By Nina Radcliff, MD with additional reporting by Kristin Detterline and Connie Capone | October 3, 2016 | Lifestyle
From screenings to stretching, the most important thing men can do is be proactive about their health. Here, Philadelphia’s finest doctors share six ways that guys can stay fit—at any age.
Testosterone molecules offer clues to how hormone levels shift throughout the course of a man’s life.
Many of the major health risks that men face—heart disease, lung and prostate cancer—can be prevented, slowed down, or treated with early screening and diagnosis. However, a proactive approach to health is where guys woefully fall short: According to the US Department of Health & Human Services, men are 24 percent less likely than women to have visited a doctor within the past year. Studies show that men have been raised in a culture “to endure pain” and that many only seek medical counsel when under duress from a family member or when their condition has deteriorated to a severe state. These statistics especially hit home when considering, on average, men live approximately five years less than women. More has been learned about health and disease in the past 50 years than in the entire history of medicine. A number of breakthroughs over the past half century have happened right here in Philadelphia. Here are some of the most fascinating advancements that are becoming standard operating procedure.
Obesity is the number-one risk factor for Type-2 diabetes.
Hormone changes are a natural part of aging, in both men and women. “Traditionally, menopause has been at the forefront, but now men are coming to the table more than ever in the last 15 years, and low testosterone levels are being popularly debated,” says Dr. Anthony J. Bazzan, director of the Hormone Health Program at the Myrna Brind Center of Integrative Medicine at Jefferson.
Decreased testosterone levels can have adverse health effects. “Symptoms can be described on a spectrum or as a continuum. It goes from psychological traits to alterations in actual body composition. Often we see sexual symptoms such as low libido or erectile dysfunction. In other cases, we see a history of feeling unmotivated, tired, or depressed,” explains Dr. Bazzan. “If men are wondering if this is an issue, they can complete the ADAM questionnaire—Androgen Deficiency in the Aging Male. It is available online and contains 10 simple questions to screen for low testosterone levels.” The Hormone Replacement Program at the Myrna Brind Center of Integrative Medicine at Jefferson is a “unique collaboration in an academic institution with boardcertified doctors that practice, meet, and do research together,” says Dr. Bazzan. “When it comes to testosterone replacement, it should not be thought of as a panacea, that it will make people 20 years younger, or just pump hormones into you. We have created a carefully designed protocol to assess symptoms and determine appropriate personal treatment goals, and offer the most advanced treatment.”
The Hormone Replacement Program places great emphasis on embracing a better lifestyle—a balanced diet, being physically active, and decreasing stress. Additionally, “we strive to answer patients’ questions and are always available so people feel like they are being followed throughout the process.” Myrna Brind Center of Integrative Medicine at Jefferson, 925 Chestnut St., Ste. 120, 215-955-2221
America’s obesity epidemic has hit new heights. Currently, one in three adults are obese—and a growing number of those are severely obese. It is a well-known fact that carrying excess pounds increases your risk for heart disease, diabetes, high blood pressure, stroke, and other serious, even fatal, health conditions—nevertheless, men have continued to pile on the pounds. And new research found that being overweight is three times deadlier in men compared to women. “Obesity is a medical disorder that kills. It is not a cosmetic or vanity issue, but a medical disease that is associated with a decrease in the quality of life, life expectancy, and medical complications related to every organ system,” says Dr. Ramsey Dallal, vice chair of the department of surgery at Einstein Healthcare Network.
Surgical intervention is not just life-changing, but, in some cases, life-saving for many who have tried and failed at weight loss. “People often have a misconception that obesity surgery is for those who are 500 or 600 pounds. That is not necessarily the case,” says Dr. Dallal. “Generally speaking, if you are 100 pounds over your ideal body weight, you may be a surgical candidate. And that number drops to 75 pounds if you have diabetes, hypertension, or sleep apnea.”
Einstein Healthcare’s Bariatric Surgery Program offers minimally invasive, including robotic, weight-loss surgery. These techniques have been shown to decrease hospital stays and facilitate recovery. “Patients typically go home the day after surgery and can return to work within days,” says Dr. Dallal. The program is accredited by the American College of Surgeons Bariatric Surgery Center Network. “This means that we have demonstrated appropriate safety measures, training, and qualitycontrol initiatives,” he explains. “Research shows that patients in these centers have better outcomes than non-accredited centers.”
