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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


The following listeners have sponsored this show by pledging on our Patreon Page:

– Anne Lynch– Ken McQuade– Leigh Tanner
– Debbie Ralston– John Dachauer– Tim Alexander
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Thank you!

Another episode you may enjoy


September 3, 2018

How’s it hanging with Dr Neil Baum

On episode 335 of the 40+ Fitness podcast, we meet Dr. Neil Baum and discuss his book, How’s It Hanging?: Expert Answers to the Questions Men Don’t Always Ask.

Allan (0:49): Our guest today is a professor of Clinical Urology at Tulane Medical School. He has written several books and many long-running columns for American Medical News and Urology Times, and more than 250 peer-reviewed articles on various urologic topics. He is Dr. Neil Baum. Dr. Baum, welcome to 40+ Fitness.

Dr. Baum (1:11): Good morning, Allan. Thank you for the invitation. I look forward to our discussion.

Allan (1:17): Absolutely. Now the book that you have here – I have a copy of it; I really enjoyed it – is called How’s It Hanging?, which is an apropos title. We’re going to talk a lot about men’s health, but I want to be clear because I do this when I talk about women in menopause and I’ve had a few experts on that. We’re talking about men’s health, but for anyone who has a man in their life, this is an episode worth listening to, because you’re going to learn a little bit and it’ll help you have the right conversations with him so he knows what’s going on. I just want to put that out there first because I think a lot of people will hear this is a men’s topic and think they can tune out. And the reality is, our health and the health of the people around us is really, really important, and this book can be a great resource for the men in your lives, if you don’t happen to be a man. Before we get into it, as I got into the book, one of the things that was really good about it was how you very carefully went through. Some of this is really complex medical information, but you’ve taken it down to, “Let’s just have a conversation, guys. Here are what the basics are.” Pretty scientific, pretty difficult, and really kind of dumb it down for the rest of us, for a lack of a better word.

Dr. Baum (2:25): That was very much intended, that I didn’t want to talk in medical language and be high-brow about it, but I wanted to make it something that everyone could understand, and then take that information, digest it and become more knowledgeable when they go and speak to their physician, so the patient, or the man, and the doctor are on the same page. That was what was intended.

Allan (2:55): I think that’s so important because it used to be a situation where the doctor said, “This is what you should do.” I think the medical practice is that people now are being given decisions, opportunities to choose different paths of how we deal with different medical things. Having a basis of understanding where you can go in and have that conversation with your doctor is really, really important because the doctor won’t necessarily tell you, “This is the treatment you’re going to do.” In many cases, they’re going to give you these different treatments with all the pros and cons, and then you personally have to make the decision that’s right for you.

Dr. Baum (3:38): This has been the shift in thinking in the last four decades of health care. In the past, the doctor had all the knowledge and the patient was at the mercy of the doctor to tell him or her what advice or what they needed to do. In 2018 any patient has as much information as the doctor has. Consequently, the patient can be in the driver’s seat and it can be shared decision making. I think that’s a much better way to have a doctor-patient relationship, when they’re a team working together to help the man or the woman achieve optimal health.

Allan (4:27): That’s why this book is so valuable, because this is going to give you the information so that you can be a valuable team member in your own decisions, so you’re not just going at this saying, “Okay, the doctor says this.” This book will actually give you an understanding of why the doctor’s saying what they’re saying, and as things continue to advance, this is a good primer for you to basically be in the driver’s seat as you’re going through making those decisions. I wanted to shift the conversation, because as you go through the book, you talk about various things that men may or can deal with, particularly as we’re getting older. One of those that I think strikes home for a lot of people is the prostate cancer. Can you tell us a little bit about what’s going on with prostate cancer, why it could be a big problem for us, and what we can do to know whether we have a problem or not?

Dr. Baum (5:14): Can I begin by telling the audience what is the prostate gland? Is that okay to start?

Allan (5:19): Sure, absolutely.

