September 26, 2023

Men’s health with Dr. Neil Baum

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Men have a lot more going on downstairs than it may seem. On episode 609 of the 40+ Fitness Podcast, we bring back Dr. Neil Baum to discuss issues around men's health including the prostate, osteoperosis, and telehealth from his new book, Men's Health Guide: Expert Answers to the Questions You Don't Always Ask.


Let's Say Hello

Note: Because Coach Allan is on vacation, there is no hello session for this episode.


[00:02:49.430] – Allan

Dr. Baum, welcome back to 40+ Fitness.

[00:02:52.950] – Dr. Baum

Allan, it's so good to be back and talk with you about something near and dear to me, and that is my baby for the past two years. It's very interesting. When you write a book, every person who's a good cook, someone says, you ought to open up a restaurant, or every doctor who's approached, oh, that's really a good idea. You need to write a book. Well, let me tell you that you don't open a restaurant or you don't write a book with the idea that it's going to take off and you're going to be on the New York Times bestseller list. It doesn't work that way. And also, it takes longer to write a book than to have a baby. So when I say, this is my baby, you know, I really mean it?

[00:03:44.730] – Allan

Yeah, I do. When I wrote my book, I got it done in a little over nine months. And that was fast. Everybody's like, how did you write a book? Well, I didn't do anything else. I mean, this was all I did was write a book. So when that's all you're doing, it can seem like it's pretty fast. But if you're actually trying to live a life and enjoy yourself and actually get some other things done, it is a lot of work. And the books that you've put out, it's like, okay, I know a lot has happened in science and technology and in the medical field in the last five years, but this was really good. I learned more about my body in this book than I think anything else I've read in a long, long time. And the interesting thing was, well, as a guy, we've got this really interesting organ in our body. It's called a prostate. And what seems like a fairly benign function that we like to use as often as we can, but it can go wonky when we get older and cause us a good bit of grief as we get older.

[00:04:54.280] – Allan

And as a man, and I deal with the same thing every other man does, is we don't want to go to the doctor. We don't want to complain about things. And so sometimes this prostate can get in our way and make our lives really uncomfortable and deadly. At some levels, it's the second largest cancer or most common cancer is prostate cancer. And while it doesn't kill as effectively as, say, lung cancer or pancreatic cancer, it is still a very dangerous thing and something we've got to be very careful about. And I just really like the way you put this book together and some of your other books that I've read in that you're giving us the guidance to ask the right questions because each of us has our own journey as we deal with these issues. We have to have information to make good decisions, and your book gives us great tools to do that. So I appreciate the opportunity to talk to you about your books today.

[00:05:49.650] – Dr. Baum

Well, thank know that is really kind of one of the reasons why I wrote the book, because most men all over America have an attitude. If it ain't broke, you don't have to fix it. And that may apply to your car, but it doesn't apply to this wonderful body that we've been given that we have to take care of. And most men tend to shut down when they go into the doctor's office. They just zip it up. They don't ask the right questions. The majority of men over the age of 50 have heard the word prostate. They don't have a clue where it is and what it does. And so that's why I think a book like this is really important and why I'm so delighted to participate in this podcast because we have the opportunity to get the word out, to help educate men, to make them informed so they can make good decisions about their health.

[00:06:58.550] – Allan

Now, the first thing I want to talk about is I want to talk about the kind of almost aging natural thing that's going to happen, and that is that our prostate is likely to enlarge as we get older. The symptoms we most frequently recognize are I have to go to the bathroom a lot more often. And so it's kind of the old man of okay, or you're waking up a few different times during the night to go to the bathroom, and then you're up again to go again more often than you probably should be. So let's talk about why the prostate enlarges and what we can or should do about that.

[00:07:32.200] – Dr. Baum

All right, let me start by describing a little bit the anatomy of the prostate and its function. The prostate, normally up until the age of 50, is a walnut sized organ, and it surrounds the tube going from the bladder to the outside of the body. That tube going through the penis is called the urethra urethra. And that tube is surrounded by the prostate like a doughnut. And the tube goes inside the doughnut. As men get older, for reasons not entirely understood, that prostate gland enlarges. And as it enlarges, it presses down on that tube that goes through the penis. As a result, men, the bladder has difficulty squeezing and getting the urine out. And now the man starts to have the symptoms. They start to dribble. The stream is not as strong as it was when they were younger. So a young man in his 20 or 30s can stand a foot or two away from the toilet or the

[00:08:58.200] – Allan

Don't do that though. Your wife will hate you for it. So just stand close.

[00:09:02.830] – Dr. Baum

Yeah, or for sure, when you lift up the seat, put it down. Yes, both of them. I am constantly reminded that I got to put the seat down. So we have a decrease in the force of the stream and we have to stand closer. We dribble after we're done. And so a man who's wearing khaki pants, and he goes to the bathroom and he thinks he's done, and he walks away and he'll have a little circle on his pants reminding him that he wasn't quite done as he thought he was. So now we have the stream. And because the bladder is squeezing harder, it doesn't empty all of its contents. So imagine a gas tank. And the gas tank is always half full, so therefore you don't have to put much more fluid in before you have to go again. So you go frequently. But the issue that really impacts men with this benign condition, it's not malignant, it's benign. Growth of the prostate is getting up at night to urinate. If a man gets up once or twice a night, no big deal. When he starts getting up four or five times a night he doesn't sleep as well.

