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Dr Brian Weis (Host): Well, greetings. Hey, welcome back to the Get Wise with Weiss Podcast. It is my distinct pleasure today to have Dr. Seth Wilhelm with me, one of our Northwest Texas family physicians. And Dr. Wilhelm, could you just take a second? Maybe introduce yourself, tell a little bit about your background.

Dr Seth Wilhelm: My name is Seth Wilhelm. I'm a family medicine physician as Dr. Weiss said. I started at Northwest Physicians Group, the family medicine clinic, about six months ago. Previously, I was working in Toyah. I was doing traditional family medicine there, working in the hospital, the ER, in their clinic. My wife and I met in Amarillo. She's from Canyon. We didn't realize how much we liked Amarillo until we moved away. And so with a growing family and everything, we decided to come back tomorrow and have really enjoyed working for Northwest since.

Dr Brian Weis (Host): Fantastic. We're delighted to have you back in town. So, Dr. Wilhelm and I talked about that we would speak about maybe the things that affect the health of men. And that's not a topic you oftentimes hear. But when I was in private practice, for many years, I have a man come in and say, "Hey, what brings you in today?" They say, "My wife." All right. And so it was very clear that a lot of men would come in to see the physician at the encouragement or oftentimes the mandate of the woman in their lives. And it made me realize there's a reluctance or hesitance of men necessarily to seek medical care. But certainly, there was a thing that they did not understand a lot of the importance of maintaining their health. So, Dr. Wilhelm, think about it, in the men you see, what kind of medical issues do we see in men frequently?

Dr Seth Wilhelm: So the medical conditions you see mainly with men are similar to women. Like you said, they're less likely to come in and seek help. Men are 50% of our population, but far less than 50% of our patient population because of that reluctancy to come in and be seen by a physician. And so their problems are the problems we see with everyone, high blood pressure, diabetes, just your chronic conditions. They're just as likely to have problems with obesity, weight gain. But they're reluctant to come in and be seen by a physician.

Dr Brian Weis (Host): Absolutely. You know, I think my experience of men is, you know, if I seem to be feeling well, I'm not having symptoms and why would I go to see a doctor? But let's talk about obesity, is a big one, I think. Certainly, a lot of men played football in high school and college, or other kinds of very demanding sports. And, in those sports, they were told to bulk up and stuff like that. And then suddenly that their lifestyle changes when they graduate from high school or from college, but they continue a lot of times to eat like they did when they played football. And so certainly, obesity is a big issue. How do we determine if someone's obese or not?

Dr Seth Wilhelm: So the main thing to determine obesity is the BMI or body mass index, which is calculated every time a patient comes into the clinic, bases off of their height and their weight. And normal BMI is 18 to 25, 25 to 30 is overweight and then greater than 30 is obesity.

Dr Brian Weis (Host): Yeah, absolutely. And I think, nowadays, we see a lot of Americans kind of started hitting that 30 plus on their BMI, not uncommon. What kind of health problems tend to come with people carrying extra weight?

Dr Seth Wilhelm: So with obesity comes lots of different problems. People usually feel joint pain with having to carry around extra weight. They come in with low back pain, hip pain, knee pain. But then also other medical problems are associated with obesity, like high blood pressure, diabetes, high cholesterol, and those put you at increased risk of stroke and heart attacks.

Dr Brian Weis (Host): Absolutely. So I know for a long time, we just talk about what's called metabolic syndrome. That encompassed all these almost hidden things that are happening in the body, that we may not be aware of when we carry extra weight. And as you mentioned, the high sugars, diabetes, the high blood pressure, cholesterol abnormalities, all that can affect us down the road. And it's kind of a silent process that we don't realize is going on. Now, you know, a lot of times, you see men and they sit down to a meal and, boy, what they do is they just wolf everything down and they go, "Oh, my God. I ate too much again." How can men address their weight control?

Dr Seth Wilhelm: Men's diet usually isn't the best. Men are more likely to skip meals, and then binge eat later on in the evening. And with that binge eating, it is excessive calories and that excessive calories is what leads to weight gain and obesity. One thing that can really help with patient's weight is not skipping one to two meals a day. And then, whenever you do eat, don't overeat, don't overindulge. I try to recommend patients prior to eating, drinking a full glass of water, because studies have shown that that actually will cause you to consume less calories, just because that water takes up mass in your stomach and prevent you from overeating. And listening to your body's cues. When your body starts to tell you that you're full, stop eating.

