Medical Articles, Medicine Information.

No one can explain it, but in the past decade well-to-do middle-aged men have begun falling victim to a previously rare form of cancer. This has happened particularly to white men. There has been no change in the incidence of this cancer among Asian and black men or among women.

It’s a cancer thought to be directly related to reflux – the surging up of stomach acid into the food pipe. The tragedy of this adenocarcinoma of the oesophagus or gullet is that it is lethal. Only 10 per cent of sufferers survive for more than 5 years.

Mysteriously, the incidence among white men living in Western societies is increasing at a rate of 10 per cent a year. In the past, a different kind of gullet cancer was predominant. About 20 years ago people tended to get squamous-cell carcinoma of the oesophagus, which was strongly related to smoking and the ingestion of alcohol. Now, as squamous-cell carcinoma levels have plateaued and even fallen off in men, the incidence of adenocarcinoma in men has begun increasing at a frightening pace. It is now occurring in three Australian men in every 100 000, and is particularly prevalent among the well-nourished and well-to-do.

The gullet is lined with a kind of skin, so it is understandable that squamous-cell carcinoma, which is a skin-like cancer, can grow there. It is more difficult to understand how adenocarcinoma, which is a gland-like cancer, can develop there.

Adenocarcinoma has a glandular cell structure and usually grows in glands such as those in the stomach, the pancreas and the bowel. It is abnormal to find it in the gullet. A healthy man would have no glandular tissue in his oesophagus.

It is thought that long-standing severe reflux starts the process that ultimately leads to this cancer. Of course, most men with reflux never develop it, but all those who do have it have a history of reflux.

Reflux occurs when the contents of the stomach get washed back up the gullet because the valve between the gullet and the stomach is not efficient enough to keep the acid and food in the stomach. It is thought that over the years the acid burns the skin lining off the lower end of the gullet and is gradually replaced by a different kind of lining, which is more resistant to acid.

This new lining is made up of gastric-type cells, which behave as if they were in the stomach. It looks like the gastric cells have broken out of the stomach and begun growing up the gullet. When this happens, a man is said to have a condition known as Barrett’s oesophagus. There are thousands of men out there with reflux, and it is not known why some develop a Barrett’s lining and others don’t.

Barrett’s is a precursor to this cancer, and it is not understood why some people with Barrett’s develop the cancer and others do not. When adenocarcinoma grows in the Barrett’s lining, it looks and acts like gastric cancer.

It is thought that a Barrett’s lining takes decades to develop.

When, for example, it is found in a 50-year-old man, there is characteristically at least a 20-year history of reflux.

One difficulty with Barrett’s is that men are unaware of it. It does not show up with a barium meal and X-ray and can only be found through an endoscopic examination. Because the lining has changed, it copes much better when acid is washed past, and the man may feel less pain or discomfort. With a Barrett’s oesophagus, reflux may effectively become a silent condition.

If, after a long time, a man notices a change in his reflux pattern, it could be a sign of Barrett’s. If he has had persistent reflux for 20 years and then, in the absence of new medication or a changed diet, his reflux seems to fade, he should be checked for the condition.

Tests show that men with Barrett’s have more acid in their gullet but that it does not seem to hurt as much. They also show that the valve between their gullet and stomach operates at a much lower pressure, which makes it less efficient. Usually, these men also have a hiatus hernia, which occurs when a portion of the stomach protrudes upwards through the diaphragm. This is a major factor in the valve losing pressure. Men commonly develop this hernia as they age.

At any one time, about one-third of the male population will have abnormal reflux. About 10 per cent of this third will develop Barrett’s. Of them, 10 per cent may develop adenocarcinoma of the oesophagus.

In New South Wales, about 250 people die from this cancer every year, and the vast majority of them are men. Some specialists say an effective preventive measure against Barrett’s and reflux is a hiatus hernia repair. The theory is that the hernia leads to valve weakening, which leads to reflux, which leads to Barrett’s, which leads to the cancer.

With keyhole surgery, the hernia can be repaired in an operation requiring just 2 days in hospital. Surgery for adenocarcinoma of the oesophagus is more drastic than open-heart surgery and involves removing part of the lower oesophagus and part of the upper stomach, then using the remaining stomach to form a tube to reconstitute the plumbing. During this operation, appropriate lymph nodes are also removed. Surgery certainly appears to improve men’s chances of surviving for a number of years.

