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Scot: Troy, are you ready to talk about colonoscopies?

Troy: I'm ready.

Scot: All right. Who's had one, by the way? Have you had one, Troy?

Troy: I have.

Scot: Oh, you have? I didn't think you had yet.

Troy: Yeah, I have had a colonoscopy. I went to my primary care provider last March and he said, "The recommendations have changed. You are due for a colonoscopy." And I said, "That's not the news I wanted to hear." I signed up for it and did it. I got in the first opening they had. They had a cancellation. I got in for it two weeks after that appointment. I'm like, "I'm just getting this thing done." And I did it.

Scot: Getting it out of the way. Mitch, you haven't had yours yet. You're not old enough for it, right?

Mitch: No, I'm still under 40. Is 40 the new 50? Is that the slogan?

Troy: Forty-five is the new 50.

Mitch: Forty-five is the new 50. Yeah, I got a decade.

Scot: All right. Well . . .

Troy: You're good.

Scot: Colonoscopies are one of those things that men just kind of don't want to get and don't want to talk about. We just want to ignore it, pretend it doesn't exist. But as I was thinking about this topic . . . And I have had my colonoscopy. I guess in my mind, it's two choices, right? It's possibly get the second most deadly cancer men get and have your life disrupted for who knows how long, or get a colonoscopy every 10 years, right? I don't know.

So today, we're going to talk about the reasons men don't get colonoscopies. Troy and I are going to talk about our experiences to find out if maybe some of the perceptions out there that people have about them are true or not.

Welcome to a Men's Health Essentials episode of "Who Cares About Men's Health," offering information, inspiration, and a different interpretation of men's health. My name is Scot Singpiel. I bring the BS.

And the part of the colonoscopy I didn't like was the prep. I don't know about you, Troy. Troy is the MD to my BS. What didn't you like about your colonoscopy?

Troy: I agree. The prep. And that's what I'd heard, too, going into it. The prep is the bad part. The colonoscopy is easy. That was basically my experience.

Scot: Yeah. Mitch Sears is on the show, and he's a ways away from his colonoscopy, but I guess you can't wait, right? You're pretty excited about it apparently.

Mitch: I wouldn't say excited. We're back to that area. I don't love these episodes, but it's something I want to be prepared for. So I'm ready to learn.

Scot: And I don't know his colonoscopy status, because we just met. We've got Nathaniel Ferre on the podcast. He's a community health educator at Huntsman Cancer Institute, and he works with the public to help them understand the importance of cancer screenings, including colonoscopies. Welcome to the show, Nathaniel. Have you had yours?

Nathaniel: Thanks, Scot. Great to be here. I, like Mitch, have not gotten mine yet. I'm not of the age quite. So we'll get there eventually, but . . .

Scot: All right. So, on the podcast, I guess we have Team Scoped, which is Troy and me.

Troy: Team Scoped. We've been there, done that. Speaking from experience.

Scot: And we have Team Unscoped, Mitch and Nathaniel.

So I want to start with actually both of you guys. Like Team Unscoped, what is your perception of what a colonoscopy is like? Mitch, what do you think?

Mitch: Oh, I've heard . . . No one talks about what actually happens, but it's like, "Here's this miserable prep step," and then the process itself sounds pretty uncomfortable. None of it sounds good. None of it sounds positive, but it's something you've got to do if you're not going to die from cancer. That's my perspective.

Scot: Nathaniel, you have a different perspective, obviously, since you help people understand the value of colonoscopies, and probably deal with a lot of these barriers that we're going to talk about today. What would you like to say about your perception or the perception of colonoscopies in general?

Nathaniel: Yeah, absolutely. Well, even though I haven't had it yet, I have heard it's a nice nap, right? You get a nice, solid sleep there in the middle of the day. And so that is an advantage, I guess, if you're looking for a good rest, but . . .

Scot: That's so funny because I had a friend that got it that said the same thing, that when they came out of the whatever it is that they put them under, it was like, "Can you please put me back under? I was having a great dream."

Mitch: Wow.

Nathaniel: "This is a great break right here."

Troy: That's so funny. My first thought when I woke up was, "I need to give patients more propofol," because that's the medication they gave. I was like, "That was so nice. I slept so well. I had no idea what was going on." That was my first thought when I woke up. So it was a nice nap.

Nathaniel: Yeah. Other than that though, obviously I think we've all heard about the prep. Like Troy said, it is a rough part maybe of it. But again, I think you think about the pros and the cons, and you think about what you're getting accomplished there. That few days of hard prep can really pay off with a great nap. And then, of course, the cancer screening to go on top of it.

Scot: That's right. And colon cancer, tell me . . . When we talk about cancers a lot of time, we talk about survival rates, right? We talk about dying. That's obviously the worst thing that can happen. But cancer can also cause really a lot of disruption in your life.

First of all, I did say it's the second deadliest cancer for men. How important is finding it early? How important is the colonoscopy in this step to survival or minimizing the impact on your life?

Nathaniel: Well, for colorectal cancer, extremely important. As we look at the five-year survival rates, which we normally do for cancer, if we find it early, we have over a 90% chance of five-year survival. It's really treatable. We've gone a long way to be able to treat this disease.

Where it really gets tricky and why that mortality rate is so high is the late stage. If we don't get screened, if we find it late, that mortality rate just skyrockets and the survival rate dips all the way down to 14%, which is really sad and very disruptive.

And so that just stresses the importance of screening and finding this early in order to be able to treat it much better.

Scot: And I understand about less than half of colon cancers are discovered at an early enough stage to make a difference.

Nathaniel: Yeah. Luckily, we're getting better with that as we continue to make strides in screening, but as we see some of these trends going on where people are maybe getting it younger or not paying attention to some of the prevention things that we can do, it is difficult to find it. But if we do get screened, then we can find it. It's just a matter of taking that action.

Troy: That kind of speaks to the age change too. Like I said, I went to my primary care provider. I think the recommendation just recently had changed. I was surprised to hear it had changed to 45 from 50.

I will say I had not looked forward to the colonoscopy, but I thought, "I'm good until 50, and maybe by then there will be another screening technique." And there wasn't, so I had the colonoscopy. But why has that recommendation changed, and why are we now getting it at 45?

