A. Heart Disease

Positive risk factors for coronary heart disease (CHD) include: 

1. age (> 45 in males, > age 55 in female)
2. family history of premature CHD (before age 55 in first degree male relatives, before age 65 in female first-degree relatives)
3. current cigarette smoking
4. hypertension (blood pressure > 140/90 or taking anti-hypertensive medication)
5. high LDL cholesterol (>130mg/dl)
6. diabetes mellitus

High HDL cholesterol (> 60 mg/dl) is considered a negative risk factor (good).

Total Cholesterol - The likelihood of developing coronary heart disease, or CHD (a narrowing and blockage of the arteries that supply blood to the heart muscle), is directly related to the amount of cholesterol in the blood. The higher the level of blood cholesterol, the greater the risk of CHD.

Less than 200 mg/dl Desirable level
200 - 239 mg/dl Borderline high
240 mg/dl or more High risk range

Desirable Level (cholesterol less than 200 mg/dl) - Risk is relatively low, barring other risk factors. It is still a good idea to eat a diet low in cholesterol and saturated fat.

Borderline High (cholesterol between 200 mg/dl and 239 mg/dl) - Risk is doubled. Modify other risk factors if any. Change diet to reduce cholesterol to below 200; recheck in 6 months. Trust your doctor to interpret your particular results; each case is different.

High Risk (cholesterol greater than 240 mg/dl) - May need further testing because risk is higher. Consult your doctor within 4 weeks.

LDL Cholesterol - Ideally, it should be below 130. However, as with total cholesterol, the lower the level, the lower the risk. If the level is over 160 mg/dl, risk is higher. When it is between 130-160, you are at borderline high-risk range. If above 130, reduce the saturated fat in the diet and consult your doctor.

HDL Cholesterol - Below 35 mg/dl is considered to be abnormally low and increases the risk of heart disease. The average man has a range of 35-80; the average woman, 50-60 mg/dl. Not smoking, maintaining ideal body weight and being physically active regularly will improve your HDL levels.

Triglycerides - To get an accurate measurement you will need to fast overnight for 12 hours. Levels above 250 mg/dl are abnormally high. Being overweight, drinking large amounts of alcohol, or having diabetes can also cause high blood triglycerides. Consult your doctor for treatment.

Cholesterol/HDL Ratio - Less than 5

Glucose - Elevated glucose may indicate a diabetic or pre-diabetic condition. Low levels usually require additional tests to determine if a basic metabolic disorder exists. Dietary changes often restore normal values.

Homocysteine - This is a new risk factor for heart disease. This amino acid can damage arterial walls if it reaches high concentrations in the blood. An ideal level is 6-10 micromoles per deciliter of blood for pre-menopausal women and 8-12 micromoles for men and post-menopausal women. If elevated, treatment includes three B vitamins (B6 at 2 milligrams/day, folic acid at 200 micrograms/day, and B12 at 15 micrograms per day). These dosages are found in routine multivitamins.

What you can do:

• Check blood cholesterol yearly (goal is less than 200 mg/dl) AND Homocysteine yearly (goal is less than 12)
• Diet if cholesterol is less than 240 mg.% but greater than 200 mg/dl
• Diet plus Lipitor if cholesterol is greater than 240 mg/dl
• Weight loss
• Exercise (daily walk)
• B Vitamins if homocysteine elevated (greater than 12)
• Further work up if two or more risk factors present (Stress test, rapid CT for calcium, & Cardiology consult)

B. Male Menopause (Low Testosterone)

Testosterone is the major hormone produced by your testicles, which also produce sperm and several other hormones that control normal male development and function.

Testosterone is responsible for developing and maintaining normal male characteristics:

• Growth of sex organs
• Sperm production
• Body hair and beard growth
• Depth of voice
• Muscle growth and strength
• Bone growth and strength
• Thicker, oilier skin

It is also important for normal sexual function and sex drive.

Low testosterone (hypogonadism) occurs when your testicles do not make enough testosterone. In the US, current estimates are that more than one million men may be affected.

Low testosterone may occur for a variety of reasons; loss of one or both testicles, injury, alcoholism, exposure to toxic compounds, disease (including HIV/AIDS), or aging. In some cases, it is present at birth.

