IN CASE OF EMERGENCY

If you have questions about your health, please see a medical doctor. Nothing in this manual is meant to replace preventive medical care or treatment.

In case of emergency, do not hesitate to call 911. That’s what it’s there for. Don’t “guts it out.” That “indigestion” you’re feeling may in fact be a heart attack. (See the symptoms of heart attack below.)


PREVENTIVE MAINTENANCE

Some men don’t go to the doctor because:

• They are in denial about their health risks.
• They fear the results of their physical exam.
• They find the exam embarrassing.
• They don’t want the Digital Rectal Exam.
• They are “do-it-yourselfers”—who also fix their own car.
• They don’t like the cost of medical care.

It’s far better to know your health risks earlier rather than later. If you get regular physical exams, then you have a base line from which to know if your health is changing. If you haven’t had a physical in years, then when you finally do go in, a minor indication of a health risk can possibly set off more tests because the doctor has no benchmarks for you. Read the section about Prostate Cancer below to get motivated to actually want the results of your Digital Rectal Exam. You may know how to fix your car, but it’s impossible to know all about your body without medical testing. As for the cost, neglecting your health screenings can end up costing a lot more in the end because you didn’t have the benefit of early detection of an illness. Get a physical every year—or if you’re young at least every two years. If your doctor wants you in more often, listen to your doctor!

Also, talk to your doctor. Help yourself by telling your doctor all your symptoms and your impressions of your health condition. Write your questions down before your visit so that you don't forget them. Once you’re there, you can also write down the answers.

Use your doctor as a resource. Remember all the Popular Mechanics and Consumer Reports articles you read, and conversations with car buffs when thinking about the car you wanted? Why not take your health just as seriously?

PREVENTIVE MAINTENANCE SCHEDULES

The first screening schedule is basic and necessary. Some men resist going to the doctor because of the uncertainty of what will happen and what they will be told. This first schedule is designed to give you more control by knowing what you can expect when you go to the doctor. The second has some additional maintenance options to take care of your body and mind.


MEN'S HEALTH SCREENING SCHEDULE I

This is a minimum suggested screening schedule for men with normal health risks—not to supercede the recommendations of your physician.

Screening	Age 18-34	Age 35-49	Age 50+
Testicular	Monthly self-exam	Continue	Continue
Dental Examination	Annually	Continue
Doctor’s Physical Examination	Every 2 years	Annually	Continue
Height and Weight Body Mass Index	Annually (Note unexplained changes.)	Continue	Continue
Blood Pressure	Annually	Continue	Continue
Cholesterol (LDL, HDL) and triglycerides		Every 5 years	Continue
Prostate Cancer Digital Rectal Exam (DRE), Prostate-specific Antigen Test (PSA Test) may also be orderedby physician.			Annually
Fecal Occult Blood			Annually
Hearing and Vision (Glaucoma, Macular degeneration, Cataracts)			Every 2 years Annually after age 65
Sigmoidoscopy or Colonoscopy			Every 5 years
Double-contrast barium enema			Every 5 years

MEN'S HEALTH SCREENING SCHEDULE II

These are additional screenings for men with particular risks, changes, concerns, or symptoms.

Screening	Age 18-34	Age 35-49	Age 50+
Alcohol & Other Drug Use	Annually (Note changes.)	Continue	Continue
Sexually Transmitted Diseases HIV/AIDS, Gonorrhea, Syphilis, Chlamydia, Genital Herpes, Genital Warts	Sex with new partner or other increased risk.	Continue	Continue
Psychological Assessment	Symptoms of depression, anxiety, addictive behavior, etc.	Continue	Continue
Electrocardiogram (ECG)	Physician’s recommendation	Continue	Continue

OWNER MAINTENANCE: TESTICULAR SELF-EXAM

Testicular cancer is a young person’s disease. Please pay close attention to this section if you are between the ages of 15 and 40.