[00:10:33.160] – Dr. Baum

His sleep is interrupted when he wakes up in the morning, he doesn't feel like he's got a good night's sleep and it's the getting up at night that really impacts the man's quality of life. And often that's what sends him to the doctor for assistance. Most men over the age of 50 start to develop mild to moderate symptoms and it doesn't impact their quality of life. And as a result they tend to have if it ain't broke, don't fix it and they don't get help. However, the majority of men over the age of 60 and 70 have these symptoms and it does affect their quality of life. And as a result they do turn up to the doctor's office and they often seek treatment. The treatment usually in the beginning is medication. There are drugs that are available that can shrink the prostate. There are drugs that can also open up and relax the muscles. But these drugs have side effects. Side effects which include problems with ejaculation. So instead when a man ejaculates, the bladder muscle squeezes and the fluid from the prostate goes outside the body. When you give those medication that relaxes the muscle.

[00:12:19.990] – Dr. Baum

That relaxes the muscle. Now when the man ejaculates, the fluid goes back into his bladder, doesn't hurt anything and it comes out when he urinates. But most men like the fact that the fluid comes out when they ejaculate. It is important to them. Now when the medications don't work or the side effects are uncomfortable, there are now procedures that can be done usually in the doctor's office, that can use lasers, they can use pins to tap the prostate up and widen the opening and decrease the resistance of the flow of urine. And so almost all men who have this problem can be helped. And the majority of it's very common. And the majority of men over the age of 60, 70 and 80 are going to have these symptoms that can significantly impact their quality of life. And the important thing I'd like to get across to our listeners is that it is treatable. Now let's go to prostate cancer. You mentioned you were correct, it's the second most common cause, second most common cancer in men, particularly over the age of 50 second only to cancer of the lung. Both prostate cancer and lung cancer are lethal.

[00:14:04.610] – Dr. Baum

But prostate cancer is very slow growing. The incidence of prostate cancer is about a one in eleven and it usually is the point I want to make if there's anything I'd like to get across during this interview is that early prostate cancer has no symptoms. There are no symptoms. The urination problem is not indicative of prostate cancer. If the prostate cancer grows and it starts to have bleeding and it spreads to bones and other areas of the body, that's too late. And then it's difficult to be cured. And so I want to point out it's a disease of aging, not very common in men under the age of 40. Really very uncommon, a little more common in 50 and 60 by the time someone is 80. Almost all men over the age of 80, if they were to look at their prostate after when they die from heart disease, diabetes or another cancer, and they look at the prostate, they find cancer in the prostate. So my message is that you don't die necessarily from prostate cancer, but you die with it. Now, the good news is that there are screening tests, a blood test, it's called PSA, prostate specific antigen.

[00:15:53.310] – Dr. Baum

It's a very simple blood test. It can be done as an outpatient. And if it is elevated, then there are additional tests and oftentimes a biopsy is required. Now, the important thing to remember is that this is a screening test. It doesn't mean a man has prostate cancer. There are many situations that can increase the PSA. The PSA can even increase if a man has sexual intimacy and has an orgasm and ejaculates the day before the test because the prostate gland squeezes and that can elevate the PSA. Let me back up a second. I never did mention the role of the prostate. When a man is younger, the prostate creates the fluid that allows the sperm to go. And at the time of sexual intimacy, the sperm is in this nutrient fluid, the prostate fluid, and allows it to inseminate and to start the fertilization process and for the couple to have a child. So that's the purpose of the prostate. As we get older, we're not interested in reproducing anymore. The prostate really has no function. It really is bothersome, particularly from the benign enlargement. But the point that I would like to make is that a man should have a discussion with his doctor about screening.

[00:17:45.770] – Dr. Baum

Would the patient want to know that if he is at risk for prostate cancer and the risks are age, the older you are, the more likely you are to have it. African American men have a higher risk than Caucasian men. And the other risk factor is if you have a close relative, brother, uncle, even cousin, it's less with cousin, brother, uncle or father with prostate cancer. That places you at a higher risk. And you probably should start PSA testing earlier, late 40s or early 50s.

[00:18:31.140] – Allan

Now there's also, if I understand right, in the book you were talking about, there's a particular in our genes that's common for women to know that they're at higher risk for breast cancer. And that same mutation also puts us at higher risk for prostate cancer. Is that true?

[00:18:50.040] – Dr. Baum

Yes. The broca gene. Yeah. And it's particularly useful in women because if they have it, they're at increased risk and they need to get mammograms more frequently. If it is used as part of the screening for men. If they have it, then they are at higher risk for prostate cancer, and they too, need to be screened more frequently. When I say screened frequently, it's once a year.

[00:19:21.680] – Allan

Yeah, I had a doctor that wanted me to do the PSA pretty regular, and then I had an incident, actually was an infection not long ago. And the doctor, of course, that's kind of one of the standard things. They sent me in for the PSA. So I've known about the PSA for quite some time. But one thing I learned in your book was that there's more than just PSA. It's a deeper, deeper thing. There's Free PSA. There's Pro PSA. Can you talk a little bit about those? Because I think there's a lot more screening out there than just this one simple little blood test.

[00:19:53.150] – Dr. Baum

Well, it starts with the PSA test, and if that is elevated, they can measure two types of PSA. There's free and bound PSA or free and total PSA. And the free PSA is circulating with not being bound to protein in the bloodstream, and they can take that ratio. And there's a cut off at 25%. And if it is greater than 25%, therefore, that places you at a higher risk for prostate cancer, and you may need to go to the next level, which is a prostate ultrasound and possibly a biopsy. I also point out that part of the examination that a man should have on a regular basis, and I think we are going to talk about healthy lifestyles, and that is the annual exam, which includes what's called the digital rectal exam.

