GENERAL & OVERVIEW: Recent Episodes
The Original Guide To Mens Health
The Original Guide To Men's Health podcast will be returning with fresh episodes in June. Stay healthy and stay tuned!
Health Insurance continues to be a very complex, difficult to understand and in many instances less than transparent entity.
Episode Summary:In this episode, we explore our understanding of longevity with a leading longevity researcher.
Guest:Dr Matt Kaeberlein, PhD
Former Director, Healthy Aging and Longevity Research Institute
Former Director, Biological Mechanisms of Healthy Aging Training Program
Co-Director, UW Nathan Shock Center of Excellence in the Basic Biology of Aging
Co-Director, Dog Aging Project
Professor of Pathology
Adjunct Professor of Genome Sciences
Adjunct Professor of Oral Health Sciences
Dr. Kaeberlein’s research interests are focused on biological mechanisms of aging in order to facilitate translational interventions that promote healthspan and improve quality of life. He has published more than 200 scientific papers, has been recognized by several prestigious awards, and has Fellow status in the American Association for the Advancement of Science (AAAS), the American Aging Association, and the Gerontological Society of America (GSA). Dr. Kaeberlein is currently the CEO of the American Aging Association and has served on the Board of Directors for the Federation of American Societies for Experimental Biology (FASEB), AGE, and GSA. Dr. Kaeberlein is the founding Director of the UW Healthy Aging and Longevity Research Institute, the Director of the UW Nathan Shock Center of Excellence in the Basic Biology of Aging, Former Director of the Biological Mechanisms of Healthy Aging Training Program, and founder and co-director of the Dog Aging Project.
During This Episode, We Discuss:The Dog Aging Project
What makes us age?
What are the hallmarks of aging?
What we know about longevity determinants. Genetics or Environment or both?
Are there longevity genes?
What role do diet, exercise, and maintenance of muscle mass/ strength, play in longevity
What do we know about successful cultures that live longer
What research is exciting and ongoing? What we still need to understand.
Dr. Kaeberlein's thoughts on:
Longevity Clinics
Vitamins
Growth Hormone
Calorie Restriction
Medications (Growth Hormone, Metformin, Rapamycin)
Other Longevity Researchers, Practitioners …
Quotes:“ Updated hallmarks of aging, (11 or 12 depending on who you talk to), these are types of cellular dysfunction and damage that happen with age across all animals and are directly contributing to our increased risk of developing diseases of old age, developing functional decline”...
Dr. Matt Kaeberlein
“There are all these functional declines that go along with the aging process that from a quality of life perspective that I would argue of equally if not more important than the actual overt diseases”
Dr. Matt Kaeberlein
Recommended Resources:Twitter @mkaeberlein
Peter Attia: Podcast, book, articles
Episode Transcript: Coming soon!
Episode Summary:
Bio-Technology is exciting and rapidly expanding. It is the future of health and healthcare while the technology is far-reaching. One aspect is simulation technology. What is simulation technology? Consider how we use simulation to train pilots; what about using simulation to train surgeons and the surgical team? In this episode, we interview Dr. Robert Sweet, MD, a leader in simulation training for healthcare professionals.
Guests:
Robert M. Sweet, MD, FACS, MAMSE
Professor of Urology, Surgery, and Bioengineering (adj)
Medical Director UW Medicine Kidney Stone Center
Chief, Division of Healthcare Simulation Sciences
Executive Director of WISH and CREST
University of Washington
Dr. Sweet is a Joint Professor of Urology and Surgery and Adjunct Professor in Bioengineering at the University of Washington. He is the Inaugural Chief of the Division for Healthcare Simulation Science and the Founding Medical Director of the UW Medicine Kidney Stone Center.
Dr. Sweet founded and led the University of Minnesota’s SimPORTAL and cofounded the University of Washington’s ISIS, which was renamed the Washington, Wyoming, Alaska, Montana, and Idaho Institute for Simulation Technologies (WISH) when he assumed the Executive Director position. He is the PI for all programs in the Center for Research in Education and Simulation Technologies (CREST), including the “Advanced Modular Manikin.”
During This Episode, We Discuss:
- What is Surgical Simulation? How is it utilized?
- How today’s simulation differs from simulation technology of the past: Virtual Reality, Augmented Reality, and simulation in Mixed Reality.
- Applications for Paramedics, The U.S. Military, Emergency Medicine Physicians, Internal Medicine Physicians, Pediatricians, Orthopedics, ENT
- The ability of simulation to create unexpected or uncomfortable scenarios that the entire team can react to, review, debrief, and improve in a safe environment.
- Current limitations of virtual reality simulators and the current efforts to resolve and correct those limitations through more complex and life-like models using advanced materials science, integrated computer-generated models, machine learning, and Artificial Intelligence.
- The evolution of simulation science with computer scientists, electrical engineers, mechanical engineers, special effects artists from the film industry, sculptors and molders, graphic artists, human factor engineers, and clinicians.
Quotes (Tweetables):
“Simulation goes beyond Surgery and involves all members of the healthcare team, we are even beginning to use simulation for education for patients as well.”
Dr. Rob Sweet
"Teaching tactile physical and nontactile skills, for instance, teaching professionalism. Focusing on communication for teams in the form of debriefs in a safe environment, training for an uncomfortable scenario A shared mental model."
Dr. Rob Sweet
"The limitation of current robotic virtual simulators is that they can’t model soft tissue behavior. Actual complex things like dissection and navigating around critical structures are not quite there yet…a really important area for development."
Dr. Rob Sweet
"Allows us to build mannequins or physical parts that are smart, that have the capability to sense what we are doing and give feedback to our performance."
"We are beginning to make the tissue more dynamic."
Dr. Rob Sweet
"I would love to see and shift our focus in using the type of data we're getting in systems we're building in simulation toward a more predictive model (through Artificial Intelligence, Machine Learning). It will be exciting to see the next generation of robots with simulation in the background providing therapeutics and real-time protecting structures that we may not even see in real-time."
Dr. Rob Sweet
Recommended Resources:
Center for Research in Education and Simulation Technologies
CREST.uw.edu
WISH:
The WWAMI Institute for Simulation in Healthcare (WISH) is the University of Washington’s premiere simulation training facility for healthcare education. Its mission is to improve the health of the public through innovative programs for the development, application, and dissemination of simulation science throughout the five states: Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI) region.
Episode Transcript:
Coming soon!
Episode Summary:
This episode demystifies clinical medical care ‘best practices’ — clinical guidelines & outcome measures. These are regularly created, validated & updated, by expert teams and organizations. This rigorous, evidence-based process provides the USA with a quality and up-to-date clinical health care system.
Guest:
John L. Gore, M.D. Professor of Urology, Professor of Surgery, Health Services Researcher, University of Washington. Urologist, surgeon, clinician, researcher, educator, and expert in clinical care guidelines and outcomes. Dr. Gore is the PI of a large pragmatic trial in bladder cancer, and a quality of care expert. He previously served as the American Urological Association (AUA) representative to the National Quality Forum, which endorses national health care performance measures, and has been on guidelines panels for the National Comprehensive Cancer Network (NCCN) for kidney cancer, and the AUA for bladder cancer.
During This Episode We Discuss:
- Clinical Outcome or Performance measures are what should be practiced most of the time, based on the best available evidence to date. They are specific and rigorous. For example, Anyone over 50 yrs of age should be strongly considered for a covid vaccination booster (assuming they have received the initial dose(s)).
- Clinical Guidelines are ‘best practices' for a given medical issue; based on the best available evidence to date. Guidelines can include a range of options and can be broad in scope. Most guidelines will rate the strength of the recommendation. An example of a clinical guideline: Of the vaccines available for COVID, vetted options include Pfizer, Moderna, et cetera.
- Guidelines can and should be used by patients as well as doctors. Most Guidelines for medical issues are available to the public. Here is a link to the American Urological Association’s clinical care guidelines.
- Clinical care follows the evidence. Guidelines and performance measures are based on rigorously collected, evaluated, and validated evidence.
- Evaluation of clinical care considers structure (for example, what kinds of medical technology are available at hospitals in a given location), process (for example, decision making, including with patient), and outcomes (for example, response to surgery or a cancer drug). (See Avedis Donabedian link in Resources below)
- Clinical care improves via many avenues. Pre- and post-surgery checklists are now routine clinical care processes but were originally inspired by pre and post-flight checklists. They have since been validated with strong evidence as significantly improving patient health care.
- Clinical care best practices aim to guide care providers, health care payers, and patients. Patients can ask their doctors “What do the guidelines say I should do, as a patient with x condition?”
- Clinical care guidelines necessarily evolve as science advances, with new drugs, treatments, and methods becoming available.
- One challenge with creating and using Guidelines and Performance Measures is that “A lot of these performance measures and guideline statements are based on evidence that may not be reflective of the patients we see in our practice every day…..and we do have to think outside of the box and have some flexibility in the care that we provide.” (Dr. Gore)
Quotes (Tweetables):
—“We’re talking about the ways we prescribe (health) care, based on our best available evidence.”
Dr. Gore
—“The process by which you come up with the (quality/outcome/performance) measures is a pretty rigorous process…”
Dr. Gore
—“When we talk about using “evidence-based medicine” we’re partially referring to the fact that we use outcomes” as evidence for guidelines.
Dr. Pelman
—“One of the problems with performance measures, clinical measures, and guidelines is that the evidence changes. The treatments change, and so the guidelines have to change with them.”
Dr. Gore
— Guidelines evolve because “Good science is not frozen, it is fluid and dynamic and it adjusts as more information is known.”
Dr. Pelman
—“A lot of these performance measures and guideline statements are based on evidence that may not be reflective of the patients we see in our practice every day…..and we do have to think outside of the box and have some flexibility in the care that we provide.”
Dr. Gore
—Patients can ask their doctor “What do the Guidelines say I should do as a patient with this (particular health issue)?”
Dr. Gore
Recommended Resources:
- Avedis Donabedian — the author of a classic core framework for evaluating the quality of medical care, laid out 50 years ago; the basis of our system today. This link is to a recent article about Donabedian and his work and is helpful for understanding how and why outcome measures and clinical guidelines are needed and beneficial for quality health care.
- American Urological Association (AUA) Guidelines for Urology Care — find current health care guidelines for prostate conditions, bladder cancer, erectile dysfunction, etc.
- National Quality Forum (NQF)— a nonprofit US organization that sets standards for quality health care, and provides other services that advance quality health care.
- National Committee for Quality Assurance (NCQA)— a nonprofit US organization that works to improve health care quality through the administration of evidence-based standards, measures, programs, and accreditation.
- Agency for Health Care Research and Quality (AHRQ) — the lead US Federal agency charged with improving the safety and quality of healthcare for all Americans. AHRQ develops the knowledge, tools, and data needed to improve the healthcare system and help consumers, healthcare professionals, and policymakers make informed health decisions
Episode Transcript:
Coming soon!
Episode Summary:
Dental care for all ages has come a long way in the last couple of decades. There are new tools and methods for preventative and restorative care, and for reducing fear of the dentist. This episode gives you the basics plus these updates, and has helpful tips for optimizing your personal dental health, and even how to help pay for it.
Guest:
Gary Burt, DDS. Private practitioner for more than 35 years in the Seattle Washington USA area. Specializing in General and Family Dentistry, Esthetic Dentistry, and Complex Restorative & Cosmetic Dentistry.
During This Episode We Discuss:
- When to start dental care, and what care is needed at different ages: kids, adults, seniors. Different types of dentists: family dentist, periodontist, orthodontist.
- The importance of fluoride — especially for kids with developing teeth. In areas where water is not fluoridated, other sources (beyond toothpaste) are needed.
- Strategies for reducing fear and discomfort of dental procedures.
- Regular use of a soft tooth brush + water pik + flossing = good oral health and breath. Whitening toothpastes, and stiff toothbrushes can be damaging. Brushing your tongue or using mouthwash are optional.
- Significant advances in dental care include light cured resins and other technologies (e.g. higher quality porcelains) for restorative dental work (crowns, fillings, veneers).
- Damaging to oral health: sugars, candy, soda pop, chewing tobacco, smoking. Some health conditions (e.g. diabetes) may contribute to oral health issues.
- Poor oral health (e.g. gum disease) can contribute to poor health in other body systems (e.g. heart disease).
- Despite dental advances, and connections between good oral and overall health, dental insurance is not available for many people in the USA. Challenges and strategies for affording and accessing dental care are discussed (see also: Resources).
Quotes (Tweetables):
— “Good oral health..has manifestations beyond just a smile.”
Dr. Pelman.
— “My hygienists are big fans of a new instrument called a water pik. It's funny, cuz I remember this from a kid growing up, … …….. but it's come back big time now in the last five years.”
Dr. Burt
— “Is brushing your tongue useful?”
Dr. Pelman
— “Once you hit the golden age of 30 we kind of figured you’ve outgrown the decay years. But…”
Dr. Burt
— “I look at excellent dental health as really crucial to a high quality of life.”