Dr. Baum (5:21): The prostate gland is unique to men; we’re the only ones that have it. It’s a small, walnut-size organ. It’s located at the base of the bladder and it surrounds the tube called the urethra that goes through the man’s penis. It is that gland that secretes fluid that nourishes sperm when a man is in his reproductive years. So, when a man is younger, it’s a gland of enjoyment and pleasure. However, as men age, for reasons not entirely known, the prostate gland grows. And when it grows, it compresses that tube, the urethra, making urination difficult. Most of the time when that prostate gland grows and compresses that tube, it’s benign and it can be treated usually with medication. However, for reasons not entirely known, sometimes the gland grows and develops a malignancy in the prostate gland that can spread locally to other organs in the pelvis, and it can spread to distant sites like bones and liver. These are examples of what we call “spreading” or “metastasis”. 250,000 men every year develop prostate cancer. That’s new cases every year. It usually begins around age 50 to 55, and then it gets more common as men age. By the time a man is 80, most men will have prostate cancer. However, in an older man it is usually not a major problem, and most men die with prostate cancer, not from it. However, if it develops in a younger man, 50-55, in his middle age, then it can be very problematic, and then it requires aggressive treatment. We’re not going to talk about treatment today, but I want to point out that about 35,000 men every year die from prostate cancer. Most of those deaths don’t need to occur, because if a man gets a diagnosis early, when the disease is confined to the prostate gland and it’s slow-growing, it can be cured. Have I explained everything so far?

Allan (8:25): Yeah. One of the interesting things that I got out of the book was, this is not something where you’re going to have really any outward symptoms that you have a cancer. Some cancers, you can kind of sense that there’s a problem early on, but this is one that it can get all the way to the point where it’s spreading and you may not even know that you have a problem.

Dr. Baum (8:47): If there’s one thing I want to leave this program with, it’s that comment – that early prostate cancer has NO symptoms. It does not affect the urethra, it does not affect urination. It may have no symptoms, and that’s why men over the age of 50 need to talk to their doctor about getting screened for prostate cancer. That requires an annual blood test called PSA – Prostate-Specific Antigen. That’s a very simple blood test; the result is available in 24-48 hours. And they have to have a digital rectal exam, and that’s where the doctor inserts his finger into the rectum and feels the prostate gland because it sits right on top of the rectum. Now, what’s the doctor looking for? If I can ask you, Allan, and the audience – if you make a fist and you feel the soft part at the base of your thumb, that’s what the prostate gland normally feels like – kind of rubbery, movable, and soft. Move your finger to the top of the knuckle. Have you done that, Allan? I’m kind of watching you.

Allan (10:20): Yes. I’m here, I’m doing it.

Dr. Baum (10:23): Alright. If it feels like the top of the knuckle – that’s a nodule, and that’s suspicious and it needs to be evaluated. Now, there are certain men who are at a higher risk of prostate cancer. Those are African-American men, and any man who has a brother, uncle, cousin, father – a blood relative who has prostate cancer. Those men are at risk for prostate cancer, and they need to start being tested with that blood test and the digital rectal examination around age 40 to 45. If it is a man with no family history, not African-American, he can begin testing at age 50. And then I recommend at age 70 they stop getting tested. If you have prostate cancer at age 70-75, it’s a very slow-growing cancer, it’s not going to cause a significant problem, and it does not require treatment. But every man should have a discussion, have this communication with his doctor and decide should he agree to a screening or testing program, because if you wait until there are symptoms, like you said a few minutes ago – those cases where it produces symptoms, it’s going to be too late. Then it has spread to other organs in the pelvis, to the bladder, blocked the kidney and spread to bones and to the liver. Don’t wait for prostate cancer to develop symptoms before starting to proceed on a screening or treatment program.

Allan (12:34): I think “cancer” is one of those words for a lot of people, I know for myself, it’s just a scary word, because it seems like your body is going haywire and there are things that you can or can’t do about it, but there’s not a good cancer out there. But sometimes we go out and get these screens, and I understand we can get a positive PSA. That doesn’t mean we have cancer. It’s a marker that we then need to do additional diagnosis on, so I don’t want a person to go out and get their PSA tested, have an elevated PSA and freak out, because two things: One, you said it’s very slow-growing, and there are treatment options.

Dr. Baum (13:09): And also the majority of mild elevation of PSA in men is usually, most frequently not due to prostate cancer. It’s due to inflammation of the prostate, infection called “prostatitis” – easily treated with antibiotics, or it is due to that growth of the prostate gland that most men have after the age of 50. So it is really the trend of the PSA. The normal range is 0 to 4. If you have a PSA that is 3, that’s not alarming. The next year the prostate gland grows a little bit; it’s a little larger and the PSA is 3.5 – really not that alarming. Then if all of a sudden, four or five years later, the PSA is 6 or 7 – that becomes an issue. It’s the trend in the PSA. That’s why it’s good to get a baseline PSA. There are men I see who have a PSA less than 1.0. I don’t want to bog us down in numbers in this program, but they have a normal examination of a PSA less than 1. They can come back every two to three years for a test, if the PSA is that low. But if the PSA is in the 3 to 4 range, they probably ought to come back annually.

