Men’s Health:

Six ways to take control

Prostate cancer is one the most common cancers among males worldwide. According to the American Cancer Society (ACS), about one in nine men will be diagnosed with prostate cancer during their lifetime.

Located in front of the rectum, the prostate gland is responsible for producing a fluid found in semen. DR NEIL FORREST, a GP at International Medical Clinic’s (IMC) Camden clinic, says that although most cases are diagnosed between the ages of 65 and 70, it’s a good idea for men to discuss screening with their doctors from the age of 50 to be safe.

Unfortunately, he says that the uptake of screening is poor because many men are reluctant to discuss this issue.

What makes prostate cancer so common? Risk factors include being over 50, having a family history of the disease and having a diet that’s high in fat or alcohol. There is also some evidence to suggest higher rates in those who are overweight, who smoke, or who are of Afro-Caribbean ethnicity. Yet, there is really no one cause, according to Dr Forrest.“Prostate cancer is unusual in that there are no definitively proven ways to prevent it,” he explains.

That being said, it’s important for men to look out for any urinary changes. Symptoms to keep an eye out for include getting up at night to urinate, problems with urine flow (stopping or starting urination) or blood in the urine.

“These symptoms can also be due to benign enlargement of the prostate, which is very common,” says Dr Forrest. “So, it’s important not to panic, and to discuss things with your doctor.”

If you’re concerned about changes in your prostate area, or know someone who is, IMC performs routine prostate checks to look for lumps or nodules. “The check will involve a discussion with your doctor, a rectal examination and a blood test. While this may sound unpleasant, it’s very quick and safe – and it could save your life!”

How treatable is prostate cancer?

IMC offers this prostate check as a key service, to encourage men to take the test. But, what happens if something abnormal is found and the results aren’t what you’d hoped for?

“If further investigation or treatment is required, you’ll be referred to a urologist. Singapore has excellent specialists who are skilled in the latest treatments, including robotic prostate surgery,” says Dr Forrest; better-known methods such as radiotherapy, conventional surgery and hormonal medication are also available, of course. However, the biggest challenge for doctors is that current research is undecided about which types of cases need aggressive therapy, and which can be safely monitored without it.

“Not all cases require treatment, and much current research is focused on deciding between which men need aggressive therapy and those who can be safely monitored.”

November is a particularly important month for talking about prostate cancer. It’s the time when men all over the world grow a moustache as part of “Movember”, a movement that raises awareness and funds for researching and finding a cure for the disease. So, this month, why not get checked – or get the man in your life to do so? You might not be able to prevent prostate cancer, but at least you could spot it early enough to give yourself or your partner a fighting chance!

Put a stop to your snoring #2

Snoring may seem harmless, but it can actually be a sign of something sinister – and should never be ignored.

While 50 to 60 percent of men globally experience snoring issues at some point in their lives, for 20 percent of men this will be in the form of sleep apnea, says sleep therapist, JOEL SIMPSON. At City Sleep Clinic, he uses an evidence-based approach to treat all kinds of sleep and breathing disorders in both children and adults.

The most common form of sleep apnea is Obstructive Sleep Apnea (OSA), where breathing repeatedly stops and starts. During sleep, the airway collapses, causing reduced or complete cessation of airflow. This, in turn, causes oxygen levels to drop, and leads to chronic sleep deprivation. If left untreated, OSA can result in a number of serious health issues including high blood pressure, stroke and heart disease.

Unfortunately, a very common behavioural issue among men is “treatment avoidance”, says Joel, and he sees a lot of it.

“It can be very difficult to convince your partner to seek treatment for snoring. Your partner might say, ‘It’s not killing me, so why do I need to go seek treatment?’”

It’s important to point out that OSA is not only linked to various health issues, particularly cardiovascular problems, but poor sleep itself can also affect one’s health.

“The three pillars of good health for everyone are diet, exercise and good sleep,” says Joel. “Issues in any one of these means the effectiveness of the other two in promoting healthy bodies and minds is diminished.”

Not only that, even if the snorer doesn’t want to go for themselves, loud snoring will almost certainly be having an impact on their partner, who will be getting poor sleep, too. This negatively impacts mood, energy, weight and overall wellbeing.

“Bad sleep causes poor cortisol regulation, which means fat is less easily metabolised, you feel less energetic, eat more – it’s a huge negative feedback loop. So you could be having trouble losing weight, and your partner’s snoring could be playing a role in this,” says Joel.

Diagnosis and treatment

Joel says snoring can often be helped with some good sleep habits; however, the problem may not be solved with good sleep hygiene alone. Therefore, it’s important to be tested.

“The first step is to get a proper diagnosis of what the sleep issue is and what’s causing it. After understanding a patient’s medical history and going through various sleep screenings, it’s often recommended to conduct a sleep study,” says Joel. “City Sleep Clinic favours an at-home study to ensure it gets the best representation of a patient’s ‘normal’ sleep.”

When it comes to treatment, Joel says that the clinic has a very holistic approach to treating sleep issues. Each treatment plan is tailored to the individual, based on what is most appropriate for that person.

