Everything You Want to Ask Your Husband’s Doctor

Health Q & A

It’s Men’s Health Month and that gets a lot of wives, girlfriends and significant others thinking about the health of the Man in their life.

We reached out to our Facebook friends to get this best possible smattering of what women are wondering about their man’s health and Dr. Josh Miller, a family medicine physician at Brookwood Baptist Primary Care in Hoover gave us the details on everything our heart desired. Here’s what he said when we asked him the answers to “Everything I’ve always wanted to ask my husband’s doctor…because he won’t.”

Q. How frequently do you think he (my husband) should be seen by you/visit your office?

The frequency of office visits is really dependent on the patient’s health status. Most of our patients come in annually for a checkup/ physical exam. So our healthy male patients with no chronic medical problems, taking no prescription medications, and with no new health concerns may only be seen once per year. However, a patient with diabetes that is not well controlled may be seen 6 or more times during the year. Visits may be well visits, acute/urgent visits, or follow up of chronic medical condition – it’s really dependent on the individual patient. (Believe it or not) many of our male patients do come in with a chief complaint of “my wife wanted me to come in for . . ..”  In many families, the wife is the one who schedules office visits for the family and ensures their husbands follow up with diagnostic testing, referrals, and medication refills. Although a generalization, there are plenty of men who defer having a medical complaint addressed and instead opt to “tough it out.” Sometimes this is from fear of getting a bad report and gentle encouragement from their spouse can help to get the problem addressed before a small issue becomes a major health problem.

Q. What screening exams does he need at what ages or based on family history?

The US Preventative Services Task Force (USPSTF) makes evidence-based recommendations to physicians about what screenings to offer and when it is appropriate. Screening for high blood pressure begins at age 18 and should be done at minimum, every 2 years. Screening for high cholesterol begins at age 35 unless the patient has another risk factor for heart disease such as smoking, diabetes, obesity, high blood pressure, heart disease, or family history of heart disease. Diabetes screenings should happen regardless of age if the patient is obese or has a family history of diabetes. Screening for obesity is done at each visit when the BMI (Body Mass Index) is calculated. The CDC recommends that all Baby Boomers (born between 1945-1965) be screened for Hepatitis C. In 2006, the CDC revised recommendations asking that all adolescents and adults be screened for HIV regardless of risk factors. Screening for depression is done when symptoms such as feeling sad, hopeless, loss of interest in usual activities etc. are present for more than 2 weeks. Colorectal screening is done starting at age 50 unless the family history indicates earlier testing should be done. If between the ages of 65-75 and a current or former smoker, he should be screened for abdominal aortic aneurysm (AAA). Despite what most people think they know about prostate cancer screening and what current clinical practice is, the USPSTF actually recommended against routine prostate cancer screening with a Public Service Announcement (PSA) in 2012. They found only a small benefit from PSA testing with many patients being harmed with follow up procedures (biopsy, surgery, etc.) with little to no improvement in outcomes. Men who are at high risk, such as those with a family history and some racial/ethnic groups, may still need screening and this should be discussed with his physician on an individual basis. When PSA screening is used, it usually begins after the age of 50. For more information about routine screening, visit the USPSTF website http://www.uspreventiveservicestaskforce.org.

Q. How many calories does a man need (as opposed to a woman)?

The amount of calories an average adult male needs depends on his size and activity level, but generally it ranges from 2,000 to 3,000 calories per day. Because the average woman is shorter than the average male a lower caloric intake is needed to maintain their current weight (1,600-2,400). Either would need to cut/burn 500 calories a day to lose one pound per week.

Q. At what age should my husband have a prostate exam?

For most men the DRE (digital rectal exam) is routine after the age of 50. For African-American men and those with a first degree relative with prostate cancer, screening may start earlier. The American Urological Association recommends screening starting at age 40 and then based on individual risks, but that is far from a universal recommendation. The DRE alone is not a good screening test for prostate cancer as a tumor would have to be of a sufficient size to be palpable on the exam. Research is ongoing to find a test / tests to replace the standard PSA to aid in detecting earlier cancers.

Q. My husband constantly urinates, how much is too much?

The average adult urinates every 2-4 hours dependent on the amount of fluids they are taking in (6-8 times / 24 hours). Getting up during the night to urinate more than once or twice could indicate a problem. An enlarged prostate can limit complete emptying of the bladder causing your husband to go more frequently. Other problems like diabetes and diseases of the kidneys can also lead to frequent urination.

Q. I hear erectile dysfunction affects men as they age, what are the typical signs?

ED is a common problem effecting men of all ages. The overall prevalence in the US is about 18% in males over the age of 18. The most common risk factors for developing ED are smoking, sedentary lifestyle, cardiovascular disease, diabetes, hypertension, and advancing age. The prevalence in men with diabetes has been estimated to be as high as 50%.The problem can be organic (like with diabetes) or psychological. The most common complaint is not being able to achieve or maintain an erection.

Q. Why does my husband snore?

Snoring is caused by vibration of the soft tissues of the upper airway. Many factors could be contributing to your husband’s snoring. Being overweight, sleeping on his back, nasal polyps, allergic rhinitis, smoking, alcohol consumption, and certain medications can all make snoring worse. Snoring can cause airway obstruction or sleep apnea which can cause high blood pressure and even increase your risk for heart disease. If he is snoring and seems to stop breathing for a few seconds during sleep he should contact his doctor about ordering a sleep study to evaluate for obstructive sleep apnea (OSA).

Q. What are normal ranges for his cholesterol (LDL/HDL/triglycerides), blood pressure, heart rate, and blood sugar? Do they change as he gets older?  

The normal ranges do not change although the incidence of high blood pressure does increase with age. His blood pressure should be less than 140 on the top (systolic) and less than 90 on the bottom number (diastolic). If he has diabetes or heart disease we may set lower goals (<130/85). Normal heart rate is between 60-100. Normal fasting blood sugar is less than 110. His HDL cholesterol should be > 40, triglycerides < 150, and his LDL goal is based on how many risk factors he has for heart disease and could be from <70 to < 160.

Q. How can my husband remember every swing four people took while playing 18 holes of golf over a four hour period, but he can’t find the coffee cups that have been stored in the same cabinet for 15 years?

I’m not sure there is actually a medical question here but we remember the things that are important to us because we replay them in our heads over and over. Golf is important to your husband. Remembering where the coffee cups are is not important because he knows you will tell him where they are.

Q. As women we have a good idea of what happens to our bodies as we age, what about men? What should we be looking for?

Unlike women, men do not experience a major, rapid (over several months) change in fertility as they age (like menopause). Instead, changes occur gradually during a process that some people call andropause. Aging changes in the male reproductive system occur primarily in the testes. Testicular tissue mass decreases and the level of the male sex hormone testosterone decreases. There may be problems with erectile function or decreasing libido. However, this is a general slowing, rather than a complete lack of function. The prostate gland enlarges with age as some of the prostate tissue is replaced with a scarlike tissue. This condition, called benign prostatic hypertrophy (BPH), affects about 50% of men. This may cause problems with slowed urination, as well as with ejaculation. Decreases in sex drive (libido) may occur in some men. Sexual responses may become slower and less intense. This may be related to decreased testosterone level, but it may also result from psychological or social changes related to aging (such as the lack of a willing partner), illness, chronic conditions, or medications.

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