One urologist told me that a seventeen-year-old boy who had one testicle much larger than the other did not come to him for a long time because he was not educated about testicular cancer. The boy mistakenly thought that a larger testicle must be a sign of virility. He said to the doctor “If you’ve got it, you’ve got it.” Men really are too macho for our own good, aren’t we?

There has never been enough publicity about the importance of screening for testicular cancer. We hear a lot about women getting regular mammograms and doing breast self-exams. Men need to examine their testicles as well.

Once a month, after you take your shower, roll each testicle around between your thumb and first two fingers. It should feel smooth and pliant, like a hard-boiled egg without the shell. Look for any bumps, changes, hardness, heaviness, or an enlargement of the entire testicle. Also be on the lookout for changes in the skin of the scrotum. If you detect any of those changes, see a urologist and get it checked out.

When you examine your testicles, don’t be confused by the epididymis, a thin tightly coiled-up tube on the outside of the testicle which stores the sperm cells while they mature. It may feel like a soft, pliant bump near the upper back side of the testicle, but it’s normal.

Successful treatment of testicular cancer depends greatly on catching it early. See your doctor if you have any questions at all. Also, be aware of new growths or changes in your skin to detect skin cancer, and while very rare, men can also get breast cancer, so be aware of changes there too.

PROSTATE CHECKUPS

Please pay special attention to this section if you are 45 or older.

It is unusual to find prostate cancer in men under the age of 50, but many men will have a diagnosis of prostate cancer by the time they are 70. For a lot of those men who are first diagnosed with prostate cancer after the age of 70, the cancer will grow very slowly and may not require treatment. The doctor will monitor it to make sure it stays contained. Many men can live a healthy life with the diagnosis, but for some it can grow very quickly, spread beyond the prostate, and be life threatening. Nearly one-fifth of all men in the United States will eventually have a diagnosis of prostate cancer, and many more may have it because it goes undetected in older men who show no symptoms. 3% of all men will die from the disease. Your doctor can give you an exam and a test for prostate cancer.

While the health screening chart in this manual calls for annual DRE's and PSA Tests in men over 50, the risk for African American men and men with a history of prostate cancer in their immediate families is significantly higher. Experts recommend that those men start with these tests at age 45.

DRE: Digital Rectal Exam

The prostate gland can be physically checked to see if there might be cause for concern about cancer even when the patient has no symptoms. The Digital Rectal Exam (“digital” refers to the doctor’s finger and not some computer readout) is inexpensive, a good indicator of bumps or abnormal areas on the prostate gland, and you get the results right away. It’s just uncomfortable! For my money, I’d get a DRE with every physical between the ages of 50 and 80. The doctor can tell if your prostate is unusually large. This will tell you if the prostate is pressing against the bladder and causing frequent urination. Because of the discomfort of the DRE, it’s sometimes hard to get men in the door for it. For me, it’s worth it for the peace of mind.

PSA Test

Another valuable screening for prostate cancer is the Prostate-specific Antigen Test (PSA Test). It’s a blood test that measures the level of a protein produced by the cells of the prostate gland when there is cancer—and sometimes when there is no cancer. In other words, the PSA Test sometimes has “false positives.” But by giving you both tests annually or every other year, your doctor can get a good idea of the likelihood that you might have a problem, and then you can discuss how serious the problem might be and what you can do about it.

Prevention

Evidence shows that the risk of prostate cancer is reduced by a diet that is lower in red meat, fat, and dairy products and higher in fruits and vegetables—especially broccoli, cauliflower, cabbage, Brussels sprouts, bok choy and kale (all the cruciferous vegetables)—plus tomatoes. Such a diet, along with limiting alcohol consumption, maintaining an exercise program, and keeping body weight down, is associated with a lower risk of other cancers as well. This manual contains valuable tips on exercise and healthy eating.
________________________________________________________________________________________

SYSTEMS
________________________________________________________________________________________

RECOMMENDED FUEL: NUTRITION

Your body is designed to operate most efficiently with a high-grade fuel on the open road at a moderate speed. What kind of fuel is best? You don’t have to measure every ounce of food and follow all the new fad diets. Nutrition can be really simple, and can boil down to four main points.

