Men's Health

Living life to the fullest starts with taking care of yourself. Good health is the foundation that allows you to build new opportunities, pursue your passions, and enjoy the very best life has to offer. Men's Health goes far beyond checking hormone levels and screening for prostate cancer. Successfully achieving and maintaining good health starts similarly to other successful ventures—by carefully understanding the relevant risks and opportunities.

• Education
• Screening
• Physical Fitness
• Healthy Diet
• Sexual Health
• Sexually Transmitted Infections
• Cancer Screening
• Sex Hormone Deficiency
• Sexual Function
• Relationship Counseling
• Mental Health
• Chronic Disease Management
• Lifestyle Optimization

Education

Dr. Kwinter has years of experience teaching medical students and residents while staying up to date with advances in medicine. He has developed a style of practice that includes explaining pertinent aspects of topics he encounters— ranging from state-of-the-art diagnosis and management of specific conditions to areas of public health that affect entire populations. Practicing evidence-based medicine involves shared decision-making and Dr. Kwinter ensures that his patients benefit from accurate and unbiased information, which helps them make informed decisions about their care.

Screening

Systematic screening for conditions that cause premature disease is one of the most effective public health measures in developed countries. Perhaps surprisingly, Cayman does not have any national screening programs. In fact, current approaches to screening in Cayman could be described as haphazard and inadequate by modern standards. Ideal screening programs are universal, systematic, cost-effective, and optimized. Thankfully, cost-effective and evidence-based screening is relatively easy for Dr. Kwinter to provide to individual patients. In his practice in Canada where comprehensive screening was implemented he diagnosed innumerable cases of chronic diseases and cancers. In Cayman, Dr. Kwinter provides his patients with significant value in terms of early detection and management of potential problems through the same systematic approach to screening that is improving health outcomes in other developed countries.

Guidelines advise systematic screening for the following conditions:

• Prostate cancer
• Colon cancer
• Lung cancer
• Osteoporosis
• Abdominal aortic aneurysm
• Arrhythmia
• Hypertension
• Diabetes
• High cholesterol
• Chronic kidney disease
• Anxiety
• Depression

Creating an individualized plan for screening starts with guidelines and then adjustments are made when considering patient factors, including:

• Personal history of disease or illness
• Prior screening history
• Smoking history
• Genetic ancestry
• Family history of diseases
• Individual risk tolerance
• Tolerance of overdiagnosis

Physical Fitness

Good physical fitness pays health dividends at all stages of life. Like other aspects of lifestyle optimization (discussed later), improving fitness is a long-term process that benefits from active coaching and follow-up for support and accountability. While it necessarily requires significant effort and discipline, the benefits of improved fitness are phenomenal. It was once found that the most fit 15% of men in a study had a cancer death rate of only 2.8/10,000 man-years, which was 81% lower than that of the least fit men¹.

Regular physical activity provides many important health benefits:

• Lower likelihood of developing chronic diseases including:
  • Diabetes¹
  • Hypertension¹
  • Dyslipidemia²
  • Dementia³
  • Depression¹
  • Obesity¹
  • Osteoarthritis¹
• Lower likelihood of developing cancers:
  • Colon cancer¹
• Protection against serious medical events:
  • Stroke⁴
• Protection against age-related wasting conditions:
  • Sarcopenia (loss of muscle mass)⁵
  • Osteoporosis (loss of bone-density)¹
• Accelerated recovery from medical problems:
  • Osteoporosis⁶
  • Improved recovery post-stroke⁷
• Improved mental health⁸
• Improved sexual health^9,10

Dr. Kwinter has successfully helped many patients find new routines that have improved their physical fitness and overall health. Every patient is unique and receives customized recommendations. Follow-up occurs easily in the context of a doctor-patient relationship where progress can be monitored over time. High-yield, evidence-based metrics that Dr. Kwinter currently uses to monitor his patients' fitness include weight, BMI, waist circumference, body fat percentage, and grip strength.