Nathaniel: Yeah, that's a great question, and it really speaks to some of the trends that we're seeing as we see younger and younger people get affected by this disease.

Actually, certain groups, too, historically have been affected worse. The screening recommendation has been 45 for a long time for African-American males and females, as it's really affected this group much more hard than other groups in comparison.

And so lowering that to 45 is really an indication of we're seeing it younger. We're seeing increased risk due to diabetes, due to some other gastrointestinal diseases. And so, in order to reduce that, we see there's not a huge risk with a colonoscopy. We're looking at what's the pro, the con, the risk versus the reward, and the risk is quite low for a very high reward of finding those cancers early and really being able to address them.

Scot: I think most men and most people know that colonoscopy is something that is beneficial for them. But I mean, let's face it, there are a lot of reasons to put that thing off, right? It's like one of those things that's really easy to postpone time and time and time again because there's kind of a lot of stuff involved that it's easy to postpone.

Troy, was there anything that made you want to put it off? I mean, you jumped right on it, but what might make you . . .

Troy: I jumped on it.

Scot: Yeah. What might make you put it off? Well, first of all, why did you jump right on it? I'm curious about . . .

Troy: I'll tell you. That's exactly why I jumped on it, because I knew of every reason I wanted to put it off. And I knew the longer I put it off, I was just going to dread it.

Here I am, a healthcare professional, trying to talk myself out of doing it. I was literally just talking to myself saying, "I don't really need this. I'm low-risk. I don't have a family history. I don't see why the age dropped to 45. Why can't I just wait a few years?" All of these things. And so that's when I finally said, "I'm getting in as soon as I possibly can," because the next appointment wasn't until August. And so I got this done in early April.

And so, yeah, the big reasons I didn't want to do it were just the embarrassment of having to go in there and having a whole lot of people around me and having a probe inserted in my rectum and going up there and looking for polyps. Just that piece of it. It's just the fact that you have to be exposed like that. So I wasn't thrilled about that.

The prep, I had heard, was miserable. I just heard it was awful, that you're just sitting on the toilet and you can't get off it, and you're going in your pants, and things like that just sounded horrible.

And I didn't know I was going to be completely sedated either. I thought it was going to be a light sedation and I would be aware of what's going on during it. I thought, "This is really going to be uncomfortable and it might hurt." So that was a fear I had as well.

So those were all things going through my mind, and those were all the reasons I said, "I've just got to get this done so I'm not thinking about it." So that's why.

Scot: How about you, Mitch? Is there anything that would make you put it off? Or does something scare you about it, or something that concern you about it?

Mitch: So I don't mess around with cancer. I don't know. If there is the tiniest bump, I go in. And so I know that whatever the recommendations are, I'm going to do it because the alternatives scare me a bajillion times more than the actual thing.

I was in the same boat. I just barely found out five minutes ago that you're put under. I assumed you had to be up and maybe people . . . I think I was thinking of a colon cleanse rather than a colonoscopy, right? Where I assumed that I was awake for the whole thing. No. If I'm out, I know it'll suck and there are a lot of terrible things, but no, I'm not . . . Check it. Make sure I'm not dying.

Scot: Right? It's like, "What am I going to talk about while they're doing this?" I don't know.

Mitch: Right.

Troy: Yeah. It's like being at the dentist. I'm trying to have this awkward conversation.

Nathaniel: That's exactly what I was thinking.

Scot: So another concern, and this is . . . well, this whole episode is TMI, right? Too much information, quite frankly, but . . .

Mitch: Or the perfect amount.

Scot: Well, yes. I mean, we're trying to normalize talking about this.

Mitch: And nailing it.

Scot: This is a dumb thing, but I think it's something that would keep somebody from getting it. How my butt would feel after. Would I be able to tell that there'd been a scope up there, right? Is this going to be a residual feeling I'm going to have for the next two days? Who's laughing at me?

Nathaniel: Well, you got Mitch there.

Troy: I think it's Mitch.

Scot: By the way, the answer was no. I wouldn't have known that anything happened.

Troy: Yeah, I'll second that. I will second that.

Mitch: We are so concerned that it's going to feel . . . All right. Cancer. You guys, cancer. Okay. I'm sorry. I shouldn't laugh at your concerns. My butt might feel weird, but it's also cancer, you guys.

Scot: Nathaniel, what are some of the reasons that you hear when you go out into the community that people put it off for? What are some of the perceptions out there that make people not want to get one?

Nathaniel: Yeah, a lot of the reasons that we've already talked about, right? That it's going to hurt, or the prep is terrible, or we're looking at, "Well, I know I should do it, but I just don't have the time to do it. My life is busy. I have things to do and it requires a couple of days of prep, and maybe I have to take work off." These things are pretty common that come up really, and it's great to address them.

Scot: Yeah. I mean, I'm really quite privileged and lucky, because first of all, I have good insurance that paid for the whole thing. Second of all, I have good sick leave, so I could take that day off. I had to have somebody else take the day off to drive me in and then drive me home, and then be with me for that day, right? So there's another potential.

But not everybody has that advantage. How do you make the case to somebody that taking time off is just really hard from a financial standpoint, let alone a couple of people, in addition to the other things we've talked about?

Nathaniel: I mean, it's hard. It's hard to be able to put yourself in every situation possible, but really, I think it goes back to that same mentality of the risk versus the reward and kind of the payoff, as we think about, "What are some things that I can do that really impact my health in the future?" And this, I think, certainly is one of those things, especially as we think about, "Hey, if you do a good prep and a good clean, and they go in and there's nothing in there, you're off the hook for 10 years."

Mitch: Ten years?

Nathaniel: It's not something that . . . Yeah, that's the recommendation, right? If everything is clean, we don't find any polyps, and you did a great prep, and you followed all the doctor's instructions, if you will, yeah, your next scope is going to be in 10 years.

And so it's not like going to the dentist. You think, "Oh, I've got to go to the dentist twice a year. Wow, I've just got to schedule around that." Not to go back on the dentist thing, but . . .

Scot: Yeah, we're going to get some . . . "Thanks, guys. Appreciate that."

