Let’s Talk About Men’s Health

Cami Smith: Welcome to Centra Scripts. Here, we talk about health, wellness, and practical tips for your everyday life. I'm your host, Cami Smith.

We're so thankful that you've joined us today on Centra Scripts. I am here with Robbie Price, who is a nurse practitioner at Centra Health, and we are going to be digging in on men's health today. And so you have a perfect perspective as a man, as a nurse practitioner, you are interacting with men on a daily basis who are coming to get checked up, but not as often as women. And so for the month of June, we want to dig in a little bit to find out why? Why do women tend to go to the doctor more than men or what is keeping men from digging into their health and taking better care of themselves. So first thank you. Thank you for being here.

Robbie Price: No, thank you for having me. I'm excited.

Cami Smith: Yeah.

Robbie Price: This will be fun.

Cami Smith: So tell me a little bit about yourself.

Robbie Price: So I am from, I've been at Lynchburg for about close to 25 years. I've worked at Centra since 1997, so I've been a nurse and then I went back and got my nurse practitioner degree. And so, I started off in cardiology. I've had some administrative roles, but more recently I've been in the urgent care for about the past year and a half. So that's been very eye opening as I've gotten to see a bunch of different patients and different complaints and it's been very educational.

Cami Smith: Okay. So you're out at the urgent care here in Forest?

Robbie Price: That's correct.

Cami Smith: Okay. All right. Wonderful. So we're going to just dig right in, because I want to make the most of our time together and I really want to hear your perspective. And so in your experience, why do you think that men do not tend to come to the doctor as often as women or first, do you see that? Do you see more women than men?

Robbie Price: Yeah. You know, I think anecdotally, I would say, yeah, I would tend to on a given day probably see more females than men, but I was a little curious about that. So I looked in the research and actually the CDC has some good guidelines that men are probably 10% less likely than women to have a wellness exam or a doctor's visit. They're probably about three to 5% more or less likely than women to go to the emergency room or urgent care.

So there is some data to backup what I see on a day to day basis. I think a lot of it probably is, I can remember as a young adult, a fear of going to the doctor, I think a lot of it is we don't want to put ourselves kind of that vulnerable spot, but also when you get to the heart of it, I think a lot of us are afraid that we're going to be told that we have something wrong with us. And nobody really wants to hear that they've got a horrific disease, which probably 90% of the time, it's not going to be the case, but I think fear and anxiety are a big, big part of it.

Cami Smith: So sometimes it's just wrapping your mind around what could be the end result of that visit.

Robbie Price: Right. Exactly. Yeah. I think that's, because a lot of men either have, which is more important, is you have family history, their mom or dad that have had health problems. You may have seen what they've gone through. And part of it may just be denial and that maybe if you don't know about it, you'll never have to deal with it, which is not a healthy response to it. But I think that's common in men. I think healthcare has changed a lot in the past 20 to 30 years. And it used to be where healthcare relationship was more paternalistic and the provider was seen as the authority and often patients felt like they had to do exactly what the provider said. Nowadays, we've moved towards a model of shared decision making, which is basically a relationship between you and your provider, where the provider gives you the information, the risk, the benefits.

And it's a conversation and it's a decision that the patient and the provider arrive it together. This happens a lot. And where I work in urgent care, about different testing or medications. And so often it's not like it used to be where you almost felt like you were taken to the principal's office when you went to the doctor's office and you maybe had not been doing what you should have been doing. It's more now that the providers will provide you with the risk of your behavior and the benefits. And then it's really more of a relationship, which gets to the point of it being really important to establish a primary care physician. Because they can get to know your style, they can get to know your preferences for treatment, whether you want to be aggressive or conservative. And I think that's why urgent care is a great spot to get periodic care, but we're not great to help treat the long term patient because you really need that established relationship with a consistent provider.

Cami Smith: Yeah. I love that analogy of the principal. Because I feel that. I mean, and I'm obviously not a man, but I feel that, that anxiety of am I doing everything right. And I feel that with the dentist, I feel that with really any doctor that you should be having regular visits with. So there's almost an anonymity about going to urgent care, because it's not this doctor that's getting to know you that you're checking in with regularly. And, that may be a little bit easier on the anxiety side, but it's so important to start to build that relationship with a primary care.