“There is a tendency here, across many therapeutic areas, to rush to a quick fix for many health issues that people face. Treating sleep disorders is particularly complex and requires a team-based approach in almost every case,” says Joel. “So, we need to first understand what’s happening and which therapies will give us the highest likelihood of success.”

Don’t be afraid to #3 ask for help

Though mental illness is a global problem that affects both genders, it’s something that can affect men and women quite differently. According to PRU JONES, a counsellor at Counsellingconnectz, men tend to not seek help – even though the occurrence of mental illness is relatively similar across genders, and even though 75 percent of suicides are males. The fact is, males account for only 36 percent of psychiatric treatment, she says.

“In our expat world, this is horribly amplified. We’re miles from friends and faced with the daunting task of finding new ones. ‘Hold on, many of us are married or have young families,’ you may argue. ‘Surely, they can turn to their wives or partners?’ No. Actually, being married increases the likelihood of isolation,” says Pru. “And fatherhood comes with its own challenges, often serving to distance partners; also, postnatal depression hits one in seven fathers.”

Some of the symptoms of depression to look for include irritability, sudden anger, increased loss of control, greater risk-taking and aggression. Men may also talk about physical pain such as backaches and headaches, rather than emotional pain, explains Pru.

Feelings of isolation

“Fifty percent of men claim they have no close friends. And, even if they do, many won’t have meaningful conversations with them,” says Pru. “Most report having fewer than two meaningful conversations a year. And, the ‘I love you, man!’ after six beers doesn’t count! If they do open up, 49 percent say the reaction is disappointing.”

So, what can guys do to help deal with these feelings of loneliness?

“Reach out to others; it can seem overwhelming and it takes real courage,” says Pru. She also suggests staying in touch with friends, however hard it may seem, and making social arrangements and sticking to them.

“Stay in touch with those mates from home who you can have good conversations with. If you haven’t been in touch for a while, try and reconnect.”

Pru adds, “Caring for others is a great way to build connection – from more formal volunteering to simply doing something nice for someone else.” In fact, supporting others has been shown to boost a person’s mood more than supporting themselves.

Identity confusion and societal expectations

“There are those who say male identity is now in crisis,” says Pru, “given some of the dichotomies in society: ‘Adhere to masculine norms (protect, provide, procreate) but be vulnerable, too’; ‘Acknowledge that the majority of violent crimes and drug and alcohol abuse are carried out by males, but the majority of males are not violent criminals or drug and alcohol abusers’; and, ‘Support the “Me Too” movement, but know that you’re not a sexual predator’.

“Stir these dichotomies into our expat environment – a melting pot of different social and cultural messages – and it’s no wonder I see men trying to work out who they are, grappling with a sense of having lost themselves somewhere along their way, and unsure how to walk on.” Additionally, a guy’s emotional repertoire is often thought to be limited. According to research, only three emotions are culturally acceptable for men: anger, contempt and pride. In reality, however, men and women’s emotions aren’t really that different.

“When you expose men and women to the same stimuli, their autonomous nervous systems fire off in the same way,” says Pru. “So, men are experiencing the whole gamut of emotions, but they’re taught to funnel these into silence or anger, contempt or pride. Repeating this over and over leads to emotional anaesthesia, making connection with others more difficult, and compounding isolation.”

Her suggestion? “Take the gender filter off – look at us as all as human, trying to be the best versions of ourselves as we navigate through our own, and everyone else’s, expectations.” Also, always question yourself. “What are the norms or values you consciously or unconsciously support? How could they be blocking or inspiring you?”

Keep talking

Whether it’s to your good friend or a therapist, it’s a good idea to keep talking.

“Bottling things up or ignoring things can work in the short term but, in the long run, it can damage the physical and mental health of ourselves and those around us. If you want to do something about this, therapy is a safe, non-judgemental space to experiment with new tools,” says Pru. “Good therapy isn’t about just sitting and talking about your feelings, it’s about being empowered with tools to be the best version of yourself.”

Research suggests that only three emotions are culturally acceptable for men: anger, contempt and pride

Take care of your heart #4

Heart disease is a leading cause of death worldwide, with the most common type being coronary artery disease (CAD) – a condition in which cholesterol-rich plaque accumulates within the walls of the arteries that supply blood to the heart muscle. Because it develops over time, CAD can go unnoticed until a complete blockage of the artery occurs and creates a heart attack. However, there are plenty of preventative measures you can take to thwart this “silent killer” in the first place. Adopting a healthier lifestyle is a good start, says DR ROHIT KHURANA, cardiologist at The Harley Street Heart and Vascular Centre. This includes increasing physical activity, quitting smoking and committing to a healthier diet, as well as altering risk factors such as high blood pressure and cholesterol.

He also recommends screening for CAD from the age of 40 to detect if an individual is at an elevated risk for developing heart disease. Some of the factors that would put someone at higher risk of CAD include a family history of early-onset heart attacks, diabetes and heart failure.

“Since much of heart disease is silent, screening tests allow for early detection of both measurable risks and the presence of heart disease, which empowers the individual to be more proactive at reducing those risks,” says Dr Khurana.