And I guess something else maybe to consider, I don't know, but this is so hard when you're in that situation where money is tight anyway to take that time off, but if you end up getting colon cancer, that's a lot more expensive and going to take you out of work and out of your family, out of your life for a lot longer. I mean, what's it like when somebody gets colon cancer? What's that experience like that you've seen?

Nathaniel: Yeah, it's really tough. I think it's one of the cancers that you can definitely see on the outside, especially when you think of oftentimes if it's a late stage. Our surgeons are going in and actually removing large sections of your colon, which really interrupts your life as we talk about needing the use for ostomy bags and other things to help you move forward.

And luckily, we do have those advances. We do have ways to address it in the later stage, but it's just a lot more difficult, to your point, right? It requires a lot more effort, a lot more time away. And if we can find it early, we don't need to do those things.

And one of the great things about a colonoscopy is actually it's one of the only cancer screenings where we can actually do something about it during the same screen, right? During the colonoscopy, we can remove those polyps in that same procedure.

Troy: I think that's one of the coolest things about colonoscopies, is not only does it detect early cancer, it prevents cancer. If you find a pre-cancerous polyp and they remove it, it's great. That risk is gone. That polyp is out of the way. It's not going to develop into cancer. So I think that's a really cool thing about it.

Nathaniel: Yeah, you're really getting kind of that two-for-one there. You don't have to go back for an additional procedure or what have you to remove that polyp. They just do it right then and there.

Scot: For somebody who doesn't necessarily have the best insurance and there's going to be some out-of-pocket expenses, are there other resources that could help that those individuals get their colonoscopy? Or are there some alternatives that might not be quite so expensive that can help prevent colon cancer?

Nathaniel: Yeah. We definitely can look at . . . There are a lot of great free clinic resources and federally qualified health centers, which is what we call them, throughout the Valley. And they have some good resources to help with this. And there are a lot of voucher systems or being able to pay out of pocket at a reduced cost.

But you bring up a good discussion that we can have. There are other ways and other modalities for people to get screened for colorectal cancer if it is hard to go in and get the colonoscopy due to cost, or maybe even you live far away from somewhere where you can get a colorectal cancer screening test.

Scot: And what are those that are recommended?

Nathaniel: Yeah, maybe some people have seen on TV Cologuard. It's in kind of that white box, and that is one. We call that a DNA FIT kit, or alternatively, just a normal FIT kit. And FIT stands for fecal immunochemical test. Sometimes it's referred to as a fecal occult blood test.

And really what it is, is it's almost like a pre-screen to a colonoscopy. And so these tests, you can do at home. They're very inexpensive. Even if you're paying out of pocket, we're looking at like $20. And what they're testing for is just elevated or abnormal levels of blood in your stool, and that can be a marker that there might be something wrong in your colon. There might be a polyp that's bleeding or something else.

And so you can do one of these tests at home, and if this test comes back negative, then you're good. You repeat the test in a year. If it comes back positive, then you know for sure you need to go and get a colonoscopy and make that effort. If it's coming back positive, there is something we need to get a better look at.

Scot: I will say my doctor gave me that option, right? My doctor kind of laid out the FIT test or the colonoscopy. Here's what made my decision. The FIT test, you have to do your own stool sample and send it in. Am I correct?

Nathaniel: This is true.

Scot: Yeah, and you have to do that every year.

Nathaniel: Exactly. I mean, colonoscopy continues to be the gold standard. And like I said, even if you do a FIT kit, these tests do not diagnose colorectal cancer per se. They just say, "Hey, there's something going on. We need to get a colonoscopy for sure or not."

And so it's really a great resource again, like I said, for if you're unable to really foot the expense, or you really don't have the time, or maybe if you live somewhere that's hours away from a place that has an endoscopy suite. Those are the instances in which they really make a great impact and we can make sure we need a colonoscopy before going in and doing it.

Scot: And I'm going to say, risk versus reward, right? I've had to take a fecal sample before, and it sounds worse than it is. At least in my experience it was. I mean, if it's between getting colon cancer and doing that, I'll tell you what I'll do every single time.

Mitch: Right?

Nathaniel: Exactly.

Mitch: Everyone is just talking about all the potential . . . For me, it's just like, "Or you could have cancer," right? That's just me.

Scot: Isn't it funny? We're supposed to be men and we're supposed to be so brave, but this is such a thing for us, right? Isn't it bizarre?

Troy: And I will tell you in hindsight, no pun intended, that I'm glad I had the colonoscopy.

Mitch: It was intended.

Troy: It wasn't until I said it, and then I thought, "Okay."

Anyway, I'm glad I had the colonoscopy, and it was the prevention piece of it that really makes me glad I had it. I had two polyps removed. Neither of them was cancerous, but because of that, I am now recommended to go back in five years to get another colonoscopy.

If I hadn't had a colonoscopy, if I just had the FIT test, if those were not bleeding, which probably they wouldn't have been, there was no blood they saw in the colonoscopy, those would not have been detected. They wouldn't have been removed.

So the fact that they did see those, they did remove them, I'm glad I had the colonoscopy to make sure that was done, and I'm glad I know that I need to go back in five years. So I think for me it was beneficial.

Nathaniel: Yeah. And that brings up a good point. That is something, again, that's very unique to a colonoscopy as we compare it to maybe other different cancer screenings. Colonoscopy, we really can do a lot. If we're looking at getting the biggest bang for our buck, a colonoscopy, we're going to remove those polyps, we're going to take care of it, and send it for biopsy all right there.

Troy: Yeah, and that was great. Like you said, it was all one and done. It's not like I had to come back for a second procedure. They did the procedure, I was out for I think 20, 30 minutes, whatever it was, and then got the report a couple weeks later that reported what they found with the pathology results and they said, "No cancer, but recommended just getting it again in five years."

So it was nice just to get everything done at the same time and also have that prevention piece of it as well.

Nathaniel: And that's maybe another thing. I mean, Mitch, did you realize the colonoscopy really only lasts 20 or 30 minutes? It's a pretty quick thing.

Mitch: No. Everyone makes it sound like it's this whole ordeal. You go in and you are put under for 20 to 30 minutes?

Troy: You're under for 20 to 30 minutes, but yeah, it's . . .

Scot: Let me go through my experience just to give you an idea. Again, we're talking about risk/reward, but I think this is one of the reasons why this is easy to put off, right? The prep isn't fun. I mean, I'm not going to lie. I don't like the feeling of diarrhea. I just hate it.