Robbie Price: And that may be some of the disparity we see in the statistics where men are much less likely to go in for a wellness visit, but they're more likely to come to the emergency room or urgent care. And I think that may explain it, that it's easy just to go in when you've got a problem presenting itself and you know something's wrong that you can't just ignore and hop in and not feel bad for maybe not taking better care of yourself. And we definitely try in urgent care to plug people into primary care. Centra has a great network of primary care physicians and providers and there are other great groups in the community. So I think this area is fortunate that we have a network of primary care providers that we definitely try to plug patients into. Urgent care definitely has a spot because unfortunately with the current environment and COVID everywhere, everybody is just taxed.

So I think we definitely don't mind helping out, but I think you really need to have that relationship with your provider and that needs to be a long term relationship and it needs to be something that you're comfortable with. I think I remember as a, I mean, one of the biggest memories I have as a child is my mother getting chastised by our pediatrician because she was late on one of my immunizations. Unfortunately we didn't have a lot of money growing up, so we didn't have insurance. So I think that kind of sticks out on me as the pediatrician pointing his finger at my mom and almost yelling at her. And I think that is a lot of the experience that sometimes unfortunately men may, or men and women may associate with the physician, but I will say the climate has changed much more to where it is definitely a relationship versus kind of an authoritarian type of model.

Cami Smith: Yeah. It's amazing that has stuck with you over the years. And so, so many experiences that men and women are having have brought them to the point where they are now, whether they're going regularly or completely avoiding. So as far as these annual visits, men should be going, women should be going to an annual visit. So as a part of these visits, there's so many screenings that over the years you mentioned as a child, you're getting immunizations. But over the years you have to start introducing screenings into your healthcare plan. And so for men, what are those important screenings that they should be thinking about?

Robbie Price: Well, I think it really kind of is broken down into age groups. There are certain things in our twenties that we need to be worried about versus in our fifties. Really, almost everybody above the age of 17 should at least have a cholesterol screening, younger if they certainly have high risk features. And then testicular cancer is a concern. It's the most, one of the most common cancers in men 15 to 34. So being aware of testicular cancer is... There's been some change in the guidance that used to be, they recommended that men do testicular self exams. Lately, they've noticed that that could be potentially adding some unnecessary testing or anxiety to men. So I think having an awareness of it, fortunately with testicular cancer, it is one of the most curable cancers, even in late phases with the most recent statistics showing a five year survival rate around 95%.

So I think it's one of the things that men worry about and rightfully so, but also to help with the anxiety part of it's also one of the more treatable cancers that if found really at any point it is treatable. So I think if you're a young adult male worried about your cholesterol, worried about your testicular cancer, those are all kind of the young adult things to be aware of. Also making sure that you're doing, immunizations don't stop with kids. As we get older, we need to make sure that we're doing our flu, following whatever guidance there is on the COVID vaccines. I know that's sometimes a moving target, but I would definitely recommend making sure you're staying on top of that. And then the hepatitis B vaccine, if you're at risk or want to get vaccinated for that, and even the HSV vaccine, for men under 24 years of age should consider getting that risk, that risk. So.

Cami Smith: So it's just a different level of awareness. So instead of thinking, I don't need to go to the doctor, I'm not sick, which I think most people would identify with. It's thinking about just taking care of yourself overall and preventative and maybe not right now, but what can I do now to live a longer and more healthy life.

Robbie Price: Right. And I think I look at it like a car analogy. Most men are very car men. So you take your car in every 10,000 miles or so for an oil change even if nothing's going on and they always do the, whatever, 30 point inspection, they'll make sure everything's looking okay. I think that might be a good way for men to kind of wade into getting used to going to a physician, is just to make sure you schedule those visits. The guidance really is, if you're average risk, you don't have a lot of health history problems and you're under the age of 50 or so, probably one visit to your family doctor about every three years is what you need. As you get older or certainly if you get other diagnoses like diabetes or high blood pressure or cholesterol, then having an annual visit with your provider is certainly reasonable as well.