[00:21:04.390] – Allan

Now, heads up real quick. When they say digital, we're not talking electronic. No, that's a different digit. Yeah.

[00:21:14.890] – Dr. Baum

The digital rectal exam. It's uncomfortable? Yes. Painful? Not really, no. It would be equivalent to a woman having a pelvic exam. Women don't like to have a pelvic exam. But it is not painful. It is uncomfortable. And the same thing. Men just don't have things placed there, and it feels like a foreign object in there, and it's uncomfortable. And it lasts 3 seconds.

[00:21:47.330] – Allan

Yeah, at most.

[00:21:49.650] – Dr. Baum

Suck it up, guys. You can handle the digital frequency, so that's part of it. And I recommend that men over the age of 70 stop getting a PSA test. If you have prostate cancer at age 70 or 75, you don't need any treatment. Treatment is not necessary.

[00:22:14.490] – Allan

That's somewhere I wanted to go because you brought up something I think was really important in the book, was this isn't always. I mean, we think cancer and we think, oh my God, I got to do something. But sometimes just actively monitoring yourself is actually the best thing to do because of the downside risks that some of the surgeries could have on us. Can you talk a little bit about that? When would we know? Okay, this is something we definitely need to deal with now, versus we can comfortably sit back and know, yes, I've got the cancer, but it's not going to harm me in the next 5, 10, maybe even 15 years.

[00:22:50.710] – Dr. Baum

You're talking about the advice of active surveillance. So let's say a man has an elevated PSA and he gets a biopsy, and a biopsy has shades of gray. It's not just black and white. There's shades of gray and there are various scores that the pathologists will give. And so there's very almost normal cells that are cancer called well differentiated cells. And then there are highly malignant cells. And if you have well differentiated cells and PSA is mildly elevated between four and ten, mildly elevated active surveillance is definitely appropriate. But that means coming back to the doctor every four to six months and getting a PSA. And if it jumps up significantly and then you might have to have another biopsy. And if that shows more aggressive cancer, then you might have to proceed to definitive treatment. And we can talk about the side effects of treatment and the treatment. Usually if the disease is confined to the prostate, no spread outside the prostate. The two options, common options are surgical removal of the whole prostate gland or radiation therapy. Both of these have adverse events or side effects. And it's often these side effects that discourage men from having the surgery or the radiation.

[00:24:50.020] – Dr. Baum

With the surgery, it'll affect their erections. Their ability to achieve and maintain an erection is diminished. And they can have a problem of loss of urine, which is terrible situation that it can ruin a man's quality of life, and he has to wear a diaper or he has to have additional surgery because of the loss of urine. It's embarrassing. The man often becomes reclusive. They can become depressed. It's a terrible situation for a man, but he needs to know that if he's going to have the surgery. It doesn't occur with radiation, but they can also have a problem of impotence. So let's just say a man 60 years of age, he's sexually active, he has a very low malignancy PSAs between four and ten. Active surveillance, if he's committed to close follow up, is definitely appropriate. Now, take a man 70 years of age, and if he has comorbid conditions, he's let's say diabetic, heart disease, high blood pressure, and has got other medical problems. He has COPD, chronic obstructive pulmonary disease. He has shortness of breath. He probably isn't going to live five years with all those core morbid conditions. In that situation, I wouldn't recommend that he have surgery because the quality of life that he will have afterwards could be severely affected.

[00:26:52.750] – Dr. Baum

He's already having problems. He's already short of breath. He's already taking five to seven pills a day. Okay? So that man would not be, in my opinion, would not be a candidate for definitive treatment. On the horizon, Allan, are new treatments called focal therapy. Instead of treating the whole gland with radiation or removing the whole gland. They can just go in and do an equivalent as what's called a lumpectomy in a woman with breast cancer. Instead of removing the whole breast, there are certain situations where you just remove the lump. Well, this is the equivalent called the nickname for it is a male lumpectomy that's on the horizon. And there are studies being conducted now and following these men and it looks very promising that if it's caught early enough, listen, if it occupies the whole gland, well, then you remove it. But if it occupies one little tiny area and they can localize that and they can focus on that particular area and destroy that cancer in the prostate, I think that's going to be the way to go. And that's going to be, I think, go mainstream in a very short period of time. Studies are being conducted now for focal therapy.

[00:28:35.950] – Allan

Well, it definitely makes sense because you're going to have fewer side effects and risks associated because you're not removing as much and you're not touching on some of the sensitive areas as much. So it sounds like a really good breakthrough when they get that out there. But what I wanted to come away with in just this whole conversation about the prostate is that when you go in to work with your doctor, you do need to educate yourself so that you can make the right decision with your doctor's guidance. The doctor is not there to make your health decisions for you, but you got to do your homework. You can do a little bit of work here. The good thing about the prostate is that the cancers aren't typically that aggressive. And you do have time, you have time to think, you have time to sit down. It's not a panic kind of situation. Whereas some of the others, when you catch them, you usually have symptoms. You catch those. Now you got to make some decisions, you got to make them pretty quick and your doctor is going to tell you got to make them pretty quick.

