SYMPTOMS
AND SOLUTIONS
Conditions
Men Get, Too
by
John Henkel
Seymour
Kramer noticed a patch of what looked like blood on his pajama
top three years ago and thought he had cut himself. But he
wasn't scratched. His doctor tested the discharge and told
the New Jersey man he had breast cancer.
Dan, 70,
a retired Michigan engineer who asked that his last name not
be used, was pulling weeds three years ago. For no apparent
reason, he fractured two vertebrae. Doctors told him his bones
were wasting away. He has osteoporosis.
As a teenager,
Gary Grahl was obsessed with having a trim, "athletic"
body. The Wisconsin resident shunned food and exercised excessively.
Sometimes he'd do situps and pushups for three hours before
school. He ate little and shrank from 160 to an unhealthy
104 pounds. Over a six-year period, he was hospitalized four
times. Now 26, Grahl says he is "completely recovered"
from his eating disorder.
What do
these men have in common? They all suffer from illnesses typically
thought of as "women's diseases."
Breast
cancer, osteoporosis, and eating disorders all occur in men,
too, though their prevalence is much greater in the female
population. As a result, many men, unaware that the diseases
affect both sexes, may fail to recognize symptoms. Likewise,
doctors and families often don't suspect these illnesses.
This can delay therapy and make disorders difficult to treat.
Medical
experts say men may shy away from seeking medical treatment
for disorders they feel are unmasculine. In support groups,
men use terms like "very scared" and "ashamed"
to describe initial feelings about their illnesses. Others
express frustration at the difficulty in finding information
and therapy.
Osteoporosis
High on the list of such conditions is osteoporosis. A
disorder in which bones become weakened, osteoporosis is sometimes
called the "silent disease" because it has no symptoms.
It often manifests itself in fractures of the hip, wrist,
spine, and other bones. Among both sexes, it is responsible
for 1.5 million fractures a year. Scientists are still piecing
together just how osteoporosis develops, but it is well known
that a key factor is deficiency of the mineral calcium. Calcium
intake over a person's lifetime is crucial to preventing bone
loss. Ideally, a diet adequate in calcium starting in childhood
can maximize peak bone mass, helping to ensure strong bones
and make osteoporosis less likely.
About
99 percent of the body's calcium is stored in bones and teeth.
Bone is continually being broken down and rebuilt. If the
amount of calcium absorbed equals the amount lost, a state
of balance occurs. When calcium absorption is greater than
losses, the body accrues a "positive balance" that
it can use for bone growth and repair. But when dietary intake
of calcium can't meet the body's needs, the body draws the
mineral from bones to allow a constant bloodstream supply.
Ultimately, the breakdown process can exceed deposits, causing
a possible reduction in bone mass and density.
Osteoporosis
is seen less often in men than in women for several reasons.
Men generally have greater bone mass than women, and in males,
bone loss begins later and advances more slowly. But men do
have a hormonal drop-off in testosterone similar to women's
reduction of estrogen after menopause. Testosterone may diminish
as a result of hypogonadism, a condition marked by decreased
function of the testicles. Testosterone levels may naturally
become lower as a man ages.
Loss of
sex hormone results in accelerated bone loss in whomever it
occurs, whenever it occurs, for whatever reason, whether that
translates to osteoporosis depends on how much bone you have
when the loss begins and how quickly you lose it.Women find
relief from osteoporosis with estrogen therapy, and some men
respond to testosterone injections. But successes with hormone
therapy come most often from seeing young men in the early
stages.
Another
therapy shown to slow bone breakdown and reduce pain associated
with fractures attributed to osteoporosis is the drug calcitonin,
marketed as Miacalcin or Calcimar. Under study for osteoporosis
treatment are sodium fluoride, which some researchers think
may help increase bone mass; vitamin D, which helps the body
absorb calcium; and a nasal spray version of calcitonin.
Factors
that raise the risk of osteoporosis include cigarette smoking,
alcohol consumption in excess of two drinks a day, advanced
age, and an inactive lifestyle.
Though
osteoporosis cannot be cured, it can be slowed down and steps
can be taken to prevent it. The National Osteoporosis Foundation
suggests these preventive measures:
* Eat
a balanced diet rich in calcium.
* Exercise regularly, especially in weight-bearing activities.
* Don't smoke.
* If you drink alcohol, do so in moderation.
Breast
Cancer
Primarily associated with
women, breast cancer also occurs in men, although rarely.
Men typically do not perform breast self-examinations to detect
tumors, and doctors do not ordinarily examine men for breast
cancer during physicals. Unlike women, men do not get routine
mammograms. Consequently, a tumor may be present and go undiscovered.
As with
breast cancer in women, symptoms include the presence of a
breast lump that is usually firm and painless. The nipple
can have an abnormality such as retraction, crusting, or a
discharge. Patients frequently are over 60.
Seymour
Kramer was 70 when a gooey, bloodlike discharge from his nipple
prompted him to seek medical attention. After analyzing the
secretion, doctors told him he had breast cancer and recommended
a lumpectomy, in which the nipple and a small amount of breast
tissue are taken out. He also had several lymph nodes removed,
and he underwent five weeks of radiation therapy to help ensure
that residual cancer cells were killed. Though his prognosis
appears very good, Kramer won't say he's been cured. But he
expresses optimism: "Just because I had cancer doesn't
mean my life is over."
