Men: is your body’s engine due for a service?

Routine screening tests are crucial for early diagnosis. Discovery Health highlights the most important screening tests for men.

Screening tests, such as those available through the Discovery Health Medical Scheme Screening and Prevention Benefit, find diseases early when they are easier to treat. 

For example, with early detection, colon cancer can be nipped in the bud while diagnosing diabetes early may help prevent complications, such as vision loss and impotence.

It is estimated that nearly half (48,7%) of South Africans with high blood pressure (hypertension) have never been screened. Therefore, remain undiagnosed. They are unaware of their increased risk for heart disease and stroke. 

Dr Goodman, Chief Medical Officer for Discovery Health, adds, “Similarly, estimates indicate that around 1,58 million South Africans have undiagnosed diabetes that, if left untreated, can lead to nerve and   kidney damage as well other equally concerning complications.” 

Prof Mutambirwa, a urologist, adds, “First, it is crucial to get the idea across that majority of the diseases that kill the most men (and women) worldwide are non-communicable disease, or diseases of lifestyle. It always comes down to the daily choices we make; they accumulate to keep us healthy or make us sick. Foods high in sugars, junk foods, and highly processed foods cause high cholesterol, high blood pressure and diabetes. For men of all ages, the commonest killer disease of lifestyle is cardiovascular disease i.e. heart attack and stroke. Up to 50% of people who have a stroke have very few warning symptoms before the event.”

The three HIGHS

• High cholesterol infiltrates the area inside a blood vessel beneath the endothelial lining. This causes plaque deposits and atherosclerosis (disease of the arteries, deposition of fatty material on their inner walls). Resulting in heart attacks. In most cases, high cholesterol doesn’t have symptoms until there is progressed damage to blood vessels. However, it causes emergency events like heart attack or stroke when the plaque build-up narrows the arteries so that less blood passes through them. A blood test will determine your cholesterol levels. 

• High blood sugar causes all sorts of damage to the body and leads to diabetes. Consequences of high blood sugar include whole-body blood vessel and nerve damage leading to a risk of blindness, organ failure, limb amputations and more. Men need to eat food that promotes blood sugar stability and do exercise to increase their sensitivity to the hormone insulin which removes sugar from the blood stream. Symptoms of high blood sugar or diabetes can be so mild that men might miss them. They include hunger, fatigue, a need to urinate urgently and frequently, being thirsty, a dry mouth and itchy skin and blurred vision. A blood test will determine blood sugar levels. 

• High blood pressure (hypertension) causes damage to the inside coating of blood cells (the endothelium of the blood vessels). According to the Heart and Stroke Foundation South Africa, 45% of adults in SA have high blood pressure. Symptoms are vague but include dizziness, blurred vision, shortness of breath, and chest pain. Your doctor can do a blood pressure test manually, or using a machine with a pressure-measuring gauge and an inflatable cuff that goes around your arm. 

Donít exceed the 96cm mark

“These conditions are part of what we call metabolic syndrome,” says Prof Mutambirwa. “It’s evident where a man’s waist circumference exceeds 96cm which means there is fat (visceral) around the internal organs. This fat causes the release of inflammatory cytokines which damage blood vessels and, eventually, leads to heart attack  and stroke.”

He adds, “Stress and depression also causes a release of similar inflammatory markers by the brain so they are also key elements to get under control. Healthy eating and exercise go a long way to relieving and reversing the damage caused by stress and poor lifestyle.”

Men of all ages should visit a GP to check their blood pressure, blood sugar and cholesterol annually. That is all you need to do until age 40. “After age 40 we, doctors, like to get a little more specific about the screening tests we  do,” explains Prof Mutambirwa. 

Routine male cancer tests 

The 2017 Discovery Health Medical Scheme (DHMS) claims data shows that men account for 48% of scheme members claiming for oncology treatment. Prostate cancer tops the claims list for men, followed by colorectal cancer (53%), melanoma (54%), and soft-tissue cancers. “Also, 60% of DHMS members with the most expensive oncology claims were men,” adds Dr Goodman. 

“When it comes to claims under the Severe Illness Benefit, Discovery Life’s 2017 claims data shows that 36% of male claims related to heart and artery conditions, 31% for cancer, followed by nervous-system illnesses (15%),” says Chief Medical Officer for Discovery Life, Dr van der Walt. “Prostate cancer related claims increase as men get older, particularly from age 41 and up (reaching up to 45% of cancer claims for clients older than 60). In the age group: 31 to 50, cancer claims relate predominantly towards skin, haematological and gastrointestinal cancers.”

According to Prof Mutambirwa, lung cancer is the most common cause of cancer-related death, while prostate cancer is the second most common cause of cancer-related death in men over the age of 45. 

Skin cancer screening

“If caught early enough, skin cancers are not life-threatening, but advanced melanoma does have a high mortality rate,” says Prof Mutambirwa. 

