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In Control of Your Health

Going to the doctor is a task that many adults put off, but men especially. A 2019 study by the Cleveland Clinic showed that 60% of men don’t go regularly, choosing to wait until they are seriously ill. This only does a disservice to their health, however, and physicians say delayed visits could mean diagnoses go overlooked and untreated.

Dr. Benjamin Kaplan, an internal medicine specialist at Orlando Health Medical Group, has witnessed this phenomenon firsthand. 

“Men can be among the more reluctant to come to see a doctor. Men are still fearful of the unknown. What if they find out they can’t go to work, feed the family and pay bills? A majority of the time they are prompted by their spouse/partner, their employer or sometimes they had a friend or family member who had a medical event and now they are coming in,” he says. “The concern is all of the other male patients who are not coming in. The health care system is missing them.”


Primary Care

The first step to taking control of your health is to visit a primary care physician (PCP). No matter how many years have passed since your last checkup, your PCP will assess your overall picture of health, including your personal medical and family history, take vitals such as blood pressure and heart rate, listen to your lungs and discuss concerns. 

When seeing male patients, Kaplan takes into account that the leading cause of death in men is heart disease—one in every four male deaths, according to the CDC. “The first thing I ask about is vascular health. Are they optimizing their risk factors? Do they smoke or drink? What is their diet like, are they reducing fatty foods? Are they active?” he says.

In a post-COVID environment, the stressors of daily life have contributed to a rise in risk factors. “We’re seeing the impact of it, including financial concerns, loss of family and loved ones and professional stress from working at home. Those are all affecting other risk factors such as smoking and drinking, or eating all day because you’re home. And people are more sedentary. We have to spend time filtering through those risk factors and give patients options and outlets to optimize their risk factors,” says Kaplan.

Screenings are an important part of the process and he notes there are low-dose CT scans for lung cancers, and men should be screened for prostate and colon cancer. Kaplan will also discuss injury safety, including wearing seat belts and firearm safety. 

Conversations with patients often include vaccine information. “It’s challenging because there’s a lot of information out there and we make sure to go over which vaccines are best for the patient based on risk factors,” he says.

Once a patient has renewed their commitment to their health, there are innovations and technology available (and some coming soon) that makes maintaining that commitment easier, says Kaplan.

One such innovation is personal health devices that can monitor patients in their home. From the common Apple Watch or Fitbit to a pulse oximeter easily purchased at a local pharmacy, these devices can alert patients and their physicians to sudden changes or concerns. Kaplan is a fan of the technology, but says it’s a double-edged sword.

“The challenge is that more information becomes too much information and it can bog down the health care system. If there are irregularities, I want to know about it, but I don’t need messages every day if the patient’s blood pressure is normal,” he says. “We need to make sure patients are trained to use the products in an intelligent way. These devices are great in the hands of educated patients, but there’s always going to be a ‘nervous Billy’ who is calling his doctor with every beat.”

Prescriptions may soon become more accurate with the future of pharmacogenetics, he continues. This is the study of how a person’s genes respond to certain medicine.

“Through genetic testing, we can find out how your DNA makeup influences how you metabolize certain drugs. For instance, if you need to be treated for depression or anxiety, this test might tell a doctor that your body would do better with Effexor over Zoloft, so it can save you and the patient time in figuring out what works best,” Kaplan says. “In the opioid crisis, dosing of medication kept getting higher and higher in order for the patient to feel better. Targeted genetic therapy, if used properly, is going to give them better outcomes from the right medications.”

Nothing will change without making that call for an appointment, though. “Ultimately, the most influential component to a patient’s health is to have a primary care physician,” Kaplan says. “If patients don’t have someone counseling them on how to navigate the complicated system, they tend to lose trust. Your primary care physician is your home base and in your corner to help you get the best outcomes.”


Dangers of Diabetes

It’s not unusual for specialists to see patients and provide a diagnosis that a primary care physician would have otherwise noticed had the patient gone regularly.

Dr. Matthew Cunningham, a vitreoretinal specialist at Florida Retina Institute, says diabetic retinopathy is the leading cause of blindness among working-age adults in the U.S. Diabetic retinopathy occurs when diabetes starts to affect the retina, the film at the back of our eyes. “It causes 8,000 cases of legal blindness annually, but it causes other impairments. A majority of patients who have diabetes will eventually develop diabetic retinopathy,” he says.

Approximately 16 million people in the U.S. have diabetes, Cunningham continues, and sometimes he is the first one to tell that to patients. “I get patients referred in daily who have hemorrhaging at the back of their eyes or retina. Often these are young individuals who were never diagnosed because they don’t go to the doctor or don’t have a doctor. I may be the first one to get blood work for them and diagnose them with diabetes, and that’s scary because these individuals are of working age.”

Cunningham says symptoms range from mild to severe, and sometimes there may be no symptoms. “In its mild stages, a person could have perfect 20/20 vision, but as things start to progress, they’ll have blurred vision that is transient, which means it’s associated with fluctuations in their blood sugar, or not transient, which is secondary to retina damage,” he says. “They may also notice floaters. All of these could lead to severe vision loss and even blindness or retinal detachment.”

Cunningham can’t emphasize enough how important it is to be screened for diabetes. “The earlier you catch a disease, the quicker we can jump on it and get patients a better outcome.”

He recommends anyone who has been diagnosed with diabetes type 1 or 2 receive yearly dilated eye exams. “If someone is diabetic and not getting these, I would highly urge that patient to make an appointment with their eye care provider. Even if they have perfect vision, it’s key to find issues early. If we can treat them while symptoms are still mild, they do better long term,” Cunningham says.

As someone who sees this daily in his line of work, Cunningham hopes the connection between diabetes and diabetic retinopathy is elevated in public awareness. “This is a significant cause of vision loss in so many patients, not just men, but women and kids, all races. It doesn’t discriminate,” he says.