Although young men can experience testosterone deficiency, it generally occurs at middle age, when testosterone levels tend to decline.

If you develop low testosterone as an adult, you will maintain most of the male characteristics that you acquired during puberty, though you may experience some decrease in the thickness of your beard and body hair. Also, your voice will not change and your penis size will most likely remain the same.

If testosterone deficiency occurs during childhood, normal male sexual development often is delayed or may not occur at all.

Potential consequences of low testosterone:

• Difficulty achieving or maintaining an erection
• Reduced energy level
• Depressed mood
• Decreased bone and muscle strength

• Testosterone shots (depo-testosterone injections-given monthly)
• Testosterone patches (Androderm patches - 2.5 mg. & 5.0 mg. - applied daily)

A Screening Test - The prostate specific antigen (PSA) test is a blood test used to help in the early detection of prostate cancer. PSA, an ingredient of semen, is made by the prostate. Some PSA naturally leaks from the prostate into the bloodstream. The PSA test measures the amount of PSA in the blood. As a man ages, more PSA leaks into the blood. Problems with the prostate - such as prostatitis (prostate infection), BPH (benign prostatic enlargement), or cancer - may cause extra PSA to enter the blood. A digital rectal exam or prostate biopsy can also raise PSA levels. If a PSA test shows higher than normal blood levels of PSA, other tests are necessary to help determine the cause of the increase.

Why a PSA Test Is Done - Your doctor may recommend a PSA test for one or more of the following reasons:

• You are over 50 years old.
• You are over 40 years old and an African-American or have family members who have had prostate cancer (factors that increase your own risk for prostate cancer).
• An abnormality is detected during your routine prostate exam.
• You have symptoms that may suggest prostate problems, such as frequent urination (especially at night), urgent urination, having to strain when urinating, blood in your urine, or pain.

If your doctor finds suspicious areas in your prostate or if your PSA blood test is abnormal, a biopsy may be recommended. To do the biopsy, your doctor takes tissue samples from the suspicious areas of your prostate for examination. A biopsy is often done during the ultrasound test.

• The small tip of the biopsy needle is inserted through your rectum into your prostate.
• Six or more tissue samples are taken from the prostate (this is only slightly uncomfortable). Your tissue samples are sent to a lab for examination.

• When the results of your biopsy are ready, your doctor will talk with you about them and any further exams or treatment that may be needed.
• You may notice some rectal bleeding or blood in your urine for a few days.
• You may see blood in your semen for two to three weeks.
• Ask your doctor if you should temporarily limit exercise or sexual intercourse after your biopsy.
• Call your doctor if you have a fever, excessive urinary or rectal bleeding, muscle aches, fatigue, or difficulty urinating.

• Yearly digital rectal exam and PSA (twice yearly checks if either is abnormal)
• Vitamin E 200 IU/day-OTC
• Selenium 200 micrograms/day-OTC

The large intestine is the second most common cancer site. Colo-rectal cancer accounts for about 20 percent of all cancer deaths in the USA. Symptoms are non- existent in the early stages again requiring education and screening. This is a preventable disease with screening. Men give the following excuses for not visiting a doctor: 

1. Nothing is wrong
2. No health insurance
3. No regular doctor
4. Difficulties dealing with health insurance companies

Prostate and colon cancer have no early warning signs or symptoms making screening the key.

• Reduce meats and fatty foods in the diet.
• Eat more fiber (or take fibercon 2 tabs/d), fruits, and vegetables
• Insist on a complete colonoscopy by a Gastroenterologist beginning age 50 and repeated every 5 yrs. if negative, or every 3 yrs. if premalignant polyps (adenomatous) are found by biopsy.
• Baby aspirin daily cuts colon cancer by 50% (cox 2 inhibitor)

About the Author: Dr. Fetner is a urologist who practices with other physicians with the Dallas Urology Associates in Dallas TX. His special interests are preventative health for men and prostate cancer. If you would like to contact Dr. Fetner you may reach him at his office by phone (972-566-4904), by FAX (973-566-4656) or you may send him e-mail.