1. Balance

From the Four Food Groups of the 50’s to the revised Food Pyramid of today, nutritionists have always stressed the importance of balance in our diets, with an emphasis on fresh fruits and vegetables as a primary source of vitamins, minerals and fiber. It’s worthwhile to make the extra effort to eat five servings of fruits and vegetables every day. Start with an orange, glass of orange juice, or half a grapefruit. Have a banana for a snack. Carrot and celery sticks go well with lunch and before dinner. Cook two vegetables with your dinner, or have a vegetable and a salad. It’s not that hard.
We used to have a sense that if we ate too much bread (and other simple carbohydrates) we’d put on weight. Then we were told to avoid fat. Now we’ve come full circle and we’re told that “carbs” (found in bread and pasta) are the culprit. The safest course we can take is one of balance. Eat a wide variety of foods. Spend more time in the produce section of the supermarket and try new things. Here’s a tip: the produce that’s in large supply and priced lower is probably in season and will taste good!

2. Portion Size

When nutritionists tell us to make sure we get five portions of fruits and vegetables per day, they do not mean a small piece, but something the size of a tennis ball—in other words, the whole fruit or vegetable. The recommended portion of bread or pasta is the size of half a tennis ball. The Italian restaurants show big overflowing plates of pasta to get people in the door and make the meal look like a good value. So we mistakenly come to think of that as an appropriate portion size.
The recommended portion of a cut of meat is the size of a regular deck of cards. The restaurant billboard that shows a 72 ounce steak (that’s four and a half pounds!) and advertises that if you can eat it all you won’t have to pay for it may catch our attention, but it’s not a healthy offer. Most of us need to learn about portion size and resist the advertising.

3. Nutrient Density

Nutrient density means the quantity of vitamins, minerals and protein per mass in a food item. Which do you think has more nutrient density, an apple or a donut? (Answer: the apple.) If you’re eating a sub sandwich and you start to fill up, throw away some of the bread and finish the meat and veggies. Make it a habit to select food items that are more nutrient dense.

4. Timing

Many diets prescribe not just what you should eat, but when you should eat it. When we’re busy, it’s tempting to have a donut and coffee for breakfast followed by a quick lunch, a big dinner, and a high fat snack like crackers and cheese or ice cream before going to bed. That’s a recipe for disaster.

Recently, we’ve seen several new diets that recommend eating nothing after 7:30 PM. If you start the day with a good breakfast, then eat two or three more small, nutrient dense meals in the course of the day, and avoid the late night snack, you can stay in shape. The secret is: Eat more healthy food early in the day.


RUNNING THE ENGINE: EXERCISE

Your engine needs to be run at regular intervals in order to stay in shape. Sometimes it needs to be run at higher speeds than normal to keep it running efficiently.

Here are just some of the benefits of regular exercise:

There are three types of exercise your body needs on a regular basis:

1. RESISTANCE 2. STRETCHING 3. AEROBIC

1. Resistance

Resistance exercise strengthens your muscles. You can lift weights, use weight machines in the gym, or use a stretchy elastic “Dyna-Band” or some similar device to build and tone your muscles. Building muscle speeds up your metabolism, which helps you to reduce weight. Resistance exercise is not just for young people. After the age of 60, if you don’t do some resistance exercise, your muscles will start to atrophy. Everybody needs resistance exercise. You can add it to your aerobic routine, or do it on the alternate days of the week.

2. Stretching

When we get older, we tend to get stiffer. It’s a sign of old age. If you want to stay young, stay flexible. If you stretch, you also improve your balance and coordination. Whether we do yoga or back care exercises, we all need to stretch. We can stretch in six basic directions: forward, backward, side to side, and twisting in both directions. Find time to do your favorite stretches every day. They make you feel good while you’re doing them, and for the rest of the day.