Mitch: No one does.

Troy: I'm going to correct you, Scot. It was not a feeling of diarrhea. It was a feeling like there was a river running through my body.

Scot: Yes. Right?

Troy: It was different than diarrhea. It was so weird.

Scot: I will say after the first couple times, I got used to it. It's not that big of a deal.

Troy: Yeah, exactly.

Scot: The prep wasn't as bad as I thought it would be. It's not terrible, but it was a little bit more of a disruption in my life. Three days before, you can't eat any nuts, popcorn, granola, uncooked veggies or fruit, whole grain bread, anything with bran. I mean, I eat fairly healthy, so that was a little bit of an imposition, right? I had to completely change how I ate three days before.

Troy: Yeah, me too. That was a big change.

Scot: Yep. The day before, you have to start a clear liquid diet. No solid food at all. And dealing with the hunger, that wasn't as big of a deal as I thought it would be.

And then as far as the prep, that started for me in my instance at 4:00 that night. So I was able to work that whole day, if we're talking about time being a consideration, but that night was done because you start taking the prep and then around 7 or 8 is when the cleansing, let's say, began. I did sleep through the night. Did you, Troy, or did you have to get up a lot?

Troy: I had to get up quite a bit. Yeah. I was up every couple hours just because that stuff was flowing through my system. See, the difference between me and you, though, probably is that I had to start my prep at 7:00 a.m. the day before. I also worked an ER shift that day while I was on a clear liquid diet, which I would not do again because I was just chugging Gatorade and I was so hungry. It was just not a good thing. And then I started the prep at like 5:00, so that night, it was definitely like every two hours.

Scot: Got it. I was able to sleep through the night, and then I had to get up really early because I think my procedure was at 8:00 and you have to get up and do more prep like four hours before the procedure.

And I was really stressed that it wasn't going to be clean enough. But I'll tell you what, literally 10 minutes before, that very last time at the doctor's office before I went in, it was like, "Well, we're there." That was a little bit of a stressful situation, like, "I don't want to have gone through all of this to not be able to do it."

So then they took me into this room, like the prep room, right? And this kind of East-Coast-sounding accent nurse named Tony told me that I was the kind of guy who doesn't like to be not in control. He was funny. I actually liked Tony a lot. Tony was great. Made me laugh, made me feel pretty comfortable in the situation.

They take you into the room. The gastroenterologist introduced himself. You've got everybody else standing around. I don't know if that's when they administered the stuff that makes me take the nap, but it was almost instantly I was asleep. And then I woke up back in the prep room and went out for a burger. I mean, I was hungry and I felt good. I took the rest of the day off, and it was fine.

Just like you, Troy, they found a few polyps, they removed them, they were non-cancerous, and now I have to go back in 5 years rather than 10.

Troy: There you go.

Scot: As Mitch would say, "But, guys, cancer."

Mitch: It's cancer.

Troy: Come on, guys. Quit complaining. Cancer.

Scot: I suppose I shouldn't complain about that.

Nathaniel, is there anything that we missed that you really feel like we should get in here? You deal with individuals . . . You have the hardest job in the world, I think. You could have found an easier gig than convincing people that colonoscopies are a good idea, but maybe not. Maybe it's a super easy sell. Is there anything else that we should really talk about here before we wrap up?

Nathaniel: I think the only other thing that really applies to cancer broadly, and colorectal cancer for sure, is just knowing your family history, right? This can be another big reason why, "Hey, I should get a colonoscopy if somebody in my family's had colorectal cancer," or even a different kind of cancer.

The more and more we learn about these genetic risk factors, the more and more we find the importance of just, if you can, knowing what kind of health issues run in your family and addressing those in a timely manner.

Troy: So I guess that brings up the question then, if you do have a family member who had colon cancer in their 30s or early 40s, should you be getting screened then?

Nathaniel: Well, you should definitely be talking to your primary care provider about that. Oftentimes, yes, we do scope people younger than 45, particularly if they have extensive history of early or numerous cancers, particularly colorectal cancer.

There is something called lynch syndrome, which is a genetic syndrome that you can be diagnosed with where you have many people in your family back first-, second-, third-, even fourth-degree relatives that have had colorectal cancer.

Scot: Does your risk go up if you have relatives that just have had other types of cancer? Or are we looking specifically at colorectal cancer for an increased risk?

Nathaniel: It depends. You want to know all cancers that are coming up, and there are some cancers that share common genetic risk factors, and there are common genes that might contribute to multiple types of cancer. So it's good to know all cancers that have run in your family, and then talk those through with your primary care provider.

You might get referred to somebody called a genetic counselor. That's just a trained medical specialty that can talk you through, "Hey, these different cancers that run in your family might put you in an increased risk for this. Let's think about genetic testing and see if you have these genetic predispositions as well."

Scot: Any additional risk factors that would make you want to have that conversation with your primary care provider getting tested earlier than the 45, other than genetics?

Nathaniel: Other than genetics, we do look at diverticulitis, if we've been diagnosed with that, or inflammatory bowel disease. Some of these other gastrointestinal diseases can lead to an increased risk of colorectal cancer.

I really like to put it this way. Anything that's making your gut work harder than it should, whether that's a disease or the types of food you're eating, that's generally just not a good thing, right? And so if your gut has to work harder than it should, it is just increasing that risk a little bit.

Scot: And what is your 60-second message as we wrap this up to men about colonoscopy or colon cancer screening? What would you say if you only had the elevator pitch?

Nathaniel: Well, I think as we've heard today, it's a great opportunity to get a great nap. And as a side benefit there, we can prevent cancer. I think that's the biggest thing that I say. Colorectal cancer is something that we have a great resource for.

And as you meet these patients and their stories, and you see especially the great stories of patients who haven't ever gotten a colonoscopy and were able to get it through a program or a pilot program that we have, and we find some polyps, we remove them, that makes a huge difference on a lot of people.

And not just that person, right? I think it's important to remember that. Our health is not just our health, right? I mean, we have friends. We've got family. These people we have to also care about, and this is one of those diseases that we can address.