Healthy Diet

Despite claims that are often made about the benefits of trendy "fad diets," there is actually no need to adopt an extreme or overly restrictive dietary regimen to achieve good health. The human body has evolved over millennia to extract the nutrients we need from our food, while detoxifying most harmful substances. In general, a diet that contains a variety of fruits, vegetables, grains, fats, fibre, carbohydrates, and protein will be sufficient in essential nutrients to support good health. Evidence currently supports that the Mediterranean diet¹ has the best combination of these components. The Mediterranean diet lacks processed foods and features fruits, vegetables, nuts, seeds, nut butters, legumes, whole grains, fish/seafood, poultry, eggs, dairy, herbs/spices, and healthy fats². Patients undertaking changes in their lifestyle or management of specific medical conditions may benefit from adjustments in their diet, for example adding protein to support efforts to gain muscle mass or reducing carbohydrate intake as a component of managing diabetes.

Health problems attributable to diet are often due to a relative excess of some component of the diet, such as calories, specific nutrients, or toxins.

• Calorie surplus, (consuming more calories than are metabolized on a daily basis), results in obesity. For this reason, portion control and limiting consumption of calorie-dense foods such as fats and alcohol is essential.
• Excessive intake of carbohydrates (sugar) can result in developing type 2 diabetes mellitus.
• Excessive sodium (salt) intake is one of the most common reversible causes of hypertension.
• Consumption of highly processed foods has been associated with increased risk of developing colorectal cancer³.
• Consumption of excessive amounts of certain fish such as tuna (especially in pregnancy) can cause mercury poisoning and affect fetal brain development⁴.

Some individuals do have specific dietary deficiencies. This is usually seen in very specific cases such as pediatric patients who are "picky eaters," people who do not eat meat or dairy (vegans), patients with a history of gastric or small bowel surgery, and patients who have a constitutional inability to absorb certain vitamins (e.g. Vitamin B12 deficiency due to pernicious anemia). Patients with concerns in this area should book a consultation with Dr. Kwinter, as he has experience managing these conditions and can ensure all dietary needs are met.

Sexual Health

Men's sexual health refers to several important topics. These include: awareness, prevention, and detection of sexually transmitted infections; screening for cancers of the reproductive organs; detection and treatment of deficiencies of sex hormones; detection and treatment of other conditions affecting sexual function; and relationship counseling.

Sexually Transmitted Infections

The most important public health considerations regarding sexually transmitted infections are education, testing and prevention of transmission. Dr. Kwinter routinely covers these topics with patients in high-risk age groups in his practice. He emphasizes critical information including the fact that barrier methods are not completely effective in preventing STI transmission and that infections can be asymptomatic, so precautionary testing in sexually active patients is an essential part of maintaining good sexual health.
More about Sexually Transmitted Infections

Prostate and Testicular Cancer

About 1 in 8 men (and 1 in 4 men of African descent) will be diagnosed with prostate cancer in their lifetime. It is rare in men under 40, with 6 out of 10 cases diagnosed in men who are 65 or older. Prostate cancer screening is primarily done with PSA (blood) tests, with or without a supplementary digital rectal examination. Screening starts at 40, 45, or 50 years of age depending on ancestry and family history of prostate cancer.
More about Prostate Cancer Screening

Testicular cancer is relatively rare (about 1 case per 300 men). Most cases occur in males in their late 20s and early 30s. There are no standardized screening programs for early detection. Thankfully, its cure rate is greater than 95%. Most cases are found by men by chance. Each testis contains irregularly shaped structures that are entirely normal parts of male anatomy, such as the epididymis and spermatic cord. This can make it difficult for an individual to determine whether something found incidentally is abnormal or not. Generally, anything that is new or changing is more likely to need medical attention. This is where an experienced family physician can make a big difference. In his high-volume ER and clinic work in Canada, Dr. Kwinter diagnosed many cases of testicular pathology and can differentiate normal from concerning physical exam findings.

Sex Hormone Deficiency

Low testosterone can result from dysfunction of endocrine tissue either in the testes in cases of primary hypogonadism or the hypothalamus or pituitary gland in cases of secondary hypogonadism. Either condition can produce the same syndrome of low testosterone:

• Decreased vigour and libido
• Decreased morning erections
• Depressed mood
• Decreased muscle mass and body hair (late finding)
• Hot flashes (late finding)
• Gynecomastia (breast enlargement)
• Infertility
• Small testes

Population-level screening for hypogonadism is not cost effective and is not recommended. However, patients with concerning symptoms or other clinical history that put them at a higher likelihood of having low testosterone should be tested, this includes patients with:

• Type 2 diabetes mellitus
• Osteoporosis or low-trauma fracture, especially in a young man
• Moderate to severe chronic obstructive lung disease
• Medications that affect testosterone productions, such has prolonged use of high-dose steroids and sustained-release opioids
• Diseases that may affect the hypothalamus or pituitary gland
• HIV-associated weight loss
• End-stage kidney disease and maintenance hemodialysis
• Infertility

Guidelines suggest that, due to variability of testosterone levels, a finding of low testosterone should be repeated two additional times before pursuing further investigations and/or hormone replacement. Hormone replacement is not without risks and should be discussed with a family physician, internal medicine physician, endocrinologist, or urologist.