[00:29:30.070] – Allan

They're not trying to rush you because they want to do the surgery. They're rushing you because they know it's necessary before it spreads even further. But with prostate, you do have a little bit more time to think about it and make the right decision for you and your family. I want to pivot a little bit because there were a few things that you got into in the book that albeit rare, I think it's so rare. I mean, it's not as rare as we think it is, but it is rare. But it's something we wouldn't even think would ever happen. And I want to get into all of it because there's a lot of them. But one of the big ones was osteoporosis. Men know that women suffer from osteoporosis when they get older because they start out with less bone mass, bone density. They experience it usually earlier and worse. But men can very much suffer from osteoporosis. Can you talk a little bit about that and what's going on there? Because one of the statistics that you had in the book, which was fascinating and scary as heck, is that men are more likely to get hip fractures and have a bad health outcome as a result, much worse so than even women.

[00:30:34.570] – Dr. Baum

Osteoporosis is, in the past, is a disease that women have. Women have osteoporosis when they go through menopause. The lack of estrogen affects the bone mineral density and weakens the bone. The same thing happens in men. Not estrogen, but testosterone, the male hormone. And as a result, bone is always undergoing breakdown and rebuilding. Breakdown and rebuilding. It's in a constant balance. And as long as any bone cells are no longer useful and are replaced by good bone cells, a man's bones are in good shape. However, about one in eight men will have a situation where the breakdown of bone is greater than the remodeling or new bone, and the bone becomes less dense. And osteoporosis in men is a silent disease. The only time they start to have symptoms is when they get a fracture. And they get the common fracture in men is the hip bone and the vertebral bone, the back, the spine. Those vertebral bodies can become crushed, and that can affect the nerves that go in between the two vertebral bodies. And that causes severe, severe pain and discomfort. And there are various risk factors that men need to know about that can result in osteoporosis.

[00:32:26.130] – Dr. Baum

First of all, it's a disease of aging. The older you are, the less your body is going to make new bone. It also has to do with smoking. Smoking significantly increases the risk of osteoporosis family history. If you had a relative, a male relative that had osteoporosis, you're at an increased risk. And testosterone, as men get older, they lose testosterone about 1% to 2% a year, starting around they start losing it around age 30 or 40. So by the time they reach 60, they may have a 40% reduction in testosterone. And that affects the bone. And as a result, these men are at risk for a bone fracture, a hip fracture and the collapse of the vertebral body. Some of the signs of this are a man loses height. A man, let's say, is five foot ten at age 40. At age 60, he may be 5'9 5'8 and a half because those vertebral bodies get smaller and get shrink and the height of the man decreases. They're also the posture of the man, they're a little more bent over. And in bad cases, you can see it in their back. Their back sticks out. The appropriate diagnosis is made by a scan called the DEXA scan.

[00:34:20.280] – Dr. Baum

This is done in most radiology departments. And they can look at that hip and they can tell you, hey, you are really at increased risk and you need to start taking calcium and vitamin D because those are promoters of bone health. You take 1000 milligrams of calcium per day and 600 units of vitamin D. Also, you can get vitamin D for free by sunshine. You go outside and the skin makes vitamin D if you're exposed to sunlight. But if you're at risk for osteoporosis and your DEXA scan indicates that, I would still recommend that a man take vitamin D. And there's other drugs that are available, but those are the simple things. And it's also the recognition if you're at increased risk, you should get this DEXA scan. It's not uncomfortable. Insurance pays for it for the most part. And you can identify those men who are likely to get this and can start supplementing them with the vitamins, the calcium and various medications that can help control it.

[00:35:53.330] – Allan

There's another way to control it's also a lot cheaper resistance training. Within the realm of where you are. Obviously, if you have thin bones and you got issues, you're not going to start throwing a bunch of weight on your back because that's exactly how you get one of those fractures. But being active, doing some resistance training with what you can where you are, that additional resistance training is going to train the bone to be a little bit more dense.

[00:36:18.290] – Dr. Baum

We're talking about like using weights or bands.

[00:36:23.700] – Allan

Or bands.

[00:36:24.590] – Dr. Baum

Or bands, yeah, or walking. Getting outside and having a brisk walk or jog can help. And then also you can be very proactive and protective and avoid high impact exercises like jogging. Instead, convert to swimming. I just bought what's called a rebounder. It's a trampoline. It's about 3ft wide and it has a bar and you can run on this trampoline and watch TV or engage in exercise. And you're getting a kind of a good workout and it's joint protective

[00:37:10.810] – Allan

and it's moving lymph through your system. So you're helping keep your body properly detoxified. You don't need a detox, you just need to move your body because your muscles are going to do everything you really need them to do if you move around enough.

[00:37:23.330] – Dr. Baum

Well, we're going to talk a little bit, I think, about health and fitness and longevity. And I would like to throw this out there that we are able to make people live longer. We can increase the lifespan of people, but our real goal is to increase the health span of people. And I'd like people to think about focusing on movement, mobility and marbles. And those are the two things that I think add to good health and increase the health span as we get older. If you're able to ambulate without a walker, a cane or a wheelchair, that's a real plus. If you're able to engage in communication and have your memory is still intact, that's a plus. And I think so much of what we're going to talk about in terms of longevity has to do with mobility and the marbles. Our brain and to preserve the marbles leads to enhanced quality of life. Quality of life is terrible if you're confined to a chair, you're sedentary and you can't remember to take your medicines or what you had for breakfast or who your loved ones are. That's a sad state of affairs. It doesn't have to be that way.

