The Aging Male

• Testosterone and the heart
• Are erectile dysfunction pills safe for men with heart disease?
• New aneurysm screening guidelines for male smokers
• Testosterone, prostate cancer, and balding: Is there a link?
• Alcohol Increases the Risk of Gout
• Active lifestyle free of alcohol, tobacco may promote sexual health in men
• Killer snow
• No link found between prostate cancer and vasectomy
• Comparing the Side Effects of Prostatectomy vs. Radiation Therapy

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Killer snow

Every winter, about 1,200 Americans die from a heart attack or some other cardiac event during or after a big snowstorm, and shoveling is often the precipitating event.

Why is shoveling so hazardous?

• Shoveling uses your shoulders and arms, and upper body exercise tends to put strain on the heart because those muscles aren’t well conditioned.
• Working in an upright position adds to the arduousness because blood pools in the legs and feet, so to maintain blood pressure, your heart must work harder.
• Much of snow shoveling is isometric exercise: your muscles are working, but there's little actual movement until you finally heave a shovelful up on the bank. During isometric exercise of any type, your heart rate goes up, and your blood vessels constrict, presumably to send more blood to the straining muscles. As a result, your blood pressure goes up.
• Without knowing it, shovelers sometimes perform a version of the Valsalva maneuver, bearing down as they would during a bowel movement while holding their breath. Waiting to exhale while straining like that can lead to abrupt changes in your heartbeat and blood pressure.
• First thing in the morning, the time when many people dig out from a storm, stress hormone levels tend to be higher, platelets in the blood “stickier,” and heart attacks more likely.
• Shoveling involves exposure to the cold, another cardiac stressor.
• People who are out of shape often shovel, making the sudden intense exercise even harder on the heart.
• Most people don’t warm up before they shovel or cool down afterward.

If you have a heart condition, you shouldn’t shovel under any circumstances. People older than 50 should also try to avoid it. Contact your local council on aging to see if they provide a list of teens in your neighborhood who you can hire to do the job for you. Or buy a snow blower. If you must shovel, take it easy. Rest often. Dress warmly and stay well hydrated. Wherever possible, push the snow rather than lift it. Clear only the snow that blocks your path into the house, the rest will melt on its own. And of course, listen to your body. Head home if you experience potential signs of heart trouble, including chest pain, palpitations, undue shortness of breath, fatigue, lightheadedness, or nausea. Also stop if your fingers or toes get numb or hurt — you could have frostbite.

January 2003 Update

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No link found between prostate cancer and vasectomy

Good news for the millions of men worldwide who've had vasectomies: a new study disputes a link between this birth-control operation and prostate cancer. Two 1990 studies that connected prostate cancer and vasectomies caused men to question the procedure, even though no medical explanation for the connection could be found. Other research has both confirmed and denied the association in the past 10 years.

But the new study, published in the June 19, 2002, Journal of the American Medical Association, should ease men's minds. It involved over 2,000 men of European descent living in New Zealand, the country with the highest rate of vasectomies.

Researchers asked 953 men with prostate cancer and 1,260 who were cancer free about their medical histories — including whether they had had a vasectomy. It turned out that slightly fewer men with prostate cancer had undergone the surgery, which supports claims that going under the knife doesn't cause cancer. The same held true for the 38% of men studied who had had the procedure more than 25 years ago, which suggests that there are no long-term effects.

One reason why the link may have been found in earlier studies is that men who have vasectomies generally see their urologists more often, which may lead to more tumors being found in these men as compared to others, the researchers said. The study also found no link between prostate cancer and history of sexually transmitted disease, smoking, drinking alcohol, and number of children.

Prostate cancer will be diagnosed in 198,000 Americans this year, and it will take 31,500 lives. Although prostate cancer lags behind heart attacks, strokes, and lung cancer as the leading cause of death in American men, it's the disease many men fear most.

August 2002 Update

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Comparing the Side Effects of Prostatectomy vs. Radiation Therapy

Prostate cancer is the most commonly diagnosed non-skin cancer among men in the United States. When caught early, it is also among the most treatable. Two of the more aggressive — and common — methods of treatment for early stage prostate cancer are radiation therapy and surgery (radical prostatectomy) to remove the prostate gland. Although both options have favorable outcomes, physicians have not reached a consensus on which therapy is more effective. This means that men who are treated with either surgery or radiation can usually expect to live for many more years. The caveat is that they often have to live with the side effects of their treatment. Deciding on a treatment option, then, becomes a question of which side effects are more likely with each therapy, and also which side effects are more tolerable to a particular patient.

A recent analysis of data from the Prostate Cancer Outcomes Study helps to clarify this issue by comparing the side effects of the two therapies in men between the ages of 55 and 74, two years after treatment. The results showed that men in both treatment groups experienced significant decreases in sexual function. Of the men in the surgery group, 80% became impotent, compared to 62% of the men in the radiation group. Age and status of sexual function prior to treatment affected these outcomes. Twelve percent of the men who underwent surgery experienced dripping or leaking urine, compared to only 2% of the men who had radiation therapy. Few men in either group were bothered by bowel problems. Of the men who were affected, however, radiation patients experienced more diarrhea, bowel urgency, and painful hemorrhoids (33%, 30%, and 19%, respectively) compared to surgery patients (22%, 16%, and 10%).

Overall, this study showed that men who opt for surgery can expect to have more urinary and sexual problems, while men who choose radiation are more likely to suffer from bowel disturbances. A man's age and initial health are also important factors in the development and duration of long-term side effects from either treatment. Physicians and their patients should use this information, as well as a discussion of the patient's priorities, preferences, and concerns, to help decide which treatment method is appropriate.
March 2001 Update

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