Dr Brian Weis (Host): That's a great point. Years ago, I suggested some of my men patients, you know, "Hey, what you can do is sit down and you have a three-course meal. You can eat whatever you want. Okay? But it's 20 minutes per course." So you put that stopwatch on and you can eat. You got to wait 20 minutes before you go to that second course. And when you slow men down like that, A, they usually lose interest pretty quickly, "I am tired of eating." But as you pointed out, they become more sensitive to those cues like, "I'm not hungry anymore. I really don't need that third course." So, yeah, I think sometimes just having men slow down when they eat is a big part of that effect. And you made a great point, even a big glass of water just consume space in the stomach like that. So, how about exercise? What are your views of exercise? Worth doing?

Dr Seth Wilhelm: Exercise is definitely important. you know, they recommend 150 minutes per week of aerobic exercise. That kind of calculates down to 30 minutes, five days of the week. I'm not telling patients they have to exercise every day, but trying to get at least five days a week of exercise, and that exercise should be aerobic exercise if you're working to lose weight. Patients can check a few different ways to see if they're exercising efficiently or not. One easy way that most people have is a smartwatch. The smartwatch will monitor your heart rate and it'll tell you what goal your heart rate is. If you don't have a smartwatch, an easy thing to remember is whenever you're exercising, you should be able to talk, but not sing. And so I actually tell patients that a lot. If you can sing, you can probably go a little faster, go a little bit harder. But if you're going hard enough to where you can't speak in a sentence, then you're going to hard and you probably need to back down. That's a pretty easy way to gauge how rigorous your exercise is.

Dr Brian Weis (Host): Just in a previous podcast, we talked about the fact that, you know, moderate exercise, the definition of it, that you should be able to talk and hold a conversation, but not be able to sing because, you know, my experience too is you'd tell someone, "Hey, you got to go start working out, do some exercising." First thing they do is they go out and they powerlift for 45 minutes and they're sore for the next six months and totally defeat themselves. And so, it's that reality of, A, be reasonable about it. Start slowly, let your body kind of tell you what it can take and build up to really what you said is that goal of a 30 minutes a day, at least five days a week.

Dr Seth Wilhelm: I tell a lot of patients, if you have to start out with just walking, just start out with walking. If you can only make it a few blocks, that's a few blocks further than what you were making a few weeks ago. Slowly increase the distance. Once you start getting the distance, then you can slowly start with a slow jog, even if it's a jog for five, ten minutes, and just work your way up.

Dr Brian Weis (Host): Yeah. Fantastic. I mean, there's so many options today to exercise. You know, when you think about, if you like to run, great. But, you know, everything from these bikes and Pelotons, stuff like that to swimming, all these things. But the trick is just get moving in absolute ways to control weight. So we talked a lot about some people carrying extra weight. One thing I hear a lot about is obstructive sleep apnea, OSA, and it seems like it's all the rage. Everyone wants it. Everyone's got it. We want to be part of their club. What is obstructive sleep apnea?

Dr Seth Wilhelm: I'm probably part of the rage about sleep apnea. Most of my patients will probably tell you, I've asked them about their sleep habits and if they snore, if they have witnessed apneic spells. Part of that rage is because of excessive amount of overweight and obesity we have in our current population. Obstructive sleep apnea is just described as, whenever you're falling asleep, you stop breathing. There's two main causes of sleep apnea, one is central, but the most common is obstructive. And most of that has to do with your body habitus and being overweight. And sleep apnea can cause all kinds of problems, can cause high blood pressure, can cause reflux, can cause poor insulin resistance leading to diabetes, can cause decreased sexual libido. I mean, it really is amazing how many problems can be caused from one small diagnosis that can be fixed.

Dr Brian Weis (Host): Absolutely. I mean, we are learning so much about sleep hygiene, if you will. Just kind of a broader term of how much sleep you get, how good is the sleep you get. For years, we thought you just tough it out. If you only get four hours of sleep a night, that's fine, you'll learn to live with it, which is not true anymore. We now know that each of us genetically it's determined how much sleep we need to feel well. Now, are there any symptoms I would look for that might suggest I have a sleep issue like sleep apnea?