[00:39:16.300] – Allan

I agree. Now, there's a lot of bad things that happened in the last few years since we last talked with COVID and everything there. But kind of one of the, I guess the silver linings that have come out of the whole COVID thing is that there's been a seismic shift. In my opinion, moving from the way things used to be with going to your doctor's office and sitting in a waiting room for however long going to a second waiting room where you wait for the doctor for however long you're going to be there. The guy comes in, reads your chart, says, okay, looks like you've lost a little bit. What about lost some weight? Gained some weight. You need to do this, you need to do that. What's your problem today? Oh, you got a sore throat or you got this or that? Well, here's a script. I'll see you. Goodbye. He might even shake your hand before he takes his gloves off.

[00:40:02.850] – Dr. Baum

But I hope he washes his hands first.

[00:40:06.820] – Allan

Yeah, either way, he's in there for such a short period of time and if you're not prepared, you're not asking the questions that you need to ask. But with the advent of telemedicine, I'm not driving the 45 minutes to get to my doctor's appointment, getting there early so I'm not late, but then still having to wait until it's late. And so I'm losing three or 4 hours of a busy work day to go see my doctor and then he's going to give me the prescription. So now I got to go by the pharmacy and pick that up. Now I'm getting home late. And so it's like, well, let's just stop by the fast food and have dinner because we run out of time to cook dinner. We're all busy and it's really hard to prioritize our health when that's what we know is in front of us with regards to most doctors visits. But we've moved and transitioned over to where telemedicine is approved and utilized a lot more. Can you talk about telemedicine and how we can lever that to make sure we're getting done what we need to be done with all the other busy stuff we've got going on in our lives?

[00:41:09.510] – Dr. Baum

You use the word seismic shift, is.

[00:41:12.170] – Allan

That I think so, yeah. I think it's significant.

[00:41:15.690] – Dr. Baum

I think it's a tsunami. It really has changed the course of medicine in the past, five years ago, before pandemic, the doctor says, I've got to see the patient, I've got to touch the patient, I've got to look at body language. Bunch of crap, really. Bunch of crap. A doctor. I can see you now I can talk to you now I can see you. I can take care of 50% of urologic problems over virtual using virtual medicine. If you have enlarged prostate, I can talk about your symptoms in your medication and I can make adjustments. If you have erectile dysfunction, I can talk about the risk factors and about getting your diabetes under control, and I can write you a prescription and I can follow you. If you have a urinary tract infection, I can send you to the lab to get a urine culture and then I can prescribe an antibiotic. And then a few days, seven to ten days later can contact you again on telemedicine and I can follow up. If you've had prostate surgery and you are having a normal course and you're off of your medications and you need advice about when you can go back to activities, I can give you that advice over using telemedicine and video conferencing.

[00:43:07.830] – Dr. Baum

If you have incontinence, I can manage that oftentimes using virtual medicine. Point I'm trying to make is that there are so many conditions that can be managed this way. And we have now come to the realization that the doctor can practice good medicine. Good medicine without having to touch the patient and without the patient having to go to bricks and mortar offices. The doctor has to recognize, just as you said, trip to the doctor could be four to 6 hours out of your day for just a routine follow up. Four to 6 hours until you leave your office, travel there, find the parking, get in there, fill out the paperwork, wait in the reception area, wait, and then go get the prescription and come home. It can be four to 6 hours, and that's time when you should be productive at work. And the doctor hasn't realized he sees them in ten minutes. Well, that's ten minutes for the doctor. That's 4 hours to the patient. I also want to point out that another boon to telemedicine is the doctor now gets paid for it as if it were an in office visit. So that has become a motivator.

[00:44:50.260] – Dr. Baum

But now I think doctors have learned that they can be good doctors. You're not blowing the patient off. You can have a longer, more comfortable visit. You can have the patient monitor their blood pressure and their weight at home. They can do home testing for glucose. There are so many things that now with fitness trackers and sleep monitors there are so many ways that you can care for the patient. And telemedicine is really a big plus for patients and for doctors. And also I have found that when you do telemedicine, the patient is on time and so is the doctor. In the past, the doctor was late and he was 45 minutes, an hour late. The doctor got away with it. Just say, oh, I was in the emergency room at a sick patient. Now, when you have a telemedicine, I said to you, I'll be available at 02:00. You knew I was going to be on time, and I knew you were going to be on time. And that's the way telemedicine works. And so it's much more efficient. Much, much more efficient. And it's good medicine. Yeah.

[00:46:20.090] – Allan

And a lot of times people won't follow up. And because of that same thing, it's like, okay, well, I don't feel anything bad right now because I got done what I wanted, I got the script, I feel better. And they want to go back to their lives, but the doctor says, okay, we'll set a follow up appointment for two weeks. And you don't do that follow up appointment if you're feeling okay, because the problem,

[00:46:40.910] – Dr. Baum

especially men, especially men, women are much better at follow up. Men are derelict.

[00:46:47.640] – Allan

And so this is a good opportunity with the doctor, particularly if you're going to look at going to a new doctor or specialist, have the conversation with them. Do you do telemedicine? Can I set up appointments and do this over video? It's going to save me a ton of time. It's going to save you a ton of time. And we're going to be able to communicate a lot better because I'll be prepared heard instead of being all flustered. And the other side of it is I can put a blood pressure monitor sitting in my own living room. My blood pressure is going to be a lot lower than having driven across town walking into a doctor's office. It's going to be more natural to how my normal afternoon would be if I don't have to go to that trouble.