Sustained weight loss after surgery poses some unique challenges. Dr. Dallal notes. “That is why we provide free and unlimited access to dieticians and psychologists to help them with education about food and exercise as well as their eating behavior. Our center offers a high level of support.” Einstein Medical Center Elkins Park, 60 Township Line Road, Elkins Park, 800-346-7834
The Hospital of the University of Pennsylvania was the first in Philadelphia to become certified as a Comprehensive Stroke Center.
Despite advances in many areas of health care, stroke—insufficient blood flow to the brain that leads to cell death—remains a devastating disorder. Strokes are the fourth leading cause of death in men in the US. “For the majority who survive, strokes are the chief cause of serious, long-term disability,” explains Dr. Scott Kasner, professor of neurology and director of The Penn Stroke Center.
The Hospital of the University of Pennsylvania was the first in Philadelphia, and among a select few throughout the US, to become certified as a Comprehensive Stroke Center. Dr. Kasner says, “This prestigious designation underscores that as we evaluate, diagnose, and treat stroke—and other diseases affecting the blood vessels in the brain—our patients will receive the most advanced care.”
Along with significant resources in staff and training, research is a key component of the Penn Stroke Center. Currently there are dozens of research trials and projects underway. “Our physicists developed a tool that we are using at the bedside to measure blood flow to the brain in real time. This allows us to individually optimize blood flow instead of using the typical one-size-fits-all approach,” says Dr. Kasner. “Research is necessary to advance stroke care.”
Penn Medicine also employs tele-medicine to extend its stroke care to other medical centers. “A monitor allows us to examine and communicate with the patient as well as look at imaging studies. In doing so, we can provide on-the-spot expertise to their doctors and help to determine the best treatment, and even who would be a candidate for transfer for surgery and/or specialized care at Penn.”
The fact is that men need to be extra vigilant about the risk factors, including hypertension, diabetes, smoking, and physical inactivity. When early recognition of warning signs is combined with timely treatment, says Dr. Kasner, “we can avoid or decrease disability and perhaps save someone’s life.” Comprehensive Stroke Center, University of Pennsylvania Health System, 3 West Gates Building, 3400 Spruce St., 215-662-3564
Screenings at the Center at Cooperin Colorectal Cancer Program at Lankenau Medical Center save lives.
Colorectal cancer is easily preventable, but it remains one of the nation’s leading cause of cancer deaths. Although it occurs in both genders, men have an increased incidence of this type of cancer, and are more likely to develop it at an earlier age and die from it.
The most effective way to prevent colorectal cancer is colonoscopy, yet screening rates remain low. John H. Marks, MD, section chief of Colorectal Surgery at Main Line Health and medical director of the Colorectal Cancer Program at Lankenau Medical Center, says, “While there’s hesitation when discussing your colon, timely colonoscopies can save your life.” It’s recommended that colonoscopies begin at age 50 and continue until 75; screening should start earlier if there are other risk factors—a personal or family history of colon cancer, polyps, or inflammatory bowel disease—or if symptoms like bleeding, change in bowel habits, or unexplained weight loss occur.
“Many patients are reluctant to seek traditional treatments because they are concerned that it could greatly affect their quality of life,” explains Dr. Marks. “The Colorectal Center at Lankenau Medical Center has spearheaded the use of minimally invasive surgical techniques that preserve sphincter function and eliminate the need for a colostomy bag—an external system that collects stool.” At Lankenau, 90 to 95 percent of colorectal cancer resections are performed this way utilizing laparoscopic or robotic techniques, compared to 40 to 60 percent for the national average. “Patients around the world visit us to receive innovative, high-quality care that preserves and enhances their quality of life,” he says.