The
ACS says risk factors for male breast cancer include:
* hyperestrogenism,
or abnormal secretion of the hormone estrogen
* Klinefelter's syndrome, a male disorder characterized by
reduced or absent sperm production, small testicles, and enlarged
breasts
* gynecomastia, or enlargement of the male breast.
Though
medical professionals typically don't recommend detection
exams for the general male population, doctors may advise
men with gynecomastia to perform periodic breast self-examinations.
Because in men the disease is often detected at an advanced
stage when the tumor has spread, radical mastectomy--removal
of breast tissue and pectoral muscle--is often the initial
treatment. But if the cancer is found before it spreads to
surrounding tissue or to the lymph nodes, a lumpectomy can
be performed. Radiation sometimes is used without surgery,
but the verdict is still out on its effectiveness. As in Kramer's
case, radiation also can be employed after surgery to reduce
the chance of local recurrence and to relieve symptoms in
advanced cases. If cancer has spread into the lymph nodes,
some physicians use chemotherapy. A therapeutic "tumor
vaccine" for men and women to treat breast cancer that
has already spread is in clinical trials now.
Possible
complications after surgery or radiation include decreased
shoulder function, fluid retention in the arm, and pain or
stiffness in the operated or radiated area.
Patients
also need follow-up monitoring--including regular exams, blood
chemistry, imaging (such as magnetic resonance imaging), and
bone scans--to discover any recurring tumors quickly.
Kramer
says his experience of being blindsided by the disease put
him on "a crusade" to inform men and medical professionals
about breast cancer in males. "During a routine physical
exam, I think doctors should run their hands across a man's
breast to see if there's anything irregular," he says.
"I'm not saying men have to go out and get wholesale
mammograms. But [as a rule] doctors don't do this [touch test]
and men don't inspect themselves. Those men who are not aware
need to be shocked into the fact that,'Hey, guys, this could
happen to you.
Eating
Disorders
Though many people associate eating disorders with women,
these illnesses also occur in males. In one disorder, anorexia
nervosa, the person limits food intake to the point of starvation.
In another, bulimia nervosa, sufferers alternate between eating
large amounts of food and ridding the body of it through vomiting
or laxative use. About half of those with anorexia also have
bulimia symptoms.
It's a myth that these are illnesses of rich, white, perfectionist
women. Just as a man or woman may become an alcoholic, either
may fall victim to an eating disorder.Medical professionals
say the disorders most often surface during the teen years,
but in rare cases, men as old as 60 and boys as young as 8
can be afflicted. In both sexes, the illnesses can lead to
lifelong medical and psychological complications. An estimated
6 percent of cases result in death. Most people find it difficult
to halt the behavior without professional assistance. Though
some men ultimately seek help, many continue untreated with
the disorders, often for years, and sometimes for a decade
or more.
Diagnosis is complicated by a reluctance some men have to
seek medical help for disorders that are still primarily women's,We
live in a 'macho' society. Many men simply are ashamed to
have an illness of this type.Thus, they suffer in silence.
Another problem, is that a great number of doctors and health-care
professionals are not trained to identify or treat male eating
disorders, especially anorexia. Families, too, often fail
to see the diseases' symptoms. The illnesses then can progress
to a more advanced stage where they are harder to treat.
During recovery, men sometimes are unwilling to participate
in support-group sessions because the groups are mostly female.
Men as a whole are not comfortable in eating disorder support
groups, But we encourage them to go anyway."
Unlike many women, who acquire eating disorders because they
"feel" fat, men often are medically obese at some
point in the illness and feel pressure to be thin. Sometimes
athletic activities induce this struggle to be lean, prompting
not only the eating disorder but also compulsive exercising.
Men also may adopt disease behaviors when teased or criticized
about being fat at critical development stages, such as puberty.
Treatment can be very effective, according to Arnold Andersen,
M.D., an expert on eating disorders in men who has written
a book on the subject. He describes a regimen of inpatient
or outpatient hospital treatment, depending on the illness
severity. Conditions such as anemia or depression are treated,
and patients gradually relearn proper eating habits. Treatment
also usually includes psychotherapy, which helps patients
understand why they have the illness.
One antidepressant drug, Prozac (fluoxetine hydrochloride),
is under review by FDA as a treatment for bulimia. Other antidepressants
also are being studied. One, Wellbutrin (bupropion), was shown
to induce seizures in both anorexia and bulimia patients.
Doctors sometimes prescribe tricyclic drugs--a class that
includes Elavil (amitriptyline), Tofranil (imipramine), and
Norpramin (desipramine). FDA has approved tricyclics for other
uses but not specifically for eating disorders. However, doctors
may prescribe approved drugs for "off-label" uses
if, in their judgment, the patient will benefit.
Patients
also undergo what Andersen calls "nutritional rehabilitation,"
which allows them to regain a desirable body weight. Treatment
is followed by weeks, months, even years of follow-up to ensure
complete recovery.
Men in support groups for eating disorders, as well as those
for breast cancer and osteoporosis, say the public gradually
is becoming more aware that these disorders can occur in men.
They also say there's a long way to go. Some think doctors
need to be enlightened. Others bemoan the lack of research.
But most seem to agree that men should be educated about the
disorders and how to detect them.
As breast cancer patient Seymour Kramer says: "Men need
to get the word that, yes, this is a woman's disease. But
you're not immune. It can happen to you."
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