Dr. Burt
— “Retired people don't have dental insurance. Self-employed people don't have dental insurance. And so what happens with that is that I coach people to set up their own plan.”
Dr. Burt
Recommended Resources:
- How to find a dentist: 1) Ask friends, family or colleagues for general dentist recommendations. 2) If you are new in town, try calling the local periodontist--they usually know most of the general dentists in an area. 3) https://findadentist.ada.org/
- For low cost, high quality care, visit the clinic of a University Dental School (e.g. in the Seattle area: https://dental.washington.edu/patient/clinics/ )
- Look for city, county or organizational health fairs that offer dental clinics (e.g. in the Seattle area: https://seattlecenter.org/skcclinic/. https://www.facebook.com/SKCClinic/
Episode Transcript:
Coming Soon!
Episode Summary:
The end of life is devastatingly hard, and difficult to navigate, for those grieving a loss, as well as the friends, family & colleagues of people grieving. We don't know what to do, what not to do, or how to cope. Dr. Jennifer Levin, a traumatic grief counselor, talks us through understanding, coping with, and even growing with grief.
Guest:
Jennifer R. Levin, Ph.D., MPH, MFT. Trauma and grief therapist, marriage and family counselor, with extensive experience in counseling and education on trauma, death and dying, bereavement, and loss.
During This Episode We Discuss:
- There are different categories of grief experience: Natural, Traumatic, Anticipatory, Disenfranchised, Complicated, Prolonged, Delayed, Chronic, etc.
- Everyone grieves differently. It varies within a grief category, within a family experiencing loss, and over time. This is so important to remember, to avoid judgment and hurt. The ‘stages of grief’ that you may be familiar with are not discussed in this episode—grief is more complex than the stages suggest.
- There are many common themes in grieving, thus support groups provide critical communities.
- We cover how a dying or grieving person's community can help them. And equally important, what NOT to do.
- Organize your critical documents and affairs (see resources below), and clue someone in on where to find this information. This is something grievers say they are very grateful for.
Quotes (Tweetables):
“…how an individual grieves is going to depend on their age; their cultural beliefs or practices; their religion; the relationship they have to a person who died; the intensity of the relationship; the history they've had of how many other people they've lost; their life stressors; their comfort with grief or with people who are sick; their personality.”
Dr. Levin
“ ….not everybody's grief gets along and there are many different grieving styles that occur within the family.”
Dr. Levin
“…I say all the time to clients, ‘Grief has no timeline. It works on its own timeline."
Dr. Levin
“…I always wanted to write a book—‘What to Do After all the Lasagna’s are All Gone’…”, when “..the individual left grieving feels very alone, very isolated and has a difficult time re-entering the world.”
Dr. Levin
Recommended Resources:
- AARP Advanced Directives Legal forms and guides for planning your end of life care, by USA state.
- Five Wishes Discussion guides and forms on advanced care planning, for people to let loved ones know their wishes in advance of an expected or unexpected trauma or death. Helps people talk about end-of-life wishes with their family.
- From Grief to Growth, Online resource (Traumatic Grief resources, Covid-19 and Grief resources, free mini-course) and support website by our podcast guest, Dr. Jennifer R. Levin.
- Religious organizations provide support groups and resources for those experiencing loss.
- Hospitals usually provide support groups and resources for those experiencing loss.
- Link to Dr. Levin’s C/V/ Bio
- Untethered: Healing the Pain from a Sudden Death, A Podcast
Episode Transcript:
Speaker 1 (00:00):
The Original Guide to Men’s Health is moving to a monthly release schedule. We will be releasing new episode’s the first Wednesday of each month. We really appreciate you listening, and we hope you enjoy this episode.
Speaker 2 (00:17):
[inaudible]
Dr. Pelman (00:18):
Whatever you do, whatever you enjoy, you need your health. Welcome to The Original Guide to Men's Health, a podcast designed for men of all ages to learn about and access good health. This guide shares knowledge on how to be and stay healthy, maintenance and prevention strategies, along with reviews of conditions and issues affecting wellness are explored. Please join me, your host, Dr. Richard Pelman, as I interview renowned experts who will provide you with timely, relevant, and vital information so that you can embark on a journey towards better health.
Dr. Pelman (01:07):
On this episode of The Original Guide to Men's Health, we'll be reviewing grief, grieving, and end of life. You may be wondering why on a men's health episode, we're looking towards grief and grieving. But it is part of life, particularly in this pandemic where unexpected events happen suddenly. I think it's reasonable for us to discuss these issues that are important and are part of the life cycle. To help guide us through this, we are going to be interviewing our guest, Dr. Jennifer Levin. Dr. Levin specializes in working with adolescents, teens, and adults experiencing traumatic grief and sudden loss. In 2000, Dr. Levin received her doctorate from UCLA School of Public Health. And in 2014, she earned her master’s in a clinical psychology program from Pepperdine University. She is a recognized fellow in thanatology, the study of death, dying and bereavement from the Association of Death Education and Counseling.
Dr. Pelman (02:13):
Professionally, Jennifer has served as the executive director of Hospice of Pasadena and has taught at several California universities. She provides continuing education, training, and consulting mobile grief services to schools, community-based organizations, experienced bereavement and loss. She is a licensed marriage and family therapist with a private practice in Pasadena, California, where she works with clients living with chronic and terminal disease, bereavement, traumatic death, and post-traumatic growth. Dr. Levin, welcome. Thank you for taking the time to meet with us, and I know most people don't like to preview the end of life or grief grieving. But as I've learned, it's important for people to come prepared or be prepared or have resources. So take us through grief. First of all, a little bit of your experience of why it's important to understand this issue, that one time or another will impact us all.
Dr. Levin (03:16):
Absolutely. Well, I just want to start off with a basic understanding of what grief is and grief is actually a natural response that we all grow through when we lose someone or something that we love. And in this case, we're talking about someone who has died and it's not a pathological response. It is like I said, it's very natural and it's not a problem that we need to fix. It's nothing that's wrong with us. And when we think about grief, we commonly focus on the emotional response that an individual goes through. But in reality, it's so much more than that. There's a huge physical component that goes through. And we also experience cognitive reactions, behavioral, social, cultural, spiritual, and a large existential component that's all part of the grieving process as well.
Dr. Pelman (04:21):
So there are different types of grief that we as humans experience and categories are fairly varied and different. Do you want to just kind of go through the different categories that we might look at is the overall grief experience in the human condition?
Dr. Levin (04:40):
Yeah.
Dr. Levin (04:41):
Most people think that all grief is the same and actually it's not. A lot of it has to do with the way that an individual died. There's what we tend to think of as natural grief. And this is often expected grief when somebody dies due to old age or the end stage of a disease such as cancer* or failing health. There's something called anticipatory grief, and this is when you anticipate a death of a loved one. Someone you know who's going to be coming to the end of their life in a short period of time, even as long as a year or longer than that sometimes. And with anticipatory grief, we have all of these micro losses that occur along the way. And so it's just loss after loss, after loss and the person who is watching a loved one dies also begins to wonder during this time what their life is going to be like when they're gone.
*Cancer: https://www.cancer.gov/about-cancer/understanding/what-is-cancer
Dr. Levin (05:52):
So they're anticipating the grieving process. There's something called disenfranchised grief, and this can include not being given certain grieving rights by family members or even society who chooses not to recognize that you're grieving a loss. Or you may be experiencing what we call an ambiguous loss, which is a loss in which you never seem to get answers to how a loved one died or the circumstances resulting in their death, which also makes it very difficult to grieve. There is grief such as complicated grief, prolonged grief, delayed grief, chronic grief, cumulative grief, and other forms of grief as well. Personally, I specialize in traumatic grief, which is one of those forms of complicated grief and where an individual experiences a sudden and unexpected loss often in a traumatic manner. And the griever is usually impacted by symptoms of trauma and grief at the same time, which can make the grieving process extremely difficult.
Dr. Pelman (07:12):
So as we view these different types of grief reactions, the behavior, and sort of the way that people will respond to you, or you respond to them may be different. For instance, as you talked about anticipatory grief, someone has a prognosis, a loved one that we all know will eventually end in death. So you have time to prepare versus the traumatic grief where it's very short-lived and there isn't that time. So there's going to be a different interface in each of those. Do you want to go through a little bit with each of those of what actual grieving would look like? So, you know, people sort of have different approaches to this.
Dr. Levin (07:58):
Sure. Let's say an individual has cancer and there's the diagnosis, there's the treatment. Well, it depends, you know, cancer is a different beast as well. There's so many different types of cancer. You know many times there's treatment and, you know, it looks like things may go well for a while. And then unfortunately with some types of cancer, that cancer comes back and there gets to be a point where there's nothing else that can be done medically, end of life is going to occur from the disease. And an individual has time to spend with their family. And this is where anticipatory grief comes on, but they get weaker, they get sicker, they lose things. They lose the ability perhaps to walk or to eat, or to do certain things that they used to be able to do. But during that time, there's time to maybe express wishes, to say goodbye, to see people and get things in order.
Dr. Levin (08:58):
And this can be very painful watching all of these changes occur, but at the same time it also gives, it gives the individual who's dying the opportunity to get a lot accomplished. As I said, with the individuals that I work with, they may wake up on a Tuesday morning and I get into a car accident on their way to work. Or they may go out for a walk and have a heart problem and not come home from their walk. Or a suicide may occur during the day. And it's very, very hard for family members and loved ones to, you know, see a person in the morning and then by the end of the day that they're gone. So there's disbelief, there's numbness, there's shock. There's all of these different factors that come into play, not to say that those things don't occur to a lesser extent in the other types of loss. Unfortunately in traumatic grief, many individuals may see the accident occur or the traumatic loss occur or may find their loved ones. And then there's actual symptoms of trauma: hypervigilance, rumination of something they wish they hadn't seen over and over, flashbacks. And there's actual symptoms of trauma that occur as well that actually need to be addressed and resolved in addition to the actual grief or dealing with the loss of their loved one on top of the trauma.
Dr. Pelman (10:40):
So when we have a individual who has a sort of sudden event, and those that are left are totally unexpecting that to have occurred in their lives. When you encounter people who have been dealing with traumatic grief, what are some of the, well, first of all, unique features to that type of bereavement? And how can people, first of all, other family members, everybody's affected differently, friends, acquaintances, coworkers help that person or those people?
Dr. Levin (11:21):
Well, let me start off. You said, “What are some of the unique features?” And again, this is like right afterwards in the beginning of the grieving process, one of the things that's important to know is not only has their world been turned upside down. And again, this is for somebody who's experienced the sudden and unexpected loss. But in the beginning, it no longer feels safe. Everything that they thought to be true of their world no longer exists. For example, I use the example of somebody going out for a walk. We expect that when a loved one goes out for a walk or goes in a car to drive and get groceries, but doesn't get home. We expect that when people go out for a walk, they come home. We expect that when people go driving to go pick up groceries, they come home. And when those things don't happen, the assumptions that we have about how the world works no longer hold.
Dr. Levin (12:22):
And so the world no longer feels like a safe place. So in the beginning, one of the most important things to do is to help an individual feel safe again in the world. And some of the things that can be helpful for that is re-establishing routine and structure, simple things like eating meals at a regular time, being surrounded by loved ones, daily routines. I know I just mentioned that really strong self care, doing anything that establishes a little bit of normalcy at a time that is absolutely not normal whatsoever. But just doing things that make your world feel a little bit safe again. After a traumatic loss, you're numb, you're in shock. You're, you know, in denial. Your body and your mind hasn't caught up with what has just happened. And so having family and friends who are very supportive and understanding what you're going through while your body is adjusting to this trauma at that time is very important while your mind is just catching up with what has happened. Having people who can help you just picking up the kids, getting some groceries, walking the dog, doing the tasks that all of a sudden you're not able to do at that particular moment as you're just trying to function, you know, just to eat, sleep, just do those basic things.
Dr. Pelman (13:59):
And for those who surround the individual who's in this grief process or the family or, you know, close friends, coworkers who are all grieving, there are varied reactions from some people who just don't deal with death very well and may turn away. So the family, the spouse, child, or coworker, or friend may wonder why somebody they know fairly well has just disappeared in their life. And there's other people who are trying to be supportive and not unwelcome, but be a little more forceful than the person is ready for. So how do people gauge and what should people do? And how do we view those two extremes?
Dr. Levin (14:45):
Something that my clients probably struggle with immensely is reactions from family and friends. You know in our society we are so uncomfortable at large with the topic of death and dying. And we're so uncomfortable being in the presence of others who are grieving. And so many times when our friends and families who are grieving need us the most, we're so uncomfortable. We don't know what to do. So we don't do anything at all. So we do turn away. We don't call because we don't know what to say. When in fact people need us the most, they don't need much from us. They need our presence. They don't need us to fix anything because there's absolutely nothing to be fixed. I think some of the things that my clients will say are the worst things that you could do are to say things like, you know, “He or she is in a better place,” or, “It was God's plan.” Other comments such as, “If you need anything, just call me.”