[00:47:22.750] – Dr. Baum

My advice to people embarking on a new physician is to interview that new doctor. Ask pay for the interview. Usually they don't charge for it. You pay for the interview. You read my book

[00:47:38.610] – Allan

Yeah, there's questions. You've got a whole script in there. Here's what you say when you walk in the door. Here's what the doctor is probably going to ask you to sign this waiver, basically informed consent form. And so these are the things you're going to expect. And you laid it out in the book very clear. When you go in, ask these questions. If they don't feel comfortable with the answer, go back to your insurance company, find another doctor on the list that you can interview well.

[00:48:04.920] – Dr. Baum

And also, you are correct. You want to ask, would you agree to telemedicine for the first visit? I really don't think should be a telemedicine visit. I think you need to develop rapport with the doctor. It can be done. My art style was to visit the patient for the first time and examine and touch my hands on the patient and examine the patient. But then you are finding, does the doctor do telemedicine? Does the doctor do email? Does the doctor return email and phone calls within 24, 48 hours? You don't want to wait two weeks to get a report. And does the doctor have a portal? The portal is that this records the results of laboratory testing and imaging that becomes transparent between the doctor and the patient that it's put up on the portal. It's encrypted, which means nobody else can look at it. You have to have a username and password.

[00:49:19.590] – Allan

And I think most of us, we've used online banking, so we're very comfortable with logging into a website and seeing things that we don't want other people necessarily see. There's all your transactions laid out. This is similar. Your details are going to be there. So when your doctor tells you, well, okay, yeah, your cholesterol is a little high, your HDL is really good, your LDL is a little elevated, your triglycerides are down. Here's what I feel the course of action should be based on what I see in front of me. And you can see it too, and you can say, well, okay, that makes sense based on what I see and what the doctor says versus, yeah, you got to wait, get a piece of paper. When you walk in the office, you're scanning through it and trying to figure out what the doctor is going to ask you and talk to you out. And there's so much going on because they're weighing you and then they're taking you to a little room, and now you're stuck. Versus if there's a portal. You go in there, you look up your details, you kind of have some questions that you know are on the top of your mind.

[00:50:11.760] – Allan

If the doctor doesn't bring it up, you bring it up. So it's a much fuller and better prepared conversation on both sides.

[00:50:18.220] – Dr. Baum

I would like to mention that the health care for patients is so much better if they prepare for the visit. And that means writing out what questions do you I used to give out a card, a three x five card. It says, what three questions would you like to ask the doctor today? That avoided me thinking that I'm done managing the patient. Put my hand on the doorknob, ready to walk out and say, wait, I got one more question. And that's not a good way to ask the question. You write it out, you think about what you want to accomplish on your visit, and you share that with the doctor, and the doctor appreciates that. If you write it out, give the doctor the papers that I'd like to cover these three things today. These are three questions I would like to ask you. You're a better patient and you're going to have a better health outcome when you are proactive. Women start from a pediatrician, and then they start having reproductive in their 20s and 30s, and they start seeing the obstetrician, and they do get women are much better at breast self examination than men are with testicle self exam.

[00:51:48.370] – Dr. Baum

And the point that I'm making is that women have a relationship with their doctors from the time of their pediatrician till their middle age. A man at the age of 18, when he goes off to college, he's done with the doctor, and he doesn't see a doctor till he's 50.

[00:52:09.050] – Allan

If he's lucky.

[00:52:11.050] – Dr. Baum

If he's lucky, he'll get to see the doctor at age 50. But men really don't have the same health care experience that women have. And as a result, men are in the dark. They become silent. They don't know what to ask. And as a result, I think their health lingers on. Their problems linger on. They don't get diagnosed with hypertension. A guy could be never see a doctor, and hypertension is silent. You don't feel that your blood pressure is up. The men are silent, and they don't seek out health care till they're about 50 when things start to break down. And so, really, this kind of a book, answering these questions and preparing the patient for a visit to the doctor is very helpful. I never resented patients who come in with a briefcase full of articles from the Internet, and I just say, I don't think that's the place to go for your healthcare.

[00:53:30.540] – Dr. Baum

Oftentimes those aren't credible sites. Let me give you a list of credible sites that are available to you and let's go from there. But I never resent a patient wanting more information about their health. I think that's a good thing.

[00:53:49.270] – Allan

I do too. I do, too.

[00:53:51.930] – Dr. Baum

Not to discourage, but to promote.

[00:53:54.890] – Allan

Dr. Baum I define wellness as being the healthiest, fittest and happiest you can be. What are three strategies or tactics to get and stay well?

[00:54:03.390] – Dr. Baum

Diet and exercise. I got it down to two. We are an unhealthy nation. Obesity is not a problem of willpower. It's a disease, and it needs to be treated, and it needs to be treated early on. And proper nutrition is so very important. And I think if you have a good diet, fresh fruit, vegetables, lean meat, chicken, fish, avoiding trans fat and polyunsaturated oils, having high fiber in the diet is very important. Absence of artificial sweeteners and diet drinks should be avoided. Smoking cessation, moderate alcohol. Alcohol is good. The books say one drink a day. I think for a man, one to two glasses of wine a day is probably medicinal and healthy. And so I don't tell men, you have to be a tea toller. Limiting the caffeine consumption, especially late in the day, because it can affect your ability to sleep. And insomnia is a problem of middle aged and older men. And then exercise. We are a sedentary nation. We sit still far, far too long, and there are so many things that we can do, so many ways that we can exercise. Like that rebounder I talked about. I could have a rebounder right here, and I could be jumping on the rebounder and talking to you and not feel that I'm not giving you my undivided attention.