His advice is to visit your GP to ensure a proper assessment of any changes in the texture, size or colour  of freckles or moles, or other possible warning signs of melanoma cancers. He adds that the sooner a skin cancer is identified and treated, the better the chance of avoiding surgery or, in the case of a serious melanoma or other skin cancer, potential disfigurement or even death. “Talk to your doctor about your level of risk and for advice on early detection.”

Prostate cancer screening

Men should discuss screening for prostate cancer with their doctor. Screening guidelines take factors, such as family history, age and personal history into account. A prostate-specific antigen (PSA) blood test can detect early prostate cancer. 

A rectal prostate examination may also be required to screen for prostate cancer. This is because the prostate is an internal organ, so your doctor cannot look at it directly. The prostate lies in front of the rectum, so your doctor can feel it by inserting a gloved, lubricated finger into the rectum and feel the prostate for abnormal areas. The test takes only a few minutes to complete and causes only slight, momentary discomfort with no damage to the prostate.

Colorectal cancer screening

Most men who get colorectal cancer are over the age of 50. “Though South African data shows a prevalence of this cancer in younger black men in their 30s or 40s. The best way to pick it up is with a colonoscopy through the anus as there are very few symptoms,” explains Prof Mutambirwa. 

These symptoms include bowel habits changing towards ongoing constipation or diarrhoea; blood in the stool; fatigue and gut pain (presents when the disease is advanced) or low blood iron levels. You’re at risk if you have a family history of colorectal cancer. 

Lung cancer screening 

Smokers must assess their lung cancer risk through an X-ray done every couple of years. Prof Mutambirwa adds, “If a man has a family history of lung cancer or any cancer and is a smoker, this sort of screening is very important. My advice: just stop smoking. It’s a health risk on every level.”

Stress – the modern-day sabre-toothed cat chasing men

Psychiatrist, Dr Moch, whose passion is for resilience and how to develop it in the face of stress, has treated many men of all ages and from all walks of life. “It is critical that men manage stress which may be linked to male depression. Both stress and depression are linked to cardiovascular disease and cancer,” he explains.

Stress is one of the most important lifestyle factors that men can manage for optimal health. With that said, stress is also one of the hardest elements to manage. “We can never break the link between mental and physical wellness. We encourage all men to feed their resilience and self-care. To find time for exercise even if they don’t have time to get to a gym, like taking the stairs, standing during meetings, taking time off to rest occasionally, and feeding their emotional, spiritual and intellectual health,” says Dr Goodman. 

Dr Moch also drives the car service analogy home to men. “When the petrol is low, a warning light sounds. When you’re driving too fast, the speedometer reflects. Similarly, the body and brain give out signals that we are driving too hard in life. However, most people simply silence the alarm by working harder, smoking, or numbing themselves with alcohol, drugs or medication. But the warning lights are still on. Chronic stress leads to a chronic low-grade inflammatory response which is linked to so many illnesses, from fibromyalgia and up to one third of cases of depression to dementia. We have 400 miles of blood vessels in the brain and once they are inflamed, damage occurs in the neuronal systems,” he explains. 

How to handle stress

Dr Moch suggests several ways for men to manage stress:

• Stress management is about energy management. How are you apportioning your energy? 
• How do you manage information relating to what is within and outside of your control? If you can make a positive change, make it. If you’re stewing over something you can’t control then you’re burning precious energy and accumulating stress on the road to burnout. 
• Are you consuming foods that fuel your energy, especially Omega-3 fatty acid-containing food which is key to mental health? 
• Are you avoiding tobacco, processed sugars, excess caffeine, alcohol and fatty junk foods? These are elements which sap mental and physical energy.
• Are you exercising? If so, are you under-exercising or doing the opposite and suffering from chronic overtraining-syndrome? Both of which contribute to mental and physical stress. 
• Are you sleeping enough? That half hour or hour of sleep most men lose every day adds up. 
• Do you make space for creativity and relaxation? A lot of executives spend so much time working that there is no space for an exciting hobby: reading good literature, getting out into nature and so on. 
• Are you always on? The elephant in the room is our inability to detox from the digital world. We get a miniscule stress response every time we read bad news, which we’re doing constantly. How do you manage the exhausting compulsion to hit refresh and check the latest messages? 

Take home message

• Many illnesses are difficult to pick up, and symptoms are not always reliable measures of whether a man needs medical help. So, if you feel unwell, get yourself seen by a doctor. 
• Everything in current medical literature suggests that being a non-smoker, being active and maintaining a healthy body weight is the best way to minimise heart disease. It’ll also help with diabetes, stroke, kidney disease, and even anxiety and depression. 
• Healthy choices, made every day, are a long-term investment in wellness. They will go far in ensuring a healthy, resilient body and mind, and pay dividends well into old age. 
• Knowledge is power in the quest for every man to live his best life.