A Holistic Approach to Men’s Health
By Kenneth N. Woliner, M.D.
“My
wife made me come.”
It
was no joke. Bruce hadn’t been to a doctor in
over ten years. He shook off most of his aches
and pains, preferring to take over-the-counter
medicine than miss a day’s work. “My father
had a heart attack at 42 and since I’m now 39,
I guess
Sandy
’s concerned a bit. I tell her not to worry,
but she still does. I am in great shape. I work
out at the gym and play basketball at the YMCA
two days a week. I’m fine.”
Men
don’t like seeing doctors. They think their
physician will find something wrong on a lab
test or something, and then be forced to take
pills the rest of their life. And when the pills
cause side effects, they start to feel sick when
they felt healthy before. Even when something is
wrong, many men would rather not know about it.
Being in denial is often preferred to feeling
vulnerable and weak. “I’ll make this as
painless as possible. I am going to give you a
complete physical that should put
Sandy
’s mind at ease. If anything comes up, be sure
to ask me; you might as well take advantage of
your time here.”
Other
than his father’s heart attack, Bruce’s
history was rather unremarkable. He didn’t
smoke, had normal blood pressure, and had no
family history of cancer. There were some items
on his review of systems checklist, however.
“Low
back pain? Muscle spasms?”
Bruce
was defensive. “Well who doesn’t have that?
I’m a lawyer who sits at a desk all day. And
when I play ball I sometimes get a charley
horse. No big deal. A little Advil and I’m
good to go.”
“Trouble
maintaining an erection?”
“Well,
I’m not as firm as I used to be and …”
Bruce hesitated. “This is a little
embarrassing to say, but I don’t know if I
satisfy my wife.”
“Bruce,
what you say here stays between you and me. I
don’t even have to write it down if you
don’t want me to. What’s going on?”
“Okay
then. I’ve always been a little quick on the
draw, if you know what I mean.” I nodded. “I
love my wife, but at the end of the day I’m
tired. And after we have sex, I’m ready to go
to sleep, but I can sense her frustration.
That’s all.”
“There
are some things we can do for these concerns,
but how about we finish our exam so I can give
you a clean bill of health.” A routine EKG
showed a slight abnormality. “I don’t think
your heart is damaged, I believe this is caused
by how muscular you are. I want you to make a
‘shrinky-dink’ sized copy of your tracing
and leave it in your wallet next to your
insurance card. If you ever happen to end up in
an ER, I don’t want the docs to freak out
about something that was always there.
“I
think it would be a good idea to check your
cholesterol among other things.”
“No
need doc. I gave blood a month ago and my number
is down to 196.”
“That’s
fine, but the truth is that most people that
have heart attacks have normal cholesterol. The
type of cholesterol you have is more important.
Triglycerides and LDL are bad, like chicken fat
that clogs your arteries. HDL is like Drano, and
cleans them out.”
“That’s
why I switched to red wine.”
“Unfortunately,
it’s a myth that wine helps your heart. There
is evidence that suggests it raises a
sub-fraction of HDL that is not that protective
at all. If there is money to be made selling
something, you can create research to prove your
point. I saw one article that suggested
the real reason James Bond was indestructible
was that he ordered his martini’s “Shaken,
not stirred.”2 It preserves the
anti-oxidants.”
“Humph.”
“There
is a more sensitive cholesterol test that I send
out to a lab in
Alabama
that will tell us if the numbers are as good as
we hope. I am also going to test other
things such as CARDIO CRP and HOMOCYSTEINE.”
“I’ve
heard of these on the news!”
“That
makes you more in the know than some
cardiologists. These tests are more
predictive of heart attacks than total
cholesterol.” 3
“Hey
doc, are you going to test my PSA?”
“Actually,
no. The PSA has been used to screen for
prostate cancer but is falsely elevated for many
reasons, including the rectal exam I just did. The U.S. Preventive Services Task Force does not
recommend routine screening as false positives
scare men into getting rectal ultrasounds and
prostate biopsies.4 Most men die with
their prostate cancer, not from it. For
most people, surgeries and radiation treatments
haven’t been shown to save lives but do cause
impotence and incontinence 65.6% and 88.4% of
the time respectively.” 5
“I
think I’ll skip the anal probe for now.”
“Other
than a baby aspirin and a multivitamin (without
Iron), I’d say you’re doing everything right
to protect your health. Now let’s make
it so you enjoy your life better by improving
your athletic and sexual performance.”
“Pecs
and Peckers.”
“Nicely
put. How would you like to jump higher and
not pull any more muscles?”
“My
basketball team is second in the league.
I’ll take any edge I can get.”
“The
first thing is to improve your diet to lose some
fat weight but preserve your muscle. Stick
with a lower carbohydrate diet such as “The
No-Grain Diet”, but you can add up to 25 grams
of carbohydrate per hour before and during your
workouts to give you the energy you need.6
½ gram of protein for every pound of body
weight divided six times per day, and be sure to
drink lots of water. Trim the fat off your
meat, chicken without the skin.” Bruce
was taking active notes.
“Now,
“The No-Grain Diet” is a bit strict, and it
has pretty complicated recipes to allow you to
have similar foods to what you’re used to
having. Most of the men in my practice
rather have an executive chef service such as
‘Zone-to-Go’ make meals for them, or they
will prepare foods with 5 ingredients or less.
Preparing foods ahead of time (or at least doing
some prep work ahead of time) allows you to have
the foods you want to eat, on hand. There
is no need to quickly reach for a bag of potato
chips when you have great tasting healthy food
immediately available.