Dr Seth Wilhelm: Three main symptoms you're probably going to have is snoring at night. Most people don't know if they snore or not, but if your significant other mentions snoring. Another one is witnessed apneic spells or witnessed episodes of where it sounds like you're not breathing for a few minutes while you're sleeping. And then, the last one that patients usually tell me is excessive daytime drowsiness, excessive daytime fatigue. Those are the three main symptoms that we look for that we can screen and then send you off for a sleep study.

Dr Brian Weis (Host): Yeah, fantastic. You know, I think I call it the church test. If people are sitting in church, I look around and see which men are dozing off in church. And, you know, that those are probably the ones that need to be looked at for sleep apnea. So, yeah, so that somnolence, what it means is that literally, you sit down and five minutes, you're drowsy if you're in front of TV or more scary, if you're driving, you can get that somnolence. So what if I suspect I have that? What do we do?

Dr Seth Wilhelm: The first thing you need to do is come see your primary care doctor. We can assess it. We can check your heart rate, check your blood pressure, discuss the symptoms that you're having, and then send you off for a sleep study. You can either do a sleep study in a sleep lab or you can do a sleep study at home, and that test will pretty much tell us within a night if you have sleep apnea or not. And then from there, it's simply getting tested and fitted for a CPAP machine and start wearing it at night. Once you get used to it, it might take a few nights or a week or two to get adjusted to it, but once patients get adjusted to it, they tell me that there's a complete night and day difference in their overall health with using the CPAP.

Dr Brian Weis (Host): Absolutely. I have found that, in many of the men I've taken care of, is a life-altering change in their life, is that somebody had that CPAP. I had one friend that we used to go camping with the Boy Scouts and you could hear him snoring throughout the canyon. And he got checked, ended up with a CPAP and he loved it so much that any time we went camping, he would bring his CPAP with car batteries in his tent. He would not do without it, because it made him feel so well. So yeah, you made some excellent points.

Dr Seth Wilhelm: I mean, I have patients that they tell me that is the first thing they pack whenever they go on trips, is their CPAP machine, because they don't want to go without it.

Dr Brian Weis (Host): And if they don't pack it, their wife will.

Dr Seth Wilhelm: Exactly.

Dr Brian Weis (Host): So, yeah. Again, you mentioned, if you ask, "Do you snore?" And most men are like, "I don't know," and you look at the wife, and you get this big nod, like, yes. So you can make the whole family happy with this. So now, we talked about a lot of men, one fear is things like heart attacks and strokes, as we get older. Can we prevent those or is that just inevitable that a man's going to have a heart attack?

Dr Seth Wilhelm: No, we can definitely prevent them. We already talked about eating healthy and exercise. That's probably one of the biggest prevention that can prevent men from having a heart attack or a stroke. But there are other things that we can monitor and check to help prevent a patient from having a heart attack or stroke. We recommend at least coming in once a year to get your blood pressure checked. One in three men over the age of 25 have high blood pressure, a large percentage of those are undiagnosed because they just don't come in. Being able to get your blood pressure checked and then managed properly will decrease your risk of a heart attack and a stroke. We can also check blood for your cholesterol and for your blood sugars. Both elevated cholesterol and diabetes puts you at a higher risk of heart attack and stroke and managing that and getting it to within proper ranges will decrease your risk of heart attack or stroke.

Dr Brian Weis (Host): Yeah. Thank you. I am old enough to remember when cholesterol, basically the LDL receptor was first discovered in the mid-1980s in Dallas. And that was a revolution in our understanding of our physiology that prevents things like heart attacks and strokes. And it's interesting, for men, we talk about the good cholesterol and the bad cholesterol. Bad cholesterol is that LDL, which we watch. But then, there's this good cholesterol called the HDL. And that's the one that we know the higher it is, the better. It seems to have a protective effect, if you will. And when you look at a lot of men where the whole family has had men have heart attacks early in their life, it tends to be a very low HDL that's the problem. So if you can talk about how can we raise our HDL? Anything we can do to bring that up?

Dr Seth Wilhelm: Yeah. So ways to improve your HDL, again, healthy lifestyle, healthy diet and exercise, eating healthy, such as fish and chicken. Omega-3 fatty acids, fish oils can help increase your HDL. And like you said, the HDL is your good cholesterol, and it has been shown to help decrease your risk of heart attack.