Dr. Levin (15:54):
Those are comments I hear over and over again as being so unhelpful. Comments or things that are very, very helpful are to drop off meals; come over and water the lawn; pick up kids from school; just do things that need to be done. Because when people are grieving, they're fatigued, they're tired, they're overwhelmed, they're disoriented at times. And again, a lot of what I'm talking about is right in the beginning stages. And we can talk a little bit more about what long-term grief looks like, but often we're out of sorts. And so having people just do things for us without having to ask is such a relief or such a welcome gift. I know one woman said, you know, everybody comes over and grieving during the pandemic has also been a very difficult thing for many people because of the social distancing, because of the isolation where normally we would congregate that hasn't been such an opportunity for many people. But one woman talked about, you know, people came over, they fixed my fence, they mowed my lawn, they took the trash out, and just how helpful that was for her without having to come up with a list or having to ask people to do certain things. But just being there, being present, not having to let people know what you need. Cause like I said, a lot of times people who are really in the midst or the depths of grief don't really know what that is.
Dr. Pelman (17:35):
So it would be something to sort of ask as not immediate family or very close friend, but you know, somebody you're well acquainted with and I'm certain that many people feel they're going to be too intrusive to come in and do many of those things, which would be welcomed. So how does somebody who's not immediately within the nuclear family or absolutely so close that it's not an issue approach somebody who's grieving to find out where the boundaries are? What's the easiest way for them to do that?
Dr. Levin (18:06):
That's a great question. Usually closer member of the family will arrange a meal train or a will be organizing tasks that can be helped. So if you're not in that inner circle, ask around and find out who is organizing it. Or, you know, Instacart or whatever, will deliver groceries or deliver food. I mean, if you can't, you know, get in and do those real close things, there's always things that you can just have delivered or sent or a note, things like that.
Dr. Pelman (18:45):
And then let's look at the actual close nuclear family or very close friends, immediate relationships. We'll take the person who is grieving to the point where they're not functioning. And then the opposite, the person who continues on, goes to work, does all the things and doesn't seem to have even stopped for a moment to ponder what happened. People will look at both of those and think they're extremes, but we're all different. So how do you address those two polar opposite types of approaches to grieving?
Dr. Levin (19:19):
So let's talk a minute about what grieving actually looks like among different people. Grief is so unique. It's such, I mean, it's like a snowflake, no one will grieve alike. Everyone has different patterns. Everybody handles grief differently. There's grieving styles across genders. Research by Kenneth Doka has shown that men are more likely to be instrumental. They like to grieve or it's helpful for them to grieve doing tasks, instrumental tasks, doing things around the house, fixing things where women are more intuitive. They like to talk. They like to express their feelings. Of course, how an individual grieves is going to depend on their age; their cultural beliefs or practices; their religion; the relationship they have to a person who died; the intensity of the relationship; the history they've had of how many other people they've lost; their life stressors; their comfort with grief or with people who are sick; their personality.
Dr. Levin (20:28):
So many different things. You use the example of someone who goes to work. Some people do not want to express their feelings. They unfortunately sweep it under the rug and they feel if they go to work, it'll distract them. If they pretend everything is normal, then it didn't happen or they're going to be able to function better that way. Usually these are people who will experience what would be called delayed grief and maybe 2, 3, 4 years later, they may experience illness. They may experience a mental health struggle and it will come up and catch up with them later. Some people do become non-functional like you said. They may become extremely depressed. They may stay in bed. Many of my clients, especially with a traumatic loss, you know, if there has been a suicide, an overdose, a car accident where several family members have died, they do become non-functional.
Dr. Levin (21:35):
Luckily it usually lasts, you know, a period of anywhere three months to six months to nine months. Everyone is completely different. And hopefully there's a lot of family support and love and care, and people who come and help with a lot of the daily functions to help somebody be able to get back on their feet. It's just different for every single person. So grief is going to be very, very different. It's very common to see people feeling overwhelmed, to have a lack of interest, to not want to go on with their life early on without the person that they loved. You see this so often when spousal loss, I mean, people who've been married 30, 40, 50, 60 years who's grown up with a spouse and done everything with the person, their partner, all of a sudden doesn't know how to exist without their loved one. Doesn't know who they are.
Dr. Levin (22:36):
They've lost their identity. You see yearning and sadness and crying and loneliness. All of those things are very, very common. But one thing I share with clients is it's not always going to be this way. It does get better over time. It doesn't go away, but there's a lot of tools that we work on in therapy and with social support and friends. So it does get better. We talked about, you know, it's very common to feel like it's difficult to fit in with friends. It's a very known reality that there's a tremendous amount of support, right? After a loved one dies. I always wanted to write a book, what to do after the lasagnas are all gone. You know, everybody crowds around and gives a tremendous amount of support after the funerals. But then life goes on. People get back to their normal routines.
Dr. Levin (23:42):
And the individual left grieving feels very alone, very isolated and has a difficult sometimes time reentering the world. Again, those who've been grieving during the last 18 months have been really struggling during COVID because it's been very difficult to re-engage during the world, or into the world. And many times they feel that other people don't understand what they're going through. So grieving is very different, very unique for every single person. Individuals who are grieving are also faced with what we call triggers. Sometimes I call them grief attacks, or it's a name often used throughout grief professionals. These can be sights and smells and sounds. Sometimes the dates are anniversaries or special events that come on without warning and just kind of hits you like a load of bricks or a wave. And you can be doing really well one moment. And then you're just flooded with a grief emotion. And there are many ways that we help individuals cope with these memories or just bouts of extreme grief and sadness that are very normal, very natural, and just helping people work through those triggers that just bring up intense feelings of sadness that are all just part of the grieving experience. So I don't know if that answers your question about how unique the grieving experience is. It's probably one of the most unique experiences with many, many commonalities.
Dr. Pelman (25:31):
So a number of things, obviously everyone is different and everybody's reaction is different. When you mentioned an author, Kenneth, you say that again or spell it.
Dr. Levin (25:42):
His last name is D-O-K-A.
Dr. Pelman (25:45):
And he explores a lot of what we just reviewed?
Dr. Levin (25:49):
He’s done a lot of research, but he was one of the first people who looked at gender differences in grieving.
Dr. Pelman (25:56):
So let's, again, look at those polar opposites. The person who doesn't seem least bit affected, you know, goes to the funeral, is at the gatherings, goes to work, comes back. If there's family members, maybe they're not that close. Maybe they are, or friends. What should they do, if anything?
Dr. Levin (26:16):
You know, if someone's not that affected, I would be very curious about the relationship they had with the individual who had died. You know, in terms of, you know, was it a parent that there was a falling out with 10, 15 years ago? I would hate to say, or be hard-pressed to say that somebody is not affected. It would just be whether or not they're choosing to acknowledge it, or they're just reentering their world right away as a way to distract themselves from what's happened. Right.
Dr. Pelman (26:49):
Okay. Let's say that they're just choosing to not be affected and you know, said sometimes it comes back. Is it the place of somebody within the family to offer them the fact that perhaps they should get some counseling? And take the opposite, the person who seems so affected, they can't get back on track. That person would be more obvious. The person people say, “Hey, counseling may be good for you.”
Dr. Levin (27:16):
Yeah, everybody does grieve differently. And a lot of times I'll work with families. And one of the things that I will say is not everybody's grief gets along and there's many different grieving styles that occur within the family. And often family members don't like to be judged by one another in terms of who's grieving one way or another way are judged to be grieving right or wrong. Usually there's a lot of critiques among family members as to whether or I've encountered many critiques among family members about whether one person is grieving an appropriate manner or another. But in reality, it's unique for everybody.
Dr. Pelman (28:03):
Again, the person who is so withdrawn and not able to perhaps get to work, take care of themselves, get out, they seem to become isolated. That would seem very obvious. When friends or family or coworkers recognize this as an issue, how should they approach somebody?
Dr. Levin (28:22):
Just by, you know, noticing and say, you know, I noticed that you're really struggling since so-and-so, you know, has died. Have you thought about joining a support group? Have you thought about talking to somebody? There's also some wonderful books. A lot of religious organizations will offer support through a church or a synagogue or another religious institution. So a lot of different ways to get grief support there's online programs and groups. A lot of the support groups nowadays are online due to COVID, but there's, you know, in-person groups, there's online groups, there's in-person therapy, there's online therapy, you know, or many people talking with their friends is sufficient. And then there's the benefit of going to see a counselor. Going to see a counselor does not mean that you're not handling your grief well. Some people just like to process the loss and the things that are associated with a loss, whereas other people will find they're having significant problems in terms of parts of the relationship that were never worked through, or they're having physical problems that have started stomach aches or headaches.
Dr. Levin (29:53):
They're not sleeping since a death has reoccurred. They're having nightmares. They're replaying situations that they saw in their head associated with the death. So people might engage in therapy for all sorts of reasons. I lead a spousal grief group and they find it participants will talk about how they find it, just so helpful to hear how other people are handling their loss. What are they doing about the loneliness? What are they doing about cleaning out closets and rituals around anniversaries and milestones? And so, it could just be a wonderful place to get support. So again, seeking support doesn't mean that there's anything wrong whatsoever. It could just be a wonderful resource or it could be an excellent avenue. If you are struggling with something specific related to your grief.
Dr. Pelman (30:58):
I know that many of the hospitals offer a group grieving opportunity for people to attend sessions. It doesn't have to be immediate after somebody has passed away. It can be a year or two, even longer?
Dr. Levin (31:14):
Yes. I've had participants in groups five to 10 years afterwards, and I've had people, you know, reach out and call me the day it's happened. And again, those are in more of the traumatic situations, but I say all the time to clients grief has no timeline. It works on its own timeline. And as soon as you set a timeline on grief is this as soon as it's going to backfire on you.
Dr. Pelman (31:43):
And if we looked at the, I think it was anticipatory, we were talking about individuals who have a very poor prognosis that will at some point end in death. Tell me a little bit about, first of all, for that individual, the people who have received that very bad piece of news, go through some trauma right away. Everybody does. I mean, as a physician, we've had to talk to patients about a prognosis. Some are shorter than others, but what would you advise to the person who just received some bad news?
Dr. Levin (32:21):
There's a lot going through somebody's head who's just received news like that. I spoke to a woman last week who thought she was doing well and was just told she had a three month prognosis, and she was incredibly overwhelmed and confused and angry and sad. And to be honest, all I could do at that point was just listen and give her the space to absorb everything that she heard. There wasn't really anything I could tell her at that moment.
Dr. Pelman (33:01):
There seem to be stages in dying, obviously. And hospice situations are very well set up for that individual and the family to come to terms with sort of the end of life, that last turn of events that will lead to death. When I asked this question, I was thinking more in terms of, I just received the news, you know, reaching out for support. Obviously the physician, family, friends, some people would want to tell people, other people don't like anybody knowing what's happening. So again, we have polar opposite reactions cause we're all different. So how do you, for that first part, that initial just got some bad news, how would you advise individuals? And then we'll talk about the family and those around that individually.
Dr. Levin (33:50):
Yeah, absolutely. So first just give the individual some time to process what they heard. You know, what's the first thing that comes to their mind, help them identify what are their biggest fears, the biggest concerns that they want to address in the amount of time. You know, I am a huge supporter of hospice. I think it's an absolutely wonderful organization. I used to be a director of a hospice 20 years ago, and it's something that I'm highly supportive of. And of course, you know, the goal of hospice is that everybody has a dignified death and a death without pain and able, it’s actually been a while since I've looked at the actual goals that hospice would say, so I apologize if I'm miscommunicating them. But you know, not everybody still reaches the acceptance and is okay or comes to terms with their death. Many people still die, unfortunately, feeling cheated and angry. But you know, to ask, you know, and actually I’ll be speaking with this woman later tonight, what is it that she wants to accomplish? What is it that's important to her and what is it that she feels that she needs to do? And helping her in any way that I can accomplish those things, who does she want to talk to? What does she need to do to get her affairs in order? You know, just making those things happen to her so that she can not have the regrets. Is there anything that we can accomplish so that she doesn't have the regrets that are there any regrets that we can eliminate?
Dr. Pelman (35:36):
And then for those that surround the individual, you know, for the person who doesn't wish to be isolated, yet many people don't want to bother that person or intrude on somebody at this time. So what's a general rule for people feeling comfortable about how far they can intrude or not intrude? Or, you know, how can they help? And, you know, again, we kind of started with this at the beginning, but now we're in a very particular situation. Somebody who, you know, well enough mentions to you that they just were told they had X amount of time or a terminal diagnosis.
