The man´s service inspection

 I have always had something of an allergy to all kinds of machines and gadgets.

Cars are no exception.

My ignorance of them is almost complete.

When I was a child, birthday presents were rather different from what they seem to be today. Nowadays, children often get money, and every guest seems to arrive with roughly the same amount, almost as if they were paying an entrance fee.

When I was young, people actually brought proper presents.

Unfortunately, this meant that I repeatedly received Matchbox cars.

I couldn't stand them.

All I really wanted was something connected with sport.

As a teenager, most of my friends developed an obsession with cars and engines, so naturally I tried to keep up. But I never really understood what all those engine names and technical details meant, so I soon gave up trying to master the subject.

Throughout my life, the thing that has generally mattered most to me about a car has been its colour.

I realise this may disqualify me from membership in several male clubs.

I have owned all sorts of cars over the years, most of them bought used. More recently, however, I have bought new cars and have been reasonably good at taking them in for regular servicing, as the dealers recommend.

In the old days, my maintenance programme was simpler.

Change the tyres when the seasons changed.

Occasionally wonder about the oil.

And if a light came on somewhere on the dashboard, perhaps it was time to ask somebody what it meant.

My ignorance of machinery extends well beyond cars.

I am never entirely sure whether the lawnmower, brush cutter or whatever machine I happen to be standing beside takes petrol, mixed fuel or something else entirely.

When I was younger, I could manage simpler jobs around the house. Put up a light or replace some plumbing under a sink.

I have largely stopped trying. I am much better at seeing the big picture as a manager, organising what needs to be done and getting the right people to do it. So these days I leave such things to professionals — or occasionally to my wife, who is considerably better at them than I am.

At work, strangely enough, I have always been quite good at fixing things: broken bones, complicated wounds, burns — things that should, if possible, be put back together and made to work again. But I lack a carpenter's eye. I could certainly never reshape people's noses the way plastic surgeons do.

I suspect this puts me somewhat out of step with many other men. Reading a technical manual nearly makes me black out. IKEA instructions are about my limit — because otherwise, why even shop there?

Some men seem to love machines.

They own cars, jeeps, snowmobiles, power tools and enough gardening equipment to invade a small country. They know how all of it works. They hear the slightest change in the sound of an engine and immediately know something is wrong.

And they maintain everything with extraordinary care.

Which makes it rather strange that some of these same men pay remarkably little attention to the maintenance of the most important machine they own.

Themselves.

 The Machine That Came Without a Service Manual

We understand preventive maintenance perfectly well when it comes to other things.

The car goes in for service before the engine blows up.

We change the oil before it runs dry.

We have the brakes checked before discovering halfway down a mountain that perhaps we should have done it earlier.

But when it comes to our own bodies, we often use a different system.

If nothing hurts, nothing is wrong.

If something hurts, wait.

If it still hurts, wait a little longer.

If it becomes unbearable, perhaps mention it to someone.

Men can be remarkably optimistic mechanics when it comes to repairing themselves.

Dental health is a simple example. In Iceland, children's and teenagers' teeth are well monitored. After that, some adults continue to see their dentist regularly.

Others renew their acquaintance with the dentist when the toothache begins.

Eyesight and hearing are much the same. We generally notice when they deteriorate enough to interfere with daily life, and eventually we seek help.

Women, however, often claim that we can't hear a thing, even though we can hear perfectly well enough to know when we don't want to listen.

But many of the changes that matter as we age are much quieter.

High blood pressure has often been called the silent killer, and for good reason. You can feel perfectly well even when your blood pressure has become much higher than it should be. In the old days, it could almost be a stroke of luck if a blood vessel burst in your nose and somebody then decided to check your blood pressure.

After all, a burst blood vessel in the nose is rather more harmless than a burst one in the brain.

Fortunately, home blood pressure monitors are now inexpensive and easy to use, and many people regularly check their own blood pressure.

This is maintenance I understand.

Not because we should spend our lives looking for disease.

Quite the opposite.

The purpose of maintenance is to keep using the machine.

The Warning Lights Change With Age

As men move beyond middle age, the dashboard begins to change.

Body composition changes.

Muscle becomes easier to lose.

Recovery can take longer.

Hormonal changes may become relevant, particularly when symptoms give us reason to investigate them.

