It Has Another Purpose

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A man’s penis is a marvellous bit of gear: it is an indicator of health problems long before the symptoms may become apparent.

The Massachusetts Male Aging Study showed poor quality erections were a significant predictor of an adverse cardiovascular event during the next five years.  Meaning, a heart attack is more likely in men who are having difficulties initiating or sustaining a firm erection. This is most likely due to poor blood flow in the penile arteries as a result of fatty plaques narrowing the bore of the arteries and limiting flow. Exactly what happens in the heart leading up to an ‘adverse cardiovascular event’. Apparently these fatty plaques can’t tell the difference between a coronary artery and a penile artery – they just clog it up.

Here is the message – if your health wand is sending out it’s warning, you need to address the underlying lifestyle risks causing the fatty plaques to gum up the plumbing. These include smoking, obesity, diet, cholesterol, blood sugar control and blood pressure. It would also help to undertake regular exercise.  If you don’t, getting an erection may be the least of your problems down the track.

Here is some other warnings your penis can alert you to:

  • If you can’t see it – you are too fat
  • If you cant reach it – you are way too fat
  • If it won’t pee straight – you may have an obstruction
  • If it won’t start peeing – your prostate may be enlarged
  • If it won’t stop peeing – you may be drunk
  • If it dribbles when you think you are done – you are not alone
  • If it burns when you pee – you may have an infection

See how useful it is? No wonder the girls wish they had one.

 

Premature Congratulations

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Unlike the Captain of the Italian cruise ship that recently ran aground I do not suffer from premature evacuation.

I do however, display repeated symptoms of premature congratulation (PC) – a condition I have observed in many men.  While not technically a medical condition PC does impact on the health of those afflicted. So what exactly is PC?

Premature Congratulations

La erección que se produce después de tomar Viagra Original es absolutamente natural, insuficiencia cardíaca NYHA y válvula II en los últimos 7 meses, debe tomar no más 25 mg de Lovegra una vez por cada 24 horas. Es un principio activo perteneciente a una nueva generación de inhibidores de la PDE5. Pero le sugerimos a la gente que consulte con sus doctores antes de tomar comprimidos de Tadalafil hcl 20mg, que se persiguen una vez y proporcionan el flujo durante 26-57 horas.

This condition is very common at this time of year, around four to six weeks after the making of New Year Resolutions.  Whether the promise was to drink less, lose weight, stop smoking, spend more time with the family, reduce working hours, tidy the backyard or read more books is irrelevant.

The first week or so of the program is usually quite positive.  You are at your most motivated and changes come more easily when fired up and the early signs of improvement are good.  A few kilos less on the scales, knocking off earlier at work, and half a book dealt with. In fact, you are surprised how easy this is and wonder why you didn’t do it years ago.

The next couple of weeks are also good, you goal is in sight. It is clear that if you continue the smoking will be forgotten, the beer will last longer and again you are pretty chuffed about the progress you are making and the ease with which it is happening. You are so chuffed and finding it so easy that you start to imagine you have achieved the goal already!  I mean, it is going well and obviously working so it wouldn’t matter if you eased up a little on the discipline…

Bang! There it is – Premature Congratulations: the foreseen achievement of a goal when it is in sight but not yet actually completed leading to a lapse of concentration and relapse of your previous habits. Have you ever seen an athlete begin to celebrate before passing the finish line as he or she enjoys the moment of achievement and basking in the adulation of the crowd (or themselves), only to be passed at the penultimate moment by a competitor who has not waivered and fallen victim to PC.

This happens a lot.  I am an expert in this PC phenomenon because I have indulged it many times.  And consequently disappointed myself. So how to combat this common problem?

