Talk To Your Doctor
The ten most important questions a man should ask

By Joel Warner

From the time he was a teenager until his 40s, Ernest del Casal never set foot in a doctor's office. "I thought I didn't need to," says del Casal, who lives in Las Vegas. "I thought I was perfectly healthy. I never even had a cold." So when del Casal started experiencing stomach pains when he was 38, he ignored them, thinking it couldn't be anything serious. The symptoms worsened, however, and at age 42 del Casal was rushed to the hospital in terrible pain and diagnosed with testicular cancer. Now, eight years later, not only does a fully cured del Casal go for regular checkups and screenings, he also hosts a radio show in Las Vegas about men's health.

Del Casal's story is just one example of how men avoid doctors' offices. Although men in the United States live five years less than women and lead women in 12 of the 15 most common causes of death, men are three times less likely than women to have visited a doctor in the previous year, according to a 1998 survey of men's and women's health by the Commonwealth Fund. To end this disparity, experts agree, men need to accept doctors' visits as a normal, intelligent, and even masculine part of life—and not fear them. To help you on your way, here are ten questions you should ask your doctor, not only to build a healthy lifestyle, but also to encourage a positive relationship between you and your health care provider.

What are my greatest health risks?
When it comes to disease prevention, the key is to know your susceptibilities. A review of your family medical history is vital because a vulnerability to many serious diseases, from prostate cancer to heart disease, can be hereditary. Other health risks are tied to lifestyle and occupation. For example, men who have physically demanding or high-risk jobs—construction workers, for example—are especially prone to ill health, not just because of occupational hazards, but also because they are less likely to notice health problems at all. After all, says Jean Bonhomme, MD, MPH, founder of the National Black Men's Health Network, "When you spend 40 hours a week ignoring your aching back at work, when you go home and feel a pain in your chest, are you going to pay attention to it?" This situation is especially dangerous because heart disease is the number-one cause of death in the United States.

How can I lessen my health risks?
Just because you are at higher risk for a certain disease doesn't mean your destiny is sealed. "You can drastically reduce your risk factors," says Paul Reilly, ND, staff physician at the Seattle Cancer Treatment and Wellness Center. "[Risk factors] are not locked in concrete." Here are some suggestions Reilly gives his patients: If your blood sugar levels are too high, limit your intake of starches and avoid weight gain. If you are at risk of prostate cancer, steer clear of red meat, drink green tea, and eat foods that provide plenty of selenium, such as Brazil nuts. And if you need to watch out for heart disease, pass up fatty foods in favor of those rich in antioxidants, such as brightly colored fruits and vegetables.

What screenings do I need?
"The sooner you catch a disease, the easier it is to treat it," says Thomas A. Kruzel, ND, vice president of clinical affairs and chief medical officer at the Southwest College of Naturopathic Medicine in Scottsdale, Arizona. Along with regular blood pressure tests, urinalyses, and blood tests, doctors often recommend fecal occult blood tests to look for indications of colon cancer; blood screenings to check for signs of heart disease; and PSA tests for those at high risk for prostate cancer, including black men, those with a family history of the disease, and all men starting at age 40 when risk factors increase. For more details and recommendations, see "A Guide to Men's Screenings."

Many diseases can be detected early if men understand their bodies' warning signals. What signs of disease should I look for?
Doctors can detect many diseases early when patients understand their bodies' warning signals. Reilly, for example, tells his male patients to watch for a number of red flags: Weight around the abdomen can be an indicator of heart disease or diabetes. Difficulties starting or stopping urination are often associated with prostate problems. Headaches might be a sign that blood pressure is too high. And bloody stools, masses or swelling in the testicles, and night sweats are all possible signs of cancer. If you notice any of these symptoms, see a doctor to rule out serious health concerns.

How can I lead a healthier life?
"If your car is out of gas, changing the oil isn't going to make it work any better," says Reilly. In other words, the first step to a healthy life is having enough energy. Men should get at least eight hours of sleep per night, says Reilly, as well as eat a balanced, vitamin-rich diet and avoid large amounts of coffee and alcohol. Reilly says he likes to see his patients partake in a variety of athletic activities that strengthen all the muscles, including both aerobic and anaerobic exercises. He also advises his patients to be active throughout the week, not just on the weekends, to reap the greater benefits of daily exercise.

How can I deal with stress and depression?
Stress and depression can be killers, often because they drop the body's defenses against other diseases—for example, hypertension, which is now the 13th leading cause of death in the United States. "I have very few male friends who aren't affected by stress," says David Gremillion, MD, FACP, professor of medicine at the University of North Carolina. He adds that men are more likely to hide depression, which could be one of the reasons they are four times more likely to commit suicide than women. You can do many things to avoid stress and depression, says Gremillion, including exercising regularly and taking an annual vacation.

When should I next see a doctor?
"If every man in the United States went to his doctor every two years, we would have a much better health state for men," says Peter Rumm, MD, MPH, chief medical officer at the Wisconsin Division of Public Health in Madison. Younger and healthier men don't need to go in to their doctors' offices for a full physical every year, says Rumm, just as long as they have a checkup regularly. Older men and those with existing illnesses or at higher risk of disease need to see their doctors more frequently.

Do you have any questions for me?
According to a recent study, doctors ask only one in three men about their family medical history. And minority men are less likely than others to have an open relationship with their doctors, says Bonhomme, even though they are often the ones most susceptible to disease. "Men have to be active participants in their own health care," says Bonhomme.

Men's Health Resources

To find general health information for men:

Men's Health Network
www.menshealthnetwork.org
202.543.6461

To find health information for black men:

National Black Men's Health Network
404.524.7237

To locate a naturopathic physician in your area:

The American Association of Naturopathic Physicians
www.naturopathic.org; 866.538.2267

To research health issues on the Web:

WebMD
www.webmd.com

How can I learn more?
"There's a point in the future where we will become our own doctors, so to speak," says Gremillion. He points out that many men love the anonymity of looking up issues for themselves in books or on the Internet (see "Men's Health Resources"). Kruzel often recommends books to his male patients, including Love, Medicine, and Miracles by Bernie S. Siegel (HarperPerennial, 1990) to help patients tap into the powers of self-healing, Dealing with People You Can't Stand by Rick Brinkman and Rick Kirschner (McGraw-Hill, 1994) to help in controlling stress, and Eat Right for Your Type by Peter J. D'Adamo (Putnam, 1996) to help patients maintain a healthy weight. Another good source is Eat, Drink, and Be Healthy by Walter Willett, MD (Simon & Schuster, 2001).

How can I encourage my son to see a doctor?
For Gremillion, this is the most important question of all. The answer, says Gremillion, is that men need to visit their doctors regularly, not just for their own health, but also to serve as role models for their children. "That's where the change is—in the younger generation," says Gremillion. "Let's redefine [health care] so it's manly to see a doctor."