Why do most men go to the doctor? It’s because their significant other, their mother, or their grandmother tells them they need to. This is the typical reason that I see men in my office. Someone in their life sees something on their back and tells them to follow up with a doctor. Half of the time they don’t show up. When they do show up, they are not sure why they are there in the first place. As a man and a physician, I’m guilty of both. My girlfriend is currently harassing me to get my screening colonoscopy. I keep coming up with excuses as to why I haven’t done it yet. My current excuse is that I’m too busy at work. Part of this lack of follow-through is confusion. The other part, is laziness. Here, I’m going to try to simplify men’s screenings with regards to health. This will help with the confusion. Laziness will be tackled on a different day!
Let’s start with ABCDE’S of health screening for men:
A: Abdominal Aortic Aneurysm (AAA)
Recommendation: Screening abdominal aortic ultrasound once from the age of 65-75 if you smoke or have a family history of AAA
The abdominal aorta is the largest blood vessel in the body. It moves blood from the heart into the abdomen (belly) and down to your legs. Hypertension may be the largest risk factor. Diseases such as diabetes, obesity, and smoking are also risk factors. If and AAA is not treated early, it can cause sudden death. This can completely alter your family’s future.
B: Blood Pressure Testing (I’m going to add weight to evaluate obesity risk)
Recommendation (Blood Pressure): Blood pressure by a health care provider every 2 years without risk factors. If you have risks factors such smoking, diabetes, or a strong family history, this should be done at least once a year, starting at the age of adulthood.
From heart disease to strokes to colon cancer to inflammatory bowel disease, high blood pressure (hypertension) puts you at risk for almost everything you don’t want to have medically. This is usually the starting point for developing cardiac disease and having a heart attack (myocardial infarction). Hypertension can cause you to have a stroke and lose complete function of your arms and legs. This risk can usually be controlled by taking 1 or 2 pills a day. When you have hypertension, it has to be managed and not treated. Treating hypertension early can definitely save your life.
Recommendation (Weight): Weight and height to calculate your body mass index (BMI) once every 5 years past the age of 45.
Body mass index is calculated by obtaining your weight in kilograms and dividing it by how tall you are in meters squared. There are plenty of apps to calculate your BMI. Just download one. If you’re obese you know it. If you think you are obese then you probably are. As men become older, we become less active. This sedentary lifestyle (sitting on you’re a$$) puts you at risk for multiple health problems. If your BMI is greater than 27, you have room for improvement. If your BMI is greater than 30, you are obese. If your BMI is greater than 40 you are morbidly obese. Considering weight loss surgery or changes in lifestyle such as diet and exercise can completely transform your health risk.
C: Cholesterol, and Colorectal Screening
Recommendation (Cholesterol): Cholesterol laboratory panel with your initial visit by your primary care provider. If undergoing treatment, a blood draw should occur once every year. If your cholesterol panel is within normal limits then, once every 5 years.
This is part of the basic panel of labs your primary care provider should get when you come into the office. If you’re seeing a health care provider on a regular basis, they check this every year. Cholesterol, which comes from eating animal products, increases your risk of having a heart attack or stroke. It does this by clogging the arteries that supply blood to an organ. High cholesterol can also put you at risk for losing extremities, especially when it’s combined with smoking and diabetes
Recommendation (Colorectal): Colorectal cancer screening starts at the age of 45 and continues to the age of 80. This can be achieved by 2 methods: Fecal occult blood testing annually and/or a colonoscopy every 10 years.
When you have a screening colonoscopy you are asleep. You won’t remember anything. Most gastrointestinal doctors and surgeons who perform these do so many that they will not remember what your butt looks like the next day. The thought of the process is worse than the actual procedure. The worst part is the bowel prep, but its’ temporary. Remember that time you ate some bad potato salad at the family cookout? It’s like that. Rough but done in 24 hours. During the colonoscopy, you can remove a large polyp. This can prevent someone from having their colon removed (colectomy) if the polyp is found early. A fecal occult blood test looks for bleeding only. It should be used in conjunction with a screening colonoscopy. We used to start this screening at the age of 50 has now been moved up to 45. It is also 10 years before an immediate family member was diagnosed with colorectal cancer.
