Women's Work

SPECIAL TO THE TIMES

They're as much a part of the Kansas State Fair as the tractor pulls and hog judging: women dragging men, against their will, to Dr. Mark Austenfeld's prostate cancer screening booth. Austenfeld, a clinical associate professor of urology at Kansas University Medical Center, offers blood tests that screen for prostate cancer, a painful disease that kills thousands of American men each year.

The screening is free, quick and simple. But amazingly, most of the men at the fair hurry past the booth without stopping to take the free test.

"It's women who grab the men by the shirt and drag them to the booth," Austenfeld says.

That's how it is in Kansas and in the rest of the country: Women are the gatekeepers of health care for their families. They take care of their own health, their children's health, and the health of the men in their lives.

No, it's not fair. But for many men, a trip to the doctor is like a fate worse than death. That leaves women in a difficult position: Either they cajole their husbands, fathers, brothers, sons and male friends to see doctors, or they risk losing them. Since so many diseases that cut men down in their prime are preventable if detected early, not going to the doctor can be a death sentence.

Women have their work cut out for them.

Why don't men go to the doctor? The reasons are numerous, and it starts when they're just boys.

"We socialize men into invulnerability, and we tell them not to show their emotions," says men's psychology expert William Pollack, co-director of the Center for Men at McLean Hospital in Belmont, Mass. The message they get is to not admit they're vulnerable to anything--including disease.

Men are also stoic. They'd rather just take what comes.

"Men are men," says Dr. LaMar McGinnis, a surgical oncologist and spokesman for the American Cancer Society. "They are busy and tend to push things under the rug."

There's more, experts say: Men don't want to waste the doctor's time. They don't want to waste their own time. They're afraid of the exams. They're afraid of what the doctor might find. Actually, we should give men a bit of a

break. Unlike women, men have never had to succumb to routine annual medical probes--with the expected result of a clean bill of health--that women take for granted.

"Men tend not to see a physician unless they are sick or their job requires it," says Dr. Richard Stein, chief of cardiac prevention and rehabilitation at Lenox Hill Hospital in Manhattan. So it's frequently up to a woman to take the bull by the horns.

A good place to start is by learning about the following six ailments. They're the ones most likely to afflict a man in middle age. Luckily, they're also problems that, if diagnosed early, can usually be treated successfully. Here's what you need to know so he'll be around for you to worry about for a long, long time.

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Prostate Cancer: There are nearly 200,000 new cases and 40,000 deaths each year in the United States.

Symptoms Women May Notice: The need to urinate interrupts the night's sleep. But most early cancers are symptomless.

Treatment: Surgery and / or radiation.

The words "prostate gland" give men the shivers: They don't want to talk about it. They don't want to think about it, and they certainly don't want a doctor touching it. But quick and simple prostate screening tests are the only way to detect prostate cancer early. It is this simple: When it's caught early, prostate cancer is highly curable. When it's discovered late, it can cause a slow, painful and needless death.

Prostate problems are notoriously difficult to diagnose using symptoms alone. The symptoms--frequent interruption of sleep to urinate and diminished urinary flow--can also be signs of benign prostatic enlargement, which is generally not a problem. On the other hand, cancer can develop without obvious symptoms.

"Whether or not you have symptoms, get an exam," Austenfeld urges.

Here are the facts about rectal prostate exams: A doctor uses his gloved finger to check the prostate gland for irregularities, such as nodules or thickening. This is known as a digital rectal exam. Another test is the PSA (prostate-specific antigen) blood test to detect a substance produced by enlarged or cancerous prostate glands. If nothing is found, the patient is home free. If something is amiss, the doctor will use ultrasound for a closer look. If that exam is irregular, the patient will need a biopsy--an outpatient procedure.

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Colorectal Cancer: There are more than 136,000 new cases and 55,000 deaths each year in the United States.

Symptoms Women May Notice: You won't. Colorectal cancer can develop without symptoms. For the afflicted, blood in the stool or rectal bleeding can signal advanced disease, but that's often difficult to identify.

Treatment: Surgical removal of cancerous tissue once cancer has developed; removal of benign polyps while they are precancerous.

Colorectal cancer has a lot in common with prostate cancer. First, death is highly preventable. "With colorectal cancer, we could cure almost all cases," McGinnis says. "But we cure only 50% of people who come in late."

Again, the tests involve body parts that men would rather not talk about: the bowels and the rectum. And although the tests--barium enemas and flexible sigmoidoscopies--are no day at the beach, McGinnis says, "It's nothing you need to worry about."

Diet and exercise are key to avoiding problems. A diet rich in vegetables, fruits and fiber is best, McGinnis says. And physical activity helps because it speeds bowel activity, quickly ridding the intestines of potential carcinogens.

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Heart Disease: The leading killer of men in the United States (450,000 male deaths each year).

Symptoms Women May Notice: Fatigue, discomfort during exercise. Chest pain or pressure and shortness of breath are critical symptoms requiring emergency-room care.

Treatment: Dietary changes, exercise, medication, surgery.

Because it's so common, even men are worried about coronary disease in all its forms: heart attacks, angina, hardening of the arteries and high blood pressure. But just because they worry about it doesn't mean they talk with their doctors about it.