3. Aerobic

Aerobic exercise raises your heart rate up to a specific level that builds the strength of your heart and lungs. Most people reading this will need to get their heart rate up to at least 120-140 beats per minute to get the aerobic effect.
You can get the aerobic effect by running, walking very quickly, swimming hard, bicycling, or working out on a wide variety of machines including the treadmill, elliptical machine, step climber, rowing machine, and exercycle. This is the single most important type of exercise. You need a healthy heart. Exercise aerobically for at least 30 minutes three or more time a week. If you have a favorite activity that’s athletic or adventurous that gets your heart rate up to the aerobic level, all the better.

To determine your target heart rate for aerobic exercise, first take your resting heart rate, then use the chart below.

THE ENGINE THAT DRIVES YOUR BODY: YOUR HEART

Probably the three best ways to ensure that you have a healthy heart for better endurance and a longer life are regular aerobic exercise, healthy eating, and effective management of stress. This manual has good tips on all of those topics. It’s also valuable to know how to recognize a cardiac emergency and what to do about it.

Here are the most common symptoms of heart attack for men:

• Uncomfortable pressure, squeezing, fullness, tightness or pain in the chest,
usually in the center behind the breastbone, often radiating to one or both
shoulders or arms and/or the neck or lower jaw.
• Shortness of breath, lightheadedness, fainting, sweating, weakness and/or
nausea.

Other symptoms may include:

• Pallor or bluish color to lips, skin, and under fingernails.
• Extreme exhaustion.
• Shock.
• Swelling of the ankles.

(The most common symptoms for women are slightly different.)

If the victim is not breathing, administer CPR and have someone call 911. Otherwise, make the victim as comfortable as possible, usually sitting propped up with pillows, and ask the victim if he has medication he takes for this. Assist the victim, following his instructions.


AIR INTAKE: YOUR LUNGS

In addition to strengthening your heart and extending your life expectancy and enjoyment, aerobic exercise helps you to keep your lungs healthy.

Another way to keep your lungs healthy is to avoid toxins. There are pollutants in the air we can try to avoid, but many men still “voluntarily” inhale the single worst pollutant for the lungs.

In the United States, approximately 1 in 4 men die of cancer. A third of those cancers are lung cancer. Nearly 90% of all deaths from lung cancer are a result of smoking.

Perhaps because men started quitting smoking before women did, a smaller percentage of men are dying from lung cancer than women. In recent years, the death rate due to lung cancer among men has been decreasing, but to continue this trend we need to educate young people about the dangers of tobacco.


THE ILLUSION OF TOBACCO

The illusion of tobacco is that it appears to have value, when in fact it has none. If you look around and see people smoking all day long, standing outside buildings taking time from their day to have a cigarette, getting together in groups to smoke, and missing their cigarettes greatly when they aren’t allowed to smoke on planes or in restaurants, you would think that smoking must be highly pleasurable. In tobacco advertisements, smoking is sometimes associated with the clean mentholated air of beaches and streams and trim-looking models having a good time. Even in smoking cessation literature, we are sometimes told that it is difficult to give up smoking because smoking “gives us pleasure” and “reduces our stress.” We conclude that smoking must be a highly pleasurable activity!

In fact, this is an illusion because smoking is, in fact, not pleasurable. It actually gives the smoker nothing of value. What it really does is take something away, then it seems to give some of it back in the form of increased heart rate, breath rate, and blood pressure, creating the illusion of a lift. If you’re a smoker, imagine that there’s a cigarette inside you that wants to smoke. That’s the nicotine telling you it wants more nicotine in your system. It is a strong physical addiction.

The first cigarette that one smokes disrupts the mood of a normal, healthy non-smoker. Further cigarettes simply put more nicotine into the bloodstream and brain of the smoker. As that nicotine becomes depleted, the smoker experiences a low feeling—below the normal level of a healthy non-smoker. It creates a physical craving that can also become a psychological craving. The nicotine in each cigarette increases the heart rate, breath rate, and blood pressure temporarily, and thereby creates the illusion of relief. However, the mood never gets back up to the normal level of the healthy non-smoker. The only way to get back up to that level is to get all the nicotine out of your system—a process that can take 3 to 5 weeks.