The Colorectal Center at Lankenau is a dedicated space for excellence in comprehensive treatment and surgical care. “We’ve championed a multidisciplinary approach to colorectal cancer—incorporating specialists in radiation and medical oncology, pathology, genetics, gastroenterology, and radiology—to provide superior care,” says Dr. Marks. “We are an interactive center for scientists and clinicians to solve the most demanding problems in the fight to prevent, treat, and manage colorectal cancer through active clinical research and innovation.” The Colorectal Center at Lankenau Medical Center, Medical Science Building, 100 E. Lancaster Ave., Ste. 375, Wynnewood, 610-645- 9093
Erectile dysfunction, also referred to as ED, is a problem that affects an estimated 30 to 40 million American men. “And that number is in essence double that because the partner also suffers,” says Dr. Jay Simhan, director of Urologic Trauma, Reconstruction and Prosthetics at Einstein Healthcare Network. “It is a highly sensitive issue, and many times a man feels as though he has lost some component of his manhood. I often see the wife or partner advocating for their loved one—calling the office asking for help.”
The vast majority of cases of ED are medical in origin, only 10 to 20 percent stem from psychological factors. And although the risk increases with age, it is not an inevitable part of aging. “Erectile dysfunction can occur when there are blood flow problems—heart disease, diabetes, stroke, spinal cord injuries, and even with common medications such as beta blockers, antidepressants, and cholesterol-lowering medications,” explains Dr. Simhan.
“Many of our patients seek consultation for a penile prosthesis after they have tried conventional medications and other treatments that have failed,” he says. “Nationally, there are around 15 board-certified surgeons that perform more than 50 implants a year. At Einstein Healthcare Network, we do approximately 90. Our volume and expertise is one of the reasons that we have a large referral base that crosses state lines.”
Patients who elect to undergo the procedure can expect general anesthesia, an average operative time of 30 to 40 minutes, and an overnight hospital stay for monitoring. “I also tell my patients they will usually need two to three weeks of pain medications,” Dr. Simhan adds.
“One of my goals is to destigmatize erectile dysfunction,” he says. “In our society, we often speak about breast implants after cancer without hesitation, and rightfully so. When appropriate, penile implants can help return form and function for men after prostate cancer treatment as well as other chronic illnesses or trauma.” Einstein Medical Center Philadelphia, 5501 Old York Road, 800-346-7834
It’s no secret that professional athletes face the greatest risk for injuries, particularly knee injuries, which in some cases can abruptly end careers. But even recreational athletes of all ages, disciplines, and abilities are at risk for what is one of the most common reasons that patients seek medical attention, according to the American Academy of Orthopaedic Surgeons: In 2010, there were 10.4 million patient visits to doctors’ offices due to fractures, dislocations, sprains, and ligament tears, all of which can lead to cartilage injury.
Drs. Bradford S. Tucker and Kevin Freedman, sports medicine surgeons at the Cartilage Restoration Center at Rothman Institute, know these statistics all too well, with the majority of their patients, including many of Philly’s top athletes, visiting for cartilage injuries to the knee. When there is damage or deterioration in cartilage—a firm, smooth, and slippery covering on the ends of bones that protects and cushions the bones in your joint—patients can have pain and discomfort. The Center offers many new advances in cartilage restoration that are helping restore normal activity and delay—or eliminate the need for—knee replacements.
“The ideal candidate ranges from teenaged to 50 years old, can’t do the things they want to, and conservative treatment—physical therapy, cortisone shots—has failed them,” says Dr. Tucker, director of the Cartilage Restoration Center. Cartilage restoration involves surgically transplanting live cartilage or growing new cartilage over time by implanting cells. Dr. Tucker notes that the recovery process is lengthy, from six months to a year, with daily physical therapy.
Although even normal wear and tear from aging can contribute to knee injuries, there are preventative measures that men can take. “Appropriate strengthening and stretching around the hip and knee can decrease knee injuries up to 80 percent,” says Dr. Tucker, noting that squats, lunges, and “learning proper technique in jumping-and-landing” activities are some of the best moves. “Often ‘weekend athletes’ will go out and play a pickup game of basketball and sustain an injury because they aren’t in shape.” It’s these types of incidents that differentiate men and women when it comes to knee injuries. “Women usually suffer from cartilage deterioration over time, but injuries to men are typically more traumatic in nature,” says Dr. Freedman, associate director of the Cartilage Restoration Center. “That’s why prevention is so important. That same principle applies to other joints around the body like hips, shoulders, and elbows.” Freedman adds: “Young or old, men want to remain active. This program is destined to help men achieve that goal.” Rothman Institute, 925 Chestnut St., 800- 321-9999