Troy: Nathaniel, I'll say, too, if my primary care provider contacted me today and said, "Hey, you need to get another colonoscopy in the next month," I'd be like, "Okay, no big deal." I've gone from someone who really quite honestly dreaded it to having been through the process. It wasn't a big deal, and I would not hesitate to get it done again.

Scot: Well, it's been a fun conversation. I think it's been an informative conversation, and I think the takeaway is this is not one of the easiest screenings to get, and there are a lot of kind of unknowns about it. People are kind of afraid of it. We all kind of have our own things. Some people feel like it's a threat to their masculinity, I've read. There are just a lot of reasons you might say, "Eh, I'm not going to do it." But it's just, as we learned, super important.

And it does take a little planning. I had to get the calendar out. I had to work with somebody who's going to take me there. I had to make sure I was trying to get it around a time where I could take minimal time off. So it does take a little effort, which, of course, as we all know, makes people less likely to do something. But the upside is so, so huge to get your colonoscopy.

Nathaniel, thank you for being on the show today. We do appreciate it. And thank you for caring about men's health.
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This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

Scot: We're pretty excited on today's episode because we get to celebrate something, Troy. Do you like to celebrate things?

Troy: I love to celebrate things.

Scot: You know what we're celebrating today?

Troy: I do know, yeah. But I'm not going to spoil the surprise

Scot: Okay. It's Mitch's two-year quitversary from nicotine. He once was a smoker, then he was a vaper, and now he's a quitter, and he's been a quitter for two years. This is the one time that us guys . . .

Troy: That's amazing.

Scot: . . . can say that being a quitter is a great thing. So congratulations, Mitch.

Mitch: Oh, thank you.

Troy: Congrats, Mitch. And it's amazing to think it's only been two years, but at the same time I'm thinking, "It's only been two years?" So much has happened since you quit smoking. It's beyond quitting smoking. It's been quite a ride here. And the fact that you have not started smoking again in the past two years is absolutely remarkable.

Scot: I mean, I've been close myself and I've never smoked in my life.

Troy: You and me both, man.

Scot: Mitch quit two years ago. He quit on this show. We followed his progress. He quit right before Thanksgiving, which, wow, with family stuff coming up and all that stress, we kind of questioned his sanity on that. But you've managed to make it stick, which is absolutely amazing. How do you feel two years later?

Mitch: I feel good. There are a lot of positive things that have happened. I'm not afraid at any time my chest hurts that I have lung cancer. That little peace of mind is good. I'm running again, or biking recently, but I'm able to cardiovascular stuff. That's great.

My general health seems to be doing a lot better than before, and maybe that's something that we can kind of talk about today. But it's not all sunshine and rainbows, I guess. I don't know. I guess I was expecting, "You quit and then you . . ." In the commercials, you dramatically crumple up that carton of cigarettes and toss it in the trash and walk away defiantly. I still have cravings. I still have occasional ideas of stopping at that Maverik. And it's not every day, but I'm a little surprised that that's still going on. And I just wonder, "Is that just what happens now?" So, anyway.

Scot: All right. Well, to celebrate Mitch's two-year quitversary on "Who Cares About Men's Health," we have brought in somebody that hopefully can answer some of those questions. Her name is Edlira Farka. She is the tobacco cessation program manager at the Center for HOPE at Huntsman Cancer Institute, which is a service that is provided to patients at Huntsman Cancer Institute. How're you doing today, Edlira?

Edlira: Hello, everyone. I'm so excited to be here.

Scot: Yeah, this is exciting. We hope to kind of really talk about a lot of stuff today. We'd like to talk about somebody in Mitch's position at the two-year point, how is he in better health now than he was two years ago? What are some of the reasons why he continues to crave? What are some of the challenges he might face in the future?

And then if somebody is listening that still smokes, that is one of the best things you can do. I say low-hanging fruit, but that makes it sound like it's an easy thing to do, which it is not, but that's one of the best things you can do.

Mitch: No. No, it was not easy.

Scot: It's one of the best things, though, that you can do for your health. It's one of the best investments you can make.

So this is "Who cares about Men's Health." My name is Scot Singpiel. I'm the guy that kind of tries to keep everything on track. The MD to my BS, Troy Madsen. Say hi, Troy.

Troy: That's me, yep.

Scot: And then, of course, today, the reason we're wearing our party hats, Producer Mitch.

Mitch: Hey, I'm here.

Scot: All right. Mitch, I thought maybe this first part of the show, I'm going to back off the mic and let you step up to the mic and talk to Edlira about any questions that you have at two years in on your quitversary.

Mitch: Sure. So, Edlira, one of the things that I guess I would like to talk about now that I'm kind of looking back two years on is . . . This is my seventh time quitting. I guess I don't want to sound hopeless here, but for a lot of people, they don't quit on the first time. How common is it for people to . . . After two years, am I good to go? Is it going to be a constant battle? How likely are people to slip after they've hit the two-year mark? Is there a finish line where people do a lot better or . . .

Edlira: First of all, I want to say congratulations. I think it's amazing that you have been nicotine-free for two years. It's huge. And it's true it's an everyday struggle for many people.

So I will start just by saying that nicotine dependence is a chronic disease. And as such, even though we talk about the transition period a lot, the moment that you start quitting and the withdrawals, and the first two to three days are really hard, and it tends to get easier with time, there is a part of nicotine dependence that doesn't completely disappear with time due to the fact that when most of us . . .

Most people that start smoking or vaping or using nicotine in terms of chewing, any type of tobacco really, they start when they're teenagers or young adults, and our brain is . . . We've heard of neuroplasticity. Our brain responds to those chemicals, to the nicotine, and we start creating more receptors in response to that.

And when we stop using nicotine, those receptors do not disappear. They become sleepy-like. I like to think of them as flowers that are withering, and they still stay there. And that's part of the reason why you've been vape-free or smoke-free for two years and you still think about it occasionally.

Mitch: So that's pretty common then? I don't know. Maybe it's all the PSAs I see. It just looks like you quit and then your life is amazing afterwards, like you've beat the beast and you're done. But that's not what I'm experiencing.

Edlira: Yes, exactly. And what you're experiencing is very normal. And I think we have to change the way we think about it. We have to think about this as a chronic disease. So if we were talking about hypertension and a lifestyle change that helps hypertension, like exercise, we think of that as an ongoing process. It's not something that you exercise today and then you're done with that effect. It's the same kind of idea with quitting smoking. It's an ongoing process.