The prostate also tends to enlarge with age. Suddenly, a man who used to sleep through the night may find himself getting up again and again to urinate.

That usually gets his attention.

Prostate cancer is common, but screening for it is more complicated than simply telling every man to have one blood test every year. PSA testing can be useful, but age, risk factors, symptoms and the possible consequences of further investigation all matter.

This is where the car analogy starts to become a little more complicated.

With a car, finding a fault is usually useful.

In the human body, finding an abnormality does not always mean that it is dangerous — or that treating it will improve your life.

The Image Is Not the Patient

Then come the aches and pains.

The knees.

The hips.

The shoulders.

The back.

After decades of use, few bodies look as though they have just left the factory.

Sometimes imaging is necessary. An X-ray, CT scan or MRI may help explain symptoms, rule out something serious or guide treatment.

But one of the things I learned during a long career in orthopaedic surgery is that what you see on an image and what a person actually feels do not always match.

Someone with severe back pain may have a relatively normal-looking spine.

Someone else may have no back pain at all and undergo imaging for an entirely different reason, only to discover a spine that looks rather like Berlin after the war.

And yet its owner has been walking around perfectly happily with it.

That matters.

An MRI is not a verdict.

An X-ray is not the person.

The image is only one piece of information, and it has to be interpreted alongside the symptoms, the examination and the rest of the story.

We treat people, not images.

New or unexplained symptoms should, of course, be taken seriously. Persistent pain, neurological symptoms, unexplained changes or anything that genuinely does not feel right should not simply be dismissed with:

“I'm just getting old.”

Age explains many things.

It does not explain everything.

Should We Go Looking for Faults?

This is where the idea of a service inspection for the human body becomes a little more complicated.

Should a perfectly healthy person have a whole-body MRI just to be on the safe side?

Opinions are sharply divided, although most doctors advise against it.

The idea is easy to understand. Put the entire body through the machine and find everything before it becomes a problem.

The trouble is that the human body is full of all sorts of harmless abnormalities.

The harder we look, the more we find.

And once something is found, it can lead to more scans, more tests, more anxiety and sometimes even treatment for something that would never have caused any trouble.

On the other hand, there are established screening programmes and risk-based examinations that can detect serious disease before symptoms appear. Breast and cervical cancer screening are familiar examples, as is colorectal cancer screening in appropriate age groups.

Lung cancer is also a good example. In people with a substantial smoking history who fall within certain age and risk groups, screening with low-dose CT could reduce the risk of dying from lung cancer.

That is very different from scanning everybody simply because the machine exists.

The same principle applies elsewhere.

Good maintenance is not the same as removing every single screw and nut just to see whether something is wrong.

What About Blood Tests?

I think it makes sense to know a few basic numbers as we get older.

Blood pressure.

Blood count.

Blood lipids.

Blood glucose.

Pancreatic, liver and kidney function.

And depending on age, medical history, medication, symptoms and individual risk, other blood tests may be appropriate.

But there is no single blood-test package that every healthy sixty-year-old man needs every year.

The useful question is not:

“How many tests can I have?”

It is:

“Which information would actually change what I do?”

That is a much better basis for a service inspection.

A man with symptoms suggesting hormonal problems may need hormone testing.

A man considering a PSA test should understand what the result can tell him — and what it cannot.

Someone with cardiovascular risk factors may need closer monitoring of blood pressure, cholesterol and blood glucose.

Symptoms call for investigations directed at those symptoms.

And all of us need to know our own bodies well enough to notice when something has genuinely changed.

Keeping the Old Machine Running

I am not suggesting that men should become obsessed with their health.

God forbid.

The last thing Nordic Wolves needs is thousands of men sitting at home comparing test results and discussing their prostates — although it might make for quite a race to the toilet.

There is a life to be lived.

That is precisely the point.

The service inspection is not about anxiously searching for everything that might eventually kill us.

It is about giving ourselves the best possible chance of continuing to do the things we still want to do.

We take the car in for service because we want it to start tomorrow morning.

We maintain the boat because we intend to take it out to sea again.

We sharpen the tools because we intend to use them.

Perhaps every now and then we should extend the same courtesy to ourselves.

Because I understand perfectly well that it would be bloody annoying to end up stranded at the side of the road because I failed to maintain the machine.

But it would be considerably worse to end up stranded at the graveside.

Especially if someone could have spotted the warning light years earlier.