[00:56:14.150] – Dr. Baum

Walking the stairs. Walking up the stairs, not down. And having 10,000 steps a day, that's 5 miles. And you have to wear a tracker. Did you have a watch? Fitness watch?

[00:56:30.030] – Allan

I have a phone, and I carry the phone in my pocket that tracks my steps. When I'm out, I make sure I have my phone in my pocket.

[00:56:38.920] – Dr. Baum

Okay? So 10,000 steps a day and 150 minutes a week of aerobic activity, and that is some for brisk walking, jogging, tennis, swimming, 150 minutes a week. There are four conditions that are impacting this nation and the American health care budget. American health care budget over $4 trillion a year, 18% of GDP. More than we spend on military, we spend on health care. And yet, in America, we don't have the outcomes that compare to a nation like Sweden, Denmark, Germany, France, who spend about half that amount on health care per capita on their population. And we don't have the outcomes to support all that spending. And there are four diseases, four conditions that are bloating the healthcare budget, that is, cardiovascular disease, hypertension, heart disease, diabetes, cancer and neurodegenerative disease, alzheimer's disease. All of those are reasonably preventable and with proper diet and exercise and a few other things. Healthy lifestyle. Use the seatbelt every time. Go around the block. Put the seatbelt on. Smoking cessation. Don't engage in foolhardy activities. Don't go bungee jumping at age 60. That's probably not healthy to do. But practice good lifestyle habits. Get 7 hours of sleep a night. Good dental hygiene, which means brushing and flossing your teeth. I see.

[00:59:03.310] – Allan

You can't help it. You can't help it.

[00:59:06.530] – Dr. Baum

Okay. All right. Flossing your teeth. So much of health, poor health, can occur with a bad mouth. If you have periodontitis and you brush your teeth and it gets into your bloodstream, that can make you real sick and cause chronic inflammation. And then screening tests. Screening tests for colon and rectal cancer with a stool test, which we could go into, but you know what I'm talking about. Colonoscopy. Depending on your risk factors, the PSA test, cardiogram, chest X ray, these are preventive health that can take those four conditions and move them off the plate.

[00:59:58.930] – Allan

So, Dr. Someone wanted to learn more about you. Learn more about your books, including the Men's Complete Health Guide expert Answers to Questions You Don't Always Ask. Where would you like for me to send them?

[01:00:11.510] – Dr. Baum

Send them to Amazon.com.

[01:00:14.120] – Allan

Okay. Of the links in the Show notes, you can go to 40plusfitnesspodcast.com/609. And I'll be sure to have links to the books there.

[01:00:24.060] – Dr. Baum

And one other book that I highly recommend is Outlive by Peter Atia, and I'd like that to be in the Show Notes as well, because this is written for laypeople about trying to make our health span equal to our lifespan. We've done a really good job with lifespan from 100 years ago, we've added 20 years to our lifespan, but now we need to talk about the health span, and this book goes through a lot of practical ideas that we have discussed today that I highly recommend this book as well as my own.

[01:01:14.920] – Allan

Yes. All right, well, thank you so much for being a part of 40+ Fitness.

[01:01:19.370] – Dr. Baum

I look forward to getting together with you again, Allan. Last time it was five years. Let's not make it that long.

[01:01:25.870] – Allan

Let's not.

[01:01:27.000] – Dr. Baum

Okay. Thank you, Allan.

Post Show/Recap

[01:01:29.930] – Allan

Hey, Ras.

[01:01:31.470] – Rachel

Hey, Allan. It was nice that you had Dr. Baum back. That's pretty cool to have a repeat author on your show. Must be very prolific with his books.

[01:01:39.590] – Allan

Yeah, I barely remembered the interview I'd had with him back then, other than it was an interesting title, like how's it Hanging? The title of his book. I would say this was a little bit more formalized, and he was doing another doctor. So the Men's Complete Health Guide obviously doesn't have as much swagger as how's it hanging? And five years. A lot's happened in the field of surgery and around prostate cancer and some of the issues there. So I was glad to have that conversation withhim. Dr. Baum's written a lot of books on this topic, and particularly he has one that's on prostate cancer, which is awesome as well. And then How's It Hanging is a very similar book, but maybe a little bit more casual than this one. It's really just to get men aware that we have these health issues, whether we want to admit it or not. And if we wait till we're broken if we wait till we're broken, sometimes that's too late to really fix the core problem. And so that's why I wanted to have him on, to have this conversation. And things like telemedicine is a game changer, because when you can sit down and just call your doctor, it's 15 minutes phone call, and then you're back to work.

[01:02:55.830] – Allan

You literally close your office door or you go somewhere where, like, a conference room, and you sit down and have a 15 minutes conversation with your doctor, and you're back in the work. You didn't have to drive across town. You didn't have to sit in a waiting room. You didn't have to do all that kind of stuff. And the doctor can basically help you meet your health outcome goals right there on the phone. I think that's huge. And, ladies, you can schedule the call and don't tell your husband. Just hand him the phone. He's like, this is for you. Who is this? Your doctor. Have a conversation and then gosh. You have a list of questions. Have a list of questions for him right there. Hand him the paper. Hand him the phone, and then just say, go. And again, it's high time that it happened. I'm glad that it's happening the way it had to happen. With COVID and everything is kind of sad. But the shiny silver lining of this whole thing is that telemedicine is now a commonplace. Before I had a doctor, my health doctor, we were telemedicine because I didn't live where he is, I would go in there about once a year and see him in person.