Allan (14:43): Okay. Now, another cancer that I think scares a lot of men, because now we’re getting close to home, is testicular cancer. Can you go through the same exercise we just did with prostate cancer, talk about what this is, how we would potentially know that we have it?

Dr. Baum (15:00): The testicle is the organ that is located in the scrotum; there’s one on each side. Most men have two testicles, and the testicles have two functions. One – production of sperm, which is necessary to fertilize an egg and start the reproductive cycle. And the second is, the testicle is responsible for the male hormone, the testosterone, that is responsible for muscle mass, it’s responsible for libido or sex drive, it is helpful for erections, bone mass, wellbeing, controlling the red blood cell production from bones. It is a very important hormone that begins when a boy is in adolescence. Around the age of 12 to 14 a young boy develops pubic hair, hair underneath his arms, and by 16 he starts to grow a beard. That’s all due to testosterone; that’s the male hormone. The counterpart in a woman is called estrogen, and in a man it is testosterone. The testosterone unfortunately peaks around age 22 to 25. Around age 25, the testosterone slightly decreases about one percent a year. So a 25-year-old man, very sexually active and functional, and has good muscle mass – he’s not going to notice that one percent change at age 26. He won’t notice it at age 30. But by the time he reaches age 50 to 55 and his testosterone has gone down 10 to 15 percent, he may become symptomatic.

The symptoms of low testosterone are decrease in libido, a lethargy or a lack of energy, the erections are not as good or as strong as they were when the testosterone was normal. They may notice a decrease in muscle mass and strength. One of the common symptoms that’s often overlooked as a cause of low testosterone is falling asleep after meals. A man usually will report that he just runs out of gas at 4:00 or 5:00 in the afternoon. He has his dinner meal, and then he’s sitting in a chair watching TV and falls asleep. Often times that symptom is due to low testosterone. Also, I want to point out that testosterone increases the risk of obesity, it increases the risk of diabetes, and it also increases the risk of depression. This is a condition that is very common after the age of 50 to 55 in almost all men, because the normal aging process results in a decrease in testosterone one percent a year. It becomes symptomatic at age 50 to 55. That’s a beginning introduction, and let me turn it back to you and see what questions you have, and then I’ll go on and talk about the treatment, Allan.

Allan (18:50): Okay. Obviously we need our testis to make sure that we’re keeping the tee that our body can produce. And then here we are faced with the potential that we could get cancer. How are we going to recognize that we have a cancer, that we may have a problem there, so that we can know that we need to have a conversation? I’ll go to my doctor and they’ll ask me basic health questions about how I feel, but they’ve never specifically tested me to say, “You might have this problem.” So, I want to take it upon myself to understand what I need to do to, not self-diagnose, but to recognize there’s a problem.

Dr. Baum (19:28): I want to answer that question, and I want to backtrack, because I do want to talk about testicular cancer, but those are two entirely different conditions, because one part of the testicle makes sperm; another part of the testicle – different cells – make testosterone. So let’s talk about the two different conditions. What you have to do regarding testosterone – you say, “I’m in my early 50s and just not feeling quite as peppy as I used to. I’m having difficulty holding my erection. My interest in sexual intimacy has diminished.” You say to your doctor, “Would you please order a testosterone level on me?” I would request it for a middle age man who has symptoms. Now, if you don’t have any symptoms, you don’t screen for testosterone deficiency. If a man is sexually active, strong, energetic, no problem with the muscle mass or energy, not irritable or depressed – you don’t need to get a testosterone. It’s fine; that’s not a problem. But if you’re starting to feel the symptoms of decreased energy and decreased sex drive, falling asleep after meals – you need to ask the doctor for a testosterone level.

Shift gears now for a second. Let’s talk about testicle cancer. Testicle cancer is the most common cancer in men between the ages of 20 and 40. Again, like prostate cancer, early testicle cancer has no symptoms. Now, here’s the suggestion that I hope men get from this webinar. I want to mention again, there are no symptoms for early prostate cancer. There are no symptoms for early testicle cancer. Women are instructed every month, after their period, to do a breast self-examination. The health care profession is deficient in not instructing men between the ages of 20 and 40 to do a testicle self-exam every month. When they’re in the shower and the scrotum is relaxed, they need to feel their testicle and examine it. It feels very smooth and there are no lumps and bumps in the testicle. If they feel that nodule, like I showed you when you make a fist on the top of your knuckle – if you feel that in the testicle, you need to make an appointment with your doctor to get this examined. Often you will get a blood test and a testicle ultrasound examination, and that will make the diagnosis of testicle cancer.

