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Scot: Guys will do it for their cars, but they won't do it for themselves. What am I talking about? Preventative maintenance, these screenings, these things that we should do because if they catch something early, it can make a world of difference in our health and our lifestyle as well. Today we're going to find out more about the preventative maintenance we should be doing to our bodies.

This is "Who Cares About Man's ÐÇ¿Õ´«Ã½," with information, inspiration, and a different interpretation of men's health. My name is Scot. I bring the BS. The MD to my BS, Dr. John Smith.

Dr. Smith: Good afternoon.

Scot: And he's a convert. He cares about his health now. Started out, not so much. Now he does. It's Producer Mitch.

Mitch: Hello.

Scot: So to take the analogy a little bit further, for us guys, if something serious happens, if the old "check engine" light comes on, for example, maybe we'd go to doctor. If your "check engine" light came on, would you go to a doctor, Mitch?

Mitch: Oh, absolutely, if I had something like that. Wait, will you not? Are you not going to go if you're all of a sudden, "Ding, ding." I don't know where it is on your body, but . . .

Scot: Right. But also, just like your car, sometimes you just have to take it in and let the mechanic check things out, check out the rear diff fluid, if you'll.

Mitch: Yeah, if things are shaking that shouldn't be shaking, etc.

Scot: Right. Or even if they're not, it's just good to have a mechanic look over stuff, and the same is true for us and our health.

Today, Dr. Smith is going to give us some stuff as men that we should pay attention to when it comes to the preventative maintenance. Even though nothing is wrong at the moment, even though the "check engine" light is not on necessarily, these are things that we should proactively go into the doctor to have checked because it can make a huge difference in our health.

Let's go ahead and start. How do you want to organize this? Most important to least important? By age? What are you thinking?

Dr. Smith: I think age probably is the best, and then I may spend a little bit more time on some of these things that are a little bit more of the heavy hitters, so to speak.

Scot: So with the car analogy, you go in for your 15,000, your 30,000, your 60,000, your 120,000, and maybe you might have some different stuff done at each one.

Dr. Smith: Sure. So some of the stuff that you want to do in your 20s and 30s, they recommend getting checked for some communicable diseases like Hep-C and HIV if you are at risk. And so those are the years, in your 20s and 30s, where you may be putting yourself at risk to get those done.

But that's a one-time thing where they want you to get it checked at least once in your life. And then if you're in a higher risk population, obviously keeping up on checking that on a regular basis.

Scot: Okay. And you had said a list of these things that you should check is from the Task Force.

Dr. Smith: So all the things that we're going to talk about today, you can find on your own. There's this group called the United States Preventative Service Task Force, and they've kind of put together a list of things that are good to keep an eye on as far as keeping your health, the risk factors of certain things, or just making sure that you stay ahead of the maintenance type thing.

Scot: Yeah. And they grade these As and Bs. I was surprised after looking through this whole list . . . which it's a very comprehensive list, and we're not going to cover the whole thing. We're just going to cover some highlights on the list. Most of the stuff was given a grade of B for . . .

Well, first of all, what's the grading for? Why are they grading them A or B?

Dr. Smith: So from my understanding . . . obviously I don't work for the USPSTF, but as far as the recommendations go, A is the stuff that you really should be doing.

Scot: I was surprised, though, a lot of the sexual disease screenings ranked as A. Why are STDs ranking as an A, even higher than getting your hypertension checked? That really surprised me.

Dr. Smith: Well, the few of them that are there, like the Hepatitis C and HIV, are chronic diseases that can really wreak havoc later on in life. And we have great treatments for those diseases these days, but that being said, if you don't know you have it and you don't get the treatment, it can really affect your health in a negative way. And so that's why a lot of those are there.

Plus, I think it's important to let people really understand and know that those are things that are important. And they're also things that can be shared with others as well. So that puts it where it's not just your problem now if you're spreading that to other sexual partners.

Scot: If you have hypertension, you're not potentially giving other people problems, right?

Dr. Smith: Right. And I'm not giving hypertension to my new sexual partner.

Scot: Yeah. And I noticed as far as sexual diseases . . . So you talked about hepatitis. HIV is also on there. That's a big one.

Dr. Smith: There's also tuberculosis on there, which is one where you're like, "What?" But there are a lot of people who travel to the United States or have been in other countries where tuberculosis is something that's more common than it is here. And so if you've been in those areas or you travel, those are things that you want to just obviously be tested for and make sure that they're taken care of.

Scot: All right. And when we're talking about that younger age group, what else do we want to kind of focus on as far as our maintenance is concerned? We're between, what are we talking, 20 to 30? Is that kind of where we're at right now?