  1. Set a goal beyond what you want to achieve so if you get PC you still make the grade.  This strategy requires the unique ability to believe your own lies.
  2. Stay the course. When PC kicks in, focus on what remains to be done, not what you have already accomplished. This may have to be repeated several times as you near your goal.
  3. Seek help. Recruit either a like minded and perhaps a little bit competitive colleague who will provide an external drive to your internal project.
  4. Give up. Recognise that your expectations exceed your ability and remain as you were: a disappointment to yourself.

Now, how close am I to my pre-holiday preferred weight……. Damn, no where near it.  I will let you know when I make it, not when I get close.

Craig Allingham

Don’t Get Stressed About Dying Younger

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Despite western men getting more physical activity (on average) than women, we still manage to die 5 to 10 years younger.  So obviously exercise alone isn’t the answer to a longer life. Other research shows the fitter you are in your mid life (using aerobic fitness factors) the lower your risk of developing degenerative diseases such as diabetes, Alzheimers and heart disease (Arch Int Med. Published online August 27, 2012). So perhaps exercise does help quality of life (not being sick).

Genetic factors (including testosterone and the associated aggression and risk taking behaviour, read: dumb decisions) apparently account for around 30 per cent of the longevity equation while environmental factors kick in for the rest.  These include smoking, food decisions, alcohol, exposure to pollutants and toxins and stress.

Stress is the interesting one on the list because it is not the stress itself that can shorten your life, but how you react or deal with the stress.  Women tend to involve other people (usually women) by sharing their problems and seeking solutions. Whereas blokes tend to deal with it solo, either fighting on or moving on.  The Fight or Flight Response. This reaction is fueled by testosterone, especially in your younger years, and perhaps becomes your habitual default position later on even when your testosterone has waned.

However it works, it isn’t working very well. As one who is prone to sweating the small stuff I can tell you changing how you initially respond to stress (gut churns, focus narrows, rational thought ceases, breathing becomes shallow, heart rate increases) is an uphill battle.  Deep breathing, centering, counting to ten, imagining being bathed in a healing white light – these are very simple to practice in the absence of stress, but darned hard to program when the excrement hits the ventilator.

I don’t have a magic answer, but I do understand the importance of the social aspect of dealing with stress.  So even if you feel like strangling someone or kicking the garden hose (never ends well), hold off and try and explain to someone (perhaps even yourself) why the situation is so challenging and what might be the worst possible outcome.  Usually it is not too drastic, and by the time you have considered this, the initial testosterone surge is easing and the other strategies can help smooth out the remaining bumps.  Not sure about the white light, however.

If you get good at this, you will have more years to practice it even further.

Healthy is the new Safety

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While giving a presentation last week as part of National Men’s Health Week, it occurred to me there were parallels between safety culture in the workplace and the strategies of healthful living. I wonder if my men’s health education work would be more ‘sticky’ if I pursued this line of thought by helping men to adopt the safety cultures they are immersed in at work as a tool for managing their physical and mental health more effectively.

For example, the concept of ‘procedural drift’, the phenomenon of  what happens when nothing happens. Detailed industrial safety protocols provide guidance to avoid injury and death, and are usually followed to the letter when commencing a new task or process.  However, with time the workers may start to take some shortcuts in the interest of perceived efficiency (or laziness), safe in the knowledge that no injury or death has befallen them. They start to drift from the procedures as written.  This can be minimised by regular safety audits and training. But humans being human, and the laws of entropy, suggest the drift will start again.

Here is an example from agriculture. A primary producer I know told me when he started working with a particular chemical he followed all the recommended safety procedures when transferring the chemical from drum to dispenser.  He gloved, masked, used a well ventilated space and had a hose handy for any spillage. With time, however, the mask, gloves and hose were gradually dispensed with as he never had any problems… until. But that is another story.

Lifting technique is another example.  Following my workshops on manual handling, it is apparent the workers think and act differently when lifting. For a while. Then they tend to drift back to their previous habits because, well, nothing felt any different with the new procedures.  Interestingly, those workers with a history of back pain or injury tended to continue the new approach longer than those who had never experienced difficulty.