When I began my career as a urologist in the 1970s, testicle cancer took the lives of a lot of young men. Today, the treatment is so effective that very few men will succumb or die to testicle cancer. But they must make the diagnosis, and it is the responsibility of the health care profession to explain to young men. Men in high school and young boys should get health classes and learn how to do a testicle self-exam. There is nothing wrong with men doing it. It is good. Women do it for breast self-exams; there’s a lot of publicity around this. It’s kind of amazing to me, Allan, that every October, the National Football League goes pink. You know what I’m talking about? The breast cancer awareness month. Are you aware of that?

Allan (23:55): Yeah, absolutely.

Dr. Baum (23:57): What happened to the National Football League telling men to check for prostate and testicle cancer? It just boggles my mind that the women, who are much more aggressive about the marketing and promoting of breast cancer awareness, got a boys’ game to put the pink on and get the word out. I think the month of September or November ought to be men’s health awareness month and talk about prostate and testicle cancer.

Allan (24:35): Before we get off that, there actually is a movement to do something exactly like that. It’s called Movember, and it’s an organization I participated in last year that basically you try to grow a mustache for the month of November. You donate money and you’re trying to raise money, so all of us are doing fundraising. We did it at our company; there was a big group of us that got together and we all grew a mustache. The basic thing is, someone is going to comment if you start growing a mustache out of nowhere. If you’ve never had one and you start to grow one, you actually start getting comments on it, and that’s the opportunity to have that initial conversation about men’s health issues that include these two cancers. So, it is happening.

Dr. Baum (25:19): That was a genius idea. I believe it started in Australia. I’m not sure. Does that sound familiar?

Allan (25:25): I’m not sure of the exact origins of it. I just know it was interesting around the office, because people were talking about men’s health issues like they never had before. It was a very interesting opportunity and I’m glad I went through it. I think it’s a growing movement and I hope it does continue to grow, because this is one of those big things. It kind of goes down to that whole point – women seem to be the caregivers in the home, and men want to be these macho tough guys. It’s how we were brought up – we’re here to take care of other people. The women tend to look on the health side. You wanted me to ask you the question why do men live shorter lives, why do women live longer than men? And I do think that’s a big part of it, that there’s much more awareness by women of their health issues.

Dr. Baum (26:08): Women start into the health care arena right after they graduate from high school and college, when they are in their reproductive years. They frequently see their obstetrician and gynecologist, and they are programmed into annual health by getting a pap smear and a mammogram at a very early age. Men, on the other hand, have a void. After they graduate high school, they will seldom see a physician until they’re in their mid-50s, and consequently they’re not programmed to take care of themselves. In the South we have a saying here, “If it ain’t broke, don’t fix it”, but men apply that not only to their cars and their fishing boats, but they apply it to their bodies. Unless they’re having a symptom, they don’t have to go in to see the doctor, so consequently they can go years with hypertension, diabetes, high cholesterol, because early on they don’t have any symptoms. So if it ain’t broke, they don’t fix it, and by the time they go in, when it becomes symptomatic and they have full-blown diabetes and they’re overweight and hypertensive and they have high cholesterol, they end up being on four to six medicines a day. The average man, after the age of 50 – middle age – is taking four to six pills a day. He wouldn’t have to do that if he went to see his physician early on, got his blood pressure checked, got his weight down, got an annual examination, and practiced good health habits. Men take on risky lifestyles – they smoke more than women, they consume more alcohol than women, most of the drug abusers are men more than women; and as a result, it’s impacting their longevity, and they die five to seven years earlier than women. I think the playing field is equal when we’re born. We all have two kidneys, one heart, one brain. And what happens, I think, women take much better care of themselves than men do. Men often take better care of their cars and their fishing boats and spend more time planning a vacation than they do taking care of their health. So programs like Movember are absolutely phenomenal in increasing awareness towards men’s health.