Dr. Levin (36:09):
Well, and again, I'm going to speak about this particular case. She has so little control of the remainder of her life. And so it's going to be about what does she want with her friends and her family and how does she want help from them. And it's not really going to be about what her family and friends can do for her. It's what does she want from them. Because at the end of life, she's lost all control over what's going to happen to the remainder of her life. And so making sure she has as much control about the last decisions that she has available, while at the same point acknowledging that it's so important that the people who love her have a chance to express how they feel. And if she does or does not want, you know, visitors or things like that, finding a way that's acceptable for her to be able to receive their support. Whether it's in a written way or a video or whatever, it's all going to be about what she's comfortable with and what's okay for her.
Dr. Pelman (37:30):
So if say a friend, not somebody that they see all the time, but here's from maybe one of the other family members that this is happening. What's the safe way for them to approach this person? They may feel hesitant to do so. And yet still on the other side, if they don't, after the person passes, feel some guilt that they didn't. So, you know, it's a human condition and kind of give some advice just in general. And of course we're all different. So nobody holds you to absolutes.
Dr. Levin (37:59):
Yeah. And you know, you're touching on such an important issue that I train my staff on because oftentimes there's something called the Ring Theory*. And I wish I had it in front of me to show you. There was an article in the LA times about it. There's a series of rings. So if you imagine a dart board. Okay, so the person who's grieving or who's dying is in the very middle. Okay. And according to the Ring Theory, you put comfort in and you dump out. So the person who is grieving or the person who's dying is in the very middle and it all centers around their needs, and everybody else is external. So it's all about what they want and what they need. So the friend who may or may not be that close, what they want or need is peripheral. It doesn't matter as much as what the person in the middle wants or needs. And so they may have a need to express condolences, to express grief, sadness, or sorrow. They can only dump out their guilt or their sadness that they didn't get to do that to people who were more peripheral than they are. They can't dump in their sadness that they didn't get an opportunity to do that. Does that make sense?
*Ring Theory: https://www.latimes.com/opinion/op-ed/la-xpm-2013-apr-07-la-oe-0407-silk-ring-theory-20130407-story.html
Dr. Pelman (39:35):
Yeah.
Dr. Pelman (39:36):
You know, I think for the individuals who were hesitant, you know, because maybe they're close, but not there every day, but they heard this not from the individual. They want to approach individual, to be honest and say, I'm not good at this, but I do want to. Would that be acceptable?
Dr. Levin (39:53):
Yeah. I mean, but they need to talk to people and say, gosh, I feel really bad that I wasn't able to do this. I'm not good at that. They need to talk to people on the outside of the circle, not to people on the inside who are more impacted by it. So they can write a note and send letters or condolences. But with their frustration about their inability that they didn't get a chance to say goodbye or that they, you know, feel bad that, you know, they weren't there for the person, that has to go out towards the outer part of the circle and not the inner part.
Dr. Pelman (40:38):
And, you know, while the person is still with us and they want to approach that person, can they take that approach? Yes.
Dr. Levin (40:45):
The person in the middle of the circle gets to do whatever they want.
Dr. Pelman (40:49):
So you want to approach the dying person and you know, your acquaintance? You can't.
Dr. Levin (40:55):
Unless they give you permission
Dr. Pelman (40:58):
And how would you even? You know, they're out and about and you run into them and you've heard.
Dr. Levin (41:05):
You know, hi, how are you? And if they say, “Fine. I'm doing great,” then you leave it at that. If they say, “Actually I'm not doing well, I have X, Y, and Z,” then you can go there because otherwise, you know, what happens is the person in the middle begins to take care of everybody else. And that's what's exhausting for the person in the middle.
Dr. Pelman (41:31):
And then, well, we have just the opportunity to explore not somebody who's received a diagnosis, but just somebody who's preparing their family for an event that may occur in a number of years or sooner based on age or just statistics. I was recently at a celebration of life for a friend who was in his mid to later eighties. And, you know, his family expressed two things. One is he had told his daughters that he was, and his grandchildren, that when he passed he had a great life. And they can be sad, but they shouldn't feel that he was deprived of anything. And that was very helpful for them to just know that he had had that fulfilling life. The other was, he was very meticulous because his work required it and he had a book and he made sure they all knew where the notebook and it was organized book of accounts. You know, from financial to wishes, to desires, to property, to what to do. And obviously some of this runs into estate planning for those that can take care of the states and have the means to look after wills, but just to have a book where everything is organized with such relief to the family. So for those who are doing well, but eventualities it just seemed like a nice thing to do for those who remain.
Dr. Levin (43:03):
What a gift. You know, as I mentioned, I work with so many people who have dealt with an unexpected death and unfortunately some of them on the younger side, you know, thirties and forties and fifties, who never thought that this would happen so early. Who not only, you know, are dealing with the fact that their loved one unexpectedly died, but all of a sudden they have to figure out how to bury them, where to bury them. They have no idea whether it's passwords to anything. There was no organization to anything. And it's an absolute nightmare. It's an absolute nightmare of paperwork, of bank accounts and it doesn't end. And it is such, I hate to use the word “Burden,” but there's no other way to put it on the person. You know, especially I had just a slew of men in their forties having heart attacks, you know, unexpected heart disease that nobody knew about.
Dr. Levin (44:03):
And, you know, women in their forties with young kids or, you know, kids in middle school, early high school, all of the sudden figuring, having to, you know, be single moms, all of a sudden having no idea how to find things out. And it was just the most stressful thing on them ever. And so I encourage everyone, everyone to get organized, no matter what age you are. I encourage everyone to complete forms such as an advanced directive*. I encourage everyone to have all of their passwords and whatever in a notebook. And speaking from personal experience, I not only is it hard to do these things, but it's hard to be the receiver of this information. You know, my dad many times has showed me this is where all this information is. I don't even want to hear that. And even though it's all organized, I know where it is, but we don't want to talk about it and we don't want to receive it. But it is so important because life can turn on a dime. And so the individual you were talking about gave his family a true, true gift.
*Advance directives: https://medlineplus.gov/advancedirectives.html
Dr. Pelman (45:19):
So Dr. Levin, what does healing from grief actually look like?
Dr. Levin (45:23):
So that's a really great question. People ask all the time, am I ever gonna get over this? Or is my grief ever gonna go away? And in reality, no, we never really lose or, excuse me, we never fully recover from losing someone we truly loved. We never fully heal, but here's what happens. The hole, literally people talk about a hole in their heart, things grow around the hole. The hole doesn't necessarily get smaller, but instead lots of growth takes place. And there's a couple of ways that I've heard this explained. One is commonly referred to as the Fried Egg Theory*. And if you think about an egg and if you put an egg in a pan and there's the yolk. So if you look at the yolk as the grief, the yolk stays the same, but what happens is the white of the egg gets bigger and bigger and bigger.
*Fried Egg Theory of Grief: https://www.funeralguide.co.uk/help-resources/bereavement-support/the-grieving-process/tonkins-model-of-grief
Dr. Levin (46:36):
And that is the growth that the occurs. So some days, you might feel like you're closer to the yolk or you're stuck in the yolk and the grief hurts really bad. But other days you are so lost in the growth, the white of the egg, which has grown so much, you're super far away from the actual grief. And you forget that the pain is there. Another way I've seen this explained is like a ball in a jar. If you put a golf ball and a really small jar, the golf ball takes up the entire jar. But if you put it in a medium sized jar, the ball is still the same but the jar is bigger, and there's more room and there's more air. And if you put it in a huge jar, again, the ball is still the same, which represents the grief, but the jar is so much bigger. And there's so much more room for expansion and growth that you sometimes don't even notice that the ball is there
Dr. Pelman (47:53):
Is that happens spontaneously to some people?
Dr. Levin (47:57):
Nope. There are this whole thing and, you know, trainings on how to facilitate post traumatic growth and counseling, and how to facilitate growth. I mean, that's the whole idea. And I mean, truly that's my favorite part is to see people come in and say like, “I don't want to live anymore. My life's never going to be good again.” And then to see them go away, you know, 18 months later and talk about, you know, all the new opportunities in their life and the way they see the world differently. And, you know, that just takes place over time.
Dr. Pelman (48:31):
So some of the benefits to actually having counseling, to be in a group, to seek being with others, to have some guidance, is the ability to replace a small jar with a medium jar, to a large jar.
Dr. Levin (48:44):
And it’s just the reframing and seeing beauty in the world again. And, you know, we do a lot of gratitude work. And in terms of the work that I do with my clients who have experienced so much trauma, I rely on a lot of work that was talked about, or that has been studied by doctors Tedeschi and Calhoun in North Carolina. And they coined the term post-traumatic growth*. And this is a concept that's actually been around for a really long time. But basically according to them, after someone has experienced a trauma and they experienced a huge drop in their life as a result of trauma, they can grow in a new way that not only do they go back up to the level in their life of where they were before the trauma, they actually exceed in their life, their wellbeing way above where the trauma occurs.
*Post-traumatic growth: https://www.apa.org/monitor/2016/11/growth-trauma
Dr. Levin (49:52):
And often they experience growth in several new areas. And these areas or domains actually occur in their ability to develop deeper relationships; in their ability to try new things; increased inner strength in their ability to have a greater appreciation for life; or spiritual enhancement. So even though grief is perhaps one of the most painful things we will ever go through in our life, there are very positive things that can occur in terms of growth and healing. This is not exactly what I share with my clients when they come in to see me on the day or the first day. But it is something that I will say I find very fulfilling and helps me in the work that I do.
Dr. Pelman (50:56):
Yes. Well, we'd like to always wrap up episodes with resources and in your world, personally, you have a online program from grief to growth. And so it mentioned what you have is resources that you can think of, that we can also post for our listeners where they can find it on our website as well, but go through some resources for folks.
Dr. Levin (51:24):
Sure. So in terms of what I was just talking about for the advanced directives, AARP has a great spot on their website, AARP Advanced Directives, and they have by state. They have the legal forms that you can download and complete your advanced directives, which is a form where you can assign a healthcare proxy to make medical decisions for you. There's also a site called Five Wishes, which is a discussion in which you can talk about your end of life care wishes are with your family. And the discussion guide is at fivewishes.com. When you do these forms, it's super important that you give it to your family members and your healthcare providers so that can be part of your medical records. So that's important. I developed a online course for individuals who are living with traumatic loss, and it can be found at my website, fromgrieftogrowth.com**, and at it's under courses. And this is an online program. It has eight different modules where you can do it at your own pace and your own timeline. And again, this is geared specifically for individuals who have experienced a sudden and traumatic loss. And it's a series of videos, growing tips and worksheets designed to help you work through some of the issues that we talked about today.
*AARP Advanced directives: https://www.aarp.org/caregiving/financial-legal/free-printable-advance-directives/
**Five Wishes: https://fivewishes.org/Home
***From Grief to Growth: https://fromgrieftogrowth.com/
Dr Pelman (53:04):
And we have listeners around the states and around the world. Your religious affiliation minister, rabbi, the clergy pastor certainly have resources to help and hospitals nearby also have those resources.
Dr Levin
Absolutely.
Dr Pelman
Well, Dr. Jennifer Levin, thank you for joining us in a topic that is uncomfortable for many, many people, but is something that if we do think about and perhaps can help those who we wouldn't be able to speak with because of our discomfort. Maybe this episode will give us some insight as to how to approach folks when we've been hesitant and for family members, some resources and some opportunities, so truly appreciated. And thank you.
Dr Levin
It's my pleasure.
This completes another episode of The Original Guide to Men's Health podcast. We wish to thank all guests who volunteered their time and knowledge. The information presented is the opinion of the speakers. The show's recordings are engineered and edited by Sean Fox. Episode titles and descriptions, as well as editing assistance, are provided by Dr. Kathleen O'Connor, PhD. Music for our show is San Juan Bell's, written and performed by Dr. David Whiting. The podcast is sponsored and published by the Washington State Urology Society. The Original Guide to Men's Health is an original publication of the Washington State Urology Society. Reproduction and use without the express written consent of the society is prohibited. For more information about men's health and previous episodes, as well as additional recommended resources, visit us online at https://theoriginalguidetomenshealth.org/ . This is Dr. Richard Pellman thanking you for listening, and reminding you to take care of yourself.
Dr Pelman (55:14):
Good news. The Original Guide to Men's Health has just finished a brand new website, and you can find it online at the originalguidetomenshealth.com. Also the https://www.wsus.org/podcasts.html. Our website has podcast episodes, resources, links to our brand new social media accounts, which can also be found in the episode description.
Episode Summary: Every person in the US needs the information in this episode. First, to learn how to make informed and efficient health care decisions for themselves in our current insurance system. And second, to gain an understanding of how the current system works and doesn’t work, so they can evaluate the different positions on fixing the system taken by various political and organizational platforms. Episode Guests: Dr. Jeffrey Frankel M.D. Urologist with Frankel, Reed, and Evans; President of the Western Section of the American Urological Association.
