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Speaking to Men About Health - Ask The Expert, Christopher Lewis, MD
Christopher Lewis, MD answers your questions about Speaking to Men About Health. |
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Today we have Dr. Christopher Lewis as our Ask The Expert guest. Dr. Lewis has been a speaker at several Universal Sisters events and is a big hit with our attendees. He has developed very useful tips and strategies to help women talk to the men in their life about their health. Husbands, brothers, sons. If there's a man in your life that you care about, Dr. Lewis' advice will be a big help.
Welcome Dr. Lewis! Thanks for being with us today.
Dr. Lewis: You are more than welcome.
As usual, we received many questions. So let's get started with your answers:
Question 1. Dr. Lewis, what if I've done most of what you suggested in order to get my husband to go to health care professionals, but now I find that he doesn't follow the advice of those providers? Is there a way to get him to understand the importance of their advice and to follow it by exercising, reducing caloric intake, avoiding foods high in cholesterol, etc.? Thanks for any suggestions you may have.
Dr. Lewis' Answer: You’ve gotten over the first hurdle in actually getting your husband to go the doctor. Congratulate him on doing that. There are many reasons why people don’t follow doctors’ advice, so it would likely be beneficial to just have a heart-to-heart conversation with your husband about why he lacks such follow through. I often find it helpful to have a patient’s wife come to his appointments, so that we can all three discuss the barriers to him taking care of himself. If the problem is lack of relationship/confidence in the health care provider, by all means, have him get a new doctor that he will bond with more. I also find that having patients discuss their health with older relatives is useful. When a man sits down with his parents/grandparents/aunts/uncles to discuss their health and how it can relate to his own, it can often paint a clearer picture of why taking care of oneself is so important, and can often provide the motivation he needs to live a healthier lifestyle.
Question 2. The man I love has an eating disorder. 20 years ago he suffered from anorexia, and when I met him bulimia. He has just had back surgery for 3 compression fractures (cement) due to him having the bones of a 90 year old woman. He had an episode and took a fall down a flight of steps (20). It was also discovered the he needs a heart valve replaced. He has gone back to barely eating and has lost about 20 lbs in a couple of weeks. He is also debating not having the heart surgery. Someone at work told him that a thinner man has an easier time. He only weights about 140 - 150 lbs and is 6'6". He can wear 28 jeans. I tried to explain to him that he will lose some weight after the surgery. Help. I just don't know what to do
Dr. Lewis' Answer: Eating disorders are very frustrating for many reasons, but 2 of the most important issues are the health consequences of eating disorders and the difficulty encountered when trying to understand why someone with an eating disorder can’t make changes to be healthier. In many cases, a primary care doctor can help, but often, these patients are referred to psychiatrists or psychologists for more intensive care. It sounds like your man’s condition has progressed to the point that reasoning with him is not working, and that is usually the sign that it’s time to bring in a specialist. I would recommend a consultation with his physician and a possible referral.
Question 3. My husband had a physical at work and they tested his sugar first with a test strip then called him back in and did blood work. They said he should make an appointment with his doctor because his sugar his high. I've been testing it each morning and the lowest it's been is 237. He doesn't think he needs to go to the doctor. What should his sugar be? I am going to make the appointment for him.
Dr. Lewis' Answer: Based on the information you have provided, it sounds like your husband has diabetes. Any random sugar level over 200 is considered to be consistent with a diagnosis of diabetes, usually type 2 if diagnosed in adult life. The first step of treating diabetes is education, so off-the-bat, I send my patients to diabetic education classes, which are usually a series of classes taught by a licensed nutritionist with special training in diabetes. Type 2 diabetes is significantly affected by lifestyle, so besides making that appointment for him, it’s time to get him working on healthier eating and exercise as well.
Question 4. a. My husband is almost 45. What should he ask his doctor for regarding a physical and what types of preventative tests should he go through in the next 10 years? b. My husband’s father had prostrate cancer. When and how often should my husband be tested for it?
