By Nina Radcliff, MD | October 5, 2015 | Lifestyle
No matter what the health concern, there's no disputing the power of preventative care. Thanks to new technologies and therapies now available in Philadelphia—some for the first time in the region—it's easier than ever for men to assess and treat medical risks, from heart disease to lung cancer.
The American healthcare system is undergoing some of the most dramatic foundational and philosophical changes in its history. It is shifting from the paradigm of “fixing patients when they are sick” to focusing on prevention and wellness. And Philadelphia is paving the way—just as it did when it established the nation’s first hospital, Pennsylvania Hospital, in 1751; first medical school, at the University of Pennsylvania, in 1765; and first eye hospital, Wills Eye, in 1832. Our city has earned a regional, national, and international reputation for advancing medical science through research, educating the next generation of leaders in medicine, and being dedicated to the best quality of patient care. And when it comes to men’s health issues, Philadelphia is again leading the way. Men’s health has some unique aspects. In addition to certain conditions that only affect men, such as prostate cancer, many of the major health risks that they face—heart disease, lung cancer—can be prevented, slowed down, or treated with early screening and diagnosis. However, studies have shown men are more likely than women to put off regular checkups and medical care. So to our gentlemen—and the women who love their fathers, husbands, friends, and sons—we take a look at the top six programs emphasizing prevention and wellness for men in the City of Brotherly Love. Doing so can help guys live healthier lives now and for generations to come.
Formally established in 1973, the Abramson Cancer Center at the University of Pennsylvania utilizes a multidisciplinary team to deliver the best possible comprehensive care for prostate cancer. Its urological surgeons are worldrenowned for developing and using new minimally invasive surgical techniques. Dr. David I. Lee, chief of Urology at Penn Presbyterian Hospital and professor of Surgery/ Urology, ranks as one of the top five most experienced surgeons in the world, having performed more than 4,400 robotic-assisted prostatectomies.
“The robot is designed to provide exquisite maneuverability and precision. This makes it well suited to perform the complex reconstructive work needed for removal of prostate cancer,” says Dr. Lee. As a result, “we are seeing quicker recovery and hospital discharge, with less pain and blood loss compared to other surgical techniques. Most men can resume activities such as golf and weight lifting in about three weeks.”
Penn also offers cutting-edge, noninvasive therapies. Both proton therapy and intensity-modulated radiation therapy use “high-energy radiation technology to destroy prostate cancer cells with the goal of minimal radiation exposure to surrounding tissues,” explains Dr. Neha Vapiwala, associate professor of Radiation Oncology at the Hospital of the University of Pennsylvania and advisory dean at Perelman School of Medicine.
Dr. Vapiwala’s research centers on maximizing the efficacy of prostate cancer treatments and minimizing their side effects; all patients who undergo prostate radiation are enrolled in prospective trials to monitor outcomes and side effects. “One of our more unique studies seeks to determine whether regular structured yoga can improve physical stamina and strengthen pelvic floor muscles during treatment,” says Dr. Vapiwala. “We hypothesize that doing so may improve energy levels as well as urinary and sexual function. Not only do we want to eradicate prostate cancer, but we want to enhance our patients’ quality of life and promote healing and recovery through integrative and holistic approaches that focus on the entire person, not just his disease.”
And for those with advanced prostate cancer, there may be new hope available: Vaccine therapy is a recently approved method that teaches the immune system to attack and destroy cancer cells. 800-789-PENN
Lung cancer is the leading cancer killer in men. One of the main challenges to treatment is that by the time lung cancer is diagnosed, it has often grown large and spread to other parts of the body. “That is why Jefferson Hospital established the region’s first lung cancer screening program,” explains Dr. Mani S. Kavuru, division director and professor of Pulmonary and Critical Care Medicine and center director of Jane and Leonard Korman Lung Cancer Center at Jefferson. “Early detection is key and can help improve survival. Our program is committed to providing state-of-the-art, comprehensive, and convenient screening methods for those at high risk.”
Patients aged 55 to 77 years who have a 30-packyear smoking history (multiply packs per day smoked by years smoked; e.g., one pack per day for 30 years equals 30 pack-years) and are current or former smokers who have quit within the past 15 years may be considered high risk for lung cancer and eligible for screening.
