Sunday 18 March 2018

8 golden rules for men's health

Men die younger than women. The average age gap is five years, which is why they need to start taking practical steps, writes Dr Seamus Linnane

Men die at a younger age than women
Men die at a younger age than women

There are many inequalities in health. One of the most striking and consistent is that men die at a younger age than women. In Ireland the average gap is over five years. There are many reasons why this may be the case. The answer probably lies in a complex mix of genetics, biology and behaviour. So, if we can't outlive our smarter, stronger better halves at least we can strive to live longer happier lives. Listed below are a number of practical steps that men can take to get started.

1 Get a doctor - From adolescence to old age men consistently avoid medical assistance with health problems. Towards the end of life, this changes. As they approach death men increase their contact with doctors and health services - often too late. Part of this may be a refusal to confront a particular problem. Some authors suggest that men are not that good at recognising their own symptoms as problematic. Irrespective, there should not be a long hiatus between a neonatologist who looks after a newborn boy and a skilled general practitioner dealing with the first health scare of a man in his fifties.

2 See your doctor - Congratulations. You've registered with your GP. Now go and benefit from all the years they have spent in college and postgraduate training just to be ready to tackle your problem. Blood in unexpected places may not be grand. Uninvited pains do not always settle eventually. Sharing a symptom or problem with your doctor will help decide when to reassure, when to investigate further and when to simply observe for a time. If something worries you, it should be addressed. Be assured that if your complaint turns out not to be the tip of a terminal illness your doctor will not be annoyed. I doubt I will ever tire of reassuring patients when there is no sign of cancer or serious illness. The relief and joy of a reassuring consultation contrasts sharply with the challenges of dealing with a new diagnosis where the chances of cure have passed.

3 Live the Good Life - We are assailed daily with epidemics. Diabetes, obesity and immobility are all increasing with dire health consequences. The reality is the human body was designed or evolved with the expectation of moderate calorie intake and daily physical activity. Coronary artery disease has been described in the mummies of ancient Egypt. Modern lifestyles have magnified that trait such that markers of arterial disease have been seen in North European children. Moderate physical activity of at least 150 minutes per week is not only associated with health gains, it also improves mood and wellbeing. The World Health Organisation additionally advises men to train major muscle groups at least twice per week.

Obesity is often described using the Body Mass Index - the BMI. There are many online calculators to work out your BMI. Most men should aim for a BMI between 20 and 25. Obesity is a major risk factor for type 2 diabetes but also a host of other problems including; cancer, heart disease and sleep apnoea.

4 Conquering cancer - Cancer is the most common cause of death among Irish men and several cancers are particularly relevant to men. "Know thy nuts" is the Movember Foundation's campaign to raise awareness about testicular cancer. You only have two, you're quite attached to them and they serve you well. While not a common cause of cancer, testicular cancer often affects younger men. Every man should check his testicles occasionally and preferably after a bath or shower. Yes, it's cleaner but the scrotum is more relaxed at that time making it easier to feel each testicle. Know what feels normal for you so that if a change emerges you will notice it and bring it to the attention of your doctor.

Prostate cancer is more common and affects mainly older men. The prostate gland sits at the exit of the bladder and adds the white milky fluid to semen. Given its position, it's not surprising that changes in the prostate can affect the flow of urine. The prostate normally enlarges with ageing, so benign prostate symptoms are very common. The PSA blood test for prostate cancer is no longer routinely checked. A discussion with your doctor around your prostate cancer risks symptoms and examination will help decide if this test is appropriate for you.

The most common cause of cancer death among Irish men (and women) is lung cancer. If caught early, treatment can be very successful. Screening is increasingly popular in North America but has yet to be widely accepted in Ireland or even Europe. Smoking is the main cause of lung cancer, but other factors such as radon gas exposure are also recognised. New respiratory symptoms such as breathlessness or cough that won't settle, particularly in current or former smokers, should not be ignored.

5 Sleep - Young men don't sleep enough, old men can't sleep enough. The invincibility of youth includes our attitudes to sleep. While we don't know why we sleep, we do know that we die without it. We need seven to nine hours of sleep per night. Despite this, the frenetic pace of modern society means many men are chronically sleep deprived and often ignorant of the damage this is doing to their long-term health. Acute sleep disturbance is associated with impaired cognition and mood abnormalities. Chronic sleep disturbance is associated with obesity, diabetes, heart disease and immune disorders. Men who sleep less than five hours per night increase their mortality risk by as much as 15pc. As men age, wilful sleep deprivation and insomnia give way to obstructive sleep apnoea as the most common sleep abnormality.

Obstructive sleep apnoea occurs when the upper airway collapses during sleep and breathing is interrupted. This is called an apnoea, hence the name of the condition. Understandably the body reacts vigorously to this insult. The ensuing struggle to take the next breath leads to a surge in heart rate and blood pressure as the body drags the affected man out of restful sleep to near wakefulness. This cycle of apnoea and near waking can occur every few minutes. As a result, the man wakes the next morning completely exhausted but unaware that he has spent the night deprived of restful sleep.

Almost all sleep apnoea sufferers also snore loudly. Sleep apnoea is twice as common in men as women. A shirt collar size of 17½ or greater is also a risk factor. Chronic tiredness means the risk of serious road traffic accidents can be increased by as much as 20 times. The condition is diagnosed after an overnight sleep test. Treatment involves controlling weight, changing sleeping position, improving airflow with oral appliances or supporting breathing with CPAP machines.

7 Hearts and minds - Heart attacks, strokes and vascular disease continue to claim the lives of more men than any other condition in Ireland. Men are nearly three times more likely than women to die prematurely from cardiovascular disease. While we can't change our family history, many of the risk factors for this group of conditions can be modified. High cholesterol and high blood pressure are easily identified and treated. If they are not looked for they can't be managed. So the message is to get checked. Medication is not always required. Indeed, moderate increases can be effectively controlled with exercise, weight control and dietary measures. Where medication is necessary, study after study consistently shows improvements in length and quality of life with carefully tailored treatment. For those men who have had a cardiovascular or cerebrovascular event then secondary treatment, ie after a diagnosis, can significantly improve survival.

8 Mental Health - Tragically suicide is now the most common cause of death for young men. Mental health and wellbeing pervades all ages of men in a huge variety of ways. Ireland is struggling to confront its relationship with mental health. Men in Ireland are struggling also. In studies, men are less likely to discuss or even acknowledge mental health problems than any other health concern. Yet, with help and support, considerable improvement can be had. Men can help themselves in this regard. Social support and interaction is one of the best ways to achieve health and happiness. A lack of social support is even associated with a higher rate of death from cancer, cardiovascular disease among others. Men need to be prepared to listen to each other even when the conversation is difficult or awkward. You can save a life. You can save your life.

• Dr Seamus Linnane is a consultant respiratory & general physician. He practices in the Beacon Hospital

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