Heart attacks can be prevented. The first step is to be aware of the risk factors, which include high cholesterol levels, high blood pressure, inactivity, smoking, unresolved stress coupled with anger, and a family history of heart disease.

If he's smoking, he must stop. Call the American Heart Assn. for a packet on how to quit, (800) 242-0721. Next, his diet should be heart healthy: lots of fruits, vegetables and fiber; minimal meat and fat. The tricky part is getting him to eat healthfully when he's away from home.

"Lunch can be a third or more of your daily calories. If half of that's fat, you're fighting a losing battle," Stein says. "Make sure he has healthy lunch alternatives."

As for tests, cardiac exams are required only if men show symptoms (listed above) of heart disease, says Stein, who's also a spokesman for the heart association. You might also try getting him to exercise with you.

"Walking is just as good as jogging programs in terms of longevity," says Dr. John Mervin, an associate professor of family and community medicine at UC San Francisco. Walking also helps keep weight and stress levels down.

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Impotence: Millions of American men suffer impotence at some point.

Symptoms Women May Notice: Erection insufficient to permit satisfactory sexual functioning.

Treatment: Viagra, vacuum pumps, injections, penile implants. It's important not to get frustrated, anxious or angry with an impotent man--even if it's taking a toll on your relationship--because those emotions can compound the problem. The good news: Impotence can be cured.

"There is a therapy for virtually every case," says Dr. Ira Sharlip, a urologist in San Francisco who helped devise the American Urological Assn.'s recent guidelines on impotence treatment. Unfortunately, only a small percentage of men with problems seek treatment, Sharlip adds.

Research shows that psychological problems are rarely at the root of an impotence problem and that the majority of cases have physical causes that can be treated, including cardiovascular diseases, alcoholism, diabetes and physical injuries to the pelvis or spinal cord.

Impotence can also be caused by medications such as anti-anxiety drugs, antidepressants, blood pressure medication, diuretics and ulcer medications. In many cases, medications, dosages or the pill-taking schedule can be changed--but men shouldn't do this without talking to their doctor.

Men are highly reluctant to approach doctors about impotence because they fear it indicates a loss of manhood and virility.

"It's embarrassing," says Sharlip. If you're the woman on the losing end of an impotence problem, Sharlip's advice is to gently say: "I love you and want to help you, and I've heard there are a lot of things that can make this better for both of us."

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Obesity: Thirty-three percent of American men older than 20 are overweight (meaning their weight is at least 20% higher than accepted standards).

Symptoms Women May Notice: A thickening around the waist is the first sign of extra pounds in men.

Treatment: Improved diet and increased exercise.

It's a fact of aging. After 30 your body starts going to pot unless you take action.

"That's the point of decline in the ultimate fitness of men," says Dr. George Blackburn, chief of the Center for the Study of Nutrition and Medicine at the Beth Israel / Deaconess Medical Center in Boston.

The upper abdomen is the first place men start to build up extra fat. And as the waist size inches up, a man's health can head into serious decline.

While obesity is not a disease per se, excess weight can lead to a number of serious ills including cardiovascular disease, stroke, diabetes, degenerative arthritis and prostate and colon cancer.

Study after study shows there are no quick cures. The only way to keep fit is to eat right--again, lots of fruits, vegetables and fiber; easy on the calories, fat and meat. And it's crucial to exercise regularly. Here's where you can serve as a positive role model. Get him to walk with you. If he's reluctant, you can tell him walking is more fun when he's along or that you feel safer walking with a man.

"There's no reason we should be losing men in their 50s and 60s when most of those deaths can be prevented," Blackburn says. "What a shame when it's so easy to control."

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Mental Health: Depression in men may be one of the most under-diagnosed medical issues in this country.

Symptoms Women May Notice: Decreased activity, moroseness, lack of communication, fatigue, burnout and suicidal thoughts or statements.

Treatment: Open communication, counseling, medication.

Mental health can be one of the most difficult issues to discuss with men--but it can also be one of the most important. While women are more likely to attempt suicide in their lives, men are much more likely to be successful in their attempts. And suicide rates are the highest in men older than 65. If your man makes offhand remarks like, "You and the kids are well provided for," or "You don't need me around anymore," take him seriously.

"Those are signs of suicidal thoughts," says Pollack.

Depression in men can have various causes--from biochemical changes to changes in lifestyle. Retirement and losing the role as the family's provider and protector hit many men hard. The effects of a sluggish economy and downsizing have torn the self-esteem from many men who defined themselves through their work. And some men simply cannot handle aging.

"They wake up and realize they're balding, they're older and they can't play ball the way they used to," says Pollack, author of "In a Time of Fallen Heroes" (Guilford Press, 1995).

But things are changing, he says. Many younger men are more in touch with their vulnerability and are less confined by strict gender roles than men of previous generations. This newfound openness, ironically, can have its cost. Men who are more sensitive and enjoy close relationships with their children, says Pollack, are now victims of empty-nest syndrome--a type of depression that once belonged solely to women.

Certainly we wouldn't wish it on them, but maybe the fact that men are starting to suffer from empty-nest syndrome says something important: that they can learn some new things about what brings quality to their lives. Who knows? Maybe they can even learn to take better care of their health.

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