“Breakfast for example could be 2 scrambled
eggs (omega eggs or Just Whites if you are
worried about cholesterol), ½ can of
Publix mushrooms, ½ of an organic tomato
(you may dice a tomato ahead of time and put
into two separate Tupperware dishes so you can
cook as fast as the people on TV), all in a pan
that has PAM no-stick on it. You can make
a protein smoothie by combining 9 ice cubes, 9
oz water, 9 oz soy milk (not the Silk that has
extra sugar in it), 2 spoonfuls of Smucker’s
Natural Peanut butter, one handful of Quaker
Oats (natural – from the cylinder carton –
not the artificially sweetened instant stuff),
protein powder, and perhaps some cinnamon,
nutmeg, or vanilla extract to taste.
“Don’t say that you can’t bring lunch to
work. Fred Flinstone did it, and he worked
on top of a dinosaur! If you cook all your
meals on Sunday while watching the pre-game show
before the football game (turn up the sound so
you can hear the TV while in the kitchen), you
can put lots of great meals in your freezer and
fridge for the week. Make sure you have
enough Gladware and Ziplock bags to store
everything in. Preparing your dinners the
same way – is also a good way to not eat so
late at night. I leave extra dinners in my
fridge at work, so in case I stay late, I call
my family to tell them I can’t make it, but
eat ‘on-time’ at
6 pm
. Skipping meals causes your body to
destroy all the muscle you build when working
out at the gym and eating right before bedtime
causes all those excess calories to turn to fat.
“You’re
not as flexible as you could be, and that limits
your jumping ability, agility and speed. Do this stretching video daily, and for the
muscles that are real tight, stretch for 5
minutes every hour. Getting an egg timer
to remind you is a good way to break up your day
at work.
“Basketball
is great aerobic exercise for two days a week,
but you may want to add “Interval Training”
one day a week to increase your speed and
endurance. I want to change your weight
training regimen, I think you’re doing too
much.”
“How
can I get stronger if I lift less weight?”
“The
problem is, you’re not getting all the
benefits from your current workouts because
you’re not giving your muscles a chance to
rest. You need at least 48 hours off to
get the maximal effect from weight training. Cut back strength training to three days a
week, MWF, alternating upper and lower body
workouts. Every month vary your routine to
prevent your muscles from adapting and consider
drop-sets to combine toning with muscle building
exercises.”
“That’s
six days, what do I do on the last one?”
“You
rest. I don’t want God to strike you
down with a muscle injury.”
“Will
do. Hey doc, do you have any samples of
Viagra?”
“Viagra
does improve erection strength for many men, but
how about we find out the cause of your
difficulties rather than merely covering up
symptoms? Otherwise, your condition could
progress to where even Viagra won’t work.
“The
biggest causes of Erectile Dysfunction are
smoking, hypertension, high cholesterol, and
diabetes. The first three don’t apply to
you, but I want to screen for subclinical
diabetes with a better blood test called the
HEMOGLOBIN A1C. Anything over 5.0 is high
normal and I believe it should be treated.”
“Would
Viagra make me last longer? Right now I am
lucky to go two minutes before I lose
control.”
“Unfortunately,
no. Viagra won’t prevent premature
ejaculation. Some doctors prescribe
antidepressants such as Paxil, which help delay
ejaculation, but can exacerbate the erectile
dysfunction you already have.”
“So
what can I do then?”
“First
you should realize that most American men
ejaculate within two minutes. You’re
normal.” Bruce shook his head in
disbelief. “But if you do want better
control, consider getting a book or videotape on
Tantra.7 It will describe techniques
to increase your staying power, and there are
some exercises that you and your wife can
practice together. I have a feeling,
however, this alone won’t solve the problem
with your sex life.”
“What
do you mean? You know how they say that
men only care about T&A, but it’s not
true. I really love my wife. I want
her to enjoy having sex with me. The best
sex we had was when we were first married and I
could tell that she was excited about making
love.”
“Exactly. But if it is her satisfaction you are shooting
for, why don’t you find out what she really
wants?”
Bruce
shrugged, “Who could tell what a woman really
wants.”
“Well
for one thing, they don’t like monotony. Your lovemaking sounds as boring as a train
schedule. Two minutes of kissing, two
minutes of fondling, two minutes of intercourse
and two minutes later, you’re asleep.”
Bruce
whimpered, “It’s worse, I’m always on
time.”
“Don’t
look so sullen. It’s not that bad. There are many things you can do to improve your
sex life.”
Bruce
perked up a bit. “Like what?”
“When
my women patients tell me what makes their
lovemaking great, they almost always say, “I
know he cares for me, and I love him.”
Put some thought into it and show her that you
care. Buy Sandy
some flowers for no other reason except that you
love her. Find ways to be spontaneous. Light a candle that gives off her favorite
scent. Ask her where she likes to be
touched and how. If she is too shy to tell
you, have her read the book “How to have
magnificent sex” written by Dr. Lana Holstein,
director of Women’s Health at the Canyon Ranch
Spa.8 And don’t just roll over when
you’re done. Take some time to listen to
her and help her glow.”
“This
is great. I really want to make my wife
happy, and if this works, I’ll have better sex
too. For more reasons than one, I’m glad Sandy
made me come to see you.”
Dr.
Kenneth Woliner is a board-certified family
physician in private practice in
Boca Raton
. Though he often recommends vitamin
supplements, he does not sell them due to
conflict of interest concerns. He can be
reached at Holistic Family Medicine, 2499 Glades
Road, #106A, Boca Raton, FL 33431; 561-620-7779.
knw6@cornell.edu
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