Affluent men should be alert to a change in their digestion patterns. If food starts to stick or the man has difficulty swallowing or needs to drink water to get food down, he should see his doctor.

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If you are an older man thinking of a new family, it’s wise to give your sperm their best chance of success, as the following tale indicates:

The couple sitting across the desk seemed quite ordinary. The woman was in her early 20s and her husband was about 40. They were baffled. Why was she having repeated miscarriages?

They had come to a clinic that specialised in natural methods for fertility management, reproductive health and preconception care, and the young woman was distressed. She had always been healthy and had never had any reason to suspect her fertility had been compromised. Her husband had children from an earlier marriage and had no reason to suspect his fertility had been compromised either. In fact, he was convinced the problem resided with her.

While taking their histories, the clinician was alerted by the mans occupation. He was a builder who made a living renovating old inner-city houses. Often, he spent hours scraping or burning off old paint. Paint manufactured before the sixties contains lead, and with his kind of work it seemed possible that he had been exposed to high levels of the metal, not only from the paint but from the lead-laden dust that accumulates in these houses over decades.

But this man had come to the clinic essentially to support his wife and was not prepared to accept the possibility that the miscarriages could be due to him.

It is difficult for men to relinquish the notion that their sperm are invincible. The myth that sperm are resilient and divinely protected is very strong. Even men who are patently unhealthy assume that somehow their sperm remain healthy.

Men who abuse their bodies with alcohol, cigarettes or other toxins also assume these will have no effect on their sperm. So why should this man, who was fit and well and had already proved his fertility, entertain the possibility that his sperm were imperfect?

Reluctant to be investigated for infertility, the man did agree to have a hair analysis. This test can give an accurate indication of toxic metal contamination in the body. (Blood tests for lead are not reliable, as lead is passed quickly into other tissues, especially bones.)

Once the hair analysis showed very high levels of lead, he agreed to further tests, which confirmed that he had the classic sperm problems associated with lead toxicity. He had a low count with a high proportion of misshapen and less motile sperm. He was treated for this toxicity with nutritional supplements and herbal remedies, and about 10 months after their first visit, his wife conceived again. This time the pregnancy held and she produced a healthy baby.

What a man does before conception is just as important as what a woman does. His lifestyle and environment prior to conception can have a direct and profound bearing on his reproductive health and on the health of the baby.

Although one would expect the woman to have to behave more responsibly because she provides the egg and the nurturing environment, recent research challenges this. Sperm are more vulnerable than eggs because they are constantly being produced and are very much smaller. They are far more sensitive to factors such as toxicity, pollution, chemicals and radiation.

The clinic’s files were full of the records of men who had been exposed to occupational toxins that affected their fertility. Motor mechanics, for example, breathe in lead fumes all day, handle heavy metal like nuts and bolts covered in cadmium and use lots of chemical solvents.

As long as sperm are not visually defective, people think they are probably okay. But another view is that if 60 per cent are visually defective, those that remain have probably been adversely affected too. Sperm are made from nutrients, and there is no reason to assume some sperm will absorb more toxins than others.

The role played by zinc is an interesting example of how sperm are affected by a man’s general health. The tails of sperm are packet! with zinc, and if a man’s body is deficient in zinc, his sperm don’t get enough zinc either. Without sufficient zinc, sperm can’t waggle their tails, which means, in turn, that they can’t move. When an overall correction is made, a huge increase in fertility results.

Pre-conception care is an old idea that has been resurrected. Many tribal societies arc known traditionally to have fed special diets to young men and women of childbearing age.

Pre-conception care is starting to be considered an important component in the prevention of reproductive problems and the improvement of children’s health. Proper pre-conception care can make a huge contribution to the health of our population, not just by helping us produce normal-looking children but also by helping us produce children who have strong immune systems and are not affected by chronic or degenerative diseases. There is a growing recognition that this type of care is as important as, if not more important than, good antenatal care.

Clinicians point out that people who breed racehorses, champion dogs and cattle know that the best outcome is achieved when the health and vigour of both prospective parents are optimal at the time of conception. So why should the whole thing be left to chance when breeding humans?

