“What brings you in to see me today, sir?”
“My wife made this appointment and said I had to go, or else,” is the standard response that I receive from my male patients at the beginning of most visits. I then proceed to ask if there are any special concerns on which we should focus our attention and with additional poking and prodding I uncover a host of medical problems previously unaddressed or unrecognized. As you could imagine I also discover numerous excuses as to why they have not seen a provider sooner.
With cardiovascular disease being the number one cause of death for both men and women, I’m always shocked at the number of men who do not know their status- blood pressure, cholesterol levels, or blood sugar. Some of these men have not seen a doctor in 10-plus years! Yet, these educated men who are often times leaders in our communities in some fashion or another and who are painfully aware of their concerning family history of heart disease, strokes, or renal disease chose to ignore preventative medicine recommendations.
One major risk factor for cardiovascular disease is high blood pressure, systolic readings 140 or higher and diastolic readings 90 or higher. From 1988-2006, African American men were the largest percentage of persons with elevated blood pressure. Unfortunately, only 30 percent of African American men during that timeframe had their blood pressure under control.
Heredity and environmental factors each contribute to this potentially fatal silent killer. Contrary to popular belief, hypertension can be present without having any symptoms. If left untreated, uncontrolled hypertension can cause the left side of the heart to enlarge which can eventually lead to fluid buildup in the body called congestive heart failure. The other overlooked sequelae of hypertension is renal disease. It does not take a randomized controlled trial to prove that kidney disease disproportionately affects minority communities. A field trip to the various dialysis centers around town is proof enough that African Americans bear a large portion of this freedom-stealing condition that binds you to a machine for the rest of your life. And in regards to our historically independent men, you would think that the mere thought of losing one’s ability to choose how one’s time is spent would be motivation enough to want to preserve one’s kidneys.
Obesity and diabetes are also major risk factors of cardiovascular disease and cause a significant financial impact on the community. More than one-third of US adults are obese and the majority of those are black. In a 2007-2010 National Health and Nutrition Examination Survey (NHANES) of people 20 years and older, 70 percent of black males were either overweight or obese. High rates of obesity translate into increased prevalence of diabetes as well. Diabetic complications such as non-traumatic amputations can result in loss of wages, which then impact for example a father’s ability to care for his family.
The next major challenge following getting men and particularly African American men to cross the threshold of the doctor’s office is accepting the fact that they need a prostate exam. Mentioning this to my patients causes such a look of horror on their faces that you would think I have said something inappropriate about their mothers! No matter how I explain that prostate cancer tends to be more aggressive in African American men and that the digital rectal exam along with yearly PSA’s can potentially be life-saving, it usually takes me several visits to convince them that the dreaded finger test in the rectum is needed. Even though the exam is less than 30 seconds and my index finger is quite narrow, patients still often refuse to have it done.
African American men are approximately 1.6 times more likely to be diagnosed with prostate cancer than white men and they are 2.4 more times likely to die from the disease. Although thousands of men die each year from prostate cancer, there continues to be much controversy around screening. To date, there have been no great studies that included an adequate number of African American men to determine why such a disparity exists.
Great leaders are defined by more than just how well they speak and look the part. Great leaders provide the example for which others are to follow. Dr. Martin Luther King, Jr. taught peace by living it. Dr. Benjamin Carson taught the value of education by proving that one’s zip code did not determine their professional altitude. Lastly, Barack Obama, our 44th President of the United States, taught us that achievement, academically or politically, is not limited to people who grew up in a two-parent household.
Today, I challenge the men in our communities to take a stand and begin to lead by example. Show your wives, partners, children and extended family how to live a long, healthy life. Make an appointment to see your doctor and show the rest of us how to make positive choices, one step at a time.
Yours in Service,
Denise Hooks-Anderson, M.D.
Assistant Professor
SLUCare Family Medicine
yourhealthmatters@stlamerican.com
