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Scott Webb (Host):  Welcome to Hally Healthcast, the monthly wellness podcast from Hally health – your source for health and wellness resources, information and tips. Our topic this month is Men’s Health. Here with us today is Dr. Charles C. Liang. Dr. Liang is Family Medicine trained and currently works in the Transitional Care Clinic at Carle Foundation Hospital in Urbana. His areas of expertise include sports medicine, preop and urgent care. I’m Scott Webb and Dr. Liang, so nice to have you here today. Let’s jump right in. we’re exploring five health questions every man should ask and why they are important. So, question number one, what are the most important tests and screenings to get and when should I get them?

Charles C. Liang, DO (Guest):  So, let’s start with prostate cancer screening. Prostate cancer is really common in men, though oftentimes it ends up being asymptomatic.So, generally speaking, we’ll start the discussion at age 50 for an average risk person. If you have family history of prostate cancer in a first degree relative, so that would be if your father or brother had prostate cancer diagnosed at an age below 65; then you should be screen at age 40 and 45. And also equally important, is once when should you stop screening. I get that question a lot. And if you are again, if you are an average risk man, you should be stopping your screening at age 70.

Another test that’s really important is colorectal cancer screening and I like colorectal cancer screening because colon cancer is one of the few cancers we can actually prevent by screening. So, again, just like prostate cancer, the age of 50 is the time that you want to start screening for this. And that’s if you have average risk. Family history again plays a huge role in this. You want to start at age 40 if you have had family history in a first degree relative. It’s interesting that with colon cancer, about 25% of people have had a family history. So, a way to think of it is your average risk for colon cancer is about 4%. But if you have a first degree relative that is a parent or a sibling or if you have two second degree relatives, so that would be two aunts, two uncles, who have had colon cancer; your risk goes up to 6% instead of 4% and if you have had two or more siblings or you have had a parent and a sibling with cancer; then your risk goes up to 9%. So, more than double.

So, I guess one thing I’m trying to stress here is knowing your family history is very helpful and very important. Blood pressure screening is also one that’s important. And that’s because hypertension leads to so many other problems. Like heart disease, stroke, kidney problems and we already know that for every 20 points of elevation in the systolic number or the top number and for every 10 millimeters of mercury higher for the diastolic blood pressure; your risk of death from heart disease or stroke doubles. So, we recommend that you get your blood pressure screened every year and there’s not really an age for this one. You should start getting your blood pressure screened yearly in your 20s. 

Another test that’s recommended by the American Diabetes Association is checking your blood sugars. Your fasting blood sugar. And this is due to trying to pick up diabetes at an earlier stage than we have in the past. This is something that can be done once a year. And we recommend that testing start at age 45.

Host:  That’s great Doctor. Thanks so much for breaking all that down. Now this next one kind of hits home for me because some of my family members have had heart troubles including my dad who had quadruple bypass just a couple of weeks ago. So, question number two, how do I know if I’m at risk for heart disease?

Dr. Liang:  You are already doing the most important thing which is you are aware of your family history. The other thing that you should be doing is getting a cholesterol screening done. That will give you a lot of valuable information and that should be done fasting. The other question I get a lot is should I have a stress test done if I’m worried about heart disease. And the current recommendation is no, if you are asymptomatic and you are able to walk or run without any problems, without any chest pain or shortness of breath, you do not need a stress test. There’s also a test that I’ve done sometimes for patients that we very interested in being proactive about their cardiac history and that’s a CT scan. It’s a low dose CT scan of the coronary arteries so that’s not to be confused with the CT scan of the lungs for smokers. So, this low dose CT scan of the coronary arteries picks up plaques or calcium build up inside the coronary arteries and it can give you an early indication that you’re building up plaques inside of your arteries.  The CT scan gives us a little more information. So, for example, if it shows plaquing beginning already; that guides us into thinking that yeah, maybe we should put you on cholesterol medication now. If your CT scan is completely clean; then perhaps we can wait and watch you and maybe even repeat that in a few years. it just gives you one more piece of the puzzle to help you make that decision.

Host:  Yeah, there’s no doubt it’s great to have all those tools in your toolbelt. During lockdown, I’ve been thinking about working out and wondering how much is too much. So, question number three, how do I know what’s healthy for my body and my age?

Dr. Liang:  Well the first thing you have always got to do is listen to your body. And generally speaking, walking is a great form of exercise. It’s safe. And it’s something that you can do without going and receiving clearance from a doctor or having a stress test done or anything like that. You can just go out and walk around your block and walk at a comfortable pace where you are able to talk and you’re able to sing. That’s comfortable pace. If you do that, 30 to 45 minutes a day, five days a week, that’s a great start. Now if you came to me and said heh, I want to start running. Thar’s my ideal exercise. I would say again, if you want to start off slow, always start off slow; when you are running, you want o be able to talk. You run at a pace where you are able to carry on a conversation with someone else but not being able to sing. And you want to do that for about 30 minutes. Now if you come to me and say well, I really want to go all out. I want to get that heart rate up. I want to do a lot. Then I would say, well wait. If you want to go that hard then you should have a conversation with your physician.

