He’s thinking: I’m having a senior moment.
But it could be: A stroke. When a clot, injury, narrow blood vessel or other problem restricts blood flow to the brain, the result can be a TIA—a transient ischemic attack, which impairs brain function and can make speech difficult. It’s different from the tip-of-the-tongue reaching for an elusive word.
1. Feeling Tongue-Tied
“He might find that words can’t come out at all, or he’ll speak words that are different from the ones he intended or mumble things that don’t make sense,” says Steven Kaplan, MD, director of the Iris Cantor Men’s Health Center now under construction at NewYork–Presbyterian Hospital in New York City. Such symptoms warrant an immediate call to the doctor or trip to the ER. Mini-strokes usually last a few minutes and symptoms typically disappear within an hour, but having a TIA means you’re at immediate risk of a more massive stroke. Men have a slightly higher risk of TIAs than women, and risks go up with age, especially after 55.
2. Shortness of Breath
He’s thinking: I’m really out of shape.
But it could be: An impending heart attack. Shortness of breath with exertion such as walking up a flight of stairs could be a sign that the heart muscle isn’t getting enough oxygen—a hallmark of coronary heart disease, which men age 55 and over are at an increased risk for.
“Any condition that makes breathing a struggle, including asthma and allergies, is exacerbated by exertion,” Dr. Shindel says. “But if shortness of breath seems to be getting worse each time, we worry about the heart.” Breathing that’s labored and doesn’t improve warrants a call to 911. An electrocardiogram or EKG (which measures the electrical activity of your heart), a sonogram or ultrasound of the heart, and chest X-rays can help diagnose or rule out a heart problem.
3. Persistent Pain On One side of the Abdomen
He’s thinking: I probably pulled a muscle.
But it could be: A kidney stone or tumor. One-sided pain that goes away probably is a side stitch or pulled muscle and nothing to worry about. “But if a dull ache is persistent, it should be evaluated by a physician,” says Dr. Kaplan. “It could be many things, but a tumor is one of the first possibilities we consider.” An ache from a tumor won’t likely move around, and may get better if he takes an over-the-counter pain reliever—but will keep coming back. “Any abdominal pain that doesn’t resolve within three days deserves to be checked out.”
Sharp, excruciating pain that hits suddenly and doesn’t improve within an hour warrants a trip to the ER. “If it’s a kidney stone, the pain will radiate from a specific point and can be intense enough to make you vomit,” Dr. Kaplan says. “I’ve had one myself, and it’s so horrible it makes you want to die.” The problem could also be appendicitis, a perforated ulcer or a hernia, so it’s important to get checked out.
4. Toilet-Time Blood
He’s thinking: Must be something I ate.
But it could be: A kidney stone or bladder cancer if blood is in urine; colon cancer if blood is in stools. Bright red spots on tissue after wiping are likely from hemorrhoids. But blood in stools that have become narrower and thinner than usual (like the width of a pencil) could be a sign of cancer. Black, tarry stools might also indicate stomach bleeding from an ulcer. His doctor will likely examine the GI tract via a colonoscopy or upper endoscopy to nail down the problem.
Blood in urine may show up as a subtle pink hue, but he shouldn’t dismiss minuscule amounts or chalk it up to eating beets. “You’d have to eat a whole lot for that to happen,” says Mark Pochapin, MD, director of the Jay Monahan Center for Gastrointestinal Health at NewYork–Presbyterian Hospital/Weill Cornell Medical Center in New York City. Assume any reddish color is blood: One drop can turn the bowl pink. “Even microscopic amounts are a warning,” says Martin Miner, MD, codirector of the Men’s Health Center at The Miriam Hospital and clinical associate professor at the Warren Alpert Medical School of Brown University in Providence, Rhode Island. “If he can actually see red color, he should definitely be evaluated.”
5. Trouble Down Below
He’s thinking: There’s a pill for this.
But it could be: An early warning of cardiovascular disease. “The latest studies find that men in their 40s and 50s with erectile dysfunction may be two to five years away from a cardiovascular event like a heart attack,” Dr. Miner says. A recent study at the Mayo Clinic found that men who had ED in their 40s were 50 times more likely to have heart trouble down the road than men who didn’t. The artery leading to the penis is about half the diameter of the one feeding the heart, so experts think that restricted blood flow from atherosclerosis shows up early down below. An EKG or stress test can identify cardiac problems and a Doppler ultrasound (usually from a urologist) can test blood flow in penile blood vessels.
“The first sign of ED is usually trouble maintaining an erection during sex or not having normal morning erections,” Dr. Miner says. The good news is that the onset of ED, if it’s caused by cardiovascular disease, suggests your man may have a window of opportunity to treat heart disease before it becomes a serious problem.