"Is This Normal or Something Serious?" The Everyday Health Signs Men Shouldn’t Dismiss

26:15He said, well, you know, I finally had that orgasm. So he literally had bleeding to the point from hematoptermia because he was on a blood thinner that it just let it rip. that prostate vessel ruptured because you not had a strong orgasm in years. And he looked at me and said, Doc, I'm not mad. It was worth it. So, you know, thankfully we were able to control it with a little cautery. But, yeah, I mean, that is the nut of all nuts, right? I mean, you just end up in a hospital with blood that you can't stop. So, yeah, so, again, most of the time ejaculating blood, not good, but still can be pathological, especially if you have any kind of bleeding disorders.

26:57So get it checked out, but not so worried about it. So anyway, those are the blood things you can't ignore. What about like heart attack stuff? Things that are things. I mean, things that are issues like we know that you should call 911. You have substernal chest pain, radiating down to the arm. Most guys know that they really shouldn't ignore that. It's amazing how many still do. But what are the things that you should look for is what we call exertional chest pain. So in other words, if you're just sitting at your laptop and you get a little catch, you know, and you kind of adjust and it goes away and it doesn't come back, you know, then that's probably not a heart attack.

27:37Not as big a deal. But if, you know, if you're walking up a flight of stairs, if you suddenly get some stressful news that you clutch your chest, then that's exertional chest pain. And that needs to be worked on right away. If you have an aspirin handy, then you can chew on it because that's the first thing they're going to do when they get to the emergency room or when your paramedics come actually is they're going to give you oxygen. They're going to give you aspirin. They may give you even something like morphine or a narcotic to help kind of relax things and keep the oxygen demand to the heart a little bit less.

28:12Because basically what happens is your blood flow to the heart is not able to keep up with the exertion that you're performing. And that's what can lead to a heart attack. So you've got to slow down that with a little bit of Astro. and then again, if you've had a history of it, then everybody knows that you have a little nitroglycerin pill that you can take and that will immediately open up the blood vessel as much as you can until you get emergency care. But those are kind of the early warning signs of chest pain. But the heart is not the only thing that can cause chest pain, the aorta can too.

28:45And so if we worry about things like an aortic aneurysm or a dissecting aortic aneurysm, which again, will kill you very quickly, that tends to be more, if it's up in the upper aorta, it tends to be more in the back. You'll feel it between your shoulder blades. And any kind of boring, grinding pain that is getting progressively worse between your shoulder blades, that is what we call a dissecting aortic aneurysm until you know better. So you need to go to the emergency room right away. If it's down in the belly, you get just incredible acute onset belly pain, then we got to worry about that too.

29:20And again, that could be from a GI source. He just had food poisoning. But again, if it's this grinding, grinding pain, that can be a real sign of something bad. I'll tell you the story that came up recently that I was tangentially involved with as a young guy who had what we call a mycotic aneurysm, which is where he had a fungal infection. This came from eating. He was out of the country and he ate undercooked lamb and the lamb had something called brucellosis in it. And that can set up a fungal aneurysm where the fungus can get into the wall, the lining of an artery, and eventually erode it and then cause a dissecting abdominal aortic aneurysm as well.

30:00And again, he really didn't want to get treated. He wanted to catch a flight. But thankfully, one of my astute vascular surgeon colleagues in the ER said, no, this is going to kill you if you don't get operated on immediately. So aortic aneurysms can happen in young guys. IV drug users, male and female, can get fungal aneurysms from dirty needles. And so again, these are all things that need to be evaluated because that is stuff you can't ignore. So I laid a bunch on you there. I want you to catch up with your questions and signs of horror. You still have all your color in your face. So that's good news.

30:34I mean, chest pain, that's the scariest thing to me because I feel like the spectrum, I am not able to really tell the difference because to me, chest pain is chest pain, But the spectrum of really not being a big deal to being a huge deal is so broad. Blood coming from an orifice, that I can understand and generally understand is something you should get checked out. But chest pain, that's the thing that I think scares me more than any symptom that seems like something that you could very easily ignore. Because you're right. It could be indigestion. It could be anxiety. It could be a pulled muscle.