Host:   So, question number four mental health is hard for me to talk about as I’m sure it is for others. So, where can I go and who can I talk to about my mental health?

Dr. Liang:  The first point would be you can discuss this with your Primary Care Provider and most health systems have extensive counseling services available. One thing I would say is you don’t always have to see a “psychologist.” Counselors are an excellent resource for 90% of the issues that patients come in with. And I think that the best individual to help guide you in that would be your Primary Care Provider. 

Host:  You know Doctor, I’ve got a bonus question for you. During lockdown, I had the chance for a video visit with my doctor. I sat in my kitchen. We had a video chat on my phone. I found it to be more relaxing that our typical visits. And it saved me a trip to the office to essentially have my meds refilled. What are your thoughts about Telehealth and Telemedicine? Is it here to stay?

Dr. Liang:  I definitely believe it’s here to stay. I’ve been doing some Telehealth visits as well through Zoom. Carle has a – has set up Zoom accounts for us and patients really like it. so, for a lot of the reasons that you mentioned, I have one patient who was waiting in his car after he dropped his cat off at the vet, so he had to wait. So, while he was waiting, we did a Zoom visit. And it’s very time efficient for the patient. The other thing we find is that people are willing to do a phone visit when they might not be willing to drive all the way in and out or they are not able to. And I can definitely see when the weather gets bad again, on a heavy snow day where patients would be cancelling, they can do a Zoom visit instead. It’s definitely here to stay.

Though I do want to throw a caveat in that I think patients should still be seen once yearly just to check because you do pick up some cues on the physical exam that you might not see but for simple refills, for follow ups, I think that’s perfect. It’s a perfect idea.

Host:  As we get close to wrapping up here, question number five, as I get older, what specific health conditions should I be on the lookout for?

Dr. Liang:  One of my favorites is sleep apnea. Sleep apnea is more common in men and it becomes more significant as we get older. Sleep apnea is where you actually stop breathing for a few moments and some signs and symptoms are loud snoring, and gasping breath. 

It can set you up for heart disease. It can set you up for atrial fibrillation. Approximately half the people with sleep apnea have atrial fibrillation. Not getting enough sleep. You are basically starving your brain of oxygen. 

Host:  So, what else should we be thinking about?

Dr. Liang:  I would encourage people to exercise more and keep moving because your metabolism slows down as we age. So, you need more exercise and exercise increased blood flow to your brain too which helps keep you alert, and we know that that helps stave off things like dementia too. The other thing is I would encourage people to think about more is their diet. Eating healthy and by that, I mean – think about GFS, grains, flour and sugar. You want to try to avoid eating refined grains, refined sugars and try to stay away from flour items like cake. So, cake and ice creams basically is what I’m trying to say. And trying to eat more vegetables and lean meats and it’s okay to have an egg. It’s okay to have five eggs a week. For a while there, we had talked about eggs not being healthy and not good for you. But it makes a difference too – but now we know that it’s fine to have an egg, five eggs a week, for example. Good source of protein, good source of vitamins and I would encourage people to take a multivitamin every day. Because your absorption may not be as good as it used to be and again, going back to exercise I guess would be the most important thing.

Host:  That’s all well said, Doctor. Diet, exercise, testing, screening. We’ve covered all the big stuff today. I get my flu shot every year. And I’m wondering about vaccinations. So, kind of a bonus question here for you. What other vaccinations should we get and when should we get them?

Dr. Liang:  Well that’s a great question. And kudos to you for getting your flu shot every year. That’s a huge step in protecting yourself and your loved ones. Another immunization that slips by people oftentimes is their tetanus shot. You still need a tetanus shot every ten years as an adult. Most people think oh I get that as a kid. But you need it every ten years. There has been a change and an improvement in the shingles vaccination too. Now there’s a shot called the Shingrix which is a lot more effective than the previous shot which is known as the Zostavax.

There is also a benefit to getting the pneumonia vaccination for those patients that are over 65. And I would recommend getting that as well.

Host:  Such important advice and such great knowledge. Thank you so much Dr. Liang for all your expert knowledge and advice today. And thanks for all you do at Carle. And that concludes today’s podcast. Tune in next month and we’ll discuss the five most important vaccinations and when to get them. And remember – Hally health is your source for a wide variety of health and wellness resources, information and tips. Visit us online at hally.com. Let us help keep you and your family healthy and well.