And you're doing great and amazing, but it doesn't mean that you're not at risk of relapsing . . . sorry, reengaging is the correct term now . . . at any point in the future.

And so it does get easier with time and your success rate is much more higher at this point since you've been smoke-free, nicotine-free for two years, but there is no guarantee that you will never think about it, especially in moments of high emotions, whether it is a life situation, life or death, or even happy moments.

Sometimes it could be routines like going to, as you said, a gas station, places where you've been before. It could be with alcohol or it could be with people you're around who are smoking and you smell the cigarette. There are many different ways you can be reminded about it and think about it.

And I think the key to that is accepting that that thought may come, but it will pass, and you do not need to engage in that thought. We have all kinds of crazy thoughts in our heads all the time and we don't need to engage in those.

Mitch: I mean, just kind of going back to what Troy did, there were times in 2020 that I was, "This is not the time to be quitting. This is not . . ." When we were doing the 5K stuff, I was jogging. It seemed like everyone and their dog had picked up smoking and every single morning they were sitting on their stoop enjoying a cigarette while I was running past, and I'm like, "Oh, I bet I could go bum one real quick. I bet I could do that."

With the episode we had before when I quit for the first time, I just held on to some low-nicotine gum. And so when I had that really bad craving after a run, I would just chew on a piece of gum.

Edlira: Exactly, yes, and that's okay to do. That's what we recommend to use, especially when you're transitioning. We recommend to use nicotine replacement therapy, combination initially, meaning using a nicotine patch, and a short-acting, like a nicotine gum.

And we work with people to slowly use less and less nicotine. Sometimes you have to use nicotine gum long-term occasionally. This is not something you'd need to do on a regular basis, hopefully, but it's always healthier than the alternative, which is going back to smoking or vaping.

I just want to say one more thing, because you said this was the seventh attempt, and I wanted just to say that is very, very normal. On average, most people take about seven attempts to successfully be able to quit just because it is so hard to do.

And the key to that is every time you try and maybe you're not successful, you learn something about what is working and what didn't work. So it's a process, and it's not about getting it right the first time. It's just about not giving up on trying.

Mitch: Yeah. And just to double down on what you just said, the thing that worked for me was that dual system, right? I had the patch, and it was the first time I really committed to the patch, and the gum. Doing them both at the same time really kind of helped ease me off. I still had mood swings galore every time I switched to a lower dose, but it was . . .

Edlira: It is tough, right?

Mitch: Yeah, it was, I think, more tough for my . . . Maybe not more tough, but it was also tough for my partner having to deal with me.

Edlira: It's always . . . yeah, smoking affects not just you and everyone else, but quitting also affects you and everybody else. So it takes a team. It helps for a lot of people to just say, "I'm trying to quit. Please be patient with me while I'm going through this process of having to readjust to lower nicotine levels."

The brain craves that, and a lot of the symptoms that you feel are being irritable or maybe frustrated, anxious, and restless as you're trying to readjust to lower nicotine levels. But it does help in the transition to use nicotine replacement therapy, or the other options are some oral medications that we can use to help with those symptoms. And it makes it easier. I'm glad that you were using them.

Troy: And I'm wondering . . . this is interesting for me to hear this because I had kind of that same impression that Mitch had. You quit smoking and everything is good and you're great. I think Mitch's words earlier before we started the show were sunshine and unicorns, and it hasn't been sunshine and unicorns. It sounds like it's been . . . It's a challenge.

But it is interesting to hear you refer to this as a chronic disease. Like you said, hypertension, managing that, it's a daily battle. But do you ever find that there is that point where a person gets to the point where they have no more desire to smoke than a person who has never smoked? Will Mitch ever reach that point?

Edlira: It's hard to say. I think that there are variabilities, and they have done some genetic testing. So some people are more likely to be more dependent on nicotine than others. And we see that even in smokers, why there are people that have to smoke 20 cigarettes a day and then you find someone that smokes only on social situations.

And so for someone who was regularly using a pack of cigarettes, which is 20 cigarettes a day, or a really heavy vaper, then they're more likely to have these memories or these cravings occasionally. And that is very, very common. The majority of the people I talk to have some kind of memory about smoking and think about it occasionally. There are also people that don't think about it anymore, and they're the lucky ones.

Troy: But it sounds like for the most part, people 10, 20 years out are still thinking about it. There still is at least more of a craving than someone who's never smoked.

Edlira: Right. Absolutely. If you've never smoked, even though we have the receptors in our brain, we don't know how nicotine feels in our brain. And unluckily, nicotine feels great.

Mitch: It does. I'm sorry. It sounds terrible.

Troy: There's a reason it's addictive.

Edlira: Right? Exactly. I'm glad I have . . . I have tried smoking personally, but I have never inhaled and I've never felt that joyous moment from it. But I know that that's what is hard. When you give up smoking, you give up that pleasure, and there's not something that we can replace to truly give you that same euphoric feeling. Unfortunately, nicotine, that's why it's so highly addicting, is because it affects our reward mechanism in our brain.

Troy: I would like to say that running provides that, but I think now that, Mitch, you've run, maybe you can contradict that. It's like, "No. There's no comparison." I'm just joking, really.

Mitch: No, it's fine. But I really do appreciate that comment because it's so easy for everyone to be like, "Oh, smoking is bad. It's the worst thing for you, blah, blah, blah. Oh, it's a filthy habit or whatever." We don't often talk about how it also makes you feel good. That's why it's addictive, right? I would not inhale that stuff that makes my lungs kind of hurt if it didn't make me feel good. And so it feels very validating almost to hear, "No, it makes you feel good, but it's super bad for you."

Edlira: Right. Exactly. It's hard because the majority of us are not smokers, and so all we're doing is looking from the outside and just looking at these people that are smoking and thinking, "You know that's bad for you. Why are you doing that?"

Mitch: I know it's bad for me.

Edlira: Right? But the fact is, how many of us engage in activities that are bad for us that it's the majority of us who do it and we still continue to do it? We can think about unhealthy eating habits. How many of us do that even though we know it's probably not the best to do? But we enjoy it and we say, "Hey, it's okay. I'm enjoying it, even though I know that there are risks with this behavior."