Mark Painter, B.A. Vice President of Coding and Reimbursement Information for Physician Reimbursement Systems, Inc. (PRS). Managing Partner of PRS Consulting, LLC; CEO of PRS, LLC. During This Episode We Discuss: * What your medical coverage does and does not cover. * How medical billing works. * Is the price on your hospital invoice really the price? * How medical pricing is done. Fees are set by Medicare. * Narrow networks and co-payments, are you really covered? * Medicare coverage and payments. * Fail First Therapy….why can't you take the medication your physician prescribed? * How to select an insurance product that's best for you.
Quotes (Tweetables): “ Patients think that they have the same insurance, or on a yearly basis they get offered new plans with lesser premiums, they sign up for those plans for economic reasons and then subsequently find out they can no longer see the same doctor….it’s unfortunate but common.” Jeff Frankel, M.D.
“Medicare rates for physicians have been flat, or haven't gone up for about 10 years”
We're providing more care to more people, we are using more resources on fewer people that are living longer and using more care, we are using more technology, more medications...those shifts are really taxing everyone in the marketplace.” Mark Painter
Recommended Resources: * The Bitter Pill, Steven Brill, Time Magazine * Medicare Supplements
Episode Transcript: Coming soon!!
Episode Summary: The body and brain change a lot during the teen and young adult years. Knowledge about relevant health issues, and a plan to deal with them, empower young guys. Good self-health for the rest of life starts here. Episode Guests: Part A: Dennis Barbour ESQ, President and CEO, The Partnership for Male Youth
Part B: Leslie Walker - Harding, M.D., Professor and Chair Department of Pediatrics, Seattle Children’s, Specialist in Adolescent Medicine During This Episode We Discuss: * The importance of younger men developing a continuity of care. Young males have significant risk factors that can be mitigated by seeking health care. * The Partnership for Male Youth has collected health equity issues for young males, i.e. the educational system, the juvenile justice system, thus demonstrating the importance of approaching youths where they interact and can be involved in addressing their needs. * If you're a parent, older friend, or sibling of a younger male, listen to this episode, so as to how to help them achieve better life outcomes.
Quotes (Tweetables): ‘It’s not unmasculine for male youth to have questions about their health."
"In terms of the messaging and how we get the word out that it's important for young men to take care of their health and to be aware of things that they are at risk for, that's where we depend heavily on the advice of their peers.”
‘It’s important that we not talk down to young men.’ Dennis Barbour Esq.
"Adolescence is just a wonderful time of change, growth, realization and beginning to understand who you are in the world and who you are with your peers. That time is wonderful, but it's also sometimes fraught with risk and reality exploration."
"I actually talk quite a lot to the parents just before they get to this age and during this age too, talk to them about what their family believes. Every time kids are surveyed they look to their parents for answers about what's right and not, they also look to their doctors." Leslie Walker-Harding, M.D.
Recommended Resources: * The Partnership for Male Youth * The American Academy of Pediatrics
Episode Transcript: Coming soon!!
Episode Summary: A primary care doctor is a critical partner, and a gateway, to a healthy guy's life at all ages. Learn how and when to access the health care system, and start building your health care map for life. Episode Guest: Paul James, M.D., Professor, and Chair of Family Medicine, University of Washington School of Medicine. During This Episode We Discuss: * What a Family Medicine physician can bring to your care. * The importance of having a personal advocate, your family physician to anchor your care. * When to start goals, milestones of care for physical, emotional, and mental health. * How to choose a family physician. * How to get the most out of your appointment.
Quotes (Tweetables): “A distinguishing characteristic of what family doctors do is attempt to take care of you as an individual in the context of you as a social organism within a larger social unit. So, in the context of your work, in the context of your play, and in the context of your passions, what you care most deeply about.” Paul James, M.D.
Recommended Resources:
Episode Transcript: Dr. Pelman (00:06):
A baseball game, a day in a park with friends and family, fishing in a remote stream, work, travels, providing for loved ones, or heading out for adventures, whatever you do, whatever you enjoy, you need your health. The Original Guide to Men's Health is presented by the Washington State Urology Society to help take you through the steps necessary to get the most out of life. If you have invested in a retirement plan for your future, why not invest in your body? After all, it makes better sense to retire healthy and enjoy your future. If you take care of your car and maintain it, why not do the same for your personal machine, your body? If you know you should but haven't yet, the information in these podcasts contains some easy recommendations for where, when, and how to get started. Follow the podcast as we explore men's health with renowned experts and embark on a journey towards better health. Family medicine is for everyone, whether you're single or have a family, whether you're healthy or unhealthy. Today, we interview the chair of family medicine at the University of Washington, Dr. Paul James.
Dr. Pelman (01:56):
Welcome to today's episode of the Original Guide to Men's Health. Today, we're going to review choosing a family physician and we're fortunate to be interviewing Dr. Paul James. Dr. James is the chair of family medicine at the University of Washington, previously serving as the chair of family medicine at the University of Iowa. Dr. James is an active clinician, educator and researcher, and he has held notable positions in leadership in many key national organizations. It's a pleasure to have to Dr. James review with us family medicine, choosing a primary care provider, and helping us look at why you should. Dr. James, thank you for joining us.
Dr. James (02:36):
Thank you, Dr. Pelman.
Dr. Pelman (02:37):
I think most folks wonder what is the difference between a family doc primary care physician versus an internal medicine rimary care physician? And what do they need?
Dr. James (02:48):
So first of all, they are both excellent sources of primary care. There are a few differences. Predominantly, family physicians are trained to take care of the majority of your healthcare needs, which would include things like your mental health concerns. So things like depression, anxiety, or concerns about memory loss. They also may take care of more musculoskeletal* problems. So sports medicine injuries, musculoskeletal, things such as that, or even trauma. So if you cut yourself, the family doctor usually is well-trained to sew up the laceration or look at a broken bone. An internist is going to be more focused on internal problems, like chronic diseases and things such as that. But general internists may actually be also very well-trained in mental health care issues and dermatology issues. So what I find is it usually is dependent on the unique training that a specific doctor has and their interests.
*Musculoskeletal: https://my.clevelandclinic.org/health/articles/12254-musculoskeletal-system-normal-structure--function#:~:text=Your%20musculoskeletal%20system%20includes%20bones,problems%20with%20movement%20and%20function.
Dr. Pelman (03:55):
I think growing up, we had a family doc and took care of my brother, myself, my parents. And we went there because they’re my parents’ doctors. People wonder, “Well, do you have to actually have a family to join into a family practice and a family physician?” You could take a young adolescent person and have them come into your practice. Correct?
Dr. James (04:15):
That's true. Most of the time we are taking care of individuals. So, hopefully no one is going through life without some sort of family. And we now define families in a much broader way than the traditional sense of a mother and father and brothers and sisters. We all have communities that we, that are supportive for us. And so I would say that the, perhaps a distinguishing characteristic of what family doctors do is attempt to take care of you as an individual in the context of you as a social organism within a larger social unit. So in the context of your work and the context of your play and in the context of your passions, what you care most deeply about.
Dr. Pelman (05:01):
I think the model of family physician has resonated with people because some people grow up with their family doc, and then the family doc takes care of their family. And primary care physicians have seen multiple generations.
Dr. James (05:17):
Yes. And that's particularly true in rural communities where many of us deliver babies, and we'll do women's health care. And not only do you deliver babies, but you also are helping grandparents transition into later life stages that are equally important to the health of the family.
Dr. Pelman (05:38):
So a full spectrum of care.
Dr. James (05:41):
Yes
Dr. Pelman (05:41):
Have you seen the primary care physician relationship change as far as the ability to do what primary care had historically done? I mean, if I think back 50 years ago, surgery, obstetrics that you mentioned, subspecialty areas, now at least here in a urban area with all the specialty around, how does primary care still deliver what they need to?
Dr. James (06:12):
That's a great question, Dr. Pellman. One of the major changes that has occurred in primary care over the last few years is that primary care is now predominantly delivered in teams. And it is the whole team within the office, which could include the medical office, assistant the nurse. It may include physicians assistants or nurse practitioners in addition to the doctor who are working oftentimes in a coordinated fashion to ensure your health. Ideally, you would come in for an annual wellness visit, for example. And at that visit, there would be an identification of opportunities to improve your health. And so other members of the healthcare team, in addition to those that I've just mentioned, could include a pharmacist. They could include physical therapists. They also could include a behavioral health specialist, which is someone like a psychologist. All of these are members of a new primary healthcare team.
Dr. James (07:09):
And the goal is that together, they can deliver even better care than the single family doctor of the past. I do think it's a challenge today with large hospital systems. It's more difficult for your primary care doctor or family doctor to take care of you in the hospital. But we do have opportunities to improve communication not only between the hospital and your doctor's office, but with the multitude of great specialists that we have within our healthcare system today. So one of the wonderful opportunities we have is to make sure that we are getting the best communication between your primary care doctor and your specialists, and for them to communicate in effective ways that ensure that we're delivering the best care for you as a patient.
Dr. Pelman (08:00):
I see the primary care physician as a anchor. The specialist may be a one time or two time encounter. Patients then have their family doc primary care physician to come back to is kind of the anchor for their care. And while they might go out to have a particular need met through a specialty, they're always going to come back to seek your opinion.
Dr. James (08:24):
I do think that's one of the joys of why many of us chose the primary care specialties. Because there is a desire to have a relationship and to get to know you as a patient, and to understand what your values are and what your goals are for your health. One of the ways of defining a family doctor is that we are the doctors that specialize in you. And our goal is to learn as much about you, as an individual, as we can so that we can help guide your healthcare decisions to better understand, for example, who may be the best specialist for your needs and the goals that you have, and to then be your advocate within the healthcare system.
Dr. Pelman (09:08):
And I think that's what I truly love about primary care is you are my advocate. If I'm seeing you in the context of my parents brought me in, you're still my advocate. When I grow up, you're my advocate, and you know me. And I'm the person who's getting the care, but you're the person that I trust for an opinion.
Dr. James (09:27):
Yes, I think that's absolutely true.
Dr. Pelman (09:30):
Now, when you look at individuals, what would you prescribe, if you could, as a care plan for when you would want to start seeing a young individual or an older individual? When should they enter into healthcare?
Dr. James (09:45):
So, there are stages in one's life. For, for young adults, so for example, for young men in their twenties, we like to assess your cardiovascular risk. So that would be a visit sometime in your early twenties to have your cholesterol checked. At that time, we would have discussions about appropriate nutrition, diet, and exercise. We would talk about weight. One of my favorite things to discuss with someone in their early twenties is to ask them the question. Let's say you only gained three pounds for the next 30 years. So you're 25, you're going to be 65, and you only gained three pounds. That's not much, but by the time you're 65, that 180 pound person is now 280 because that's 90 pounds of additional weight gain. And so we have discussions about the importance of monitoring portion size and being attentive to the fact that we're not getting taller anymore.
Dr. James (10:53):
And we need to look at our at healthy lifestyles. In our thirties, we continue those discussions. And we also talk about the importance of building good social relationship, healthy relationships. I often say to young men, “Be sure that you tell the people that love you, that you love them and look after them throughout their life.” Because those relationships are the ones that are going to be important to you as you get older. In your forties, cardiovascular health becomes more important, especially concerns about blood pressure and cholesterol. We also then begin to ask about your family history and cancers. And specifically whether we need to start screening for any cancers earlier. Most of the cancers we began to think about screening are at age 50. So for men, one of the discussions that's really important to have with your primary care doctor is about, for example, prostate cancer screening*. It is a controversial area, but it's an area that I think it's important to talk about and consider testing for, especially if you're in a high risk group, or if it's in your family history.
*Prostate cancer screening: https://www.cdc.gov/cancer/prostate/basic_info/screening.htm
Dr. Pelman (12:02):
What about a adolescent male who may not have a pediatrician who is wondering about sexual health issues? How would they go about getting an appointment as a teenager?
Dr. James (12:16):
Yes. So it's important that they know that if they come to a primary care doctor with questions about sexual health, first of all, all of that visit and healthcare information is private. And it's not shared even with parents of a younger adolescent, because issues regarding sexual health or potential family violence, or even mental health concerns, are protected health information. And they should feel comfortable that they are going to be protected by the doctor in asking the important questions that need to be asked. Your question also highlights for me that is one of the areas that I forgot to talk about, which was sexual health. And so we oftentimes will do screening for things such as sexually transmitted illnesses throughout young adulthood to ensure that that someone is maintaining health. And we also spend significant time discussing safe sexual practices.
Dr. Pelman (13:18):
So if a teenager picks up the phone calls, a primary care office and they of course say, “Well, what are your needs? And how old are you?” They're not going to be told, “Well, you can't come without a parent.”
Dr. James (13:29):
That's correct.
Dr. Pelman (13:30):
They'd be able to make the appointment. They’d have to figure out some means of coverage.
Dr. James (13:36):
Yes.
Dr. Pelman (13:37):
But still, they're able to come on their own. So it shouldn't dissuade them from the potential of making an appointment.