Cami Smith: Yeah. And that brings up a good point. And you mentioned this earlier as well, anything in your family history or preexisting conditions should tie into how often you're going or which screenings you're doing.

Robbie Price: For sure. Yeah.

Cami Smith: So can you talk a little bit about that? What types of things should we be thinking about, whether it's lifestyle or family history or how does that play in to how often you make a visit to your doctor?

Robbie Price: Yeah. I think, still one of the leading causes of death in men is heart disease and that certainly has a strong familial component. So I think if anybody in your family has a history of heart disease, particularly if they had a history of early heart disease, below the age of 50, if somebody had a heart attack or if anybody's ever dropped dead suddenly from an unclear cause, I mean, I think that should raise your antenna to getting started to getting the screening sooner. And fortunately in the world of cardiovascular medicine, there are some advances and screening outside of just the basic lipid panels. They have some fancier tests like calcium scoring and stuff like that. And this is where it gets back to the shared decision making, where it really is a conversation with you and your provider about what is the right screening test for you?

And you may opt for one method versus the other, but... Diabetes is another strong familial tie. And that also has, diabetes predisposed you to a whole other litany of illnesses such as cardiovascular disease, hypertension, high blood pressure, high cholesterol. So pretty much having a really good grasp of your family history is very important because a lot of these illnesses are familial and genetic. So the earlier you can kind of get a grasp on that and the surveillance started, the better the chance of a good outcome.

Cami Smith: Yeah. So what would you say, and this is something I know that we want to linger a little bit on, but how would you suggest someone take better care of them themselves? So outside of coming to your primary care, which we encourage to do annually depending on your age, depending on your lifestyle, your family history, but outside of that, thinking about men's health as this larger spectrum thing, how would you help a man come alongside his health and better that?

Robbie Price: Right. I think really it's changing the focus. I think as men, we tend to be more reactive with our health. So when we have a problem, that triggers us to go get help. I think you need to shift your mindset to more of a preventative mode. And I kind of drilled it down to three points, which I call the three moves. And basically you need to focus on moving your body, moving away from your plate, and moving through your emotions. And basically moving your body, the body of evidence around the benefits of exercise is robust. There is no question in anybody's mind the benefits of exercise both from physical health and mental health and exercise is something that does not have a lot of upfront costs. It's something as simple as going out for a walk 30 minutes a day has proven to be very beneficial from a cardiovascular standpoint and even a mental health standpoint.

So doesn't have to be anything fancy, but I do think that making sure that you're incorporating some type of exercise into you're... At least five days a week, and probably trying to do some strength training, at least three of those days to help kind of with your bone health and overall this muscle development is important. Also the secondary gains from your mental health and just kind of helping release some anxiety and stress and it just helps you feel better after you exercise.

So I think that's where the move your body portion is important is just to make sure you're intentionally trying to get out and exercise. And also if you're a dad, it gives you more energy to spend time with your family. As a husband, you have more energy all around and you typically just feel better when you exercise. So there's very little downside, and as with every disclaimer, just make sure you have that good relationship with your family doctor before you start a regular exercise program. Because you definitely want to make sure you're not creating potentially more problems.

Cami Smith: Yeah. And I love that. So what were the three that we want to remember?

Robbie Price: I would say, move your body.

Cami Smith: Okay. Move away from your plate.

Robbie Price: Move away from your plate and move through your emotions.

Cami Smith: And move through your emotions.

Robbie Price: And so basically the second move is move away from your plate. And that basically is you really need to make sure that you're... We look at the body mass index, which is kind of your height and weight, what ideally it should be. And you need to target that in conjunction with your primary provider. And you need to make sure that you're trying to reach your goal BMI. And...

Cami Smith: Yeah, especially as we age.

Robbie Price: Right. It gets much harder.

Cami Smith: I mean, it gets much harder as you're looking at those things that change as you get old. Yeah.