So back to men’s health behaviours. Whether it is dental checkups, nutritional advice, activity guidance, relaxation or mindfulness training, any fresh information or behaviours may well gradually morph back into previous habits because there is no observable short term benefit. Think about gym memberships – the reason for enrolling persists long beyond the regular attendances because no short benefit is seen.

Health outcomes are not short term benefits. Just as health failures (heart disease, cancer, kidney failure, lung disease) are long term outcomes of poor decision making; health improvement is a long term outcome of better decision making. Procedural drift makes it very difficult to experience the long term benefits of behaviour change because of the short cuts and failure to follow the program.

Regular audits and training in the form of check ups with your health professional, information or activities to reinforce the message and the benefits and maybe even utilising a health coach to keep an eye on you and hold you accountable (the personal equivalent of an Occupational Health & Safety Officer) will improve your chances of success.

All the best,

Craig Allingham
Sports Physio and Health Educator

PS: Just as nagging from your boss won’t improve your attitude toward safety procedures, nor will nagging from your life partner improve your attitude toward better health decisions and behaviour. Just saying, that’s all.

Value Adding or Value Giving?

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I was talking with a friend recently about his business and plans he has to sell it.  He told me he hasn’t been drawing income from this business for a while (he has other streams) but has continued to work on the business to prepare it for sale.  In fact one of the reasons he has not drawn income is to decrease the wages bill to make it more attractive to a buyer.

There is no doubt that hiding expenses from the profit and loss statement makes a business look stronger.  And you could argue he is hiding nothing, as he really is not an expense to the business. Quite true. However, his input to the business is undeniable. All that has changed is he is working as a volunteer – he is donating time and expertise to keep the business looking profitable. He is not hiding expenses from a prospective buyer; he is hiding unpaid labour.

During my workshops with physiotherapists and other health providers, I walk them through an exercise in determining their actual worth to their business. Both their worth as a clinician and as a manager of the business. And we put a dollar value on both streams and calculate how much income they should be drawing if every hour of their contribution was included on a wages time sheet.  Then we compare that figure with the money they are actually taking from the business in terms of salary, drawings, dividends, superannuation top ups, vehicle use, etc.

Ideally, they should be taking more dollars from the business than they are actually entitled to based on their exertional entitlements. Money taken beyond your work value into the business is called profit. And profit is good, perhaps essential, for a business.

Many times, however, once we factor in the administrative hours worked by the owner and attribute a dollar value to those hours, we find the owner is actually drawing less money from the business than they should earn if they simply paid themselves to do their various jobs at an appropriate remuneration rate. In other words they are donating time (and expertise) to their business and not being paid for it.  They are underpaying themselves.  They own a job that doesn’t pay them what is actually earned – let alone a profit on top if it!

This figure – unpaid work by owners – doesn’t show up in the usual financial reports such as profit and loss statements or balance sheets. So there is an under estimate of the real expenses of the business making it look stronger on paper than it might be in real life. Of course a buyer will discover this later on when they find the only way to match the promised cash flow is to repeat the mistake of donating unpaid time to the business. I guess the hope is to improve the ultimate resale value to compensate them for volunteering.

Knowing if you are paying yourself (as an owner) more, less or exactly what you are entitled to based on the hours and talent you contribute to your enterprise is important. But only if you can face the possibility that not only do you not own a business (ie. it makes no profit), nor do you own a full paying job (as you are under paying yourself), but you actually donate your time and thus are fulfilling a vocation for the sheer joy of helping people.

My friend is helping improve the selling price of his business, but he has to really, given the hours of unpaid labour he is donating to keep it looking strong. I hope he isn’t confronted by a savvy purchaser who discovers the ‘hidden’ expense not reflected in the profit and loss statement.

If you want to participate in my business workshops where we do this exercise (and you get software so you can redo it as your business grows) simply enrol in any BizFizz or Red Hot Business event at the Redsok International website. If I am not coming to your area, keep a watch out for any online events which will be listed in the newsletter (to which you can of course subscribe for no cost).