31:09It's so easy to dismiss it as nothing. Yeah. And I think that's important is the persistence of it. And if you look at the number of chest pain diagnoses that are made in an emergency room that lead to, you know, immediate cardiac catheterization, you know, it's probably less than 10%. But those are the lives you're saving. Yeah. You still have to do the workup, which is usually pretty easy to do. But, yeah, it's usually the chest pain that doesn't go away, you know, in just a couple seconds that is still there and persistent that you can't ignore. So, yeah, I mean, it's tricky. You know, the human body is amazing.

31:45It heals itself pretty well, but every once in a while it can't. That's what we're here for as doctors. What about lumps? Like, you know, if you had a new lump that just developed in your neck, in your testicle, in your arm, like, are those things that you should ignore or are those things that you should, you know, seek a relatively immediate care for? I usually, just because of family history, go to a dermatologist as soon as I can or a primary care physician.

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36:36Yeah, yeah, right. Good for you. I mean, you are, you know, you're amazing. Like when we started this whole journey together, you and I, you know, you were 36 and you're like, I don't know when the last time I've been to a doctor. And now, I mean, you're just a wealth of anxiety. That's right. Well, if I've only helped one person in my entire mission on air, it's Jordan Runtog, everybody. But yeah, lumps tend to be bad. There you go. Lumps tend to be bad, but there is a way, especially if you get something not within an organ, like if it's in the testicle, always need to get evaluated. If it's in the neck and it doesn't go away, if you have a sore throat, for example, and you have a little lump in your neck and it gets better with an antibiotic, then you just add a swollen lymph node.

37:19And especially if it's tender, but if it stays around for more than a week and if it doesn't move, if you grab it, And again, you can have a lump on your arm, on your knee, and the majority of them are benign and often what we call lipomas. But if they're fixed, in other words, if you can pick up this little rubbery nodule and you can squish it back and forth in your arm, you still get it checked out and certainly removed, especially if it bugs you. But if it doesn't move, if it's there and it's like this little claw that doesn't want to move, then that's something that needs to be checked out because there's a lot of different kinds of bad tumors that can generate from lumps on the body, whether it's on the abdominal wall, whether it's on your back between your shoulder blades and your shoulders, arms.

38:02There are all kinds of things. Usually it affects younger people, but not always. And so again, get it checked out. Lumps are bad. Tell me about headaches. You know, when should you see a doctor? Yeah, talk to me about that. I mean, we all get headaches, right? I get headaches a lot because sometimes I'm poorly hydrated. I'm often stressed, bad, bad posture. So many, you know, looking at a screen too much and I don't have those glasses that are supposed to be better. So there's a lot of I get headaches a lot for a lot of reasons that I always honestly chalked up to. This is my one thing that I do tend to ignore my headaches.

38:42I get a lot of headaches. um but i i mean let me ask you how when does that cross the line into being uh other than maybe seeing an optometrist for reading classes when does that cross the line into something that i should check out um with a position yeah well you said something very important you you know you don't ignore them you know you say oh i'm dehydrated what do you do you drink and and and a headache goes away then you solved your own problem same thing it's like oh well there okay Okay, well, yeah, and Excedrin actually, you know, it's a fantastic headache cure because it also, in addition to the acetaminophen or Tylenol it has in it, it does have a little bit of caffeine.

39:22And so if you already have a little bit of a caffeine habit, then yeah, I mean, sadly, I, you know, I will open up to the world that my only true addiction, which again, isn't really an addiction, but my true dependency is caffeine. I mean, I love my coffee that, yeah, if I, you know, if I don't drink my cup of coffee in the morning, which is a never event, but if I don't say, yeah, somewhere around noon, I'll start to get a headache and say, oh yeah, that's right. I didn't have my coffee. So, you know, it's not going to kill me. And I know why. And if I said, dang it, I got to stop drinking coffee because, you know, people are telling me it's bad for you, which you'll never hear from me, even though I'm a doctor, a voice among the din.

39:58but um but the bottom line is that you know caffeine withdrawal excedrin will cure right why because it has caffeine in it so it's a little hair of the dog so yeah that's why excedrin it works but but so right if you're pounding it though and you and that's a really good point because if you're if your treatment for any headache you get is to take acetaminophen or or ibuprofen which is advil motrin those kinds of nseds or caffeine and you keep getting it the same day, same time, and you're not getting that, that actually should be evaluated. So you shouldn't have to take Tylenol every day of your life without a diagnosis of why you're getting those headaches.