Dr. James (13:42):
That's absolutely true.
Dr. Pelman (13:44):
And the relationship would then continue as that person ages, and they've entered into the healthcare system. When would you like to first see somebody?
Dr. James (13:53):
Well, I think anyone who has questions about some symptoms that they're having that are not explainable. Or, if they have questions about how they can maximize their health. I think that's a good time to come see your physician. There's not a right age. So as young as 18, or being a teenager when you have questions such as this. I'm not sure there is a bad time to come see your primary care physician.
Dr. Pelman (14:25):
And then usual young, healthy person. What would be a care plan for frequency of visits? I mean, is that a yearly or?
Dr. James (14:33):
So if someone is doing well and is healthy, and the doctor has not identified any health risk, between the 20 and 30 range every few years. So three years is perfectly fine. If there is a health concern, like a question about your blood pressure, then the physician will likely ask to have you be seen more frequently.
Dr. Pelman (14:58):
So as needs come up. Sports injuries or pains or colds or something that is worrisome to somebody, they would then make the appointment then. But just routine would be a interval, if they're healthy, of a few years at that point.
Dr. James (15:12):
Yes. And so I will say that this is a really great question to ask your doctor when you're at your visit. What would they recommend? Because they're going to be able to give a much better answer to that question based on your personal health history and your physical exam.
Dr. Pelman (15:30):
So you just set up the next important topic is how to find a family doc, and how to get the most out of the visit. How to come prepared?
Dr. James (15:39):
So in today's world, I think central to this question is who will your insurance pay for? I think we're all concerned about the cost of healthcare. And so I think I would first begin by asking your insurance provider who are the doctors that are within their plan. Because those are likely to be less expensive for you as an individual. Understanding that, the things I would look for aare they a board certified family physician? So in family medicine, those would be certified by the American Board of Family Medicine*. Other things to look for though are offices that are affiliated with health systems that you may trust. So for example, here at the University of Washington, we’re part of UW medicine. And I think many people may choose to go to a family doctor that is affiliated with a hospital or health system that they trust. Other important contributors are how accessible are they. An office where you can be seen at a time that's convenient for you, and it's reasonable for you is an important consideration. And I don't discount at all the importance of asking family and friends about doctors that they have seen, that they trust, and have found to be good.
*American Board of Family Medicine: https://www.theabfm.org/
Dr. Pelman (17:05):
Now if I'm making my first appointment with family physician, is there something I should do as a patient to get the most out of the visit? How should I come prepare it? What should I be ready to ask? Or what material would you need to know about?
Dr. James (17:20):
Most of us now we'll send you a questionnaire before your visit, and this is intended to help organize your thoughts about your own personal health. So most of us then we'll have questions about your diet and your exercise, your family history, your medical history. So what surgeries have you had? What operations? What medications do you take? And in addition to medications, if you other things such as supplements, your doctor would want to know those things. And so to have all of those things written out would be extremely helpful. Other things that we'll ask about are your exercise habits, your smoking habits, your drinking habits. We're concerned about substance abuse. And it's a real hidden issue that we think we might not have a health problem, but based on some very clear guidelines, we can help people identify if they are at risk, for example, of an alcohol abuse disorder or concerns about smoking. For example, smoking is still a significant health threat in our society. And our job is to help patients identify the best strategy for them that can help them achieve the health goals that they would like. While we may think there are reasons why it is beneficial to us, one of our tasks is to help people identify strategies to say, “Hm, maybe I didn't need that as much as I thought I did.”
Dr. Pelman (18:52):
The smoking.
Dr. James (18:53):
Yes.
Dr. Pelman (18:55):
I like to have patients at least have list because if it's something that they may be embarrassed about, they may be waiting for the physician to ask. And the physician just doesn't hit on it. They may not bring it up, and leave without getting that pertinent question to answer.
Dr. James (19:12):
That's a really important point. And many times the visits may be compressed because the doctor is being expected to then go to their next patient. So having your questions written out, and I would say, then prioritizing your top two questions, is really, really important because the doctor may not have time to get down to questions number eight and nine if you have a long list. So I would really emphasize the importance of prioritizing your questions and making sure that you get to those top two.
Dr. Pelman (19:47):
I always appreciate patients who understand that there is a visit time. I mean, we can't go all day or we wouldn't see anybody else. But say, “Can I make another appointment to follow up on this?” And that's perfectly legitimate, is yes. So let's set another time slot. Maybe that will be a longer time slot once we know what the issue is. It's very fair to come back.
Dr. James (20:08):
Absolutely. And that is an important element that many excellent primary care doctors do. The first few minutes should be about agenda setting. And at the very beginning of the visit, many times I'll have to say to a patient, “Well, you know, we're going to have to save those things for a later visit. Let's address this important thing today.” And I think that's the hallmark of good physicians. Is they're clear about what we can expect during this visit today.
Dr. Pelman (20:39):
And then referring back to concerns, say smoking, we now have strategies that work very well for issues of smoking sensation, addictions, depression. It's really an emphasis now on making certain that we've covered these topics, but the patients seem to make us aware of them. And then there are strategies for dealing with them.
Dr. James (21:01):
That's absolutely true. And that's why it's important that today's primary care offices have some of these support personnel, such as the psychologist that can immediately provide strategies for patients to begin to change their health behaviors. None of us are perfect at living our healthiest lifestyles. And yet, we do find that all of us have opportunities to do a little bit better if given the right encouragement and the right strategies. And I think that's an important role of your primary care doctor.
Dr. Pelman (21:40):
Again, the difference between a practice that's here in an urban population versus being out in a rural population where the primary care doctor may be the only health practitioner for miles around. We're going to see a difference there.
Dr. James (21:53):
There will be, although many family physicians are well-trained in behavioral health strategies. And they also have access to some community support services. They may be at the local rural hospital. They may be affiliated with organizations within their community. And I think many family doctors have learned that they need to identify those resources for their patients. But you're right. The best way, though, to have them addressed is to bring them up with your doctor.
Dr. Pelman (22:23):
With your experience of rural medicine and broader practice, what are some of the key things that happen in a rural population? Is it surgery? Or deliveries? Pediatric care? What other?
Dr. James (22:39):
So in a rural practice, because you're the only doctor in the community you're taking care of everyone. And that means newborns and mothers who are pregnant and GYN, gynecologic care. As well as elder care and taking care of patients in nursing homes, or even making home visits, which are a very rare thing in urban settings. Maybe more frequent in rural communities. And I think in part though, that also helps you in some ways to get better care because the doctor tends to not just know you from your visit, but they may know you from taking care of your mother or your spouse or your children. And there's a certain joy that comes with that even for the doctor.
Dr. Pelman (23:25):
Yeah. I think that connection with the whole family and understanding their environment, where they're living, certainly has changed over time. But I think it's the essence of taking care of people. Well, if we wanted to then look at primary care physician...
Dr. James (23:41):
Dr. Pelman. It's important to remember that in rural communities, also, the family is also taking care of the patient in the hospital, Likely delivering the babies in the hospital, in the nursing home, and actually even doing in the emergency department. That's a stark difference than what we have available today in our urban environments
Dr. Pelman (24:03):
And in the urban environment, the primary care physicians used to go to take care of people in the hospital. But it wasn't very efficient for them. They had to leave the office, travel, go back. And so in our current situation, at least in an urban environment, we now have hospitalists.
Dr. James (24:21):
Yes. And so it has been more efficient from many different perspectives, especially from the hospital perspective, to have a physician that's available all the time in the hospital who doesn't have to run out quickly and go back to their office. These larger health systems today I think are doing better jobs at communicating between the hospitalist and the primary care physician. That still remains an opportunity, though, to improve communication. There are actually studies under that are being done by actually internist, looking at the role of having a primary care doctor assist with the hospitalist in the hospital. And there are opportunities possibly for doing that even by telephone, where you can still have the benefits of having your doctor involved in care. And I think that's an area for future research and
Dr. Pelman (25:20):
Telehealth and telemedicine.*
*Telehealth and telemedicine: https://www.aafp.org/news/media-center/kits/telemedicine-and-telehealth.html
Dr. James (25:23):
Yes, absolutely. So telehealth is a strategy for actually even getting your care at home, but also then to improve communication across our specialty care environments and within the hospital.
Dr. Pelman (25:38):
If we were to design a perfect delivery system, what would you like to see as part of the most efficient and patient-accepted care team?
Dr. James (25:49):
Yes. I think the most efficient and effective one is one that is accessible, easily accessible for patients that delivers care to them when they need it at the right time, at the right place, and with high quality. In order to do that, we have to create an efficient and effective primary care system that is not a gatekeeper, but a gate opener to the high tech, highly skilled specialists that our healthcare system has, but ensuring that patients are getting to the right doctor at the right time. One of the challenges is if a patient doesn't have their primary care physician as their quarterback, and they're seeing a subspecialist who takes care of one very focused area of care, they may bring up concerns about other things. And that doctor is not as focused on those areas. There's a tendency to think, “Oh, but this is a doctor. They will know everything about this.” And I think it's important for patients to know that they need to come back to their primary care doctor when they have unanswered questions to just, again, look with fresh eyes and make sure that they're getting the right care at the right time at the right place. That's probably what I would recommend.
Dr. Pelman (27:23):
I will ask you just for one last piece of information. Many patients come in and they'll encounter a physician assistant or a nurse practitioner. And how has primary care incorporated the, we call them physician extenders but these are practitioners who are really linked to the practice, how have you incorporated them into the practice of medicine?
Dr. James (27:45):
Yes, they are. I think ideal members of the primary health care team, Many patients may actually have a physician assistant or a nurse practitioner as their primary continuity provider. I do think in the ideal setting of primary care, it is optimal if they are working with well-trained physicians so that we are taking advantage of the full resources of the primary care environment.
Dr. Pelman (28:19):
So in summation, the bulletproof young man who has nothing wrong, he says, “Why do I need a doctor?” Your advice would be?
Dr. James (28:29):
Exercise, eat healthily, come in and see your family doctor to get your cholesterol checked and your blood pressure checked. So for, for that young, healthy guy who says, “I'm invincible.” I would caution that we don't always know how invincible we are, and you may be overweight and not know it. Your blood pressure may be up. That is the silent killer. Your cholesterol may be high. For those reasons, I do think at some point in your twenties, you need to see your primary care physician, and they need to do a thorough assessment of your health risk. In that way, we can assure that you can achieve your life goals by avoiding premature death and disability, by achieving your goals of being the best person you can be, and living a long and healthy life.
Dr. Pelman (29:31):
Well, Dr. James, thank you. We truly appreciate your taking the opportunity to give us some perspective of having a primary care physician and family. Thank you very much.
Dr. James (29:43):
Thank you, Dr. Pelman.
Dr. Pelman (29:46):
This completes another podcast chapter of the Washington State Urology Society’s Original Guide To Men’s Health. This is Dr. Richard Pelman reminding you to take care of yourself. Washington State Urology Society wishes to thank all contributors who volunteered their time and knowledge. The information presented is the opinion of the speakers. The society also wishes to think Shawn Fox for his invaluable technical assistance, music theme, San Juan Bell’s, written and performed by Dr. Dave Whiting. The podcasts are the property of the Washington State Urology Society. Reproduction and use without the express consent of the society is strictly prohibited. For more information about men's health visit wsus.org, or visit your physician or care provider.
Episode Summary: Men have a higher risk of death at all ages than women, does this mean you? Could be? Guys often tend not to take very good care of themselves, because they’re busy taking care of everything else. Plugin here to a wealth of information from experts in men’s health, available at your fingertips. Let the Original Guide to Men’s Health help you beat the statistics and live a long healthy life. Episode Guests: Kathleen A O’Connor Ph.D., Professor Emerita, Department of Anthropology, University of Washington, author of the Health Initiatives in Men Study.
Kevin Loughlin, M.D., Senior Surgeon The Brigham and Women’s Hospital, Boston, MA Emeritus Professor of Surgery, Urology, The Harvard Medical School. Board Members of the Washington State Urology Society: Una Lee, M.D. Staff Urologist Virginia Mason Medical Center, Seattle, WA, Jeffrey Evans, M.D., Urologist with Frankel, Reed and Evans, Burien WA, Ken Berger, M.D., staff Urologist Lourdes Medical Center, Pasco, WA, Scott Van Appledorn, M.D. staff Urologist Evergreen Hospital and Medical Center, Kirkland WA, Mihai Alexianu, M.D., Urologist with Spokane Urology. During This Episode We Discuss: * Stories and experiences of why living healthier and taking care of yourself make sense. * Most of us realize that good performance comes from good maintenance. Your body is not different. If you take care of your car and maintain it, why not do the same for your body? * For men of all ages, knowledge about your health and how to stay healthy is true empowerment. * Listen and learn about health maintenance and prevention strategies, covering many health conditions and issues. * Follow episodes with renowned experts who review timely and important information on relevant topics, so that you can embark on a journey towards better health!
