Nancy Gahles, DC, CCH, RSHom(NA) examines why men’s health issues are often off the radar.

by Nancy Gahles, DC, CCH, RSHom(NA)

A brief scan of the health magazines that grace my office reception area revealed the issue I want to discuss in this forum. Men’s health issues are not on the radar. The preponderance of articles in this genre of magazine address women’s issues. There are the generic cholesterol, diabetes, heart and hypertension articles however, for the most part, men’s health is relegated to prostate conditions and erectile dysfunction.

Certainly, this is borne out in mainstream media. All one has to do is turn on the television for more than 5 minutes and there will be one commercial with Jamaican vacation music extolling the virtues of Viagra. When these commercials first began appearing, I wondered if it was possible that the prevalence of erectile dysfunction among men in the U.S. had risen so sharply as to warrant the abundance of products available and the amount of money spent on product development and marketing. Was this a crisis in men’s health that I had missed?

I set out to survey the men in my practice. Although I have a family practice for 28 years offering varied modalities such as chiropractic, homeopathy, nutrition, yoga and meditation, the majority of my patients are women and children. The women send their husbands, fathers, sons and brothers for care. Generally, men are not the initiators of treatment for themselves. In fact, after the events of 9/11, here in the NYC neighborhood where I practice, I took cases of firefighters over the phone with their wives because they were too proud to come in and tell me that they were “hurting” in any way from that experience. One woman, whose husband was the Batallion Chief of the entire peninsula, told me the whole story of his suffering with anxiety and insomnia, increased drinking and mood disorders. She said that she told him to come see me for his back pain and that I shouldn’t mention anything to him about causation. In fact, after talking to him for a while he did reveal the source of his “discomfort” and he was actually relieved to offload the story to a doctor. He was equally relieved to know that there was something called homeopathy that could assist him to regain balance and control of his life and emotions. No doubt this crisis had affected his libido but that was not his presenting complaint.

All too often it is. When we are in emotional pain that is not addressed, the energy that it takes for the system to handle those stress hormones can cause decreased libido, fatigue, insomnia, depression and other more vague symptoms. These symptoms are ones that men, in particular, easily suppress or ignore. Men are taught to go past these trifling feelings. Real men have real symptoms. Like heart attacks or cancer. That is when they go to the doctor. They go to the doctor when they cannot take the pain anymore. By this time, the emotional pain is an integral component of a true pathology of some kind that justifies a visit to the doctor.

One of my patients is a Chief EMT in NYC.  Every time he comes in he regales me with the “war stories” of the weekend. The majority of the calls he makes are to 5 star hotels in midtown Manhattan. The patients are overwhelmingly men in their mid to late 50’s complaining of chest pain or abdominal pain. The causation, as he puts it, is that “they are partying like they are 19 years old and they don’t want to be told they can’t do it.” “These men party too hard. They are usually overweight, have been drinking and smoking too much. They are often with younger women”, he tells me. In a chest pain case, you must ascertain if they have been taking Viagra because administering nitroglycerine, in an acute situation, can have serious consequences. He tells them what can happen if he treats them and they have taken Viagra and reluctantly they will admit it. They want to be able to perform and to make sure they can do it. That appears to be the reason for increased prescription use of Viagra more than physiologic erectile dysfunction. Men equate power, the ability to achieve, with potency. A sense of lacking in power, strength or vigor is the way in which Webster’s Dictionary defines impotence. Secondly, it is defined as helplessness. One way for that feeling to become evident is via erectile dysfunction. It makes sense then that this complaint gets the most attention in the arena of men’s health.

It appears that this age group and condition is analogous to women in menopause. The denial of aging looms large. The efforts to regain youthfulness and prowess and potency are addressed with herbs, diet and lifestyle choices.  While menopause in women is a given, it is not clearly understood nor has it been able to be competently addressed by the medical community. Much less so in male menopause or, male “intermezzo” as I call it.

What can we, as a community of integrative practitioners, do to change this around?

Jeffrey S. Bland, PhD, FACN, CNS, in an article which appeared in Dynamic Chiropractic, June 3, 2008, commented on a recent survey conducted by the American Heart Association. The survey of cardiologists and primary care physicians revealed the following:

*Only one in 10 respondents were successful in helping their patients achieve healthy serum lipid levels.

*Only half of the respondents said they were very knowledgeable about the use of lifestyle interventions to lower serum lipids.

*Few considered being overweight or having a sedentary lifestyle as important contributions to coronary heart disease.

*Dietary and lifestyle interventions were viewed as only somewhat or moderately effective.

*Respondents cited lack of patient compliance and office visit time a major obstacles in implementing the ATPIII guidelines.

As a community of practitioners with varied specialties, in my opinion, it is incumbent upon us to take up the cudgels of education and communication both with our patients and our colleagues to inform them of lifestyle choices available to them. It is imperative that we give a voice to all our patients; in this case, the squeaky wheel gets the most oil. That is, our male population. Efforts to reach out in formulating strategies and/or groups that educate men on lifestyle choices could be explored and shared. Recent studies indicate a trend in healthcare towards group problem solving at a primary care level.

Of immense importance is stressing the self-care concept. For men, this may work quite well. Empowerment through education and identifying the tools for problem solving is a methodology men can relate to. According the June/July edition of The Nation’s Health, magazine of the APHA, there is a dramatic shortage of health care workers, including physicians in the geriatric work force. “With this tsunami of baby boomers, we don’t have a matching tsunami of geriatrically trained people to meet their needs,” said Sarah Burger, MPH, RN, coordinator of the Coalition of geriatric Nursing organizations at New York University’s Hartford Institute for Geriatric Nursing.

Integrative healthcare in this case can be seen as interventional. It can also become the prevailing paradigm for health care practice.

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