Allan (28:59): I agree. I don’t take that same mindset of, “Wait until it’s broke to fix it”, because I’ve seen how bad broke we can get before we actually recognize we have a problem. We hear a screech in our car and it’s in the shop the next day. We get a little sore here or there and we think, “I’ll just work this out and I’ll figure it out”, and then it becomes a bigger and bigger problem as it gets worse. You’re right, Movember is a very good movement, but I really believe that men and women should make a point of what I call “wellness visits”. The doctor is so used to seeing people that are already sick or already in bad shape and need a lot of help. If you make a practice of wellness visits – which I do anywhere between three to four a year, where I’ll go get a blood test and talk to my doctor about it, just to see if there’s anything out there that alarms him or that should alarm me – then we can have those conversations as a part of a wellness visit, not as a part of a care visit.

Dr. Baum (29:56): I would like to see the time come when the doctor would be paid to keep you well, and if you got sick, he didn’t get paid. I think we need to shift gears.

Allan (30:09): I don’t think you’re going to get a single doctor to sign on for that.

Dr. Baum (30:12): I know that’s unlikely to happen. That’s the pie in the sky.

Allan (30:18): That’s where the man, we have to step up and realize our importance in this health team. We have to be the instigator; we have to be the one that manages the situation and drives the car, so to speak, to say, “I am going to have these wellness visits because I want to know that I’m in good health. If my health habits are working, I should see my numbers trending better. And if it’s not working, then I need to maybe readjust and do something because I don’t want to be the guy on four to six medications per day. I’d rather not go through the expense of a surgery or having a foot cut off or whatnot because I have diabetes.” So, I make a point of the wellness visit and I think that’s what we should all do, as men and women, is step forward and say, “How do we become more empowered?” And that’s just by doing, by saying, “I’m going to get the blood tests, and then I’m going to make an appointment with my doctor and we’re going to talk about this.”

Dr. Baum (31:10): You made a good point when we started, right from the get go, when you said women should be listening to this program. And the reason is, even in my own household – I’m a physician – my wife takes responsibility upon herself for my health care. On my birthday every year, an appointment is made for me to go in and get screened and treated on a regular basic. In the Western world, but particularly in America, culturally, women are in charge of men’s health. Consequently it behooves women to be as responsible and as forthright, and maybe even read the book How’s It Hanging?, so they can be on the same language and the same page as the men, and get the men to the health care provider at a much earlier age. I think that’s really important. Our society seems to work that way, and I think women should take part of the responsibility. Ultimately it’s the man; we are in charge of ourselves. We have no excuse. But I think in our society, women control the health care of the children, and it is often that they become responsible for the health care of their spouses or their significant other.

Allan (32:41): And to make your job easier, let’s go in for those wellness visits and we’ll find these things like prostate cancer, testicular cancer early. And he’ll have the discussion with his doctor about fatigue levels, his energy levels, his libido. All those conversations that he would be having with his doctor are going to help him get the treatment so he stays well and he stays energetic and he stays the guy that you may have married 20 some odd years ago, because he’s taking care of his health and he’s keeping his body from aging faster than it needs to.

Dr. Baum (33:15): These men who take testosterone replacement therapy – their lives are like a light switch has been turned on. They just have been living in the dark, and are suffering in silence and not having the quality of life that they should have when it can be treated. I also want to point out about the abuse of testosterone. Let’s talk a little bit about that. Can we do that, Allan?

Allan (33:41): Yeah, absolutely.

Dr. Baum (33:43): For men who have everything, they’re firing on all cylinders – they don’t need a testosterone level, that’s not necessary for screening, and they should not take extra testosterone to make them extra strong or build more muscle mass. This is a dangerous thing to do, and to increase the testosterone beyond physiologic normal can have repercussions. The repercussions are that it tells the testicles you’ve got extra testosterone on board; the testicles will stop producing testosterone for people who are taking testosterone when they don’t need it, and the testicles shrink and they don’t come back. Consequently they’re stuck being on testosterone forever. That is something that should be avoided in normal men. The way to build up muscle mass is get into the gym, work out, lift weights, and not take creatinine and supplements and testosterone when you don’t need it.

Allan (34:58): Actually testosterone is one of those interesting hormones that if you’re in the gym lifting heavy weights, your body is naturally going to want to produce more. So there are things you can do in a natural sense. If you’re eating well and you’re exercising, and particularly lifting heavy things, you’re signaling to your body that you need more muscle mass, and your body will often respond by producing more testosterone.

