Bloke's Health

Doctor in residence

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Heart cartoon
Anyone watching the amazing physical feats in an AFL match – or many other elite sporting codes – would have to conclude that the players involved are at the peak of their fitness and health.

And indeed they are. But even these fine athletes, prepared for the battle by rigorous training schedules and top-level coaching, are subject to conditions that can strike all men.

This observation comes from first-hand experience, as my almost three decades as a general practitioner included 15 years as a club doctor for the Hawthorn AFL Football Club.

The prime example was my late brother, Peter Crimmins, the legendary Hawthorn captain, who succumbed to testicular cancer in 1976 at the tragically early age of 28.

Survival rates for the condition were less than 5% at that time, no doubt held back by men’s reluctance to talk about such things and the resultant late detection. Out of his death the Peter Crimmins Cancer Fund was set up which funded important medical research into testicular cancer. The survival rate has now been reversed to a figure of over 95%.

My main aim in writing about men’s health is to overcome the understandable but unfortunate tendency in males to keep things, especially possible medical problems, to themselves.

In the 15-55 age group, males visit their GPs at half the rate of females. The most recent report by the Australian Institute of Health and Welfare (AIHW) on men’s health has some other damming facts:
– 95% of adult males consume insufficient fruit and vegetables
– Around two-thirds of adult males and one-quarter of boys are overweight or obese
– Nearly half of all males have had a mental health problem and nearly one-third have a chronic health condition
– 18% of males smoke
– 10% of males are considered ‘at risk’ alcohol drinkers
– 58% of males do ‘insufficient’ exercise for health
– 16% of males never use a Medicare item number which means they never see a doctor in a given year.

The issue of men’s health has arisen out of such statistics and the consequent health inequities with women. This has been described as the ‘genderisation’ of medicine.

Women have organised themselves very well in relation to preventative care. For many years they have had access to regular recall systems, sanctioned and funded by government, for conditions such as cervical and breast cancer.

These recalls result in a check-up at least every two years, and you have to wonder how many females would turn up for tests without the incessant reminders.
No such recall system exists for males and hence we have to organise regular check-ups ourselves.

Family history is so important in relation to most diseases, particularly those affecting men. I lecture college students in a wonderful men’s health curriculum (which all schools should have by the way) and give this topic the most emphasis. It is difficult to make younger men consider diseases that seem to be a long way off, but their family history is evolving before their eyes and it is crucial for their health and for the future of their own families. Know, or find out about, your family history of disease.

Knowing what you are up against is extremely important when it comes to reducing health risks. Being aware of the main causes off ill health and mortality, having regular check-ups and changing poor lifestyle habits really can be ‘a matter of life or death’.

Cardiovascular disease, including stroke, is the big one for men – accounting for about 30 to 35% of premature deaths. It is followed by lung disease (mainly cancer and read smoking) at 12%, and then prostate cancer and bowel cancer, both around the 4-5%.

Over the coming issues of ManSpace Magazine I will tackle these and other men’s health issues. In the meantime, don’t clam up – talk to your GP.

I GOT RHYTHM
The upbeat song by composer George Gershwin has a message for us all: ‘I got rhythm … who could ask for anything more?’ It was about 5 years ago when I temporarily lost my heart rhythm which triggered a myriad of heart check-ups for me. I developed a condition called Atrial Fibrillation (AF) which is an electrical problem in the heart that causes it to race and quiver. The heart beats in the 100 to 160 beats per minute range but in a very irregular fashion. The average heart rate of most individuals is about 70 beats per minute. The heart is basically a muscular pump that circulates blood to and from the lungs – where it picks up oxygen – and then circulates it around to the rest of the body. With AF, the heart pumps quickly and irregularly which loses efficiency and may lead to heart failure. The main danger however, is ‘stroke’ – a clot develops in the quivering heart which dislodges and travels to the brain blocking the blood supply to a section of the brain, destroying that segment with disastrous consequences.

Symptoms include an irregular pulse, weakness, dizziness and occasional fainting or collapse. I felt as though my heart was about to jump out of my chest when I developed it.

The most common causes of AF are conditions involving clogged coronary arteries, heart valve problems and long-term high blood pressure. Chest injury or surgery, chest infections and an overactive thyroid gland can also be causes. Alcohol, caffeine and stress are important lifestyle triggers. In some people, no cause is found. For some people AF is a one-off episode, in others it comes and goes, and in some it persists. I still occasionally get episodes but they go away spontaneously.

The initial diagnosis is made by having an Electrocardiograph (ECG) at the time it happens. Once diagnosed, it is important to have a complete cardiac check-up. This will include blood tests for cholesterol and a scan of the heart (Echocardiogram) to make sure the heart is structurally sound. A stress test may also be required to make sure there are no blockages in your coronary arteries.

Most people with AF are given a blood thinning medicine (usually aspirin or warfarin) to prevent blood clots. Warfarin requires a precise dose based on regular blood tests which can be a nuisance for some. Fortunately there is a new medication soon to come out on the market called Pradaxa® (Dabigatran) which is an excellent blood thinner that doesn’t require blood tests. If the condition persists, various medications can be tried or occasionally cardioversion techniques can be used to restore a normal heart rhythm and medication then may be prescribed to maintain it. As always, people on such medications should ask their doctor about appropriate diet and exercise.

Cardioversion sounds complicated (it is for the Cardiologist!) but is really quite simple and takes only a few minutes. In computer terms it means ‘rebooting’ the heart with an electrical impulse to restore normal function, and no surgery is needed. Cardioversion can also be carried out with medicines.

On the preventive side it’s the usual mantra for a better life:
– Regular exercise and a diet rich in vegetables, fruit and lean protein (chicken, fish, beans)
– Maintain a healthy weight
– Don’t smoke
– Limit your intake of caffeine and alcohol
– Avoid stress, and find ways of reducing any stress that is unavoidable
– Get regular medical check-ups
– Seek treatment for high blood pressure, high cholesterol, diabetes and thyroid disease.

It’s not rocket science, and once you’ve settled into a rhythm it will feel completely natural. Who could ask for anything more?

So, there you have an introduction to men’s health along with an important heart condition. Over ensuing issues of ManSpace, I will deal with other important male health issues with prevention being the key.

My book, Blokes’ Health, which I did with my footballing mate and cartoonist extraordinaire, Paul Harvey, gives a good overview of the main health issues affecting males and is an amusing, light hearted read. The main message is to set up a regular checkup. I hope you are doing that or will be doing that very soon. Stay happy and healthy!

About Dr Bernie Crimmins

Bernie has been a GP for almost 30 years during which time he has developed a special interest in men's health.

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