Dr. Smith: Yeah, we're in our 20s and 30s. I think really just taking a good stock of your health, go in for a checkup every two to five years, depending on what you and your primary care doctor kind of discuss.

If you have some chronic issues where you've developed high blood pressure, or you're a diabetic or something, obviously you're going to be in there a lot more often. But overall, just kind of maintaining your overall health and weight, monitoring those things, and also checking blood pressure.

They're going to do that every time you go for a visit. Just kind of having baseline numbers so that as you get older, you're like, "Hey, I know I used to always be 126/82 when I would come into the office and now it's kind of creeping up," then you can kind of understand and know what your body's doing as you age.

Mitch: It reminds me of my own health and some of the stuff that we've kind of discovered with me as I'm starting to go to the doctor in my late 20s, early 30s. We found some stuff that I didn't even know I should be worried about.

Say you got a new car. Yeah, you're not taking it in as regularly for maintenance and stuff, but what if you got a piece or a part that needs a recall or there's some sort of manufacturing issue that you need to know exists, or else it could be really dangerous?

Scot: Right. I've got all of those, by the way, Dr. Smith. I think I have a couple recalls. I've got a couple open recalls, and I think I have a manufacturing defect.

Dr. Smith: Well, you can apply for a lemon on that, but I don't know how that's going to go for you.

Scot: When we're talking 20 to 30, is there anything else in there that you would throw out?

Dr. Smith: So those are the big ones. We'll talk about some of the other ones that may apply, but those are the big ones that you want to do. I mean, mainly it's just maintaining good health, eating well, maintaining a healthy weight, and then any chronic medical conditions that you may have in your 20s and 30s.

Scot: And watching those sexual diseases, because that's when you're most likely probably going to have multiple partners at that point.

Dr. Smith: Exactly. You're most likely to have new partners in those younger ages, although there's a cohort as they get older where you see a little bit of it. But yeah, for the most part . . .

Scot: I've heard about that, the old people, right?

Dr. Smith: Yeah, it happens. But no, it's smart. So, as you get into your 30s and then head into your 40s, there are certain things where you want to have some pre-diabetes screenings. That's a big one, especially if you've got family history of those things.

And that's where you're going to start looking at colorectal cancer screenings. They're recommending colorectal cancer screenings younger and younger. And this is where the younger portion of people may need to take stock, is if you have a family member, a first-degree relative, that's had colorectal cancer. I believe the updated recommendation is that they recommend you getting a colonoscopy 10 years prior to when that person was diagnosed, whatever age they were diagnosed at.

Scot: That's way different from what I've always heard.

Dr. Smith: Yeah. So let's say that your dad was diagnosed with colon cancer at 42. That means at 32 you should be having a colonoscopy.

Scot: That's really new.

Dr. Smith: That's where you really want to make sure that you're keeping up with those things. But usually, when it's happening in a family member like that, the doctor's telling them, "Hey, you should have your kids get this done."

And for ladies, there are some things with breast cancer screenings and things like that, that they recommend genetic testing and things in some families, depending on what they see.

And so those are some of the caveats of this isn't for everybody, but it might be for you if you have a family history. It's nice to know your family history.

And if you don't know your family history . . . I have plenty of patients who are adopted. They're like, "I don't know." Then just follow the regular recommendations and start in your mid-40s to get that stuff done.

So when you're in your 30s and 40s, again, the diabetes screening and then the colorectal cancer screening is one where you want to make sure that you take stock of that one in your early to mid-40s.

Some of the recommendations are going to be changing in the coming year. So just kind of keep an eye on that stuff. But that's when it's started to be recommended to do that.

Also, people who have a family history of heart attack or stroke, cardiovascular disease, they recommend starting to get checked as soon as age 40 for those who have cardiovascular risk factors, and that's where you would be wanting to talk with your primary doctor.

And also, if you've developed high blood pressure and things like that, or you're a diabetic, those are risk factors for cardiovascular disease where you're going to want to kind of have that conversation with your primary doc and find the right timing to do that.

Scot: Got it. And that particular age, 30s to 40s, if you've got that baseline at 20 to 30, you can see if the trends are starting to move.

Dr. Smith: Exactly.

Scot: That's been really valuable to me. I started late, but the more history I start to see, I'm like, "Oh, you know what? I have a fasting glucose level of 98. It's concerned some doctors thinking I'm pre-diabetic." But I have a history. It's just held there for the past 10 years. So that makes me feel a little better.

Guys, guess what? I can actually throw this 30s to 40s into our analogy, and especially the colonoscopy. Sometimes particular models of cars are known for particular issues. There's a particular kind of car that has head gasket issues. So if you know you're more predisposed to particular issues, you should be having that stuff checked a little bit earlier, or at least starting that conversation.