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Teeth betray age. A well-preserved man of indeterminate years might cut a youthful figure at a glance, but as soon as he opens his mouth, his age is apparent.

While decades of red wine, cigarettes and coffee leave their mark on ageing enamel, odd bits and pieces of dental work, inattention to oral hygiene and receding gums remove all illusion of youth.

With care, however, it is possible to keep the average mouth youthful, in both appearance and function.

The first thing to take care of is saliva. For the maintenance of oral health, saliva is magic. Healthy people can’t get too much of its protective and restorative qualities. Saliva bathes the teeth and gums in a rich mixture of fluoride, phosphorus, calcium, enzymes and antibodies. It keeps the mouth fresh, hygienic and free from many undesirable bugs. It works constantly. When, for example, a high-acid diet leaches calcium and phosphorus from the outer layer of teeth, making them vulnerable to decay and wear, saliva is there to restore the balance. The same thing happens when athletes sip popular sports drinks that are high in acid and sugar.

Saliva also contains an epithelial growth factor that makes skin grow more rapidly. It is thought that this is the reason animals lick their wounds and why wounds in the mouth heal so quickly.

On average, people produce about 0.7 ml of saliva a minute, but once stimulated by chewing, production increases to between 1.5 ml and 2 ml a minute. Mouths are comfortable because oral mucosa like to be wet, there is sufficient saliva to lubricate food and swallowing is effortless.

People with perpetually dry mouths complain of a furry tongue that sticks to the roof of their mouth and teeth that have become sensitive to hot and cold because of erosion.

But not everyone is aware they have a dry mouth. Some reach for a lolly, thinking it is the sugar they are after when what they are actually doing is stimulating saliva production by sucking. Numerous dentists recommend sugarless gum to increase saliva flow.

Several factors contribute to a dry mouth. Stress and emotional upset can cause it, as can blocked or inflamed salivary glands, but two major culprits are medically prescribed drugs and dehydration.

Some drugs have anti-cholinergic side effects and reduce saliva production. If used only for short periods, however, drugs with these side effects, such as antihistamines, are not problematic. But some drugs prescribed for chronic conditions such as depression, high blood pressure and Parkinson’s can lead to long-term dryness, mouth ulcers and taste disturbances.

Radiation treatment or chemotherapy can result in saliva problems that may become so bad that patients may need to resort to artificial saliva.

Daily changes to diet can improve salivary flow and help to keep a mouth youthful. Unknowingly, many people live in a state of semi-dehydration – nothing that litres of water a day wouldn’t cure.

Fresh crunchy foods (fruit, vegetables, grains, nuts) stimulate saliva and keep mastication muscles in good shape. Chewing also stimulates ligaments around the roots of the teeth and this in turn stimulates bone growth. Bone anchors teeth, and if the bone is healthy there is less risk of teeth becoming wobbly.

Receding gums are a sure sign of age. Regular visits to the dentist can help keep insidious gum disease at bay, while proper brushing and flossing can control gum damage. In the morning, a 3-minute brush before or after breakfast is sufficient. The aim of this brush is to get plaque rather than food off the teeth. Before sleep at night, metabolism slows and salivary flow usually drops to a minimum. For this reason night brushing and flossing is crucial. The aim should be to get all bacteria off the teeth.

Brushing can conclude with a fluoride rinse recommended by a dentist. The rinse will coat the teeth for the night, prevent more bacteria settling on them and help to compensate for the reduction in saliva.

By taking care, it is quite possible to reach the age of 90 without ever becoming long in the tooth.

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Following vigorous intercourse, men may be alarmed to find translucent, worm-like masses encircling their penis. These are usually nothing to worry about and will disappear if left alone. During intercourse small lymph vessels have probably ruptured, causing a blockage that is disrupting lymph drainage. The men are advised to refrain from further intercourse until the whitish weals, known as sclerosing lymphangitis, have subsided.

Genital warts are common and arise in a variety of shapes and sizes. They may be single small finger-like projections or big cauliflower-like bunches, are often moist and may be itchy. Of the 65 different types of human papilloma virus that cause genital warts, only two (type 16 and type 18) are said to be pre-malignant. The others are benign.

