally
Commentary by Dr. Donald Greig
Men often choose to put off seeing their GP, a survey has found
In October, I highlighted some important issues in women’s health through breast cancer awareness month. It now the turn of the men who are renowned for not looking after themselves as well as their female counterparts.
Men have long been accused of putting off seeing their doctor. Last week, UK MPs were told that men’s life expectancy had fallen further than women since the pandemic because of macho and fatalistic attitudes towards seeking healthcare. A study of 2,000 men by the insurer BUPA backs this up: eight in ten would rather endure symptoms of ill health than see their GP, while 39 per cent let symptoms get to the point of pain before seeking help.
Well Hong Kong is not the UK and access to see your Family Practitioner or Specialist is so much easier here, so there is no excuse for denying yourself access to the high standard of healthcare which Hong Kong offers.
The article highlights 10 areas which should raise red flags and trigger a visit to your doctor. The list is by no means comprehensive, nor is it intended to be. It is the start of a well-being conversation.
To highlight just one of the items, point 7, about acting on blood in your stool, colorectal cancer both in the UK and HK is common. One in 15 men (and one in 18 women) will be affected with this cancer. In my view, it is preventable. As many of you are aware, I have established a colonoscopic screening program to prevent colon cancer for the over 40-year olds by detecting and removing precancerous polyps which have the potential to mutate into cancers. To date, no patients on the 26-year program have developed colorectal cancer. While having a colonoscopy is an invasive procedure, the benefits far outweighs the potential downsides.
One aspect of your health which has not been mentioned ties in with another cancer prevention program. This runs parallel with colon cancer prevention, is patients with heartburn and acid reflux. These symptoms are caused by a hiatus hernia or gastro-oesophageal reflux disease (GORD). If left untreated, the lining of the gullet becomes eroded by the stomach acid and patients can develop precancerous changes in the oesophagus (gullet). This may advance through progressive degrees of instability to develop into lower oesophageal cancer. Endoscopic screening of the gullet can prevent this cancer from developing. The key is diagnosis by gastroscopy and medical intervention to abolish acid reflux through drugs such as Losec or Nexium. There is no place in my view for self-treating acid reflux symptoms with over the counter available meds such as antacids or Zantac without a firm diagnosis and assessment being made. To date, no patients on the 26-year program have developed oesophageal cancer.
Dr. Donald Greig
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Main article:
“Men are notorious for ignoring their health symptoms,” says Dr Jeff Foster, a GP specialising in men’s health and author of Man Alive: The Health Problems Men Face and How to Fix Them.
Here are some of the health issues that can affect men in midlife, and the signs to look out for.
1. Chest pains
According to the British Heart Foundation (BHF), 100,000 UK hospital admissions each year are due to heart attacks.
“Sudden chest pain is a sign to call 999,” says Ruth Goss, a senior cardiac nurse at the charity. “Other symptoms include pain that spreads to the arms, shoulders and neck, along with nausea, feeling hot, sweaty and clammy, and an indigestion type of pain.”
Goss also says that chest pain that comes and goes with exertion also warrants a trip to the GP. “This might feel like pressure or tightness around your chest, shoulders or arms, and a shortness of breath. Even if it goes away when you stop running, get it checked because it might be angina, and this is linked to coronary heart disease, which can cause heart attacks.”
Regardless of your age and gender, prioritise your heart for the best chance of a long and healthy life. “Don’t smoke, stay active, eat a balanced diet and know your numbers — for example, your blood pressure and cholesterol levels, which your GP can advise,” Goss says.
2. A widening waist
Gaining weight in midlife — especially round our middle — isn’t a natural or inevitable part of ageing, says Roy Taylor, a professor of medicine and metabolism at Newcastle University and author of Your Simple Guide to Reversing Type 2 Diabetes. “Yet when we look around and see we’re the same size as our middle-aged friends, we assume it’s normal.” In reality, an expanding waistline is a sign that fat is settling around organs, including the liver and pancreas, which can increase your risk of type 2 diabetes.
“Years ago, doctors would use the catchphrase ‘Maintain the weight you were at 21’ to keep their patients healthy,” Taylor says. “However, due to the rise in people entering adulthood already overweight, that saying no longer means what it used to. But provided that you were a healthy weight at 21, this is the weight you should be aiming for.”
The BHF advises keeping a healthy waist size to reduce your risk of heart disease, with a circumference for men below 94cm (37in) considered low risk and 94-102cm (37-40in) high risk.
3. Frequent urination
As warning signs of type 2 diabetes, urinating more than usual (especially at night) and feeling thirsty should be noted, Taylor says. “However, these are quite far down the line in terms of symptoms and I would hope to diagnose long before they occur — or avoid it altogether by keeping a healthy weight.”