Dr. Smith: I think that's a great analogy for sure. And so those are the things in your 30s and 40s.

And the last age group I would probably put in is when you hit 50 and get 50 and older. There are a few things that you want to kind of take advantage of.

For our patients who may or may not have been smokers, there are a few specific recommendations for people who have smoked. So in your younger days, if you're like, "Hey, I had some fun years where I had some smoking," you do want to get a couple screenings. One is a lung cancer screening after the age of 50. From 50 to 80, they recommend going in and getting a one-time CT scan to kind of look at things.

As well as aortic aneurysms, which is where your vessel kind of separates and bulges out and can cause real problems. And if it bursts, that's the largest blood vessel running down through your abdomen, you run into real big problems really quick. And so they like to make sure anybody who's been a smoker you get screened for that.

If you're seeing your regular doctor on a regular basis, that is one of the things they're going to get on about if you have been a smoker. They're not going to miss that. But also, just for you to have that in the back of your mind because those are going to be important things.

Mitch: As a former smoker, I guess I'm kind of . . . I'm not to my 50s yet, but I guess I am curious how . . . I don't know how to phrase this, but how much of a smoker do you need to be to get these types of screenings? Is it, "Oh, I just have a couple when I drink," or whatever? Or is it you need to be so many packs a day?

Dr. Smith: So that's a great question. It's like you're skipping ahead in the program, like you may even know what's happening.

Scot: He does that a lot.

Mitch: That was a real question, though.

Dr. Smith: It was a real question, though. I literally was going to head right into that. I was like, "Man, this guy is good."

So the USPSTF recommends just a one-time abdominal ultrasound in men 60 to 75 who have ever smoked. If you've ever smoked in your life, that is what they want you to do.

Now, as far as the lung cancer screening, that's a 20-pack-year history. And so a pack-year is, you smoked one pack of cigarettes per day for a year. So you've got to have a pretty decent, robust smoking history.

Scot: Or two packs for a half a year. Is that how that math works?

Dr. Smith: Right. Exactly.

Now a lot of your doctors, though, let's be honest . . . We all wear pants to cover our tookus. And so some of your doctors, if you're even on the borderline of that, they're going to recommend getting that screening. And I don't blame them on that. I mean, obviously, that means they're looking to take good care of you and make sure that you're looked after. I wouldn't be upset if your doctor did that just to make sure that things were good.

Scot: I was kind of not paying attention and it just dawned on me. So I've heard of the lung cancer screening, which is kind of a new thing, if I understand correctly. The guidelines recently changed. They've lowered that. But I guess I didn't realize there's also the abdominal one that you just talked about.

So I just wanted to call that out in case somebody else found themselves kind of not paying attention as close as they should, because they thought they knew what was going on, like I thought I did, and didn't.

Dr. Smith: I mean, these are just the recommendations of looking into things. There's one thing that's not on this list that I see on a regular basis, and so I just want to put a quick plug in because I see a lot of men who have prostate cancer. It's kind of in the wheelhouse of urology.

And so we do recommend in urology checking a PSA, which is a prostate specific antigen. It's a blood test that we can take and look at and gives a risk of if you have prostate cancer. A single value of this blood test doesn't really do us any good. However, multiple of these to watch it over time and see what it's doing is where the benefit of this test comes in.

Now, there's a lot of controversy surrounding this. The family medicine physicians don't recommend following PSAs, and there's some debate on whether to do rectal exams and things like that. Those are discussions that I would love for each of you to have with your doctor.

And if you do have a family history or there's concern there, feel free to just make sure that they can get you a referral to someone who will do those things if those are things that you have concerns about. Those are the things that are going to make a big difference, is knowing your family history and then making sure that you prep accordingly.

To me, if I have a PSA every other year during your 50s and then every year during your 60s, and I watch it over time, it's very easy for me to go, "Oh, this is very reassuring," or, "Hey, I've really seen a change in the last three years," where you've started to see the PSA . . . They call it a PSA velocity, how quickly it's changing or how fast it's doubling, to be worried about. And that's my shameless plug from my own clinic.

Scot: Prostate cancer. Mitch, we did an episode on prostate cancer, didn't we?

Mitch: We did, yeah. And why guys don't typically do it.

Scot: Right. But just as a disease is concerned, the stories I've heard from men that have gotten it, it's not a fun thing to get. I mean, I guess it might not necessarily kill you, but it can really wreck your quality of life.

Dr. Smith: No, it can. And sometimes, treatment for prostate cancer can help you increase the quantity of your life, but sometimes there are some things that can occur after surgery or radiation that can affect your quality.