Luckily, he says many athletes come to him requesting CAD screenings – and for good reason.

“As we age, the most common cause of cardiac problems in the middleaged athlete is CAD. Screening tests offer an assessment of this risk and offer some reassurance to ensure that athletes know the symptoms to be aware of or what should prompt them to seek early medical attention.”

So, what do cardiac screenings entail? They’re simple and non-invasive, according to Dr Khurana, and can be extremely useful in identifying the disease at an earlier stage. Screening typically starts with a detailed medical history questionnaire, followed by a clinical examination, measuring blood pressure and body mass index (BMI), and a blood test to check cholesterol levels. And, if the patient describes chest discomfort and also has an elevated risk profile, a CT scan may be suggested to get a detailed look at the heart’s blood supply.

“If you have a prior history of heart disease, then please ensure your risk reduction is optimised and consult your usual cardiologist to ensure a more personalised approach to managing the condition.”

Stress and the heart

“Everyone feels stress in different ways and reacts to it in different ways. How much stress you experience and how you react to it can lead to a wide variety of health problems including adverse effects on the heart,” explains Dr Khurana. “While the link between stress and heart disease isn’t entirely clear, it’s well documented that chronic stress may cause some people to drink excessively, smoke or relapse into poor dietary habits, which themselves have negative effects on heart health.”

Therefore, it’s a good idea to identify the stressors in your life and make the necessary changes to avoid the unhealthy behaviours that stress can promote.

“Exercising, maintaining a positive attitude, not smoking, not drinking too much coffee, enjoying a healthy diet and maintaining a healthy weight are all part of dealing with the adverse consequences of stress.”

Stop chronic pain #5

Any woman who’s lived with a man suffering from chronic pain can attest to the fact that it’s miserable for everyone involved. Not only is it physically debilitating but it wreaks emotional havoc, too. It can cause depression, anxiety, anger and fear of re-injury, for instance.

“After a significant injury involving tissue damage, especially repetitive incidents, the chronic pain process begins. The central nervous system misfires, sending erroneous pain signals throughout the system and to the brain,” says GORDON WOON, a physiotherapist at City Osteopathy and Physiotherapy. He specialises in treating chronic pain with the Feldenkrais Method – a type of exercise therapy combining movement training, gentle touch and verbal guidance to help create more efficient movement through mind-body awareness.

“The chronic pain process can also be initiated by sudden emotional episodes, such as a loss of a loved one, a significant change in life or a traumatic experience. That’s why chronic pain is one of the more challenging conditions to treat using conventional medical and physiotherapy models,” says Gordon.

Lower back pain and shoulder pain are among the most common problems male clients come to him with. Interestingly, he says this is a reflection of prolonged sitting at desks, and an overemphasis on building up flexor muscles in the fitness industry (think six-packs and pectorals).

“The urban work and lifestyle setting has made prolonged sitting ubiquitous; the result is the adaptive shortening of the chest and hip flexor muscles. These shortened muscles affect the biomechanical movements of our shoulders, lower back and hips, resulting in the rise of shoulder and back pain, especially when tied with periodic bouts of sport and exercise.”

The Feldenkrais Method can help people to address these shortened muscles, resulting in reversing chronic neck and back pain. Additionally, he says this type of therapy is useful in treating Fibromyalgia, Chronic Fatigue Syndrome, Complex Regional Pain Syndrome (CRPS), Cerebral Palsy and a number of other conditions.

Protect your skin #6

Remembering to bring sunscreen and actually using it are two different things. And making sure it’s not just the kids who are using it is crucial! Dad may be quick to lather up the kids with sunscreen, but chances are he’s “forgetting” about himself more often than not, and failing to adequately protect his own skin. Mums are guilty of this too, of course, but studies have shown that men are even less likely to use sunscreen as part of their daily routines.

In addition to using a sunscreen with a high factor SPF, it’s also a good idea to wear a hat, especially if you have to be outside during the hottest part of the day: noon! Of course, it’s best to stay out of the noonday sun to begin with, when possible; instead, try to catch early morning or late afternoon rays. And, if you feel your skin start to redden, get some shade; even a single sunburn can increase your risk of skin cancer.

Spot the signs

Being cautious in the sunshine isn’t the only way to defend your skin. Checking your skin regularly for any changes can literally be a lifesaver.

DR DENNIS LIM, a general surgeon with expertise in head and neck surgery, and a surgical oncologist specialising in the treatment of skin cancer, says he too often sees male patients who have ignored warning signs and waited too long before seeking medical attention.

“Regardless of how many moles you have, if you find a mark that has increased in size or sensitivity, or is itching or bleeding, it should be looked at immediately by a dermatologist, as it could be a sign of skin cancer, including melanoma,” he says.

To be safe, it’s best to monitor your skin and see a dermatologist once a year, even if there aren’t any warning signs on your skin, he says.

“Dermatologists will use dermascopes and have the proper training to know what to look out for. Some even document and scan all your moles to compare the results between annual appointments.”