We can all relate to that feeling, even though we don't understand how nicotine would really affect our brain because we haven't . . . the majority of us haven't been smoking most of our lives.

Troy: More for Mitch, what have been some of the hardest times that you've experienced in the last two years? And, Edlira, I'm curious if that's typical of what you're seeing with other people you've worked with.

Mitch: So some of the hardest times for me really were March 2020. Things were bad. There was an earthquake, there was the pandemic, and everything was really changing.

Edlira, I don't know if we prepped you too much about this, but I smoked for 10 years. I started when I was very young and in college. And every moment in my past, when things got really stressful, I would go to the gas station and buy a pack of cigarettes and sit and smoke them. That is my way of dealing with extreme stress. I have a breather. I would think.

And so when that March came and everything was different and everything was hard, and suddenly we had to be inside, I didn't have that, and that was probably the hardest thing for me. I was having a really hard time emotionally because that crutch, that habit, that decade-long habit wasn't there to help when things got tough.

Scot: Decade-long coping mechanism.

Mitch: That's a better way to put it, yes.

Edlira: Absolutely. I have to agree 100%. That is what we typically see. It's very, very hard behaviorally to manage emotions, stress, anxiety, boredom, loneliness, sadness when you've created this long-term pattern of relying on smoking to help you feel better, even though we know from science that, long term, that doesn't help anyone manage emotions better.

But in the short term, like I mentioned, the reward mechanism part, how nicotine helps us feel good in the short term, that makes it hard. In the moment, you're not thinking about, "Well, what else can I do?" You're just going back . . . Your brain likes to find easy solutions. Our brain likes to find easy solutions. And so the easiest thing is, "Hey, I know that smoking helped me in the past and that was for a very long time. So can we just go back to that?"

And so finding a different way, I think, is definitely doable. It just takes a little bit of mindful practice of, "Hey, that is one way that I felt better, but I also know that that is not the best way for me to manage my emotions. What other practices can I start practicing or utilizing or think about that can help me feel better?"

I would like to ask you, because you have had to practice those things to manage your emotions. What other things have you tried that were helpful for you, Mitch?

Mitch: Well, I did running for a while. I got into running for the first time and it took a while to get it into it, but it was getting a break, getting outside, walking, listening to a podcast. It checked off a lot of the same boxes, that break, that going outside, that stopping and not thinking about all the terrible things for 20, 30 minutes.

Scot: Yeah, disengaging for a little bit.

Mitch: Yeah.

Edlira: That's great.

Mitch: So that's kind of what I turned to. And honestly, I have since quitting, oddly enough . . . or not oddly enough. Maybe because of. I have started doing some mental health stuff. I've been working with a therapist to kind of deal with stress management and anxiety and kind of fill in the hole that this habit, this coping mechanism, that I relied on for so long . . . I've been working on coming up with new strategies.

Troy: And did you find, Mitch, that it was tough not to take on other bad habits like stress-eating or things like that?

Mitch: Oh, my God. We will need to do a series where Mitch loses 20 pounds because, yes, I did indulge a little bit the last year or two. Who's looking at me during pandemic times? I'm just going to go ahead and have a double bacon cheeseburger today because that feels good. I am a junk food lover. That's me. That's the Taquito. So yes, I did indulge a little bit into that, but I'm still working on finding my best habits.

Edlira: Most of us did it. Even though we're not smokers, most of us have done that with the pandemic.

Troy: Yeah, that's why it's called the COVID-19. There's the freshman 15, and there's the COVID-19.

Scot: Edlira, what are some of the strategies that you teach people to deal with stress or any of the emotions that they used to go to a cigarette to deal with? Mitch gave some examples. Is there a core takeaway from Mitch's examples, or are there some other examples you can give?

Edlira: Yes, absolutely. So one of the things that is helpful is to recognize triggers or cues that are associated with wanting to smoke. And so I will typically talk to someone and say, "Talk to me about your day in relation to your smoking."

So common triggers are waking up in the morning, drinking coffee, after meals, taking a break, driving, before bedtime. And then obviously, it can be things like being around someone who smokes, smelling a cigarette. It can be also an emotional trigger, so feeling stressed and anxious, like we talked about.

So depending on the trigger, then you can think about activities to do to anticipate that you're going to have that thought and what else to do. Some of the things behaviorally that are helpful . . . and it can be very different for everyone. So I'm going to generalize, and maybe some of them apply to you, Mitch, but some of them don't. And that's normal, because the approach of quitting is very different depending on the triggers and the situation for each individual.

But some of the things that are helpful are holding on a pen or a pencil or carrot stick. So having snacks that are healthy but that you can chew on is helpful. Drinking from a straw. Sometimes having a straw that's cut that you can kind of hold as a cigarette, breathe from can be helpful. Toothpicks. There are toothpicks that are flavored that are helpful. Obviously candy, but we try to say use sugar-free candy if you want to or sugar-free gum.

And then in terms of the emotions, it's helpful to really try to take a non-smoking break. For a lot of people who smoke, that is one way to escape the activity that may be too stressful or too busy or tiring.

So maybe still go outside. It's helpful to change a little bit of the routine. So I'd say if you're going out the back, maybe change and go out in the front. Someone said, "I changed the entire patio outside so I wasn't sitting in the exact same place."

But it's helpful to stay physically active. That is very, very, very helpful. And think of a project that you can do. I think this really does help to start thinking of some activity that you really maybe have wanted to start for a while, like a hobby, and haven't had time or haven't thought it was the right moment. This is a good time to do that.

A lot of people will start doing new skills. Like you mentioned, running or knitting. Anything that you would do with your hands or with your body physically helps.

And then I always like to talk about the deep breathing meditation type of activities that can be very calming. But I think it's also helpful for someone who has used smoking as a coping mechanism because it does slow down the breathing. And so in a lot of ways, it can be a positive memory and help us calm down, slow down our breathing, slow down our heart rate, and kind of gather our emotions for a few minutes before we go back to what we were doing.

Mitch: I'm glad you went through all those because those were . . . I tried a bunch of those and some of them were really helpful for me. Some of them weren't. But this was the first time quitting that I actually engaged actively in finding those habits, finding what worked for me.