Scot: So catching that thing early, that's kind of one of my priorities, I think. That's just a disease that if I ever get, I just want to catch it as early as possible because it can kind of alter your life in not fun ways. You might still be alive, but you're not going to be the same guy.

Dr. Smith: Yeah. Now, there are some other things that, again, may be applicable to younger folks. They recommend screening for anxiety and depression and suicide risk in older patients over the age of 64 or 65.

I don't know if you've met anybody who's retired and then kind of feels like, "What am I doing here still?" And so there is a lot of that that happens. I think it's okay to have those feelings and to go and talk about them, because those seasons and changes in your life, you can have those feelings of anxiety or depression or different things.

And I think if that's something that you're struggling with even in your 20s, 30s, and 40s, please go talk to somebody. Go talk to your family doctor. Go talk to any of your care team, because those are things that can affect the quality of your life as well.

That can happen at any age, but they recommend screening for it in older patients because they kind of have seen upticks in some of these folks as they've gotten older when your health isn't as good, you're not as mobile, you're not as apt to do the things you may have liked to do before. And then they hit retirement age, those types of things.

There are plenty of studies out there where they talk about these different reasons why folks over the age of 65 are at a higher risk for depression and anxiety.

Scot: Mitch, we should do a separate podcast on that, I think. I think we should do something to look forward to on a future "Who Cares" episode.

I think that's kind of a new thing, right? I think we all tend to think one of the reasons you want to have a mental health screening is because it can lead to suicide. And if I've seen the numbers right, Dr. Smith, suicide tends to be high in younger adults, and then it goes away for a while, and then it comes back and it's kind of high again in older adults.

Dr. Smith: Yeah, and that is the reason that they've got a lot of these recommendations. They want to make sure that we're keeping these folks safe. When you do have these monumental changes in life or loss of a partner or different things like that, where you've gone throughout your life and it's been this thing and it all of a sudden changes with a health problem, there are increased incidences of anxiety, depression, and things like that.

So I just think it's an important one that's there to just make sure that we keep an eye on that. But also, as family members and friends of those folks, if we see them become a little bit more withdrawn or things like that, we make sure that maybe we're proactive at looking for those opportunities to make sure that they're doing okay as well.

Scot: Dr. Smith, you gave us a pretty good comprehensive list there of some of the things that we should be looking out for as far as preventive maintenance is concerned, from when we're younger to our mid-age, to our older age.

These are things that might not necessarily show up with any sort of symptoms, so we kind of have to be proactive and talk to our doctors about it, get that family history, find out if we should be doing some of these things a little bit earlier than what maybe the guidelines are.

Are we feeling pretty good about this? Did you have anything else you wanted to throw out there before we wrap it up?

Dr. Smith: I think just to keep with the analogy, there's a sticker on your car that tells you when to get the oil changed. Maybe you just put these stickers on the mirror in the bathroom to kind of give you a milestone to look for.

I mean, even though the "check engine" light is not on, it's a good idea to be proactive about your health. Think where you'd be if your car broke down this morning. You wouldn't be able to get to work or anything. Don't let that happen to your body.

Scot: Boy, that was such a beautiful ending. I almost feel bad doing what I'm about to do, which is, Mitch, do you have any final takeaways? I feel like we should just let it wrap up, but sometimes we can have some insight when it's all said and done. Do you have any takeaways from this episode?

Mitch: Well, now the pressure is on. I mean, for me at least, I'm now closer to 40 than I am to 20 and it's just a good reminder of what to look forward to. There are a lot of times where it's like, "What am I supposed to be doing even?" And just to hear, "Hey, at these particular ages, if you're in this group, these are the things that you should do," I found it extremely helpful.

Scot: Good. Yeah, that's a good point. What you used to do might not be what you need to do as we pass through these different age groups.

I think I was surprised to find out, even though it doesn't apply to me, but I think it's worth reiterating for those that it does, that sexually transmitted diseases were a big deal on this list. And the Task Force really put a lot of priority in that those are some of the things you should get done.

That wasn't the case when I grew up. Maybe doctors and people are more proactive in general about that, but I think just keep that in mind. That's an aspect, and so is mental health in a way that it hasn't been before.

Well, if you have any thoughts, observations, stories you'd like to tell, we would love to hear them. You can contact us through email hello@thescoperadio.com.

Our challenge to you is to go out and figure out what age group you're in and the preventative stuff that you need to do, and maybe make a reminder in your phone that, "In a couple years, I need to get this. I need to do that." It can pay dividends down the road just like it can with your car.

Thanks for listening. Thanks for caring about men's health.