Q&A with Dr. Marianne Legato
Thirty years ago men in our culture looked at a visit to the doctor as a sign of weakness. How would you describe men's attitude about their health today?
Men continue to neglect their health; they visit the doctor infrequently, usually only when a serious health crisis compels them to do so and usually only at the urging of their wives. Many resist medication for their illnesses; one diabetic patient waited until he had almost 50% of his main arteries blocked before he agreed to take medication. Coronary artery disease, the chief cause of premature death throughout the world, begins in men by about the age of 35 and, once they have it, generally ends their lives before they are 65. Eighty percent of coronary artery disease can be prevented simply by cultivating an optimal life style.
Men are under tremendous stress; they often have dangerous and demanding jobs, but seldom talk about the problems they face in the workplace, much less at home. Depression is widespread, under diagnosed, and underestimated. In men, it promotes isolation, excess drinking, overeating and behavior that can seriously disrupt their relationships with others.
Whom do you see as the audience for your book?
My book is not simply a health manual; it contains little known information about the unique vulnerabilities of men from the time they are conceived until the end of their lives. My own 35 year old son read the chapter intended for his age group and found the information fascinating; he discussed it at length with his friends and asked me to send him the rest of the book as I finished it. I also expect women who want their men to have better health (and health habits) to buy the book and apply the material in it to the care of the men in their lives. It is well known that women make virtually all of the health care decisions for everyone in their family.
What advice do you have for men in their 50s who are starting to think about their mortality?
Good health begins with an in depth assessment of their health with internist. A complete history, meticulous physical examination, a comprehensive panel of laboratory testing, assessment of their cardiovascular system with carotid doppler and stress echocardiogram, and any other testing that seems relevant to their particular needs. Most men have never had anything more than brief visits to a physician to take care of acute crises. Good health care should begin when a child leaves his pediatrician; he should sign up in his 20's for a yearly examination with an internist.
A program should be designed for every man that addresses his particular nutritional needs including vitamins and other appropriate supplements, builds in regular and age-appropriate exercise, and where necessary, includes counseling to address issues of stress and/or depression. It is very common for a patient to claim he "knows everything there is to know about nutrition", but for the overweight male, a skilled nutritionist is an essential collaborator in building a healthy life style. It is also very common for men to resist talking to a professional about the issues in their lives that trouble them. Men often believe that time alone and/or vacations at appropriate intervals are time wasted, but they can be life-saving.
What advice do you have for the families of these men about how to keep them on the planet longer?
A good start is to sit down with the man in your life and ask him to make a visit to a good internist to assess his baseline health-to make a list of what hurts him. It's essential to plan a program for a healthy lifestyle. Often men feel that any attention, particularly if it involves their frailties, is a sign of weakness, and resist going to the doctor until the first real crisis.
What is the single most important thing you want to men to realize about their health?
Men have inherent vulnerabilities they need to face as well as strengths on which they can capitalize. Many of them die early and needlessly because of paying attention to their health only when it is seriously threatened. Most men's lives are saved by heroic interventions that would not have been necessary if they had paid appropriate attention to correcting the risk factors that kill most of them. Prevention is a life-time task, but the benefits are enormous. Improved vitality, strength, competence and a longer life are the result.