Dr. Lewis' Answer: Every adult should have a yearly physical. At these visits, the focus should not just be on discussing a variety of minor ailments/aches/pains, but on preventive care as well. A typical male physical at your husband’s age should include screening for blood pressure, cholesterol, diabetes, HIV. His doctor should also assess his risk of cardiovascular disease, and order appropriate testing if he is at high risk. Doctors don’t all agree on prostate screening, but I follow the guidelines of yearly screening for African-American men starting at age 40 (with a baseline assessment at age 35) and for Caucasian men starting at age 50. I typically start screening men 10 years prior to the age their father was diagnosed with prostate cancer. If the screening is normal, I repeat every year
—sooner if the screening is abnormal. Most doctors agree on initiating colon cancer screening at age 50, sooner if there is a family history.Question 5. My father is undergoing a course of chemotherapy to treat leukemia but insists upon still smoking a cigar twice a week. I've been berating him about it to no avail. How can I communicate my frustration so that he'll stop?
Dr. Lewis' Answer: You may have already successfully communicated your frustration, but that doesn’t necessarily mean he is going to stop, even if he fully understands your point of view. Changing behaviors is one of the most difficult things a person can do, even in the setting you describe, where the smoking is obviously impacting his health. Berating him has obviously failed, so you should try new approaches. Many of my patients are successful at quitting smoking when children start nagging him, so if there are any youngsters in your family, educating them about the dangers of smoking, and then having them talk to him, will likely do more than you can do alone. If he has not discussed smoking with his physician, that would be a great step as well, there are many good treatment options available now to help people quit smoking. I would also urge you to consider if his smoking is a bigger concern to you than it may be to him. Depending on his age, other health issues, and stage of leukemia, he might consider his 2 cigars a week to be the treat that allows him to put up with chemo and other health-related issues and keep fighting. Take all of this into consideration before adding to the stressors in his life, particularly given the fact that having leukemia is not easy, and neither is chemo.
Question 6. My husband just started smoking at age 36 and I’ve been wondering if there might be a better way to communicate to my husband to get him to stop. I’ve tried everything but breaking the cigarettes. I even told his mom thinking that if he won’t listen to me, he’ll listen to her. Do you have any advice on how I can tell him to stop before he picks up cancer along with his new habit?
Dr. Lewis' Answer: In my experience, men seem to not respond to hounding and a heavy-handed approach that much. Have him talk to his doctor about his habit, ideally with you in the room voicing your own concerns about his health AND YOURS. Remember, second-hand smoke can be just as dangerous as smoking can be. Make sure your husband understands that he is putting your life and health in jeopardy as well as his own. There are many treatment options available now to help with smoking cessation, and his doctor can help design a treatment plan tailored to your husbands needs.
Question 7. a. My husband is in his early 30's and heart disease runs in his family. What should he have tested, how often and starting when? b. My mother-in-law has Celiac disease, which is known to be heredity. My husband displays some symptoms of the disease when he eats gluten. He doesn't want to be checked for the disease because he doesn't want to give up some of his favorite foods for his health. How can I persuade him to get tested?
Dr. Lewis' Answer: The main thing is to have your husband connected to a good primary care physician on a regular basis. He should have regular screening for cardiac risk factors, including high blood pressure, diabetes, cholesterol, obesity, lifestyle, smoking, and others, starting now, and continuing at least yearly, if not more often based on risk factors that may be identified. There is a blood test available, called a CRP, that is now being used to gauge cardiac risk in select patient populations, so it is worth discussing this test with his physician. A baseline electrocardiogram (EKG) would also be good information to have about his heart.
Making a decision about your health based on ignorance (lack of knowledge about your health) is as common as it is unintelligent. Getting tested will give him knowledge, and knowledge is power, even if he does not want to change his eating patterns. You can climb that mountain once you know his diagnosis.
Question 8. I worry about my husband's eating patterns. What can I do to encourage him to follow better dietary habits without treating like one of my children?
Dr. Lewis' Answer: In my experience, men that are able to make the most out of lifestyle change are the men who have a good support system. That starts at home, but can even incorporate support from co-workers and friends. One of my physician colleagues has health issues related to obesity, and his wife stops in our office periodically to remind the entire staff to not feed him cookies and other treats they might bring in. So, if any of us see him eating something he’s not supposed to, we gently remind him that his wife has us on patrol, and the end result is that he ends up eating healthier while at work.