40:36So that is a sort of a relative warning sign. But right, if you get a headache and you drink a glass of water and it goes away, or if you shut your damn computer down for a little bit and you go out and walk along the beach or take a walk in your neighborhood and reconnect, take some deep breaths and it goes away, great. Then that was a lifestyle-induced headache and you know that you shouldn't be on your screen 12 hours a day. If you get a thunderclap onset, they literally, that's a term, a thunderclap headache, where it's just pow, you know, comes out of nowhere. You see stars, you lose vision for a little, even a second or two.

41:09Those are really bad headaches. And you have to get those immediately evaluated because they're never good. And sometimes they are, you know, can be attributed to just acute vascular headaches that are not dangerous. But The problem is sometimes headaches can be from an intracranial bleed. A subarachnoid hemorrhage is kind of the classic one that you can get that then can lead to a stroke and that can then lead to death or intracranial pressure elevations. And so thunderclap, those you have to be evaluated, even reasonable to go to the emergency room for those. If you have a loss of vision, a lot of things can cause that from brain tumors to vascular strokes as well to the thalamic nerve.

41:49And so those need to be evaluated right away. If you have what we call photophobia or incredible light sensitivity where you can't see it, it could be a migraine, which are not benign, but they're also not going to kill you. But if you don't have a diagnosis of migraine headaches and they haven't done the head CT scan or the functional MRI or some kind of mediated MRI where they're looking with a contrast to make sure you don't have some kind of aneurysmic malformation, then you need to get you need to get evaluated for that and if you like look dude at the end of the day you just get bad migraines there's great treatment for that but and i'm sure actually this kind of says we need an episode on headaches and bring in a true headache specialist because we really can unpack a lot of stuff and it is such a common thing maybe it's more common these days because of screen use and uh and chronic dehydration and all the other things but but But yeah, we really have to bring an expert for that in.

42:44So yeah, foreshadowing. And then also then just, yeah, the uncontrollable vomiting and headache. Those are the things we worry about. You hear about things like meningitis, which can go through summer camps and college dormitories and military barracks when everybody gets together in a tight space. Those are also really bad. So yeah, in general, the only headache, well, actually you should ignore none. But can you self-treat? Yeah. You know, if you do something simple and it goes away, then you're probably going to be okay. But yeah, but headaches, they really, it's an amazing, the amount of work loss that happens on an institutional level with headaches.

43:20It's amazing the amount of pain and suffering and sleep deprivation. People that I can't exercise, I can't get out of bed. And so it is, if not a epidemic, at least it's a public health concern, both from the workplace and how much work we're able to get done. and lifestyle. I mean, if you live with somebody that has chronic headaches and they're grumpy all the time and you do your best to support them, that's tough. That could take a real caretaker toll. So, yeah, headaches are bad too. That's all I got for you, things that I worry about. I mean, again, I'm a urologist, but certainly these are the things that come up to my list of what we shouldn't do.

43:55What do you got for me that you're like, oh, Mills, you forgot this i mean like you know i've won uh i'm a big fan of uh warren zivon and i i love his interview that he gave with uh with david letterman shortly before his death which is really for i recommend to anyone really his line of you know enjoy every sandwich like basically advice from a man who's dying about how to enjoy life but he talks about how he first discovered he was diagnosed with lung cancer and he just had a chronic cough that he thought was a cold that wouldn't go away and that always haunted me and now every time you know if i've i have a cough that goes on for more than a week and a half i start to panic and thinking of you know my caudal cancer um yes i wanted to talk to you about when to get a cough checked out because it's you know summer cold season and all that kind of stuff right and then we're going to be going in the allergy season and in the fall and yeah i just want to ask you about right yeah i mean i would say that it is anytime that it doesn't go away, you know, after a solid week or two, and you don't have an explanation.

44:58So, you know, you have allergies, you have, you know, kind of post-nasal drip, all those things that you can't obviously explain away, then you definitely get checked out. If you have risk factors, like you live in an area that has a lot of fungal infections, a lot of agriculture areas, especially in the Central Valley here in California, we know something called valley fever, which is an endemic issue, especially for farm workers, people that live close to the soil. That can cause the, I mean, God, we just had the hantavirus epidemic in the cruise ship. And those, you know, we used to think those were pretty much isolated to sort of high desert regions in Southern Colorado, Northern New Mexico.