Warty lumps are usually found on the shaft but can also occur just inside the urethra. While they can be highly visible, they can also exist subclinically and be invisible to the naked eye. Studies have shown 10 per cent of men have subclinical wart disease. Warts can be treated with chemicals, freezing, burning, surgery or lasers.

Other benign bumps include hemangiomas, which are little malformations of blood vessels, and sebaceous cysts, which form small nodules.

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Desire discrepancy is an inevitability of marriage. In all long-term relationships there comes a period when one partner’s desire is greater than the other’s – when one partner wants more intercourse than the other is willing to participate in.

Most couples find a way of coping with this discrepancy, but for some it is an unbridgeable gap that gives rise to tremendous hurt and misunderstanding. It can lead to fury and family breakup or to plummeting self-esteem and pathological behaviour.

Sex therapists see more clients suffering from desire difficulties than almost any other type of sexual disorder. There are clients who worry that their libido has waned inexplicably, those who complain of their spouse’s lack of desire and those who feel burdened with an oversexed partner.

Increasingly, it is men who have low desire. The old stereotype of men being eager and women making excuses no longer applies. More and more often, women are expressing frustration about unmet needs.

In the mid-seventies, men accounted for about 30 per cent of low-desire cases treated at sex therapy clinics. By (he eighties they were accounting for more than 50 per cent of cases.

By the nineties, the great majority of complaints that one partner had fizzled out sexually were coming from women.

Women were no longer lying back and making shopping lists or thinking of England. They had become willing partners.

The sexual revolution of the sixties and early seventies promised women new enjoyment. Masters and Johnson freed them from the quest for vaginal orgasms, the pill freed them from fear of pregnancy and the inconveniences of other birth-control methods, and the women’s movement encouraged them to take charge of their sexuality.

But after all that, men began to lag behind and respond less and less frequently to women’s overtures. Women find it upsetting and humiliating to fail to rouse their partner’s libido. While not being touched and noticed affects women severely, men frequently don’t even want to think about the implications of not being interested in sex.

Mrs S.F. was sexually rejected throughout an 8-year marriage. Although she and her husband managed to produce two children, the sex they had was extremely infrequent, always on his terms and mechanical. Painfully she recounted her predicament:

While at home with my two young children I would watch soap operas during the day and cry when there was a romantic kissing scene. I wept because I could not remember what it felt like to be kissed. At the time I really believed that if he would just kiss me now and again, then 1 could cope. I had given up all hope of ever having a normal sex life.

Out of loyalty to him, and to protect myself, I told no-one. I did not feel like a women. I felt devoid of gender. Although 1 was considered attractive, I thought there must be something repulsive about my appearance or behaviour to cause his rejection. I stopped caring about how I looked, gained weight, started wearing baggy jeans, long cardigans and desert boots.

Therapists told Mrs S.F. that her husband was not abnormal. His sex drive was not absent initially but it was low (he wanted sex every 6 weeks). As a result of his upbringing, his history or perhaps his physiology, he had little drive. This is not bad or wrong.

The pain in their relationship came not so much from the differences in their desire but from their inability to negotiate sexual compromises. One therapist put it thus: not only were their sex drives mismatched, they also had mismatched sexual expectations and attitudes. She interpreted his low desire as rejecting and controlling. But it wasn’t. He was not withholding; he just didn’t want frequent intercourse with her or anyone else. She took it personally, and eventually they found themselves in a vicious cycle in which any desire he might have had originally would have evaporated.

What typically happens in such marriages is that sex becomes a highly charged issue, and this has a paradoxical effect. It enhances the sexual readiness of the partner with the high sex drive and inhibits desire in the partner with the low sex drive.

People with a high sex drive often use sex to express and experience love. They have a strong need to be desired, and if they are not, they feel rejected. People with a low sex drive find fulfilment in nonsexual ways, through closeness and communication with their partners. This man would not have understood how painful it was for his wife when he said no to sex.

Desire discrepancy is bread and butter for sex therapists. A mismatch in sex drives is a relationship inevitability, not a dysfunction, and there are ways of dealing with it.

Perfect sexual synchronicity exists only in the movies.

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