By Dr. John Aronen

Older men would be wise to get an annual PSA. A colonoscopy also is a good idea after turning 50.

 
I’ve been writing for Handball magazine since 1984. I always write about musculoskeletal injuries, the area of medicine in which I have extensive training, experience and expertise.

While I was team physician at the Naval Academy, people used to ask my wife what I did for a living. She would reply that I was a vulture: I would cover athletic events waiting for someone to get hurt. That statement is only partly true, for my love is taking care of athletic injuries, and to do that you must be where the action is.

Fortunately, most patients with athletic injuries return to an active lifestyle.

Unfortunately, over the years of my involvement with the USHA, life-threatening medical conditions have occurred not only to myself and my family but also to the members who I have grown to know and love. So let’s discuss medical conditions each of us is prone to develop but often can be prevented. Five conditions come to mind. We can significantly lower the possibility that we will develop them or, if we do, increase the chance of catching them in the early stages, when the prognosis for successful treatment is high.

 

Colorectal cancer

 

The good news is that this is a very slow-growing cancer. If detected in its early stage before it has metastasized to organs outside the colon, the chance of successful management is very high.

The bad news is twofold:

• The patient does not experience any symptoms as the cancer grows in the colon or spreads to other organs.
• The chance of successful management decreases significantly once the cancer has spread outside the colon.

Colorectal cancer most frequently occurs in men and women older than 50, but it does occur in patients between 40 and 50.

Since there are no symptoms, what can one do to ensure early detection? The answer is to have a colonoscopy performed when you turn 50, or sooner if recommended by your physician.

A colonoscopy should not be confused with a flexible sigmoidoscopy. Only a colonoscopy, which is performed on an outpatient basis at a hospital, allows the physician to view the entire colon. If the physician notes any questionable lesions or polyps, a biopsy can be easily taken.

Because this cancer is slow-growing, if your first colonoscopy is negative, you will not need another for seven to 10 years.

Alternatively, a virtual colonoscopy can be done. This involves no foreign objects being inserted into your colon. Instead multiple views of your colon are taken with a scanning device. The downside is that if any suspicious lesion or polyp is noted, a regular colonoscopy must then be done to perform biopsies.

The main things to remember are:

• Colorectal cancer, if detected before it metastasizes outside the colon, has a high probability of successful management.
• There are no symptoms.
• The only reliable tests are the colono-scopy and the virtual colonoscopy.

 

Prostate cancer

 

About 20 years ago, males had their prostate evaluated in an enjoyable exam by a urologist–typically one with large hands and knuckles! The exam allowed the physician to determine the size and firmness of the prostate, but in reality this was inadequate for cancer screening.

Now a simple blood test, called the PSA, can be done yearly to detect increased activity of the prostate gland that may be compatible with cancer. PSA tests are recommended yearly from 50 on, along with the examination.

As with colorectal cancer, there are no symptoms when this cancer is isolated to the prostate. It typically metastasizes to bone in the lower back, resulting in low back pain. Thus, evaluation of low back pain in males older than 50 should always include a check for prostate cancer. Be sure to have your PSA level checked annually.

 

Cardiovascular disease

 

Thought of as a disease of males, cardiovascular disease–coronary artery disease, heart attacks and strokes–is unfortunately just as prominent in women.

Though breast cancer gets the majority of notoriety, a significantly larger number of women die from cardiovascular disease than from breast cancer.

Factors that contribute to the onset of cardiovascular disease are smoking, diabetes, high blood pressure, elevated cholesterol and being overweight. Genetics plays a significant role in the onset of cardiovascular disease, and though nothing can be done to treat genetics, it does alert your physician of your higher risk.

Looking at these factors, it appears that each can be easily addressed:

• Stop or, more wisely, never start smoking.
• Work with your physician to keep your diabetes under control.
• Work with your physician to keep your blood pressure under control.
• Have your cholesterol checked and work with your physician to keep your cholesterol at the limits desired with a diet and exercise regimen.

If your cholesterol level cannot be controlled with diet and exercise alone, the addition of cholesterol-lowering drugs called statins may be necessary. A recent report found that most people with elevated bad cholesterol (LDL) chose to continue inappropriate dietary habits and avoid exercise since they were able to lower their bad cholesterol simply with a pill. How sadly this speaks for our society.

Cardiovascular disease typically provides warning signs. But one reason people die unnecessarily from heart attacks and strokes is denial of the symptoms.

Heart attacks can present a variety of symptoms, but in all cases patients usually
feel that something is wrong. Common symptoms are just not feeling good, a feeling of indigestion, tightness in the chest, pain or discomfort in the jaw or left arm, and sweating. It is not uncommon for women to experience tightness or discomfort in their upper back.

One of my friends experienced tightness in the chest, became scared and drove himself to the parking lot of the emergency room, only to have the tightness slowly subside. He then decided it was nothing–denial–and started to drive home, only to have the tightness in his chest return. But this time he also started sweating profusely.

Now really scared, he drove back to the emergency room and was rushed to the operating room. He had two stents inserted into the main arteries of his heart that night.

The moral of the story is having a heart attack isn’t necessarily the end of the world with the new treatment methods available. But denying that you may be having a heart attack can result in the end of your world.

Common symptoms of strokes, which occur and cause death more frequently in women than men, are numbness or weakness in one side of the face, an arm or a leg; impaired vision in one eye or double vision; confusion; trouble speaking or swallowing, and severe headache.

The vast majority of strokes result from a clot in one of the arteries in the brain. If treated with clot-destroying drugs within three hours, chances of a successful recovery are high.

Delayed treatment due to denial, which significantly reduces the chances of favorable results, is too common.

 

Breast cancer

 

Genetics plays an important role. Women with family members diagnosed younger than 50 are more prone to develop it.

Thanks to all the research, cases caught in the early stages before metastasizing have a high cure rate. All women should learn how to perform self-examinations and have routine evaluations as recommended by their physician.

 

Malignant melanoma

 

The USHA’s Matt Krueger is wise to keep the sun off his face as he works in Toledo.

There are three types of skin cancer: squamous cell carcinoma, basal cell carcinoma and malignant melanoma.

Having spent my life destroying my skin with the sun, I have had my share of squamous and basal cell carcinoma lesions removed. In comparison, my wife, who hails from Montana and avoids the sun, has had two malignant melanomas removed.

The doctors think she developed them when she suffered a number of severe sunburns as an adolescent. It appears that severe sunburns during our adolescent years predispose us to malignant melanomas in later life.

Whereas squamous cell and basal cell carcinomas can typically be treated with local excision using a procedure that ensures all the cancerous cells have been removed, malignant melanomas are different. Malignant melanomas, which typically develop from a pre-existing mole or skin lesion, result in subtle changes in their color and configuration: They usually become darker, and the borders become uneven. Additionally, malignant melanomas invade the deeper skin tissues.

Thus, what determines your prognosis is the depth the melanoma has spread into your skin tissues. Caught at an early stage, as my wife’s were, the prognosis is very good. But once the melanoma reaches a certain depth in the skin, the prognosis is poor, for it spreads throughout the body via the blood vessels. My wife has a “total body geographical examination” by a dermatologist every six months.

Any lesion that changes color or config-uration or bleeds should be evaluated by a dermatologist immediately. Other lesions that occur in areas frequently exposed to sunlight should be examined to determine if a referral to dermatology is warranted.

There are too many diseases–such as brain tumors, pancreatic cancer and leukemia–that we can do nothing to avoid. And there are too few handball players in the world. So help keep the number of handball players as high as possible by practicing preventive medicine.