Recommendation: Routine lab evaluation to check blood glucose and/or fasting blood glucose along with a Hemoglobin A1C every year with routine labs ordered by your healthcare provider after the age of 40.
There are 2 types of diabetes: Type I is usually diagnosed at an early age and usually requires insulin; Type 2 diabetes is usually diagnosed during adulthood due to lifestyle, and can sometimes be treated with medicine. This is a complex topic with a lot of ins and outs. At the end of the day, diabetes, puts you at risk for everything, including heart disease. Diabetes by itself keeps most vascular surgeons in business because it is the #1 risk factor for doing amputations. Diabetes can cause you to lose one or both of your legs. It also puts you at risk for kidney disease requiring dialysis. Talk to your healthcare provider in order to assess your risk factors.
E: Everything Else (that is somewhat necessary): Prostate and Lung Cancer
Recommendations (Prostate): Prostate specific antigen (PSA) to rule out prostate cancer is controversial. Discuss this with your primary care provider.
Prostate cancer. It is a tricky subject. Screening for prostate cancer is even trickier. A PSA is done to give us an idea about what’s going on in the prostate. It is not specific to prostate cancer, which makes it difficult to use it as a screening tool. When it is combined with a good history and physical, a PSA test can be a useful in detecting prostate cancer early.
Recommendation (Lung): The USPSTF recommends annual screening for lung cancer with low-dose computed tomography (LDCT) in adults aged 50 to 80 years who have a 20 or more pack-year smoking history and currently smoke or have quit within the past 15 years.
Pack year is calculated by multiplying the number of packs of cigarettes you smoke each day by the number of years you have been smoking. Smoking a pack a day since the age of 30 gives you a 20 pack year history at the age of 50. This recommendation changes from time to time. If you smoke, just stop. If you want help stopping, contact your primary healthcare provider. If you can’t or won’t stop, consider screening.
S: Sexually Transmitted Infections (STI or STD of you are of a certain age)
Recommendation: If you are having unprotected sex, you should get screened each time you have a new partner.
Syphilis is on the rise. HIV is real. There is more out there than cooties and the clap (which is not a real thing, but cooties are). Because this is person to person specific, there is not time line for screening. If you are out here having unprotected sex, make sure your equipment is clean and taken care of.
In summary, this covers pretty much everything that most men need to do to get screened medically and start taking care of themselves as adults. For a more thorough and complete list, check out the US Preventative Services Task Force at www.uspreventiveservicestaskforce.org. They keep a complete and up-to-date list of all screening recommendations.
At the end of the day, if you get yourself or the man in your life to a primary healthcare provider, they will take care of the rest. The first step is usually the hardest. Good luck and listen to your primary care provider. They will help keep you around for many years to harass your loved ones and continue to fish, hunt, cook, weld, shoot photography, play golf, build, and destroy as much as you possibly can as long as you can.
About the Author
Dr. George Crawford, MD is the founder and lead surgeon at The Crawford Clinic in Anniston, Alabama. After graduating from Morehouse College as a Rhodes Scholar nominee and earning his bachelor’s degree summa cum laude with Phi Beta Kappa distinction, Dr. Crawford earned his Medical Degree from Baylor College of Medicine and then completed his surgical residency at Emory University.
In addition to running his multi-specialty clinic, Dr. Crawford sits on the board of trustees of the North East Regional Medical Center and volunteers through his created mentorship program which, allows high school students a practical, first-hand experience in medicine. The clinic also serves as the nucleus for one of Dr. Crawford’s greatest passions – inventing. Filing for his first patent at the age of 16 and recently receiving his first surgical patent, Dr. Crawford is always finding ways to be innovative. He currently has two patents pending in the United States and other countries which, serve as the backdrop to the founding of his biotech company, Modern Surgical Design.
Dr. Crawford is the proud father of four very active children who all participate in family hobbies that include, soccer, fishing, and a host of other odd hobbies that are too numerous to list.