“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.”
“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.”
REFERENCES: (1) Haskell WL, et al: The effect of cessation and resumption of moderate alcohol intake high-density-lipoprotein subfractions. NEJM 1984; 310:805-810. (2) Trevithick CC. Shaken, not stirred: bioanalytical study of the antioxidant activities of martinis. BMJ 1999; 319(7225): 1600-2. (3)“10th Annual IFM Symposium: The Heart on Fire: Modifiable Factors Beyond Cholesterol” May 21-25, 2003 . The Institute for Functional Medicine www.functionalmedicine.org. (4) The Guide to Clinical Preventive Services: Report of the United States Preventive Services Task Force. Int’l Medical Pub; 3rd edition Jan 2002. www.ahcpr.gov/clinic/uspstf/uspsprca.htm. (5) Kao TC, et al: Multicenter patient self-reporting questionnaire on impotence, incontinence and stricture after radical prostatectomy. J Urol 163:858, 2000. (6) Mercola, Joseph: The No-Grain Diet. Penguin Group Limited, Chicago ; 2003. www.mercola.com. (7) Muir, Charles and Caroline: Tantra: The Art of Concious Loving. Mercury House, San Fransisco; 1989. (8) Holstein , Lana: How to have magnificent sex. Crown Publishers, New York ; 2001.