Robbie Price: Yeah. I have two teenage boys that can eat me out of house and home and not gain a pound. If I ate half what they ate, I would be a little, little larger BMI, so yeah, you're right. And the more you train your body at a younger age, it's easier to kind of get in those habits and unfortunately as good as exercise is, it will only get you halfway there as far as your weight. So not only from a weight standpoint, but there are a lot of stuff that we eat now that... All the processed foods, all the foods that have added, sugar, there's a lot of stuff that we're putting in our bodies that aren't contributing to our health.

And we're all rushed. It's such a fast paced society. It's much easier to swing by a drive through and grab something quick versus take time to maybe pack a healthy meal. So just make sure that you're practicing some form of caloric restriction or dieting, trying to avoid added sugars, processed foods, trying to incorporate as much fresh vegetables and food into your diet. Grilled, not fried. All these are fairly basic, but they're extremely hard to do sometimes but I think that will go a long way to helping with kind of general health prevention and maintenance.

Cami Smith: Yeah, it's true. It's things that we know, that it's taking that extra effort. In addition to the extra effort to making the visit to your primary care is making the extra effort to change your lifestyle to match the future that you want really for yourself. And so we're coming fresh out of mental health month and I love the third move of move through your feelings. And this can be a stereotype, and so I want to be careful because I don't want to lump all men together, but generally I don't know many men who are comfortable moving through their feelings, talking about their feelings, being very open about that. And so how would you suggest they do that?

Robbie Price: Well, I think fortunately, it has gotten very stigmatized, but I think over the past several years, we're starting to see more of a move in our society to normalizing, trying to remove the stigma of mental illness. And it really is an illness. And I think as men, so often we're taught that we shouldn't show our emotions, crying is a bad thing. And unfortunately what that does is it just leads men to feel like they can't deal with their emotions. So they internalize them. And then that, as we talked about earlier, can present itself and some physical complaints, a lot of stuff that we see from chest pain and the stomach pain, there's a lot of symptoms that are basically somatization or the physical presentation of emotional feelings.

And then eventually just like an infection that's going to present itself externally and you're either going to make some bad choices or you're going to have some physical manifestations of it. So I think it's really important to... It gets back to the relationship with your provider and just have an open and honest communication and realize that you're not alone. It's normal for men to fill these emotions. I don't know anybody, particularly in my arenas healthcare industry coming out of COVID, 2019 and 2020, does not have some level of anxiety because your whole world's been turned upside down.

Cami Smith: That's true. It's true.

Robbie Price: So I think just being open and talking about that. It doesn't always have to be a pill. There's a lot of evidence that shows just talking with somebody, whether that be through therapy or something like that, exercise.

Cami Smith: Getting it outside of yourself.

Robbie Price: Getting it outside. Yeah. But there's no shame as a man and admitting that you are feeling depressed or you're anxious, and preparing for this talk, I looked at the statistics and I think it was 2020, the suicide rate for men was around 22% versus women of, it was 6.2%. So that puts suicide at about the ninth leading cause of death in men, whereas it was 15th in female. So clearly men have an issue with mental health. And I think it's just taking that first step, getting over your ego and just saying I have a problem and your provider is very dedicated to making you feel better. And mental health is so entwined with your physical health. I think any provider is not going to look down on you for opening it up and saying, I think I need some help.

Cami Smith: Yes.

Robbie Price: And I think that's where it's going to be much easier if you've been seeing a provider for years to have that conversation versus stepping into an urgent care or emergency room setting. Certainly there are mental health crises that require stuff like that. But I think this gets back to preventing and just identifying it, identifying your emotions is key and then recognize that it's normal to feel that way.

Cami Smith: Yeah. And I think you'll find like what you just said, you may be surprised at how many people, including your primary care doctor and your health team, wherever it is that you do go. But I know we have incredible providers here at Centra who will come alongside of you. And they're willing to sit and listen and be a part of you walking forward and getting outside of yourself.

Robbie Price: Right. And there's no shame at all in asking for help in that arena. And you know, nowadays a lot of employers are even offering some employee assistance. I know Centra has a great program. I'm sure other employers in the area, that's something you can take advantage of as well. And that can be completely anonymous and you're getting yourself some help. And I know people that have gone through the employee assistance programs, but stuck with the counselor because they had so much benefit from it.