Craig Allingham

The Art of Coaching

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A couple of weeks ago there was  a great interview in the national press with one of the most respected sports coaches in Australia.  A man who has a long record of successfully bonding men, guiding them and more often than not achieving their combined goals.

The interviewer asked him directly, ‘What is the secret to your coaching technique?’ Characteristically he rejects the whole concept of him being a master coach with a system for success. The men he coaches play a fierce game demanding courage and pain. Every week, every season. 

It was a long article, many column inches, but hidden amongst the analysis was his answer.  Well, it was the answer that rang true for me as the measure of a successful leader of men.  Another coach who had worked with him for years commented that he ‘genuinely cares for his players’.  He almost nailed it, but missed the essential element.

He doesn’t care for ‘players’, he cares for men. His secret strategy is to help them be better men,  a strategy he has observed over the years actually makes them better footballers. Some coaches try and turn men in to players, this guy turns players into men and in turn they become better players.

Great coaches turn people into better people, and from that they both gain.  Let alone a company, a community, a society and a football team.

Who have you helped to be a better person recently?

Oh, the coach? A bloke named Wayne Bennett.  You can google him.

 

Speaking – Lessons from the School of Hard Audiences

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I heard recently of a conference at which speakers were banned from using PowerPoint.  The reason given was to give speakers an opportunity to show their skills at, well, speaking. 

I got thinking about the difference between a speaker and a presenter. They are both legitimate roles and I have filled them both.  I have given keynote addresses to large audiences both with and without PowerPoint, depending on what I was attempting to accomplish in terms of an outcome. Some outcomes were best achieved with a story, others were enhanced by images and text alongside the spoken word.

On occasions I use a flip chart or white board and produce the visual aids in real time as the journey is taken. Is this different from using a prepared slide presentation? Of course – it is more agile and interactive, yet infinitely less entertaining given my limited artistic skills. Unless, of course, participants find my primitive art amusing.

But enough about me; what about you? Does your job or some other interest occasionally or frequently involve making a presentation to colleagues?  If so, let me offer several hints that I have learned from bitter experience.

  • Never drink alcohol before your gig. Especially if you are nervous. No good ever comes of this and if things go well there will be a chance to celebrate later.
  • If you are speaking after a meal, eat lightly, slowly and thoroughly.
  • If you use visual aids, ensure they are relevant and simple to understand.
  • Let the visual aids make you look good, not overpower you or your message.
  • Be cautious using charts or tables if the audience is not accustomed to them.
  • Three strong and related threads braided to arrive at the conclusion you have pre-determined are usually sufficient.
  • Don’t open with an apology, unless it is part of  the bigger story.
  • Never apologise for poor quality visual aids – you prepared them

That is plenty to consider at first.  Some other hints relate to trying to control your autonomic nervous system: breathe, relax, move, pause, think, make eye contact with someone and smile. Simple really.

 

 

 

Continence after Radical Prostatectomy

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I read an article today in the Journal of Neurourology and Urodynamics that appears to be a realistic counterpoint to the optimistic predictions from urologists and medical practitioners regarding the likelihood of a bloke being incontinent after a radical prostatectomy.

Many of my clients tell me the advice they received gave them a 10-20 percent chance of incontinence following the procedure, and that it might take months to come good (following an early period when almost all men have continence problems in the first four to six weeks of recovery). My clinical observations suggested this might be much higher. But then, I see those blokes who are struggling with the problem.

The study analyzed data from 1990 to 2007 and found that 90.3% of 1,616 men who underwent a radical prostatectomy without any radiation or hormonal treatment remained incontinent at 12 months post surgery.  The researchers cautioned that this needs to followed up with other large studies to confirm their findings chiefly because they could only follow up 37% of those who underwent surgery.  A further 4367 blokes were not fully followed up after surgery.

