1. Daytime Fatigue
He’s thinking: I should go to sleep earlier.
But it could be Obstructive sleep apnea. Spending more time in bed won’t help if fatigue is due to this condition, in which the airway narrows or is blocked during sleep, cutting off breathing and disrupting slumber five to 30 times an hour. “Everyone has a night here and there when he doesn’t sleep well. But if the fatigue doesn’t go away even when he can catch up on rest, sleep apnea could be putting him at risk for health problems such as heart attack, arrhythmias, stroke or even heart failure,” Dr. Shindel says. A sign he’s chronically tired: falling asleep while doing activities during waking hours. “It’s not normal to fall asleep during usual waking hours just because you’re in a dark room,” Dr. Shindel says. Sleep apnea is especially common in overweight men and heavy snorers but can be treated with breathing devices such as a CPAP (continuous positive airway pressure), an apparatus that you wear at night to keep airways open. Losing weight and surgery to widen the airway can also help.
2. Constant Grumpiness
He’s thinking: I’m just under a lot of stress at work.
But it could be: Depression. Feeling cranky and low because of work hassles or difficult times is normal, but it should dissipate within a few days. With clinical depression, downbeat irritability lasts weeks at a time. “It’s different from run-of-the-mill blues and time for him to talk to his doctor if you’re saying to him, ‘You haven’t been acting like the person I think you really are for weeks’ or he’s lost interest in activities he used to enjoy or isn’t performing at work,” Dr. Shindel says.
Talk therapy and antidepressant medication are the options his doctor will likely suggest first. But if he has symptoms such as fatigue, low sex drive and loss of muscle mass, Dr. Shindel advises getting a blood test for low testosterone, which is sometimes the root cause of depression, especially in men over 40. Testosterone replacement in the form of gel, skin patches or injections can reverse the symptoms, but he should first talk to his doctor carefully about his medical history and the potential risks of testosterone therapy.
3. Frequent Urination
He’s thinking: I’m drinking too much coffee.
But it could be: Type 2 diabetes or an enlarged prostate. It might be the coffee—when he’s actually drinking it. But if he often gets up to go twice or more during the night, his body could be trying to get rid of excess blood sugar that’s built up because it can’t get into cells—the problem that defines diabetes. He should first try adjusting what or when he drinks at night to see if that leads to fewer wee-hour trips to the bathroom. “If he still urinates more than he did a month ago, he should get his blood sugar checked, especially if he also has increased thirst, another red flag for diabetes,” Dr. Miner says. Diabetes can usually be controlled with changes in diet and exercise, often combined with medication.
If he’s also feeling like he can’t empty his bladder completely and/or is having a slow or weak stream, dribbling and having trouble getting urine flow started, the problem may be a growing prostate. This small gland surrounds the tube that carries urine out of the bladder, so an increase in size can put the squeeze on urine flow—a common problem in middle-aged and older men. (In men under 50, symptoms could be due to a urinary tract infection.)
Though painless, an enlarged prostate can eventually get worse and lead to acute urinary retention, where he suddenly can’t urinate at all, which is an emergency that often leads to surgery. Treatment ranges from exercises to strengthen muscles in the pelvic floor to medications that relieve symptoms or shrink the prostate. Prostate cancer is also a possibility, especially for men over 50, and if the doctor suspects that, he’ll do a rectal exam and draw blood to check PSA (prostate-specific antigen) levels; higher-than-normal results may indicate prostate enlargement, an infection or cancer.
4. Yellowish Skin
He’s thinking: What yellow skin?
But it could be: Liver trouble. Yellow skin, or jaundice, suggests the liver isn’t functioning right. Possible causes in adults include liver disease, gallstones, pancreatic cancer or a viral hepatitis infection, which causes swelling of the liver.
“Hepatitis A isn’t a disease people think of, but it’s a virus found in contaminated shellfish and can be passed on by people who prepare food and don’t wash their hands,” Dr. Pochapin says. In fact, hepatitis A is one of the most common infectious diseases that’s preventable with a vaccine— worth considering for anyone who hasn’t been inoculated. Symptoms like jaundice, fever, upset stomach and fatigue usually show up within two to six weeks of exposure and get better on their own with a few weeks of rest. (And the virus doesn’t stay in your body after that.) But have him check in with his doctor, who’ll most likely want to run some tests to figure out exactly what’s going on.
5. A New Spot—Mole, Freckle, Red Patch— On the Skin
He’s thinking: It’ll go away.
But it could be: Skin cancer or seborrheic keratoses— warty, waxy benign lesions that become more common in middle age. Any time a new skin growth appears or an existing one changes in size, color or shape, he should see a doctor. Be especially concerned if a spot or mole gets darker, bleeds, itches or feels irritated—all of which are possible signs of skin cancer, according to the American Academy of Dermatology. The differences in appearance between a benign growth and skin cancer—especially melanoma, the deadliest type—can be subtle. So your physician may want to take a biopsy to make a definite ID.
I know all this from firsthand experience— and when I understood what the dangers may have been, I was glad I saw my doctor. After all, nobody’s indestructible forever.
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