At home, be the boss. Buy the food and prepare the food for him if he won’t make healthy choices. Work with him and support and encourage good habits, and remember that it’s easy for someone to change behaviors if they have a partner, so you should work on your own dietary habits as well. Incorporating healthy eating and exercise into the FAMILY routine produces more results simply nagging him about his diet.
Question 9. When should my husband begin having his prostate checked? Does his prostate influence his bladder control?
Dr. Lewis' Answer: Doctors don’t all agree on prostate screening, but I follow the guidelines of yearly screening for African-American men starting at age 40 (with a baseline assessment at age 35) and for Caucasian men starting at age 50. This screening includes a digital rectal exam (DRE) and the blood test, Prostate Specific Antigen (PSA.) As the bladder actually sits on top of the prostate, yes, an enlarging prostate can compromise bladder function.
Question 10. How often should my husband get a complete physical? I go annually to see my physician.
Dr. Lewis' Answer: Your husband should follow your lead and get an annual physical. Remember, the appointment for a physical is not necessarily the time to bring in a laundry list of problems he is already having. Sure his doctor may discuss a few pressing issues he may be having, but the focus should be on preventive care, testing, shots he may need, etc. So if your husband doesn’t get all of his issues addressed at one physical appointment, he should make a follow up, problem-focused appointment.
Question 11. How often should my husband get blood tests for his heart? (lipid profile?)
Dr. Lewis' Answer: Cardiac (heart) screening depends on a person’s risk, including the presence of high blood pressure, diabetes, cholesterol (lipids,) smoking, age, family history, lifestyle, etc. If none of these issues is a factor, then yearly screening is sufficient, but if your husband has any of the above risk factors, his doctor should tailor the plan and screening intervals according to those risks.
Question 12. What are the leading health concerns for men over age 40 and how can I emphasize to my husband the need to be screened annually?
Dr. Lewis' Answer: The leading health concerns for men over 40 include: heart disease, high blood pressure, cholesterol, strokes, diabetes, lung cancer, colon cancer, prostate, testicular disease, and depression. Many men frown upon screening tests because they don’t want to know if there is a problem. This line of thinking is backwards, because with many of these medical issues, early diagnosis means less complications and a longer life. Men often respond to analogies they understand. Compare his health to his car. If the check engine light comes on, he wouldn’t wait until the car won’t start to take it to a mechanic; likewise, he should get a tune-up/check-up yearly, so that if there are issues, they can be addressed early and save him a lot of headache, and in some cases, save him his life.
Thank you Dr. Lewis. Your insight into the male persona is of great help.
Dr. Lewis: It's always my pleasure to help SWH. Have a great day.
Updated 11:57 am EDT
About Dr. Lewis, MD
Dr. Lewis is a Family Physician working for Alliance Primary Care in his hometown of Cincinnati, Ohio. He earned his Bachelor of Arts in Biology from Harvard University in 1996. Upon returning home for medical school and residency at the University of Cincinnati, Dr. Lewis completed the International Health tract, was honored with the Intern of the Year award in 2001, and served as Chief Resident in 2002-2003. Dr. Lewis’s international health experience includes work in Honduras, El Salvador, Kenya, and Tanzania.
He holds a faculty position with the University of Cincinnati’s Department of Family Medicine, and volunteers his time training undergraduates, medical students and medical residents. He has served as a local health expert on over 30 local news programs, and is on the board of directors of the West End Health Center in Cincinnati. Dr. Lewis is a diplomat of the American Board of Family Medicine, an active member of the American Academy of Family Medicine, and a committee chair of the Cincinnati Medical Association.
He also coaches wrestling at his old high school and gives talks to public school students across Cincinnati about sexual health and responsibility and is a popular speaker at Universal Sisters conferences.
Dr. Lewis is the founder and president of Village Life Outreach Project, a Cincinnati-based non-profit organization that partners with poverty-stricken villages in Tanzania, East Africa, to fight poverty and provide clean water, health care, and education.