The only way to escape the cycle of addiction is to first understand and accept that tobacco is not pleasurable, it doesn’t give you a lift, it’s expensive in more ways than one, it causes 90% of all lung cancers, and it contributes to the severity of other diseases. Once you accept that, then quit and never smoke again.

If you are a smoker, you might want to read Allen Carr’s Easy Way to Stop Smoking, published in 1999 by Barnes & Noble. When you’re ready to quit smoking, be prepared for several difficult weeks as your body clears itself out. Your body will be purging itself of the drug nicotine. Maintain a positive attitude about how much better your life is going to be, and then experience the pure joy of clean air, smooth running, and greater peace of mind!
________________________________________________________________________________________

MAINTENANCE TIPS
________________________________________________________________________________________

STAYING ON THE ROAD: EMOTIONAL HEALTH

The best way to manage your stress might be different from the person next to you. Let’s discover something about your personality with this questionnaire. It may help you decide how to handle individual stressful situations. Check off all the statements below that seem true for you.


PERSONALITY QUESTIONNAIRE

How many statements in each group below seem true for you?

Group A

• I’m a fairly aggressive, ambitious person.
• I demand a lot of myself.
• I always try to be well dressed and looking good.
• I get angry when things don’t go my way.
• People often fail to meet my expectations.
• I have a great need for praise and recognition.
• Sometimes I have to push to get what I want.
• I’m never completely satisfied with my accomplishments.
• It seems that I easily get disappointed or frustrated.
• I hate to get sick and I often ignore minor ailments.
• I don’t like to waste my time on small tasks.
• I seem to want perfection from those around me.
• You don’t want to get on my bad side.
• I’m not really comfortable around highly successful or important people.
• Criticism tends to make me extremely angry.
• I find it hard to slow down and take things easy.

Group B

• I try very hard to be a good person.
• I hate to disappoint anyone.
• I often feel that people are talking about me behind my back.
• I can’t stand to be near people who are unfriendly or rude.
• Sometimes it’s really hard for me to say no.
• When I’m upset, I try not to show it.
• I’m quite a giving person.
• I worry about what people think of me.
• I try too hard to please everyone.
• Sometimes my situation seems completely hopeless.
• I consider myself to be quite thoughtful and tactful.
• I often become sick after I’ve been upset emotionally.
• When someone asks me for help, I find it very hard to turn them down.
• I work very hard to live up to my ideals.
• If I’m criticized, I tend to get in a bad mood.
• I try to see the good in people rather than the bad.

Ambitious people (more true statements in Group A) can benefit greatly by practicing relaxation techniques such as the centering exercise on the next page. More passive or unselfish people (more true statements in Group B) would benefit greatly by learning assertiveness skills. Know that you can be assertive—with humor and without aggression.


ALIGNMENT: CENTERING YOURSELF

Here’s a technique for deep relaxation and calming the mind—especially important for people who tend to be assertive, but valuable to all of us as a regular exercise.


1. Sit with your legs in a comfortable, symmetrical position, and with your head, neck and back in a straight line perpendicular to the floor.

2. Let your eyes be closed, or look at a point on the floor in front of you so that you are not distracted by your surroundings.

3. Breathe deeply and slowly for a while. Inhale by first expanding your abdomen and then your chest. Exhale slowly first from your chest and then from your abdomen.

4. Begin counting your breathing. First exhale very slowly and count to see how long it takes. Then inhale in half the time. For example, if you exhale to the count of sixteen, inhale to the count of eight.

5. Slow down your breathing after a while, either by adding numbers to your count, or by counting more slowly.

6. After a while, stop the counting and just let yourself breathe naturally. Without trying to control your breathing, watch the breath as it flows freely and easily in and out of your body.

7. Hold your body very still, and notice that your breathing may slow down and become quiet. Feel this help to put you in touch with a feeling of inner stillness.

8. Bring your awareness to your mind, and watch your thoughts as they enter and leave your mind. Without trying to control or stop them, be aware of the thoughts. Do not judge the thoughts. There are neither good thoughts nor bad thoughts.