Prostate cancer can also cause changes in bathroom habits. “It’s the most common cancer in men,” says Sophie Smith, a senior specialist nurse at Prostate Cancer UK. “Most early-stage prostate cancer doesn’t have any symptoms, which is why men need to be aware of their risk. It’s higher for men over 50, or over 45 if you’re black or have a family history of the disease.”
If you do notice a change in urination, Smith says it’s more likely to be an enlarged prostate, or another health problem. “But still speak to your GP.” Foster advises also looking out for blood in your urine or semen.
4. Withdrawing from friends
Research from the mental health charity Mind in 2020 found that men felt worried or low more regularly than they did ten years before, and were twice as likely to feel suicidal.
“Suicide rates are highest in men in their mid-forties,” Foster says. “This could be due to hormone deficiency, but it’s also the age when the pressure of family and work peaks, along with the likelihood of marital distress, divorce or bereavement, which can lead to a reduced social circle and feelings of isolation.”
Signs include feeling down, drinking more than usual, and a reluctance to spend time with friends. “Most men with depression and anxiety will simply cut themselves off from friends, and they become more isolated,” Foster says. “So, always tell somebody if you’re struggling, and if you suspect a friend is, take them out for a walk or a coffee.”
5. Extreme sweating
We become less tolerant to heat as we age, which means we sweat more. Women in particular may sweat more and experience hot flushes during the menopause. However, according to Cancer Research UK, heavy night sweats can be a sign of certain cancers, particularly blood cancers like lymphoma and myeloma, so always speak to your GP if you experience them.
6. Erectile dysfunction
“Half of all men have erectile dysfunction at some point, yet it has one of the lowest presentations in primary care because so few men want to talk about it,” Foster says. “However, it’s vital they do.”
He says that two of the most common reasons for erectile dysfunction are not psychological, and that 90 per cent of cases in men over 40 are due to cardiovascular narrowing in the penile artery. “On average you have three years before the same narrowing happens in your heart. So, if you have erectile dysfunction and do nothing about it, potentially you could be three years away from a heart attack.”
The other cause is a testosterone deficiency, which he says is comparable to the menopause in women. “And with low testosterone levels comes the increased risk of type 2 diabetes, osteoporosis, heart disease and poor mental health. Either way, don’t ignore it.”
7. Blood in your stool
One in 15 men (and one in 18 women) will be diagnosed with bowel cancer in the UK during their lifetime, according to the charity Bowel Cancer UK. About 90 per cent of cases are diagnosed in the over-50s, but it can affect younger people.
One of the main symptoms is blood in your poo, although this might be caused by something other than cancer. Bright red blood could be caused by haemorrhoids, which are swollen veins in your bottom. However, blood higher up in your bowel appears dark red or black, and may be due to bleeding from a stomach ulcer, or cancer, so see your GP.
8. Disturbed sleep
While it can be a symptom of low mood, Foster believes the answer to poor sleep is simple: “Midlife men spend their time buying sleep apps or sleep trackers, but most sleep is the outcome of our lifestyle. If you eat well, exercise, and go easy with coffee and alcohol, you’ll have relatively good sleep quality.”
Routine is key for sleeping well
The key is also to keep a good routine. “Go to bed and wake up at roughly the same time each day,” says Dr Neil Stanley, the author of How to Sleep Well. This sets your circadian rhythm, he says, which can reduce your risk of heart disease, diabetes and certain cancers. A 2020 study from Vanderbilt University Medical Center in the US found that waking up at the same time is as good for your heart as regular exercise and a healthy diet.
9.Forgetfulness
“Every bloke over 50 whose memory keeps lapsing worries he’s going to get dementia,” Foster says. “But the chances are he won’t. Rather it can be a sign you’re preoccupied because of stress. Other conditions that affect memory and concentration include thyroid disease, anaemia and testosterone deficiency.”
The first step is to look at your lifestyle. “Are you working too much? Getting decent sleep? Exercising properly? Having regular downtime? I’m not one for mindfulness or meditation, but I go to the gym and put my headphones in. That’s my meditation. Yours might be a dog walk and a podcast. If you’re still struggling, see your doctor who may do a blood test to ensure you have enough B12 in your system, because a deficiency is linked to impaired cognition and memory.”
10. Unexplained weight loss
While losing weight in midlife may seem desirable, doing so unintentionally can be caused by a number of conditions, including infections, hormonal imbalances and even cancer. So, if you’re losing weight for no obvious reason you need to tell your GP.
If you or anyone you know would like a comprehensive assessment, please make an appointment with Dr. Greig at Hong Kong Surgical Specialists.
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