Jefferson’s Lung Cancer Screening Program utilizes low-dose computed tomography (LDCT). LDCT is a quick, painless three- to five-minute test in which an X-ray machine uses low doses of radiation to take multiple, detailed pictures of the lungs.
“In developing this program, a premium was placed on patient convenience,” explains Dr. Kavuru. When patients call, they can arrange for an appointment in as soon as three days. During the two-hour appointment, patients will first meet with a nurse navigator who will employ a shared decisionmaking tool that actively engages patients on the risks and benefits of screening. “We want our patients’ values and preferences to be taken into account,” Dr. Kavuru says. And for current smokers, counseling on smoking cessation will be provided because “risk reduction is a critical factor in any screening program.”
After that, “the LDCT scan is read by a radiologist during your appointment,” says Dr. Kavuru. “You will know what the findings are before leaving that day. Our nurse navigator will also provide post-scan counseling and arrange for any necessary follow-up. And a physician is also on site for consultation, if required. It’s a one-stop shop.” 834 Walnut St., 215-955-LUNG
If you are experiencing blurry vision or glaring lights, or noticing you aren’t quite seeing the ball clearly enough when you play tennis or go for that golf swing, you may have a cataract. The term cataract describes when the eye’s lens, which is responsible for helping us focus and see clearly, becomes cloudy. Imagine looking through the windshield of your car, but with frost on it.
Dr. Mark H. Blecher, codirector of Cataract and Primary Eye Care at Wills Eye Hospital, says that he is seeing patients with cataracts at younger ages than ever before. “It may be that they are developing them at an earlier age or that we are less tolerant of not seeing 20/20,” he says.
While the occurrence of cataracts may be a normal part of aging, it doesn’t have to be something that disables people. “In the past, the paradigm with cataracts was to wait until your vision was poor before removing them, which would result in significant disability,” says Dr. Blecher. Years ago, cataract extraction was a complicated procedure with a number of risks. Today, it has been streamlined. At Wills Eye Hospital, which is consistently ranked top in the nation for Best Eye Hospitals by US News & World Report, Dr. Blecher says, “Cataract extraction with artificial lens implantation is dependable, one of the safest procedures performed, and with amazing quality that requires almost no downtime.”
And for those early cataract sufferers who are also having difficulty reading (a condition known as presbyopia), the new artificial lenses being used for cataract surgery can offer improved vision or possibly even a cure. Wills Eye Hospital uses multifocal lenses that allow for improved near and distance vision. “These technologies may in fact help us see better than we ever did,” says Dr. Blecher. So while you may still have some work to do on your tennis backhand or golf swing, at least you’ll be able to spot the ball more clearly—which can often be half the battle. 840 Walnut St., 877-289-4557
The Shore Quality Partners Diabetic Care Coordination Team takes a multidisciplinary approach to prevention and treatment of the disease.
Over the past 15 years, the incidence of Type 2 diabetes in men has increased at an astonishing rate. While the reasons for this are not completely understood, what we do know is that “making healthy food choices, staying at a healthy weight, moving more every day, and taking medications as prescribed even when you feel you are doing fine make a difference,” explains Dr. Jon K. Pomeroy, Shore Quality Partners Diabetic Care Coordination Team leader.
Collaboration is one of the hallmarks of the Shore Quality Partners Diabetic Care Coordination Team, which brings together a multidisciplinary group of professionals, including primary care physicians, endocrinologists, nurses, dieticians, pharmacists, and social workers. This initiative involves a clinically integrated organization of Shore Medical Center and 235 of its partnering physicians to address comprehensive issues of their diabetic patients in surrounding counties.
“Each member of our team brings their special expertise to the table to educate and create the best possible, individualized plan for our patients,” says Dr. Pomeroy. On a patient’s first visit, the team spends up to 90 minutes with him to assess all components of the disease. “We give our patients manageable goals and homework. For example, we may ask them to keep a food diary, and on their next visit to have our registered dietician break it down and find any shortcomings,” Dr. Pomeroy explains.
Uncontrolled diabetes has devastating consequences— blindness, stroke, heart disease, kidney failure, amputations, and nerve injury. The good news is that when properly managed, these complications, as well as hospital admissions, can be minimized and diabetics can live longer and healthier lives.