Perhaps of most interest to me was their attempt to link the ongoing incontinence to a range of independent factors. Having looked at the stage of the prostate cancer, the blood loss during surgery, the nerve sparing status at surgery and age of the men, the only one of these factors that correlated with the incontinence was age.  Sparing of the nerves did not make a significant difference.

Obviously more research is needed. For example, is the outcome different if the men undergo pelvic floor training before and/or after surgery?  A study along these lines is currently being done in Australia on the Sunshine Coast, but data is not in yet.

Ref:  Petersen A., Chen Y., 2012. Patient reported incontinence after radical prostatectomy is more common than expected and not associated with the nerve sparing technique: Results from the  Center of Prostate Disease Research Database.  J Neurourol0gy & Urodynamics, 31(1):60-63

Management by Stealth

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I may be a little slow at times, but I reckon I have finally worked it out.  My wonderful wife Mary has for some time talked of us getting some chickens to produce quality home grown eggs.  Of course, I pointed out that we don’t have a chicken run, there are foxes around, we have a cat and lots of other practical implications to owning chickens. So nothing happened.

Until three months ago when Mary’s son Daniel arrived with two live chickens as her (belated) Mother’s Day present. He also provided some feed pellets and a grand wire and timber chicken hutch measuring one metre by not much. We were suddenly set.  Except the chickens needed to be let out of the hutch to forage, scratch about and poo everywhere. Immediately on release they headed for the roadside and on one occasion, yes here it comes…. the chicken crossed the road!  Why? I Don’t care – but luckily some passers by let us know and I retrieved them and back into the hutch.

I purchased some chicken wire and spent the next two weekends building the Taj Ma-hen of chicken runs: 4 X 3 metres, fully enclosed with chicken wire (fox proof) and complete with shade cloth for the summer months. We now have two more chickens thanks to Dan’s Christmas present for Mary!  Eggs galore.

For her birthday, he arrived with seven fruit trees to plant in our orchard.  What orchard? No orchard – we have talked about it and even decided where it might go when the time comes…..  The time has come.  Today I spent hours clearing long grass, digging out rocks and planning a watering system ready to plant these trees.  Another couple of sessions and it should be ready.

I see what is happening.  There is a complicity between mother and son to push projects that in her mind have stalled by bringing on the urgency factor.  The arrival of chickens or trees necessitates the project be accelerated to a whole new time frame, with no consultation with me. Just an expectation that it will now be done.  Brilliant system. And hardly surprising that it is driven by a middle child.

But I am on to it now, so don’t get ahead of yourself Maggie (other middle child). Mind you, knowing what is going on and beating the system are two different things.

Now, I wonder how I can utilise this principle into a management strategy in business….

Prevention is OK – if within budget

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I was reading a very interesting article on Medscape this week which makes the point that preventative medicine is quite likely the only healthcare area in which cost is the prime driver.

Holding preventative medicine to a cost standard is something not practiced in disease care where a cure is the prime driver irrespective of price. Hence there are many government subsidised medical procedures, pharmaceuticals, screening programs and so on of questionable evidence base or cost/benefit value but are based in the disease care model so are less questioned.

Any suggestion of a preventative program is immediately costed and if not meeting budget targets, discarded. This may be a bit strong, but you get the idea.

I am reminded of a meeting I attended at the local private hospital some ten years ago where the Director was outlining their increase in medical specialists based at their brand spanking new specialist centre attached to the hospital. ‘Four cardiologists, two orthopaedic surgeons, two ENT, three physicians…’ and on he went proudly.

Later I sidled up and asked how many preventative medicine specialists they had recruited? He look at me incredulous and said ‘None, of course – they keep people out of hospital. We want doctors who admit patients.’ The business model of private hospitals is based on people getting ill or injured, and while they can’t actually promote this, they can certainly pave the way to their admission desk.

It makes you think.