Quotes (Tweetables): “One of my biggest frustrations is when men come to see me too late.” Scott VanAppledorn, M.D.
“ When I council my male patients on health issues, I like to tell them that promoting their overall health promotes their urinary health, sexual health, fertility, prostate health, bladder health."
"Good sleep, good nutrition, exercise, and stress management are really key factors that promote men’s health.” Una Lee, M.D.
Recommended Resources: * The Partnership for Male Youth * American Urological Association Male Health Checklist * Men’s Health Network * Zero - The End of Prostate Cancer * US Too International
Episode Transcript: Dr. Pelman (00:06):
A baseball game, a day in a park with friends and family, fishing in a remote stream, work. travels providing for loved ones or heading out for adventures, whatever you do, whatever you enjoy, you need your health. The Original Guide to Men’s Health is presented by the Washington State Urology Society to help take you through the steps necessary to get the most out of life. If you have invested in a retirement plan for your future, why not invest in your body? After all, it makes better sense to retire healthy and enjoy your future. These podcasts are a guide for how to take care of yourself. If you take care of your car and maintain it, why not do the same for your personal machine, your body? If you know you should but haven't yet, the information in these podcasts contains some easy recommendations for where, when and how to get started. Follow the podcast as we explore men's health with renowned experts and embark on a journey towards better health. In this episode, you will hear two interviews. The first being with Dr. Aaron Spitz and the second being with doctors, Larry Goldenberg and Dr. Martin Miner. All of these esteemed doctors will talk about the importance of men's health. We hope that you enjoy the first episode of our podcast.
Dr. Pelman (01:48):
It's my pleasure to welcome Dr. Aaron Spitz, the author of The Penis Book. Dr. Spitz is on voluntary faculty at the University of California Irvine- Department of Urology. He is in a very busy practice in Laguna Beach where he specializes in men's sexual health and fertility. He represents the American Urological Association at the American Medical Association meetings as a delegate for the American Urological Association and is well-versed in health policy. But more importantly, Dr. Spitz is an expert in men's health, particularly with issues regarding fertility, testosterone replacement therapy, and sexual function. As the author of The Penis Book*, he has tried to enlighten the public regarding issues that many men have concerns about, but don't like to discuss, enlighten us about what he thinks male health represents. Dr. Spitz, thank you for joining us.
*The Penis Book: https://www.barnesandnoble.com/w/the-penis-book-aaron-spitz-md/1128322694
Dr. Spitz (02:44):
Oh, it's my pleasure, Richard. On the question of what male health represents, I mean, at its most basic form, it's all of the health conditions that may be unique to men as opposed to women. Certainly many of the health issues that people face affect both men and women, but some are definitely unique to men. And those typically involve the male reproductive organs, which includes the prostate, the testicles and the penis, and other effects from those organs throughout the body such as the effects of testosterone* on the body, and the effects of the prostate on the urinary tract and on the kidneys. So these are some of the aspects that are so particularly obvious to men's health that are physical, but there are also aspects of men's health that involve well-being and address the particular challenges and stresses and responsibilities that men in our society face. And so I think men's health can be a very comprehensive issue as well.
*Male reproductive organs: https://my.clevelandclinic.org/health/articles/9117-male-reproductive-system#:~:text=The%20male%20reproductive%20system%20is,function%2C%20as%20well%20as%20urination.
**Testosterone: https://www.urologyhealth.org/urology-a-z/l/low-testosterone#:~:text=Testosterone%20is%20the%20male%20sex,deeper%20voice%2C%20and%20muscle%20strength.
Dr. Pelman (03:53):
So if you had a message for our audiences to what you would like to see men do to participate in their healthcare, what would it be?
Dr. Spitz (04:01):
Well the single biggest thing would be to pay attention to their health care because so many men are pulled in so many different directions, with so many responsibilities, that the last person they actually take responsibility for is themselves in a personal way. They're taking care of families; they're taking care of occupations; they're in charge of other people's well-being in many cases; but they neglect their own. And so often the case is that when I see a guy in my office, it's because he was dragged in there by a significant other. And I'd like to see men bring themselves into the office because they're concerned about their own health and not have to be dragged in reluctantly.
Dr. Pelman (04:47):
It’s said that men's health is family health, and that men need to be able to be healthy to provide. I think part of your motivation for authoring a book was to provide education to the population that needs to receive the care so that we have educated consumers. They can read. They can know what they should be doing when they come to see the physician, what concerns they might have. Was that part of your motivation for writing the book?
Dr. Spitz (05:14):
Yes, that was definitely a part of my motivation. I wrote this book with the mindset that if I could go on a retreat with my patient, spend two or three days and give them everything I know about their condition in a way that they could definitely understand and apply. That's what's in this book. So when I see a patient, I typically have about 15 minutes with them. I still do my very best to impart on them the essential information they're going to need to know to understand their condition and to begin therapy if they need therapy, or be reassured if they need reassurance. But 15 minutes is a very short window. And a book like this allows somebody to really dig in and understand the why, and the how, and the what to do. And the other motivation I had in writing this book is there's a lot of misinformation out there. And there's a lot of anxiety and fear and concern about conditions that really are normal, or that can be straightforwardly managed. And this book is intended to reach those people who wouldn't have come in in the first place, but would have continued to be under a cloud of confusion. And this book is for them as well.
Dr. Pelman (06:35):
I think one of the common themes that we continue to see is that men are driven by particular issues. If they have chest pain, they may finally show up to the emergency room. They may have blood in the stool and finally show up for colon screening, but we would like to have men enter before anything happens. And we would like to educate them regarding preventative measures. I think we have seen men enter the healthcare market because of erectile dysfunction, and it's been a great draw. And as we realize that erectile dysfunction is tied to a lot of other issues that men may be suffering from, such as diabetes, high blood pressure, cardiac disease, I think it is important for us to enlighten men that the penis is part of the body and that there are links to potential other issues that may be more important to address immediately. When you see a man who just comes in because of erectile dysfunction*, do you take the approach to educate him about the other systemic implications?
*Erectile dysfunction: https://www.mayoclinic.org/diseases-conditions/erectile-dysfunction/symptoms-causes/syc-20355776
Dr. Spitz (07:35):
Yes. When men come in, they often say, “I don't know what's happening,” or, “I don't know why this is going on.” But then they described difficulty getting erections or keeping erections, And they're confused. I look at these guys and in many cases, it's very obvious why they're having problems with erections because I can look at them and see that their general health is poor. But they don't understand that there's a link between their general health and their erections. The erection really is a window into one's total health because so many different processes have to be working properly in a coordinated matter for that erection to occur. You have to have a healthy cardiovascular system. Your blood vessels have to be open and healthy. Your heart has to be pumping strong. And then you have to have a working neurological system. Your nerves have to be intact.
Dr. Spitz (08:34):
All the pathways have to be uninterrupted and conducting properly. Your brain has to be in good health because much of what happens, how it starts in the brain. And you have to be free of a variety of toxins and medication because there are many medications and toxins that impair your erections. So many men come into my office with other medical conditions that require medications, and both the conditions, such as diabetes or high blood pressure, and the medications for some of those conditions, such as certain blood pressure medications, are impairing their ability to have the erection. So global health is reflected by erectile function. And once I explained to my patient the reason you're having trouble with your erections is because of this condition or that medication. Or this exposure affecting your cardiovascular health, your neurological health, and also your hormonal health, testosterone, is a big factor. Once I explained that to the patient, then they understand what's going on. And then when I get into what can we do about it, there's some engagement there.
Dr. Pelman (09:55):
When you see a man who comes in who perhaps has a simple issue of perhaps a kidney stone, he's young, he's 30, do you provide him with some insight into what things he should be doing for general health? Assuming he was in the emergency room, he has an established primary care, you're his first contact with the medical system and he's got his first kidney stone.
Dr. Spitz (10:18):
Yes. I'll often ask my patients if they have any family history of prostate cancer because that's something that's really not affecting them at that age, but they know if they have family history of prostate cancer in their father or their uncle, that this is something that they may yet face because they've seen it firsthand in their own family. And that I think wakes them up to the idea that your health is going to change down the line. And maybe there's some things to start thinking about now. Maybe there's some things you could do to improve your chances if it were. And I'll then explain to these young guys, whether it's because of a question about prostate cancer history, or it may be a question about their sexual function because more and more, we're seeing younger guys with some degree of erectile dysfunction.
Dr. Spitz (11:08):
It may just be temporary, maybe just be behavioral, but because our culture is so now tuned in to sexual function and that this is something that we can talk to our doctors about. Even the younger guys are tuned into that as well. But in either event, I use it as a starting point to talk about nutrition because nutrition is so important to so many aspects of our health, and it's actually really important to our sexual function. And it also is important to our risk of developing cancer, in particular prostate cancer. And I point out to my patients that the best way to eat, to maintain their cardiovascular health, which is also their sexual erection health and also to prevent prostate cancer, is to eat lots of vegetables. To go to the produce section of the grocery store and to grab as much different kinds, shapes, sizes, colors, and textures of vegetables as they might enjoy.
Dr. Spitz (12:10):
And to make that the main dish, and to really cut back or eliminate processed sugars. And it really diminish the animal product portions. And if they can get on a pathway of really chowing down on those veggies, the younger, the better. They're going to have really the best opportunity at preventative maintenance. Now, if they're already suffering from a condition, particularly my patients that aren't just 30, you know, my older patients, they can reverse some of their blood vessel disease. They can inhibit progression of prostate cancer, reduce prostate cancer risk even then. But diet is such a big, important part of one's health and loading up on those veggies is key. Also exercise. Exercise coupled with diet is important, but exercise without a good diet may not be as protective as people think. And then finally sleep. Getting a good night's sleep, we are learning, is increasingly important.
Dr. Spitz (13:13):
It's always been important, but we're just now realizing how important it is. Lack of sleep or interrupted sleep from conditions like sleep apnea for example, are linked to developing high blood pressure, diabetes, erectile dysfunction, low testosterone. I also caution my young men about taking testosterone supplements. Testosterone is a big ticket item on the media, and it's really not very long before you are solicited to get on some kind of a T-boosting formula or get on T itself. And young, healthy guys are often under the misconception that if they take testosterone, they'll go from good to better. And as we say in surgery, “Better is the enemy of good.” And in the case of testosterone, what they don't realize is that if they go on testosterone, it shuts their own normal production of testosterone off, and it shuts off their sperm production. So it's important not only to engage healthy practices, but it's also important to avoid very treacherous practices that are commonly available and commonly offered such as testosterone in young healthy guys.
Dr. Pelman (14:25):
Well, you have set up future podcasts for us. We plan to have a dietician speak about the best diet. I generally encourage patients about the Mediterranean diet as being a leading diet. We're going to have a sleep specialist talk about sleep apnea and its effects. And we will explore the other organ systems. Appreciate your time. Thank you.
Dr. Spitz (14:46):
Oh, it's my pleasure.
(14:51):
music
Dr. Pelman (15:02):
Let's review men's health. I'm fortunate enough to be sitting with Dr. Martin Miner and Dr. Larry Goldenberg. Dr. Miner is professor of family medicine with a call appointment to urology, and co-director of Men's Health Center, Miriam hospital at the Warren Alpert School of Medicine Brown University in Providence, Rhode Island. Dr. Larry Goldenberg is a professor of urological sciences, UBC, University of British Columbia in Vancouver, BC. He's chairman of the Canadian Men's Health Foundation*. I have known both Martin Miner and Larry Goldenberg for years, and have noted that they have been very early proponents of men's health. So for a perspective on generally why should we be involved in men's health, I'm going to first address Dr. Miner. Martin, give us a little background about why men's health is important.
*Canadian Men’s Health Foundation: https://menshealthfoundation.ca/
Dr. Miner (15:56):
Well, the Commonwealth Study* was the first report released by the Commonwealth Fund on the discrepancy of men's health care needs in the late 1990s in the U.S. And it showed that men on average live less than seven years than their female cohorts. They wait as long as possible to see the doctor for their more acute medical problems. They over twenty-five percent of men failed to have a primary care provider and get appropriate screenings. And it was believed that there are barriers to obtaining their healthcare needs for many men, especially those men who are minorities and have different sexual practices. So the concept of developing a field of men's health and an area of medicine that was predominantly done by men was almost foreign in its concept. The growth of women's health evolved because there was a dearth of women's health care needs and assessments and therapies, and thereby men's health was kind of neglected.
*Commonwealth study: https://www.commonwealthfund.org/publications/fund-reports/2000/mar/out-touch-american-men-and-health-care-system#:~:text=New%20research%20based%20on%20a,to%20stay%20in%20good%20health.&text=One%20of%20four%20men%20reported,his%20health%2C%20the%20survey%20showed.