9. The thoughts and sounds are like ripples on a pond. Bring your awareness down beneath the surface to a point of silence and stillness deep down within the center of yourself and feel at one with this inner peace.

10. If you lose your focus, return to the counting of the breathing, or deep breathing without counting. Watch your thoughts for a while, and continue at your own pace through the steps again. If a thought comes that you must pay attention to later, write it down so that your mind does not hold onto it. If you want, you can use an alarm clock with a soft beep to let you know when it is time to stop. Experiment with doing this centering exercise for 10-20 minutes at a time.


BALANCE: WORK AND PERSONAL LIFE

Many of us make a daily To Do list that looks pretty much the same every day. There are aspects of our lives that we don’t pay enough attention to and we get out of balance. Many people find that they feel more balanced if they create a master list of life dimensions that they want to pursue and refer to it each time they make their daily or weekly To Do list. Create your own model and try to do something that moves you forward in each dimension every day—no matter how small that action might be. Here’s an example of one person’s master list:

Range of activity within each life area:

Long-Range Goals
Short-Range Goals
Action Steps Today


________________________________________________________________________________________

A FINAL WORD
________________________________________________________________________________________

The lifestyle choices you make influence your health, enjoyment of life, and longevity. Of course there will be health risk factors that you cannot fully control (your family health history or aspects of your environment, for example). But how we live this life is our choice. No one else can take charge of it for us.

To adopt a wellness approach to life, such as the one outlined in these pages, is to go beyond the mere avoidance of illness and strive to become fully alive, or as psychologists have phrased it, to realize our full potential. If we do, we’ll not only have better lives, we’ll have a better chance of being able to help our family members, friends, and everyone around us do their best too.

I leave you with a sincere wish for your health and well-being. It’s a matter of choice, and it’s up to you. We only have one life.


DRIVER'S MANUALS

Ardell, D. B. (1982). 14 days to a wellness lifestyle. Mill Valley, CA: Whatever Publishing.
Baker, D., and Stauth, C. (2003). What happy people know. Emmaus, PA: Rodale.
Burns, D. D. (1981). Feeling good. New York: Penguin Books.
Carr, A. (1999). Allen Carr’s easy way to stop smoking. New York: Barnes & Noble.
Fellows, R. C. (1988). Awareness and meditation (audiocassette). Minneapolis, MN: Mind Matters.
_______(2000). Easily fooled: New insights and techniques for resisting manipulation. Minneapolis, MN: Mind Matters.
Fisher, R., and Ury, W. (1981). Getting to yes: Negotiating agreement without giving in. Boston: Houghton Mifflin.
Goleman, D. (1995). Emotional intelligence. New York: Bantam Books.
_______(1998). Working with emotional intelligence. New York: Bantam Books.
Hyman, M., and Liponis, M. (2003). Ultraprevention. New York: Scribner.
Kabat-Zinn, J. (1992). Full catastrophe living. New York: Hyperion Books.
Keck, L. R. (1992). Sacred eyes. Indianapolis, IN: Knowledge Systems.
Kushner, H. (1986). When all you’ve ever wanted isn’t enough: The search for a life that matters. New York: Pocket Books.
_______(2001). Living a life that matters. New York: Alfred A. Knopf.
Moore, R., and Gillette, D. (1990). King, warrior, magician, lover: Rediscovering the archetypes of the mature masculine. New York: Harper Collins.
Ornish, D. (1982). Stress, diet & your heart. New York: Signet Books.
Ornstein, R., and Sobel, D. (1989). Healthy pleasures. Reading, MA: Addison-Wesley.
Pelletier, K. R. (1994). Sound mind, sound body. New York: Simon and Schuster.
Sears, B. (1995). Enter the zone. New York: Harper Collins.
Tubesing, D., and Tubesing, N. (1991). Seeking your healthy balance. Duluth, MN: Whole Person Press.
Vaillant, G. E. (2002). Aging well. Boston: Little, Brown.