Gettysburg Medical Center
The Clinical View
by P.E. Hoffsten, M.D.
29 December 2004

WHEN WILL YOU BE STRONG ENOUGH?

Believe it or not, I can remember being in the first grade 60 years ago.   For the purpose of this column, I remember being taught how to play checkers.  I remember the attitudes of those I played with.  At first, Mom could beat me anytime she wanted to but thought nothing of letting me win occasionally.  She was strong enough to let me win.  Sometimes, I would play with my brother who was six years older than I was and as I got better at the game, sometimes I could legitimately beat him.  He could never “let me win”.  As a matter of fact after I got old enough to play him straight up, he quit playing with me because he was not strong enough to tolerate my winning.  His friends would raze him because his little brother could beat him at checkers.  When I played checkers with classmates in school, I was never strong enough to ever let them win.  Not that I was that good, but I played as hard and as well as I could because I was not strong enough to ever “let them win”.

And now as a grandfather, I play checkers with my grandchildren.  I am struck by how easy it is to let the younger children win and how much harder it is to lose to the teenagers, college students and young adults.  I am not strong enough to slough off the taunts of how I am getting old and can’t play the game anymore.  But it is alright to let the little kids win.

This example regarding playing checkers has application to healthcare.  Babies are brought in for well-baby checks frequently in the first two years of life.  Then they get a preschool physical and as they go through school, there are athletic physicals and camp physicals, etc. to check out the young person’s general health.  Then there are college physicals and military physicals and maybe an insurance physical or two.  But in South Dakota, after a man gets his last insurance physical, the healthcare community does not see him again until he has a heart attack, stroke or a cancer.  This is an incalculable tragedy because so many diseases that result in premature death of the men of South Dakota are preventable with early healthcare.  As I wrote a previous column, central South Dakota has too many widows.

It strikes me that men in South Dakota are not really negligent with their health.  Rather it is because men need the sensation of invincibility.  The attitude seems to be that the men that get preventive healthcare are over sensitive weaklings that worry too much.  The  feeling of invincibility and “there is nothing wrong with me” can be maintained as long as the man never goes to the clinic and finds that he might have high blood pressure or a high blood cholesterol or diabetes or emphysema from smoking.  These are silent health robbers and the attitude seems to be that as long as the man does not seek medical care, these conditions must not be present.  In fact, nothing could be further from the truth.

So the question of this column is, when will the men in central South Dakota be man enough and strong enough to come get their preventive healthcare and address those conditions that lead to a slow, silent deterioration in the men’s health.  Denial that there is problem without checking is a definite formula for grief.  Addressing problems in a preventive manner early before the disease presents as the heart attack or the stroke, is money saving, life saving, and leads to a far better quality of life.

The recommendations at this time include cholesterol, blood sugar and blood pressure checks on a periodic basis beginning at age 30.  Depending on the man’s family history, checks for colon cancer, may begin as early as age 40.  By age 50, men should have all of the above checked and definitely have a flexible sigmoidoscopy done to prevent cancer of the colon from ever occurring.  At age 50 and after, at least annual blood pressure, cholesterol, blood sugar checks and the effectiveness of any medications being used, need to be reviewed.

There are some women who also deny the potential that they may have a health problem but as a group, women are so much better at acknowledging their vulnerability than men ever seem to be able to do.  Ladies, the best thing that you can do to keep your guys around, is to get him in early.  Challenge him to be man enough and strong enough to get a health check. Denial that there is a disease process going on without checking is a formula for widowhood.  The health care clinics in your local communities are geared to deal with preventive health care and are the place to start.   The start of the New Year is a good time to step up and be man enough to get checked out and deal with problems before irreversible disease damage occurs.