[01:04:00.540] – Allan

But other than that, no, I was anywhere else in the world. Malaysia, Africa. I even called him one time from Iran, like that's when my call was, and I was like, okay, so it's evening, I'm sitting in my hotel room in Iraq, and I have a phone call with my doctor. We were able to do know, but he was kind of cutting edge. He was doing things that other doctors weren't doing at that point in time, which was why he was my doctor. And I didn't have to be in the hometown with him because I didn't have to go see him every time I wanted to see him or talk to him. I had a doctor that I could call when I needed to call. So I'm really glad that telemedicine is out there. This is a really good book, though. This is just a good book for you to kind of just go through. And it's not even something where you'd have to read it from cover to cover like I did it's where you can sit down and say, okay, I'm curious about this, and you can flip to that section of the book.

[01:04:57.280] – Allan

There are parts that I say, read the whole thing because he has an anatomy lesson on the front. And you may think you know your junk, but there's a lot more down there than you think. And so this is just a good idea. Why is this happening? Why am I experiencing this? Is this normal? Is this bad? What does this mean? And so this is just a really good primer for you to understand the anatomy and understand what's going on there and then just recognize some of these things just don't come to mind. Like osteoporosis.

[01:05:27.090] – Rachel


[01:05:27.940] – Allan

And the fact that, yeah, if you fall and break your hip, you could be in big, big trouble. So making sure you're getting adequate nutrition, resistance, exercise, all those things we talk about every week, they're important, and they're important for women, and they're important for men. And so don't poo poo something you learn about women, because men, we might have some of the similar issues, because guess what? We got bones, too.

[01:05:48.800] – Rachel

Yes, for sure. Yeah, these are all good things. And it's good to have, like you said, this type of primer, because sometimes you don't realize what's happening until it's maybe a little bit too late or hard to bring that back with treatment or whatever. Especially like the PSA screeening, you know, I talk about cancer screenings all the time with you, Alan. And PSA is a simple one. You get your PSA score and you keep an eye on it until it needs further attention. It's a simple screening and could save you a lot of trouble in the long run.

[01:06:21.720] – Allan

Right. And so this is something that's changed considerably since the last time I talked to Dr. Baum was before it was you got your PSA and then you got your digital check, which was not digital, very analog, and then you get that check, and then the doctor said, I think there's something we need to do here. Most of the time, the next solution was the biopsy. So now they're doing a biopsy. Now that's okay. But one of the problems with a biopsy is whenever you cut into a cancer, it has the potential to spread faster so it can metastasize because you cut it. And so the biopsy is not necessarily a thing you want to do. You don't have to. So a lot of doctors wanted to push for the MRI before the biopsy, which tells them a lot more about where the lump is, how it's lumped, so they know where also now they can do a better biopsy because they know more. But MRIs were very expensive, particularly five years ago, so most insurances didn't want to pay for that. They wanted the biopsy first, find that there's cancer, prove there's cancer, and then you can do your MRI so that you know what kind of surgery or what kind of interventions you want to do.

[01:07:33.380] – Allan

Things have changed a good bit now. Now there are other additional tests, the PSA plus and all other stuff, and there's some 4K tests and other things that can be done before. So your PSA might be high, but that doesn't mean there's a cancer. And so they can do these other tests that are non invasive before they start worrying about MRIs and biopsies and all that kind of stuff. And then they may find, well, no, your risk is very low. This is not an aggressive form. This is not a problem. We're just going to actively watch this. I don't think you called it actively watch back. Kind of my way of thinking about it was just not doing anything, which kind of sounds weird. Well, there's a cancer growing in me. How do I just not do that? But the reality is you don't want that biopsy if you don't need to, and then if it isn't spreading, you don't necessarily want to mess with the prostate because there's some downsides to the surgery. And putting it off for even a few years might mean that they come up with some technologies that make that surgery a lot safer.

[01:08:38.670] – Allan

So you may not have the side effects, but yes, jumping on it right now and saying, I got to get that out of my body, you're taking a risk, and you're taking a higher risk than you might by waiting and doing it later if you have to.

[01:08:52.200] – Rachel

Yeah, that's really great. It's awesome to see how technology and the study of different cancers like the prostate cancer has advanced over the years. It just makes things a lot easier. And, yeah, he called it active surveillance. There are cancers that could be present, but inert and are fine, just hanging out, not causing problems.

[01:09:12.900] – Allan

And some of us, whether we want to admit it or not, we're older and we're sicker, we got a lot of other things going on in our body that are going to kill us long before a prostate cancer would. And so that's the other side of it, is, do you want to take that risk and maybe mess up the quality of life that you have for the foreseeable future when that's not going to be what takes? You know?

[01:09:36.700] – Rachel

But I love this book by Dr. Baum. I hope that all the men, and maybe even the wives in our men's lives or loved ones share that with our husbands, who we know don't often choose to go to the doctor. It's a good thing just to have.

[01:09:53.220] – Allan

And I know it's a few months before Christmas, but, hey, if you're looking for a gift idea for a man in your life, this might be a pretty good one.

[01:10:02.510] – Rachel

Sounds great, Allan.

[01:10:03.960] – Allan

All right, well, I'll talk to you next week.

[01:10:05.970] – Rachel

Take care.

[01:10:06.850] – Allan

You, too. Bye.

[01:10:07.960] – Rachel

Thanks. Bye bye.

Music by Dave Gerhart


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