45:41California is starting to see it a little bit more. But again, these are rodent-borne illnesses that can start off, you know, with just a cough. And then usually it's associated with the fever. So you need to get that checked out. And again, coughing up blood at any time is bad. But yeah, even if you have a dry hacking cough that doesn't go away after a week or two, reasonable to get checked out. You know, a chest x-ray is an easy thing to start with and let your doc kind of figure out how to do the workup from there. But yeah, I mean, you shouldn't just normally cough all the time. Well said.

46:14Right? Yeah. I mean, you know, common sense mixed with a little bit of medical knowledge. That's how we roll around here. That's what we do. But yeah, I mean, I think, you know, the take home too is, you know, if anything just doesn't seem right to you that has always been right your whole life and is not getting easily corrected, you should get it evaluated. You know, you shouldn't just kind of Google it away or AI it away. There could be a source and could be easily treatable, especially if it's just annoying to you, like a chronic cough. But eventually, you know, you got to see somebody for that.

46:47You'll have a medical expert tell you you're probably going to be okay or you'll catch something, you know, as early as you can and take care of it. So either way, it's a win-win. Well, and also, you know, and make sure that you're enjoying every sandwich along the way. Yes. And I think that's true. And I quote him often. I think, you know, and then even, you know, even as he sung on his way out, My Ride's Here. I mean, that's such a brilliant song that once you watch the David Letterman, just listen to him and then listen to Springsteen do my rides here. When he announced live in concert, he just heard about Warren's death and he did it live.

47:21If that doesn't bring tears to your eyes, then, you know, you have no feeling. I'm just telling you that it is the most beautiful homage, not to mention him doing Knocking on Heaven's Door. Oh, the winds. Yeah, taking Dylan's song. And wow, I mean, between that and Axl Rose's version, you can just do a whole playlist on that. Yeah, we need to get DJ Hesta back in here and say, give me a good death playlist about what I want to hear. But my rides here has definitely got to be at the top of that. Right on, I second that. Dude, too much. That was sort of an inspiring, invigorating way to say, hey, stay alive as long as you can.

48:03Enjoy it while you can, which is what I'm going to tell you right now is that, man, you got to get out of here. Have a great day. Get out, walk the beach, get just enough sun so that you get some vitamin D exposure, but not enough to develop melanoma. I don't know what that threshold is, man. But, you know, put a little SPF on and, you know, enjoy yourself, brother. It's doctor's orders. You got it, my friend. All right, dude, so much fun. Thanks for hanging out with me again. Thanks to the listeners for tuning in to yet another enthralling episode of the Male Reproductive Specialist talking about all things health and wellness.

48:37Too much fun. And we'll see you next time. Long Transit, thanks. iHeartRadio, double thanks. Thanks.

49:14The Mail Room with Dr. Jesse Mills was a production of iHeartRadio. It was executive produced by Jordan Runtog. It was edited, mixed, and mastered by Bahid Frazier. And the theme was provided by Long Transit. If you like what you heard, please subscribe and leave a review. For more podcasts from iHeartRadio, check out the iHeartRadio app, Apple Podcasts, or wherever you listen to your favorite shows. This program is intended for educational and informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Consult your health care provider for any medical or other related questions or concerns.

49:54The views and discussions aired on this podcast are those of Dr. Mills and do not represent the official positions of UCLA or UCLA Health.

50:24some adults with overweight who also have weight-related medical problems to lose excess body weight and keep the weight off. ZepBound is approved as a 2.5, 5, 7.5, 10, 12.5, or 15 milligram injection. ZepBound contains terzepatide and should not be used with other terzepatide-containing products or any GLP-1 receptor agonist medicines. It is not known if ZepBound is safe and effective for use in children. Don't share needles or pens or reuse needles. Don't take if allergic to it, or if you or someone in your family had medullary thyroid cancer or if you've had multiple endocrine neoplasia syndrome type 2.

51:00Tell your doctor if you get a lump or swelling in your neck. Stop ZepBound and call your doctor if you have severe stomach pain or a serious allergic reaction. Severe side effects may include inflamed pancreas or gallbladder problems. Tell your doctor if you experience vision changes before scheduled procedures with anesthesia. If you're nursing, pregnant, plan to be or taking birth control pills. Taking ZepBound with a sulfonylurea or insulin may cause low blood sugar. Side effects include nausea, diarrhea, and vomiting, which can cause dehydration and worsen kidney problems. Talk to your doctor.

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