Cami Smith: Yes, yes. I've had a few friends here at Centra who've taken advantage of the program, and it has been so pivotal for them. Especially throughout the COVID season when you're just feeling taxed. I think we all felt what was inside of us in a different way. The anxiety, I didn't know that I even was processing, all of a sudden COVID just brought it to the surface. And so thankfully we're coming out of that season, but why not deal with it now that you are very aware that it's there. So those are some incredible tips. So I know you mentioned that testicular cancer is something that men need to be very cautious of and make sure you get your screenings. But I'm curious about colon cancer, prostate cancer. I know those are other things that are a concern. At what age should you get those screenings?

Robbie Price: Yeah. I think that's a good point. So colon cancer, unfortunately we're starting to see that in younger populations. It's not particularly a men's health issue. Women are at risk as well, but I do think that men need to be aware of the need for screening. The guidelines have changed a little bit, for most average risk people now they're saying at 45 you should get your initial colonoscopy. And then that will determine the rate of, how frequently you need to get them recurrent colonoscopies.

Cami Smith: You said age 25?

Robbie Price: 45.

Cami Smith: Oh , 45.

Robbie Price: Yeah. No, everybody's starting to get nervous.

Cami Smith: I was like, I am way late.

Robbie Price: Colon cancer certainly is one of those cancers where the sooner it's detected the outcomes are much, much better. So that's something to keep, as your men are approaching their mid to late forties, on the... Start this conversation with your provider and see what their recommendations are.

Cami Smith: Okay. So you said at age 45 is when colon cancer is when you need to start taking those careful steps to preventing against it. What about age 50? I know that that is what everyone considers to be a pivotal time in their life. And a lot changes in your health as well. So what things do you need to start to consider at that age?

Robbie Price: Yeah, I think at age 50, certainly as I'm rapidly approaching that target, that there are certain key things that take place at age 50, certainly it's time to start conversation with your healthcare provider about screening for prostate cancer, which is usually done through a lab test called the PSA. That's for the average risk patient, if you certainly have a family history of prostate cancer, or you have certain genetic predispositions or ethnicity, sometimes the recommendations that you get screened sooner, but that gets back just the conversation with your provider. And then at age 50, there's recommendation that you start with your shingles vaccine, particularly if you've had chickenpox as a child, we're all at risk for shingles and that working in urgent care and seeing some people come in with shingles, it definitely is not a fun thing to have.

So I would definitely recommend any steps you can to avoid that. There's a lot of conversation about low testosterone, certainly in men, studies have shown that starting at age 40 are testosterone levels start to decrease by small amounts year over year. There is some controversy around testosterone replacement. And I think just to be aware that that's something to talk with your provider about, certainly some of the side effects are, loss of sexual drive, erectile dysfunction. You can have some loss of bone mass, loss of muscle mass. And also you can have, speaking of mental health, you can have some symptoms of just depression or change mood. So those can also go along with aging. So it's hard to pinpoint it all on testosterone, but that's something to keep on your radar and talk with your healthcare provider about.

Cami Smith: I love this reoccurring theme, talk to your healthcare provider.

Robbie Price: It's a relationship.

Cami Smith: It's a really... Yeah, it's a conversation that's built over time and so important.

Robbie Price: That's so important. And I think that, full disclosure, I was late to getting an established healthcare provider and part of it was out of fear, but now I try to go annually. And I think it's very important that you have somebody that you trust and that...

Cami Smith: Absolutely.

Robbie Price: It's a two way street for sure.

Cami Smith: Yeah. We're going to make this information available to you. The three moves. We want to make sure that's at your fingertips as well as a great diagram that's going to break down when you should go to get certain screenings at what age for men's health. And so all of that is going to be available to you at Centra Today dot com. Thank you so much for joining us today here, having this very important conversation about men's health.

Robbie Price: Thank you for asking me. I enjoyed it.

Cami Smith: Yeah. And thank you all for joining us today for Centra Scripts and go ahead and visit CentraToday.com for some great information and to check out other podcasts that we have available.