ACOFP 54 th Annual Convention & Scientific Seminars. Men's Health - Medical Concerns for the Aging Male. Donald Jablonski, DO, FACOFP, FAODME

Transcription

1 ACOFP 54 th Annual Convention & Scientific Seminars Men's Health - Medical Concerns for the Aging Male Donald Jablonski, DO, FACOFP, FAODME

2

3 Don Jablonski, DO, FAODME, FACOFP Medical Director Michelin, Headquarters North America Family Health Center Men s Health The Aging Male 1

4 Aging! Time flies and so does our age! Medicine The Science of Medicine (ACOFP CME Courses) The Art of Medicine (The DO s Specialty, From Day 1) Today a little of both 2

5 Men s Health The Aging Male Do not regret growing older. It is a privilege denied to many. (Unknown Author) Men do not quit playing because they grow old; they grow old because they quit playing. (Oliver Wendell Holmes) How do we handle health monitoring for different age groups? We are not here to teach you how to practice. Maybe some of our slides will give you something to think about and take back to your office? We will breeze though the invincible years. Invincible years age 16 through.years old? Then delve into the middle age group. Followed by my age group. 3

6 Physical Exams/ Lab Tests by AGE Considerations must include.. Genetics (The family history) Weight Activity Level Social behavior Curing the Male Seeing the Doctor, (Macho Man Sydrome) too many men WAIT too long to make an appointment and only do so if all else fails and, the condition doesn t resolve itself in days to weeks.. Then they admit to defeat, and defeat sends them to the doctor. BUT the Majority of Men s Office Visits are due to.. The NAGGING wife. 4

7 Accessing the Male for Preventative Care Take every opportunity available to talk about their health. Patient comes in for cold, sore throat, back pain etc Talk about preventative care, physical exams, immunizations. Accessing the Male for Health Care We are family doctors and when we see the Health Care Coordinator, the wife, remind her about her husband s and son s last check up. 5

8 Physical Exams/ Lab Tests by AGE When do we get our opportunity to examine and give advice to the young male? Sports physical, school physical and an employment physical. Some of the physicals are brief some are more comprehensive. The time spent is an opportunity to talk about health issues. Can it make a difference? Physical Exams/ Lab Tests by AGE Screen for medical issues. Assess you re their risk for future medical issues. Encourage healthy lifestyle. Update vaccinations. Try to establish a rapport for future medical visits. 6

9 Physical Exams/ Lab Tests by AGE Screening males 18 to 39: BP check every 3-5 years. If BP between systolic and diastolic recommend yearly BP checks. (Your office, Pharmacies, Wal-Mart, Fire stations, etc.) Remind patient that BP > 140 / 90 should prompt an office visit. Genetics and other factors must be considered such as glucose testing or cholesterol levels. Physical Exams/ Lab Tests by AGE General Rules! Cholesterol testing men over 35 every 5 years. If risk factors present for heart disease, such as diabetes start screening at age 20 If patient has heart disease or kidney problems obviously check levels more often 7

10 Physical Exams/ Lab Tests by AGE Diabetes Screening BMI > 25 and have other risk factors for diabetes = glucose testing Physical Exams/ Lab Tests by AGE Dental Exam once or twice a year for exam and cleaning. Eye Exam Patient has visual problems they should be seen every 2 years or more often if needed or recommended. Patient with Diabetes yearly exam recommended 8

11 Physical Exams/ Lab Tests by AGE Immunizations After age 19 boosters with tetanus, diphtheria and acellular pertussis (Tdap) Flu Shot-yearly HPV 2 doses of varicella vaccine if born after 1980 The Wonder Years Ages BP check every 2 years or more often if indicated Cholesterol check > 35 y/o every 5 years Diabetes check > 45 every 3 years or if indicated sooner and more frequently If BMI + then more frequently start before 45 Asian and BMI over 23 screen If If any risk factors exist then sugar checks more frequently 9

12 Ages Immunizations up to date Tetanus-diphtheria every 10 years and at least one t- dap Shingles vaccine after age of 50 Osteoporosis screening if there are risk factors Prostate screening? What s Next Colonoscopy at age fifty unless other risk factors then before the age of fifty. Repeat as recommend by doctor. Stool occult blood test yearly Dental Exam Twice a year for exam and cleaning Eye Exam every 2-4 years ages and every 1-3 years ages obviously more often or as needed for good visual acuity 10

13 Lung Cancer Screening USPTF recommends annual screening for lung cancer with low-dose CT (LDCT) (Sept. 2016) Yearly for: Have a history of heavy smoking 30 pack years, and Smoke now or have quit within the past 15 years, and are between the age of 55 and 80 years Lung Cancer Screening Risks: Yes there are risks False-positive Over diagnosis-finding cases of cancer that may never caused a problem Radiation from repeated LDCT tests can cause cancer 11

14 Sleep Apnea Weight Age Physical make up Narrow throat Enlarged tongue Frequent ETOH use Smoking Sleep Apnea Age Prevalence 3.2 % ages % ages % ages

15 Sleep Apnea Consequences Morning headaches Concentration problems, worsening of ADHD Irritability, depressed and mood swings possibility of personality changes Waking up frequently to urinate Dry mouth or sore throat upon awakening Sleep Apnea Consequences Daytime sleepiness Awakening by gasping or choking Hypertension Nighttime sweating Decreased libido CVA CHF 13

16 Sleep Apnea Consequences Cardiac arrhythmia Journal of the American College of Cardiology Obstructive sleep apnea is prevalent among patients with atrial fibrillation. Proper treatment can reduce the frequency of recurrent atrial fibrillation episodes (Heart Rhythm Society) Sleep Apnea Work-up Family History Physical Exam Sleep studies Home sleep studies Polysomnogram 14

17 Sleep Apnea Treatment CPAP (moderate to severe sleep apnea) Auto-CPAP EPAP Oral appliances Surgery Jaw repositioning Tracheostomy Continuing The Aging Male Dr. Igor Altman 15

18 Really Old When we are really old we will likely measure our lives by how well we loved, how well we were loved, and by what we created, whether that be family, work, art, or friendships Joyce T. McFadden 16