Dr. Baum (35:20): Exactly. You can’t short circuit it or speed it up. It does happen when you do that, but at a risk. And the risk is that your testicles will stop making testosterone and you’ll be deficient forever. The second thing I want to point out is, testosterone is what fuels prostate cancer. So, if a man has a prostate cancer and he takes testosterone, he is going to fuel the prostate cancer and it’s absolutely contraindicated in men who are getting treatment for prostate cancer. So, before a man who is symptomatic, he has all the symptoms we’ve just discussed, he should have a testosterone level to show it’s low and a PSA to show it’s normal – then he can proceed with testosterone replacement therapy. No man should receive testosterone if they haven’t had a PSA and a digital rectal exam to make sure he doesn’t have prostate cancer. The extra testosterone or replacement therapy can accelerate the growth of prostate cancer.

Allan (36:39): I think the core of this, and the cool thing about this book is that you talk about a lot more than just what we went over today. You really go from one side to the other of men’s general health issues that we’re going to deal with, particularly as we age, and that awareness of what you should be looking for, what it means. And of course you get a little bit into what are some of the current things we can actually do about it. The book is How’s It Hanging? Dr. Baum, if someone wanted to get in touch with you, learn more about the book, where would you like for me to send them?

Dr. Baum (37:08): They can go to my website, www.neilbaum.com. They can write to me at doctorwhiz@gmail.com. And they can get a copy of the book How’s It Hanging? on Amazon.com.

Allan (37:39): This is a book that I think every man should read, and most women should probably read as well, particularly if you are the head of health at your house. You should know about some of these issues, and this is a really good book to have available so you can help understand them and be a driver in your own health and fitness. Dr. Baum, thank you so much for being a part of 40+ Fitness podcast. I really appreciate you.

Dr. Baum (38:02): Thank you, Allan. I enjoyed chatting with you, and hope we’ve brought some light onto the topic of men’s health.

Allan (38:11): Absolutely.

I hope you enjoyed that conversation with Dr. Baum. Men, we do need to be more proactive in looking out for our own health. I know a lot of us like to let the women in our lives be the ones that nag at us to do those things, but really, we need to be doing that for ourselves. So I hope you got something valuable from today’s session, and if you did, would you please go out and give us a rating and review? You can do that through the app that you’re listening to this podcast on, or you can go to 40PlusFitnessPodcast.com/Review and leave a review today. I read each and every one of those and I really do appreciate hearing what you’re getting from the podcast, what you’re learning and how it’s changing and working for you. So please, go to 40PlusFitnessPodcast.com/Review, or leave a rating and review on your app of choice.

As you’re listening to this podcast, if you’re listening to it the first couple of days it’s come out, I’m either in Belize or I’m on my way back. You’ve probably wondered, I’ve talked about taking a couple of trips here and there. I guess I’ll go ahead and somewhat spill the beans. My wife and I are looking to further downsize, further down-stress our lives. It’s no secret that stress has been something top of mind for me for over the past year as I’ve looked at what it’s doing to my health and wellness and seeing it as my next big rock, the next big thing that I need to take care of to get my health and wellness exactly where I need it to be, because my stress level tends to be the one thing that really foils and stumbles up everything else. When I’ve got my stress under control, everything else seems to just fall in place, and that’s what I’m working on doing. So my wife and I may actually move outside the country to find a lower stress, lower cost, lower maintenance level; minimalize some things and get ourselves into a better place. And so, we are checking these places out. If you are living abroad, if you are an expat and you’ve tried different places, I’d love to hear from you, really. You can contact me – allan@40plusfitnesspodcast.com, and I’d love to hear your stories, love to hear what kind of guidance you can give me on that, because we are looking to do this type of thing in the near future. I’ll still do the podcast, I’ll still work with clients. That is a big part of what makes me happy and where I find joy, so I’m not letting that leave my life just for the sake of living in a smaller, quieter, less stressful location. But I do want to do something like this and I will keep doing this podcast and I will keep doing the training, and God willing, I will get this book out.

As I talk about the book, I wanted to remind you, you can go to WellnessRoadmapBook.com to learn more about The Wellness Roadmap book. It’s due to come out at the end of November, but there are still a lot of things that need to happen between now and then to include getting a launch team together. And I’d really appreciate if you would join me on the launch team. You can go to WellnessRoadmapBook.com, and there on the bottom of that page you’ll find an opportunity where you can go ahead and give me your email address and your name. I am not going to use this email address for anything else other than to give you updates on the book and to ask for your help as a part of The Wellness Roadmap book launch team. So I hope you will go out there today – WellnessRoadmapBook.com. Thank you.


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