Dr. Miner (17:31):
We always focused on pediatrics on children's health; we focused on young adults. But we neglected the middle-aged and growing man who failed to get appropriate healthcare needs and whose family was quite dependent on him for both income and generational growth and nurturance.
Dr. Pelman (17:57):
Now, I'll ask Dr. Goldenberg the same question about how did you happen to focus on men's health? And what needs did you see that were unmet?
Dr. Goldenberg (18:07):
Public health studies have shown that 70% of chronic illnesses in our populations can be prevented by upstream preventative care measures, such as changing your health behaviors. And many of the risk factors that are associated with chronic disease are predominant in men: smoking, lack of exercise, alcohol, lack of sleep, excess stress, and so on. So we, in Canada, we felt that we had an opportunity through a public health strategy to try to change the downstream health of men perhaps one at a time by encouraging them to change their lifestyle habits.
Dr. Goldenberg (18:48):
Our motto is “Don't change much.” We encourage men to modify their behaviors and our, and we really are targeting the younger men because I think that's where the opportunities are. Men in their thirties or forties who are too busy with their careers and families to pay attention to themselves, so encouraging them. So we see that as a predominant issue in men's health in addition to all of the facts that Marty just stated. You know, the impact is not just physical on the man. It's also mental and it has social impacts on our societies, on our communities. It has economic impacts on our communities, our governments. The expense that chronic illness represents is huge. And we've done economic studies showing that just minor modifications can have huge impacts on the dollars that are needed to be spent by our governments.
Dr. Goldenberg (19:44):
And the last point I'll make is that men's health really should be thought of as family health. In that it's not just about men. We're not in a competition. This isn't a victim, a competitive victims discourse. It's not about men versus women versus children versus minority health. I think it's all important, but men fit into this puzzle and are very much part of what we need to address. So I think in 2018, it's incumbent on us as healthcare providers to address this in the best way that we can.
Dr. Pelman (20:16):
And I see that you have a website that can be accessed?
Dr. Goldenberg (20:20)
Yeah. So our website is dontchangemuch.ca. And, currently, we have 70,000 subscribers who receive a weekly health message. We have almost 200,000 Instagram followers. And so the message is beginning to spread across the country and Canada. This is a national NGO.
Dr. Goldenberg (20:41):
It's not about delivering health care to a man in a particular city or town. It's about addressing preventative healthcare through awareness through education, both professional and the public education. I point out that our doctors are not well-trained in our medical schools on issues that are particularly in the men's health domain. And that's something that I think we need to address as well as we go forward.
Dr. Pelman (21:11):
I saw this. You have an endorsement from the prime minister of Canada?
Dr. Goldenberg (21:15):
Yes. Yeah. We have an annual men's health week in Canada and he did a little video clip for us to endorse what we're doing. It had something like a million and a half views.
Dr. Pelman (21:29):
It's wonderful to see a spokesman like Justin Trudeau endorsing men's health.
Dr. Goldenberg (21:33):
Yeah. Yeah. It's, it's important. And, you know, governments across the country are paying attention to it. British Columbia, our government has given us substantial dollars to help move our initiative forward. We have funding from the federal government, as well as now from the province of Ontario to expand our programs in Ontario. And we're currently negotiating with Alberta and Nova Scotia. So I'm hoping that over the next few years, we will be a true national organization, well-funded to provide, and you know, it's all about social media, getting the message out. These 30 year olds, they're not listening to old guys like me. If I go to give a lecture they're looking at their Twitter feeds and their Instagram accounts and so on. And that's where the message has got to go. And it costs money, and you need a talented group of people to actually work on this. And, and so that's what we're focusing in Canada.
Dr. Pelman (22:21):
And on the other end of the spectrum, Dr.Miner. You're actually running a men's health clinic where you're actually seeing individual men. And tell me a little bit about that approach.
Dr. Miner (22:34):
Well that evolved from the release of Viagra, or sildenafil*, in the late nineties to treat erectile dysfunction. And it was clear that with this release of a medication for the treatment of erectile dysfunction, that men were coming into our offices. I'm a primary, I was a primary care physician at that time, a family doctor. And I was seeing men for the first time who were interested in treatment, but not necessarily in the advancement of their health or in the discussion of their lifestyle needs and overall health. But it became a moment, what I call a teachable moment, for men that you could educate them regarding the cause of their rectal dysfunction, which is always a bit psychological. There's always an issue of performance, but there's also the cause of vasculogenic or erectile dysfunction due to impaired or less vascular flow into the penis. And that happens for various reasons, but many of them are traditional heart or cardiovascular risk factors including elevated blood pressure, obesity, disrupted sleep as Larry spoke, impaired sleep due to obstructive sleep apnea, which is sleep disorders are so poorly diagnosed, alcohol use, excessive substance use and other lifestyle habits.
*Sildenafil/Viagra: https://medlineplus.gov/druginfo/meds/a699015.html
Dr. Miner (24:26):
So it was a real opportunity to sit with these men, try to determine where they are in their lives and their careers, and also what their lifestyles were like and then perhaps make an alteration in their lifestyles that might lessen those cardiovascular risk factors. Because shortly after the release of Viagra, we realized that erectile dysfunction is a sentinel marker or a marker for cardiovascular events like heart attacks and strokes. So if we could possibly reduce one heart attack or stroke in a man at, up in middle aged or early middle age. We could be doing something very, very significant. And that's what we wanted to direct and focus. We also ended up caring for men with testosterone disorders, hormonal disorders, testosterone deficiency, men with BPH or urinary symptoms of lower urinary tract symptoms. These are all men who needed to have be able to articulate their concerns about their health, but we're not comfortable doing so in the present medical system.
Dr. Pelman (25:47):
I have always thought that the introduction of the erectile dysfunction medications was one of the great moments of bringing men into healthcare. Guys tend to be reticent about entry into the healthcare system. I think guys in the sense want to hunt, and that would be applied to modern terminology. They work, they want to support families, they're responsible, and they tend to push care of themselves into the background.
Dr. Goldenberg (26:15):
Absolutely. So you know, when you see a man, if you were or urologist and you're doing a vasectomy on a 35 year old man, there's an opportunity to talk to him about that his grandfather had colon cancer. You know, does he smoke? And to give them information and let her talk to him, or actually hand out pamphlets or information about how we could change and modify his health, it's an opportunity that as physicians, we should not overlook or miss.
Dr. Goldenberg (26:40):
So it’s I think that's something, again through different organizations, we should be disseminating this information directly to the public and also through practitioners to the public.
Dr. Miner (26:53):
And I think it's also an opportunity as you see these men to delve into whether they're happy or not with what they're doing. They spend 40 to 60 hours a week working, but not really necessarily understanding what brings them happiness beyond perhaps but beyond their families. Sometimes they're so fatigued that they can't even enjoy those moments. So if you ask them what they do on the time that they're not working, they have trouble. They don't really get together with other men. They don't form. They're not going to book clubs, and they're not doing things in conjunction with other men. So you ask them for their activities outside of work. What do they like to do? What are their hobbies?
Dr. Miner (27:38):
Many men struggled to find those things that sustain them, to allow them to have a broader, happier life. And you almost have to give them permission to be happy, to take care of themselves and be happy.
Dr. Pelman (27:52):
So we have an emotional health as well as physical health that we need to pay attention to. If we were to design a healthcare delivery for men, that would certainly be a component?
Dr. Goldernberg (28:02):
Absolutely. And you know, we can't change the world overnight. So we have to accept the fact that it's going to take time. And we can address the, you know, the 30 year old, executive 50 year old executive. But there were other subpopulations that we have to attend to as well. You know, in our country in Canada, we have a large indigenous population that require, you know, they have special care vehicles.
Dr. Goldenberg (28:27):
I mean, it's, you know, we have the in Vancouver, for example, the downtown east side. We have, we formed clubs for men. So a lot of these men are just lonely and they don't know which way to turn. They want to get back to their families. So we need to help them in very, you know, dealing with a lot of the very basics of life so that they can get better. We have addicts. We have alcoholics. We have so many different subpopulations. And, you know, like some days I feel like knocking my head against the wall because it's just like how are we going to make progress with this all? It's just a matter of one man at a time.
Dr. Pelman (29:03):
So in reviewing an approach to men's health, as a general interview, our goal in these podcasts are develop each of these themes as an individual podcast. And so we will be approaching testosterone. We'll be approaching cardiovascular health, gastrointestinal health, emotional needs, and emotional health. We'll be talking about addiction. We'll be talking about appropriate diet. We'll be talking about appropriate exercise. But right now, if I was a 30 year old man and I'm going, “What should I do to take care of myself?” What would be the most important thing that you would recommend? Dr. Miner first.
Dr. Miner (29:39):
I would, I speak to the men of that age about developing good health habits and health screenings that 30-year-old man should be thinking about. STDs. He sexually, he may or may not be sexually active but he's beginning sexual activity. He's eligible for an HPV vaccination, which he 10 years ago, he was not. HPV is a significant burden to causing penile cancers, oral cancers and cervical cancers. So it's very important to think about STD and preventative, safe sex. It's also very important to lay the germinal basis for exercise. 40% of men are sedentary in the U S and they don't exercise at all. Often, they go to college and they stop exercising. It's very important that they exercise a moderate intensity exercise, almost two to three hours per week. And they, they stop at 30 and then they become more obese.
Dr. Miner (30:50):
They also have to eat better, and many men have very poor diets. So we're, you're going to have modules on all of these. Nut it's the idea of raising their consciousness about how much alcohol they consume, about their sleep, about their diets, about exercise, all of these preventative lifestyle issues including some spirituality. Something that gives them some peace.
Dr. Pelman (31:17):
Would you recommend that a 30 year old establish primary care?
Dr. Miner (31:22):
Absolutely. 30 year old needs to have someone that they can see and trust on a base, on a regular basis even when they have that first. If they're a new parent, when they have that first life insurance physical, that's another moment that's perhaps teachable. They need someone who kind of can model this for them and create a path that's easy for them to follow.
Dr. Pelman (31:47):
I think that's a key is the ease to which to enter the system. Dr.Goldenberg, your thoughts?
Dr. Goldenberg (31:53):
You know, in our society we have a shortage of primary care doctors. And many 30 year olds either can't access a primary care doctor, or don't want to. They don't have the time to. But what they do have the time for is to access a computer for 10 or 15 minutes. And we've developed a tool, a validated tool called you check. Y O U C H E C K*. It's on our dontchangemuch.ca website. And in 10 minutes, by answering approximately 30 questions about lifestyle, eating habits, exercise, sleep, and so on, it will, the algorithm will give an individual man what his risk factors are for six prominent male diseases including cardiovascular disease and erectile dysfunction. So if you’re a 35 year old, 30 or 35 year old, you run through this and it says, you know what?
*Youcheck: https://youcheck.ca/
Dr. Goldernberg (32:43):
You've got a high risk of a heart attack or a stroke, it's up to you. But you know, you might want to look into it a little bit to see what you can do to prevent that. If this tool says, you know, you have no risks, you are at low risk for all these diseases, well, then carry on. But come back in five years and do it again. So because not, you know, not every man is unhealthy. We have a lot of healthy 30 year olds out there. But there are a lot. And in Canada, our statistics show over 50% of men have one or more of the risk factors that have been discussed here. So and the last thing I'll say is that I'm surprised as a urologist, when I see men in their sixties or seventies, how many of them don't know their family history.
Dr. Goldenberg (33:24):
Now maybe they're adopted, but for the most part they're not. They just, when they were young and their grandfathers were alive they didn't ask their grandfathers, you know, “What are we made of? What's in our family? What you know, what did your father die of? And what did my aunt and uncle or whatever die of?” You know? So learn your family history, learn what you're made of.
Dr. Pelman (33:44):
In our other words, find out what your potential risk factors are through family history. It was unfortunate that that generation probably in lots of situations didn't know, didn't talk about it.
Dr. Goldenberg (33:55):
But men are not asked about what they do to relax. Those are simple questions that can allow change and forward movement if just given, just articulated. So it's, and that really cements that relationship so that it's not considered a meaningless visit.
Dr. Pelman (34:18):
Well, that's a great segue into the podcast that we'll be presenting. And we'll be featuring chapters so that men can be educated regarding various health issues prevention and come equipped to those visits with their practitioners, knowing what questions to ask and already having perhaps some information on solutions. So thank you both. I appreciate your time.
Dr. Pelman (34:46):
This completes another podcast chapter of the Washington State Urology Society’s Original Guide to Men’s Health. This is Dr. Richard. Pelman reminding you to take care of yourself. Washington State Urology Society wishes to thank all contributors who volunteer their time and knowledge. The information presented is the opinion of the speakers. The society also wishes to thank Sean Fox for his invaluable technical assistance, music theme San Juan Bells written and performed by Dr. Dave Whiting. The podcast are the property of the Washington State Urology Society. Reproduction and use without the expressed consent of the society is strictly prohibited. For more information about men's health, visit wsus.org or visit your physician or care provider.