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Some answers for those hard-to-ask questions
By Heather Morse

You’re stuck wearing one of those horrible hospital gowns, anxiously waiting for the doctor to come into the exam room. So when the doctor finally comes in, it’s no wonder you don’t have the guts to talk about, well, you know… We’ve got the answers to those questions you want to ask, but are too embarrassed to. (Trust us, they’ve heard it all before.)

 

How terrible is this prostate exam going to be?

“The exam is not as bad as you’re thinking,” says Jeffrey Tomaszewski, MD, a urologist at Cooper’s MD Anderson Cancer Center. “The exam takes maybe 20 seconds, and it’s not painful. None of my patients have ever said it was worse than they expected.”

And while it’s normal to be apprehensive about the exam, Tomaszewski says men can’t let their nerves get in the way of what is a vitally important screening tool for cancer.

“When it comes to prostate cancer, there are usually no symptoms until it’s too late,” says Tomaszewski.

“That’s why all men 55 and older should be screened every year. I also recommend that men who have a family history of prostate cancer and African-American men start screenings earlier, usually around age 50. I call it active surveillance – it’s a little thing that can make a big impact on your future.”

Tomaszewski urges men who are experiencing things like blood in their urine, painful ejaculation or a weakened urine stream to head to the doctor, no matter their age.

“Those are definite red flags and signs that something is going on with the prostate,” he says. “That doesn’t necessarily mean you have cancer, but you definitely need to get checked out by your doctor.”

 

I don’t have any symptoms, do I really need a colonoscopy?

“I get it – most people don’t even want to think about having a colonoscopy, but just because you aren’t experiencing symptoms doesn’t indicate your colon is well,” says Warren Werbitt, MD, of Professional Gastroenterology Associates. “Colon cancer can be a silent disease, and colonoscopy is one of the most effective prevention methods against it.”

Colonoscopy is the most reliable test, says Werbitt, because it allows doctors to study the entire colon and rectum. “Colonoscopy not only allows us to detect cancers in their earliest and most treatable stages, it can also help us find abnormalities or pre-cancerous polyps that can be removed during the exam, before they develop into big problems.”

Since nearly 95 percent of colon cancer deaths occur after age 50, medical professionals recommend that men and women undergo the procedure once they hit the half-century mark.

“However, if you have a family history of colorectal cancer or have symptoms like a change in bowel habits, blood in your stool or frequent abdominal pain, your doctor may recommend you have a colonoscopy sooner,” says Werbitt.

The procedure itself is painless and only takes a few minutes, explains Werbitt. “Most people are afraid to have a colonoscopy, but when done safely, there are no adverse effects. The most significant issue people have is just feeling uncomfortable the night before as their body cleans itself out. But it’s a small trade-off.”

 

So what if I get winded when I mow the lawn – what’s the big deal?

“I see it all the time: men around age 50 come into my office and are very nonchalant about symptoms like this. I call them ‘ballpark symptoms’ – like feeling out of breath after climbing the bleachers, walking the dog or doing activities around the house,” says Vivek Sailam, MD, of Associated Cardiovascular Consultants. “Lots of men think it’s a normal part of getting older, but it can actually be a sign of heart disease.”

Shortness of breath is just one of the red flags – men who are experiencing chest discomfort, fatigue, sleep apnea and even erectile dysfunction should immediately see their doctor for a cardiac evaluation, cautions Sailam. “These are not the symptoms to ignore. You’re already behind the eight ball and a prime candidate for a heart attack.”

Men who smoke, are overweight or lead a sedentary lifestyle are also putting themselves at massive risk for heart disease, he adds. “You have to take ownership of the things you can do to cut your risk. Instead of hanging out with the guys and having a bunch of wings and four beers, have half a burger and one beer.”

 

Is surgery the only way to get rid of this back pain?

“Most people who experience back pain are terrified that surgery is the only treatment option,” says R. Todd Rinnier, DO, an anesthesiologist and pain specialist with Relievus. “They figure that living with the pain is better than having surgery, but there’s no reason you have to live with it. There are so many conservative options available now that are very effective.”

The first step to successfully treating the pain, says Rinnier, is to find its source. “The key is to look at the whole picture and then go from there. Pain medication shouldn’t be the first and only option. Over time, you’ll just need more and more of it, and it’s only going to mask the pain, not stop it.”

A conservative course of treatment might start with chiropractic adjustments or physical therapy, he says. “If we try a round of physical therapy and the patient is still experiencing pain, we might progress to an epidural administered a few times a year, or the best option might be to burn the nerve that’s the source of the pain.”

Rinnier says that other options – spinal stimulation, for example – can also do wonders for patients who have had surgery but have yet to experience relief from their pain. “Sometimes people are very skeptical that these types of treatments can greatly reduce and even eliminate their pain, but they can be very effective.”

 

Why aren’t things “down there” working as well as they used to?

“When men ask me this, 90 percent of the time it means they’re wondering why they are having trouble maintaining an erection during intimacy,” says Virtua’s Andrew Cohen, MD. “It can be uncomfortable to talk about, but odds are I’ve already had this same discussion with another patient that day,” says Cohen.

And while erectile dysfunction is fairly common, says Cohen, the cause of it isn’t always straightforward.

“There are a number of causes of ED, so the first place to start is by talking with your doctor about your medical history,” says Cohen. “That can uncover risk factors, like heart problems, diabetes, neurological issues or even back problems. There are also a lot of medications that can be a potential cause. When it comes to diagnosing ED, a lot of things often get overlooked.”

Cohen, a family medicine doctor, says that men and their physician should rule out potential medical causes of their ED before turning to quick fixes like Viagra.

“Medications like Viagra augment blood flow to the sex organs by diverting it away from other areas. If you have unknown health issues and go straight to taking medication for ED, you put yourself at risk for potentially serious side effects like lightheadedness, vision changes and chest discomfort,” he says. “That’s why discussing your medical history with your doctor first is of the utmost importance.”

 

June 2017
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