Says Dr. Pomeroy, “The mission of Shore Quality Partners Diabetic Care Coordination is to educate pre-diabetics and diabetics about their disease and empower them with tools to fight, overcome, and thrive.” 415 Shore Road, Somers Point, NJ, 609-365-6260
Historically, depression was thought to be an illness that aff licted women disproportionately. However, research has shown that males experience depression at a similar rate, but are less likely to seek help and treatment.
“Men often describe feeling empty, lacking motivation, or not having energy. For some, there is a tendency for depression to manifest as anger, irritability, and aggression,” explains Dr. Marc A. Burock, medical director of Inpatient Psychiatry at Bryn Mawr Hospital, part of Main Line Health.
The Behavioral Health Services at Main Line Health consists of a team with expertise in diagnosing and individualizing treatment of mild to severe depression, as well as many other behavioral health-related conditions.
In some instances, psychotherapy, or “talk therapy,” is appropriate. As Dr. Burock explains, “Many have stereotypical impressions that come from television shows. They think they will lie on a couch and talk about their childhood, or their therapist is looking for some Freudian relevance to what they are saying. But in actuality, psychotherapy is highly recommended, effective, and can be individualized to fit your needs.”
In other instances, psychiatrists may prescribe antidepressants. “One of the most common complaints we hear about is sexual side effects,” says Dr. Burock. “In fact, some studies report that it affects up to 60 percent of men. And this may become a barrier to treating depression.”
New cutting-edge treatments are also available. “In select cases, our NeuroStar TMS Therapy is being utilized as first-line therapy for depression,” says Dr. Burock. The Bryn Mawr Hospital TMS (transcranial magnetic stimulation) Center is one of only 650 centers in the country that provides this technology. Similar to magnetic resonance imaging (MRI), this noninvasive, nondrug treatment employs precisely targeted magnetic pulses to stimulate key areas of the brain that may be underactive in patients who suffer from depression.
“Success, when it comes to depression, requires openness and acceptance of receiving help, not being embarrassed or demoralized. By asking for help, you can get help,” says Dr. Burock. 130 S. Bryn Mawr Ave., Bryn Mawr, 484-337-3000
Half of all men who die suddenly of coronary heart disease have no previous symptoms. That is why knowing your risk factors, being screened early, and modifying these risks can save lives.
Coronary heart disease develops when cholesterol-laden plaque builds up in heart vessel walls and impedes blood flow. This impairs the heart’s ability to effectively pump blood. If not effectively treated, these plaques can rupture, causing occlusion of blood flow. Cell death, or myocardial infarction (MI), can occur within a matter of minutes.
“Early screening and risk stratification are based on risk factors— high blood pressure, elevated blood cholesterol levels, diabetes mellitus, a family history of premature heart disease, and smoking,” explains Dr. Harvey A. Snyder, founding partner of The Heart House and clinical associate professor of Cardiology at Cooper University Medical School. “Your doctor may order a screening test, known as a stress test, to determine if you have coronary heart disease. If you experience characteristic symptoms during the test and/or the study suggests a blocked coronary artery, cardiac catheterization is the next step to define the coronary anatomy. Treatment options include medical therapy, interventional stenting, or coronary bypass surgery.”
And if you believe you might be having a heart attack, early action is critical. “Call 911 and take an aspirin. Time is of the essence. The faster blood flow can be restored in the catheterization lab, the less heart muscle is damaged and the better the outcome.”
Cooper Heart Institute has cardiologists available to provide emergency interventions in catheterization labs at Cooper University Hospital, Virtua Marlton Hospital, Regional Medical Center of Vineland, Kennedy University Hospital–Washington Township Campus, and Our Lady of Lourdes Medical Center 24 hours a day, 365 days a year.
“What’s remarkable is that the vast majority of patients that make it to a medical center with a heart attack leave alive. People can live a long and fruitful life with heart disease due to advancements in pharmacology and technology. We are seeing patients living well into their 90s,” says Dr. Snyder. The Heart House, 999 Rte. 73 N., Ste. 205, Marlton, NJ, 856-795-2227
PHOTOGRAPHY BY SHUTTERSTOCK
October 22, 2018