Dr Brian Weis (Host): Absolutely. You know, a couple things, obviously, we have medications nowadays that can help that. So if despite the healthy lifestyle changes you mentioned, we just can't get that HDL up into a healthier good range, and normally you talk about at least greater than 40. In most people, we want it the higher, the better though.

Some of the medications, like the statins, the lipitors, Crestor that can help with that. So, but really vitally important to help men prevent some of those things down the road, which can really haunt them if we don't find that early.

Dr Seth Wilhelm: Yes, sir.

Dr Brian Weis (Host): Yeah. And these are things that, as you mentioned, we can detect earlier in life to prevent the long range effects and stuff. So older men like myself, what do we need to think about in terms of screening for any problems that might come up as we age?

Dr Seth Wilhelm: So definitely several things to kind of screen for. I kind of already mentioned high blood pressure hypertension, at least getting checked annually for that. Checking your blood sugar to help prevent stuff like that. If a patient smokes, we need to counsel them about smoking cessation because smoking also increases your risk of multiple health problems, including heart attacks, strokes, COPD. But then, we also kind of can talk about other screening issues such as prostate. Prostate is the big thing that a lot of men come in and ask me about. The reason for that is because they don't really have a lot of education on it. Back in the day, they did a prostate exam, something that we don't do anymore. And so, there's now a blood check that we can do, your PSA or prostate specific antigen that we can check. And there's not a recommendation across the board saying you need to get it or you don't need to get it. That is something you need to have a discussion with your physician about, to decide if you need to get that PSA, get it screened and monitored annually to check and see if you have a prostate problem or not.

Dr Brian Weis (Host): Absolutely. So a prostate is an organ that as we get older as men, a lot of times will give us symptoms. It tends to cause some obstruction to urine flow as it enlarges later in life. And as you mentioned, that PSA, you can go for that. But the biggest thing is obviously that prostate cancer we're worried about. And that PSA is a very sensitive test to see if something is affecting the prostate that could be, among other things, prostate cancer. How about what I officially refer to as butt scopes. Why don't we do that? What's the recommendation there?

Dr Seth Wilhelm: So, butt scopes are a way to screen for colon cancer. It's recommended after the age of 50, between the age of 50 and 75 to get colonoscopies at least once every 10 years. But there's other ways to screen for colon cancer. A lot of patients dread the colonoscopy, not because of the actual procedure, but because of the night before, whenever you're having to prep for it. And there are now tests called FIT test, that are just annual stool samples that we can check. And that way, you can avoid having to get a colonoscopy. But it's still recommended to do one of the methods to screen for colon cancer. and that recommendation starts at the age of 50. Or if you have a family history of colon cancer, talk to your primary care physician about getting that done.

Dr Brian Weis (Host): Great point. I mean, you bring up family history and that's why it's so critical when you're talking to your primary care doctor to know your family history if you can. Obviously, some people may be adopted and may not know that family history, but it can tell us about things we need to look out for in your care. And as you mentioned, some families have early heart attacks, some families have early cancer, colon cancer, and that allows us to change that screening to hopefully prevent that. you know, the nice thing about a colonoscopy, if there is a nice thing, I guess, you're squeaky clean at the end of it. But second is this idea that if they do find a polyp, which we know is a precancerous lesion, the GI doc can remove it right then and there at the scope and it's done.

Dr Seth Wilhelm: Yeah. And I mean, it's a nice thing. It's a screening and then treatment all-in-one. I do tell patients that are reluctant to get a colonoscopy, we can do the FIT screening or FIT testing. But if that comes back abnormal, we're going to have to go ahead and do the colonoscopy. And like I said, the worst part is the night before. You don't remember the colonoscopy for better.

Dr Brian Weis (Host): I know that bowel prep is dramatic at times. But I always tell people to just drink the stuff quickly and get it over with, but that's the thing. And then, as we say, a lot of times, if you have a clean colonoscopy, that means that they did not find any polyps, you essentially have 10 years of worry-free life after that. And so again, it's one of the few things we can do that we can prevent and eliminate colon cancer, people who undergo those screening tests. Because unfortunately, colon cancer, if found late, can be a fatal development.

Dr Seth Wilhelm: Yeah, absolutely. Exactly.

Dr Brian Weis (Host): So lastly, let's just talk a little bit about the mental health of men. I think you kind of alluded to it that a lot of men kind of have that He-Man complex. You know, "I can deal with it. I can just suck it up." Tell us about depression. Do men suffer depression? And what kind of symptoms do we get from it?

