For a good 10 years, Josh Hastings had annoying stomach problems. Food just didn't sit well in his system. It got so bad he went to a doctor, who recommended a colonoscopy.
"I never went," said Hastings, now 37. "I found every excuse not to go. Didn't feel like it, couldn't get off from work, too busy." Then he saw blood in his stool. After two months of that he went for the screening test. "I knew I had to take care of it before things got serious," Hastings said.
But things were already serious.
Hastings had just become a dad in 2008 when he found out he had Stage 3 colon cancer. "The tumor had broken through the colon wall. There were spots on my lymph nodes, too," he said.
If Hastings had been tested 10 years earlier, when it was first recommended, doctors would have likely found a polyp -- a small benign growth on the wall of the colon -- removed it and sent Hastings on his way with a clean bill of health.
Instead, he dismissed persistent symptoms and ignored his wife's periodic urging to get checked out by a doctor. He did what experts say many men do when it comes to their own health -- nothing -- for as long as he possibly could.
Dr. Carmella Sebastian is senior medical director for clinical client solutions at Florida Blue. For a decade, she has focused on talking with employers about health-care utilization.
"Women use services 1-1/2 times more than men. Always," Sebastian said.
At least for men with insurance, it's not about money. Even when insurance covered preventive services, "that still didn't get guys to go in," she said.
So what is it with men not going to the doctor?
Experts offer many explanations for the behavior, most of them rooted in how little boys are taught to handle a scraped knee on the playground.
"From a very early age, boys -- more than girls -- are encouraged to be tough, to ignore pain, to shake off injuries and to keep going," said Glenn Good, dean of the College of Education at the University of Florida in Gainesville. His research has focused on the role of men in society and their use of health-care services.
"It is pounded into boys' psyches by peers and adult-to-child shaming that they must be viewed as tough, invulnerable and shouldn't express emotions such as pain, loss and sadness."
Male avoidance of doctors may go even deeper.
Men "are wired to examine the available evidence and then take reasoned action," said Dr. Francisco Fernandez, professor and chairman of the department of psychiatry and behavioral neurosciences at University of South Florida Health in Tampa.
Research shows that psychological wiring along with social conditioning allow men to dismiss the possibility that something is physically or mentally wrong with them. "Emotions more than anything else motivate men to act," Fernandez said. "You need to feel there's a risk before you do something about it." If you don't acknowledge an illness or bothersome symptoms, then there's no risk to your health and no need to take action.
Still, other men take avoidance to the next level by adding another dose of denial.
"Men think, if I feel fine, there's not a problem," said Dr. Randy Wexler, a 23-year veteran of family medicine now practicing at Ohio State University's Wexner Medical Center in Columbus.
"Until something bad happens, men won't seek out care. But sometimes problems don't make themselves known for years, like with heart disease. It may be silent for years," Wexler said.
Sometimes men avoid getting checkups, an annual physical or recommended screening tests for other reasons. They fear finding out something is wrong. They think admitting illness or discomfort makes them appear weak. They worry that a health problem may cause them to be passed over for a job or promotion.
Most men also don't like feeling out of control.
"And having a medical exam is just that," said Jim O'Neil, a professor and psychologist in the department of educational psychology at the University of Connecticut in Storrs.
Seeing a doctor and waiting for test results creates a lot of uncertainty, an emotion many men have difficulty with. Also, being touched by a male doctor "may arouse homophobic fears in some men," said O'Neil, who specializes in the psychology of men and gender roles.
As an athlete who became a physical-education teacher and elementary-school coach, Josh Hastings grew up hearing -- and believing -- that guys should be tough and self-reliant.
"We all think it's not manly, it's uncool to go to the doctor. Plus you don't want someone saying you're sick or prodding and poking at you," he said.
He no longer feels that way. Now, five years after diagnosis and treatment, Hastings is cancer-free. He credits USF Health/Tampa General Hospital surgeon Jorge Marcet for saving enough of his colon to avoid having
a colostomy bag for life.
The experience left him with a new attitude toward annual checkups.
"It's a whole lot better than going through cancer treatment or having some terrible disease growing in your body," Hastings said. "A yearly doctor visit is far better and easier on the family, easier on you and easier on the pocketbook than having something like cancer."
The Bare Necessities
If you feel fine and have no symptoms -- plus you exercise, your weight is under control, you don't smoke and you drink no more than moderately -- you probably don't need a full annual physical. But there are still a few basic medical screenings men should get periodically, says Ohio State family-practice physician Randy Wexler:
-- In your 20s and 30s, check blood pressure, cholesterol and maybe blood sugar, depending on risk factors. Get a tetanus shot, a flu shot and discuss screening for HIV.
-- At age 40, continue all the above, and if you're African-American or have a family history of prostate cancer, discuss prostate-cancer screening.
-- At age 50, do all the above, plus colon-cancer screening, and discuss prostate-cancer screening.
-- Over age 65, add a pneumonia vaccine, discuss the shingles (herpes zoster) vaccine and add a check for AAA (abdominal aortic aneurysm), especially smokers and former smokers. (Medicare pays for one screening for male smokers.)
Tips for those who love a stubborn man
How do you help the men you love overcome the obstacles and get to the doctor? We checked with several experts. Some responses:
GET THE FACTS
"Education is the only answer," said psychologist Jim O'Neil of the University of Connecticut. "Men need to know that there is much they can do over the lifespan that allows them to live more comfortable lives in the older years. Many men get into their 60s and 70s and regret their lack of self-care -- poor diet, lack of exercise and risky living."
"When a young guy, 25, 28 years old, comes in for a physical, I always ask, 'Did a young friend or family member die or did a wife, girlfriend or partner make you come in?' It's usually one of those two reasons. Some people also get health-insurance discounts or rewards from employers for getting an annual physical," said Ohio State family physician Randy Wexler.
The University of South Florida's Dr. Francisco Fernandez said parents may be able to bring about change in future generations of men. "You only have to look at a playground. When a girl falls down, she gets nurturing and comforting attention. If a boy falls down, it's not uncommon for a parent to say, 'That doesn't hurt,' even though the kid's face is saying, 'Yes it does!' "
Psychologist Glenn Good of the University of Florida said there's a reason so much of men's-health services are marketed to women. "Women and men's partners are often in the best position to educate and encourage men" to take care of their health. Not doing so increases the likelihood of becoming prone to injury, heart attacks, substance abuse, isolation and death, Good said.
PUT YOUR FOOT DOWN
Dr. Jorge Marcet, USF Health's division director for colon and rectal surgery at Tampa General Hospital, wanted his aging father to have a colonoscopy. He refused -- until Marcet told him that their Saturday-night dinners together would cease. "He has come over to our house for Saturday dinner for more than 20 years. Of course, I wasn't going to turn my father away at the door, but I made the point. He had the procedure and lived to be 91."
BUT STEP OFF THE SOAPBOX
"Nagging is never a good idea," said professor and psychologist Richard Eisler of Virginia Polytechnic Institute in Blacksburg. "I think helping men see that being healthy is more attractive and more masculine is part of the answer. How to accomplish that is not going to be easy."
(Distributed by Scripps Howard News Service, shns.com)