Sexual Function

Decreases in sexual function can be distressing to men and yet often go under-reported and untreated. There is a strong correlation between erectile dysfunction (ED) and cardiovascular disease making ED a potential harbinger of heart disease that may warrant a separate diagnostic workup in appropriate circumstances.

In many cases, after appropriate investigations it is discovered that ED is an isolated symptom that for most patients responds phenomenally well to the safe, highly effective PFE₅ inhibitors: sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), and avanafil (Stendra).
More about sexual function

Relationship Counseling

No matter what the topic, your family physician's office is a confidential, non-judgemental environment to voice your concerns and to receive genuine support. It is a privilege of the profession to be able help individuals through their joys and challenges. Even the best relationships can be difficult at times and it can be helpful and even therapeutic to simply voice concerns with someone you trust. It is important to remember that helping patients deal with all varieties of challenges is something family doctors do on a daily basis and patients shouldn't hesitate to reach out for help.

Mental Health

Anxiety, depression, post-traumatic stress disorder, adjustment disorders, prolonged grief, and other mental health conditions are common in men. Dr. Kwinter has extensive experience helping patients with these conditions and many more. The confidential longitudinal doctor-patient relationship is the ideal setting for patients to seek help with any mental health condition.

As part of a men's health visit, Dr. Kwinter conducts an assessment of mental health symptoms and invites his patients to share any concerns they may have.

Be sure to check out Dr. Kwinter's separate page about stress and anxiety, here.

Chronic Disease Management

Chronic diseases are conditions that generally require ongoing treatment and/or surveillance. These include common conditions such as asthma, hypertension, diabetes, dyslipidemia, chronic kidney disease, atrial fibrillation, and many more. A men's health checkup generally involves reviewing whether conditions are well controlled, treatment regimens remain appropriate, and that any required surveillance is up-to-date.

Lifestyle Optimization

The habits that define our current lifestyle strongly affect our future health. A men's health consultation touches on all these topics to ensure that your day-to-day activities are aligned with your goals and contribute to good long-term health.

Sleep

High-quality sleep is essential to our physical and mental wellbeing. Many factors can affect the quality of our sleep. If you find that you don't fall asleep easily, wake prematurely, or wake up in the morning feeling that you aren't well rested, you should book a consultation to identify the problem and find a solution. Poor sleep may be affecting your quality of life to a degree that may surprise you.

Substance use

Alcohol, cannabis, and other drugs are occasionally used in recreational and social contexts, but can sometimes become problematic and progress to a substance-use disorder that may result in psychosocial or medical complications.

If you suspect that you or someone you know is using a substance inappropriately, it is best to lead them towards getting professional help. Warning signs can include experiencing problems with work or relationships, using the substance with increasing frequency, using the substance alone, and having difficulty cutting back.

Relationships

Positive relationships provide emotional support, reduce stress, and enhance mental well-being. They foster a sense of belonging and purpose, contributing to overall physical and mental health. Moving, changing jobs, death, and changing priorities can alter individuals' support networks and affect individuals' well-being. It is important to reflect on the state of your relationships and to curate and nurture them so that they are positive factors in your life.

Ikigai and Self-actualization

Good health provides the opportunity for pursuits of self-fulfilment. Ikigai and self-actualization are powerful concepts that describe states of living by fulfilling ones ultimate purpose. They can be tools to help guide life decisions.

• Ikigai, rooted in Japanese culture, represents the convergence of passion, skill, purpose, and income. It brings joy, purpose, and less stress.
• Self-actualization, a psychological concept by Maslow, is about reaching your full potential.

Both concepts emphasize the significance of thriving, evolving, and making a meaningful impact on the world. They can provide motivation to pursue good health for oneself to support these lifelong journeys, which can lead to a rich, purposeful life.

If you have any concerning symptoms, questions, or want to get screened, book an appointment with Dr. Kwinter or call us at (+1 345) 623-1000.