Dr Seth Wilhelm: Men definitely suffer from depression. And men have a higher suicidal rate than women do. but at the same time, men are less likely to get help for depression. Like you said, I think part of it has to do with the men mentality of not needing help, being able to do it on their own. And we're trying to erase the stigma of depression for both men and women, because, in the last few decades, it's been understood to be more of a disease process. And so treatment with that is to help with that disease process. And so, men are just as likely as women to suffer depression. And it's nothing to be ashamed about or nothing to be worried about bringing it up with your primary care physician. We are here to help and the main symptoms you're going to have with depression would be a depressed mood, but you can also have problems of difficulty sleeping, wanting to sleep too much, and not being able to sleep at all. Your appetite changes. Some people eat a lot more or don't eat enough. Feelings of guilt, irritability. Men have a higher incidence of irritability with depression. And that may be something that they notice or their significant other notices. A lot of men come in and tell me, "Man, my wife or my kids have told me that I'm harder to be around. I have a shorter fuse." And you know, the biggest thing is don't be ashamed to discuss this with your primary care physician. We're here to help. There really should be no stigma around depression, because it's a disease that can affect other parts of your overall health.

Dr Brian Weis (Host): Yeah. Depression is not just a matter of being tough or not. We now know it really comes down to a biochemical imbalance in the brain a lot of times, not something necessarily we can control. But thereto, as we talked about with the cholesterol, we have some great medications nowadays that can help people alter that biochemistry and can, boy, change their lives. Thereto, I think I've had the experience of counseling some of my men patients and say, "Hey, why don't we just try this for 30 days and see if you like it?" And they come back and say, "Wow, I mean, what a difference. I'm not as irritable. I don't have the road rage I used to have. I feel like doing things now. I'm not withdrawn. I'm getting pleasure at things I used to enjoy that I haven't been recently." Life-changing stuff. So thereto, how we could possibly encourage men to be open, be open with your physician and say, "Maybe I've got a problem."

Dr Seth Wilhelm: most clinics, our clinic included, we have a depression screening that our nurses do prior to me even seeing them. They ask them a few questions. And if they answer yes to any of them, then that kind of helps me know what to talk about a little bit before I go in and see the patient. And so it's easier to discuss that with the patient.

Dr Brian Weis (Host): Great. Great. Oh boy, we covered a lot of topics today.

Dr Seth Wilhelm: Yes, we did.

Dr Brian Weis (Host): But I think that some real themes came out, for me, talking to you, is obviously there are a number of medical concerns men can have that we can take care of as primary care physicians and really hopefully prevent, for a lack of a better term, heartache down the road. A lot of this podcast has been this idea that preventive care is much better than reactive care. And if we can prevent you from getting sick in the first place, all of us do better better that way.

Dr Seth Wilhelm: Yes, sir. And that's what I try to tell patients, it's a lot easier for us to take care of something before it happens than to take care of it after it happens. We're here if it needs to afterwards, but coming in at least annually for a checkup to discuss issues or something you have with your doctors is one of the best ways to help with your long-term health.

Dr Brian Weis (Host): I mean, is there an age that men should start seeing their primary care?

Dr Seth Wilhelm: Every age should. I mean, as family medicine doctors, we take care of patients from infant all the way through geriatrics. So, every age of patient should have a primary care doctor and should be seeing the doctor at least once a year.

Dr Brian Weis (Host): Fantastic. I certainly agree. And you build that relationship. That's the biggest thing, you can build that relationship with that provider. That way, when you do need their attention, you've got someone to go to quickly and that knows your history and can respond appropriately. So vital. So anything that I missed talking about that you wanted to bring up about the healthcare of men?

Dr Seth Wilhelm: No. I mean, I think that's pretty much everything. We've touched quite a bit. We've gone through a lot of topics. So hopefully, we can start helping other patients.

Dr Brian Weis (Host): Absolutely. Well, Dr. Wilhelm, thank you. I appreciate your time coming to talk to us today. And I hope that this will reach out to a lot of men in the community to understand that, "Hey, maybe I need to go in and just get myself checked and make sure that I can prevent things in the future."

Dr Seth Wilhelm: Thanks for having me. I really enjoyed it.

Dr Brian Weis (Host): Absolutely. All right. Thank you.

Dr Seth Wilhelm: Take care.