I wish I had known about the sugar-free though because I went straight for the . . . Chocolate-covered cinnamon bears were the thing that I would stick in my mouth any time I wanted to smoke. And after the episode, it was very sweet, people kept buying me chocolate-covered cinnamon bears and I ended up with these giant Costco-sized bags of them. It wasn't the best for my waistline.

Edlira: What did your dentist say?

Troy: They meant well.

Scot: It's kind of funny because nobody would ever buy you a bunch of cigarettes or nicotine gum, but they're more than willing to buy you these little sugar bombs.

Edlira: I do have to say . . . You mentioned the cinnamon and it does help to have strong flavors. I mentioned cinnamon steak. And spicy stuff too also can help some people, or lemony flavors. I do have a lot of patients that do use normal candy too, like Jawbreakers, Jolly Ranchers. I don't encourage it. Not to say that it's not helpful because it's a transitionary habit, and hopefully you don't continue to do it forever, but it can help in the transition.

And I honestly think whatever works, it's okay, as long as it's not something that you continue to use and hopefully not ruin your teeth and oral health.

Scot: So, as a once-smoker and then vaper and now a two-year quitter, talk us through what Mitch's lungs and health is like two years later. How much better is it?

Edlira: So the science shows that the lung function starts to improve at between one to nine months after quitting. I'm going to kind of relate to smoking mostly, because that's what most of the research is on. Ten years after quitting smoking, lung cancer death rate is half of a smoker's. So there is a lot of benefit. However, it takes time for the lungs to heal.

So that may be why . . . I don't know if you still feel like you're not breathing as well as you wanted to. I don't know if that's what you mentioned earlier. I think I heard something about that, Mitch. But it sounds like you've stopped for two years, which is great. The lungs are constantly healing and it's always benefiting your lung health, but it's hard to measure that by year.

Scot: So, Edlira, we had talked a little bit earlier about . . . Mitch has quit for two years. Is there any research that shows after a certain point you're more likely to stick with it? Has he gone over the hump, or does he still have a hump to go over?

Edlira: No, he's definitely gone over the hump.

Mitch: Yes!

Edlira: The one-year mark is usually a great sign that you're probably less likely to go back to it. It's just that we don't want to say, "Now you're done. The race is over," because it is a journey.

And like I mentioned, the chronic dependency and the nicotine part may always be a part of your life in terms of you thinking about it occasionally. The hope is that it will happen less and less often. And once you decide, which you have in your case, you always do not think of smoking as an option, similar to someone who has never been a smoker.

For me, I will handle stressful situations, but I will never think about, "Oh, maybe I need to go and get a cigarette," because that's not an option. It's not even an alternative.

And that's the idea that I would encourage for someone who has been a smoker. It's okay to have that thought. We can't control what thoughts come into our brain, but you don't have to engage into that. And you say, "Even though I had that thought, I'm not going to follow through with it."

Troy: I was going to say this is great to hear. I've never smoked. I haven't had that experience or that dependence. But so much of what you're saying is just any change in health habits in general, or trying to do healthy things. It's never easy. I think it's always a struggle. For me, it's been a lot about trying to give up sweets and give up sugars. Mitch, similar to what you've experienced, there have been many times . . . In med school, I would buy a pack of Oreos and I would eat almost that entire thing in one sitting, and it was delicious.

Scot: I've done that.

Troy: It was amazing.

Scot: There's nothing worse. Self-checkouts are great nowadays because when you get that gallon of milk and that pack of Oreos, nobody has to see it.

Troy: Yeah, you don't get shamed for it. It's like, "I'm buying this, and I'm eating this tonight." So I think it really relates to anything we try and do. There's always that trigger, whether it's stress or anxiety or loneliness, or whatever it might be, and it's always a battle. I don't have that urge like I used to have it, but I still have that urge sometimes.

And so I can't relate certainly, Mitch, on the level I think to nicotine dependence. It's really remarkable what you've done, and especially at this time. I don't know how you've done it, but . . .

Mitch: I don't know either.

Troy: I'm incredibly proud of you. Honestly, I haven't even wanted to ask you if you were still not smoking because I was just . . . I didn't want to know the answer. I was like, "I don't know how you've done it. I just don't want to know." So I'm incredibly proud of what you've done and it's remarkable.

Edlira: I think it's great that we're celebrating this, because one of the comments that I get a lot from people who are working on quitting is the lack of awareness, and sometimes it's the elephant in the room. Like you said, it's uncomfortable to say, "Hey, are you still not smoking?" because you don't want to know the answer. But that is actually important for anyone who quits.

I'm speaking in general, and, Mitch, you can tell me if that's how you feel about this. But generally speaking, you're doing something that's so difficult and no one is recognizing it as often as it is happening, meaning that you're fighting this fight on a daily basis. And once you quit, most people say, "Okay, you quit. You're done. Good job," once. But hey, it's not a good job once. It good job always, good job for rest of your life, because it's never easy, even though it's been a long time.

Troy: See, now I feel bad. I'm sorry, Mitch. I should have been asking you.

Mitch: No, you're good. And one of the things I want to talk about is that I really appreciate that, what you just mentioned. A lot of people on the outside are just like, "Well, are you done yet? Oh, you quit. Great. High five. Oh, no, you slipped up. Oh, no." It's like, "What kind of moral failing did you have?" or, "Did you not try hard enough?" or whatever.

Kind of the thesis of our show, it was actually talking about that, right? It was talking to Scot and Troy on our first episode, where I first committed to quitting. It was that talking about, "Hey, this is hard," and having people realize that it's hard and support and to talk about the Maverik cravings, I would call it, where I'd circle the block a few times trying to debate whether or not I'd go in and grab a pack of cigarettes.

That, I think, was the biggest difference this time, and why I was able to get to the two years, was being able to talk to people about what was actually happening. A lot of times, there's so much shame wrapped up in, "You should just be strong and quit. You know it's bad for you. Just throw it away."

Edlira: "It's just willpower." And it's not just willpower. I do think it's very helpful, for whoever is still smoking and can benefit from this, that once you decide that you want to do it, it's helpful to find the reason why, why you're doing it.

And the why can be very different for many people. For some people, it could be financial. Most of the time, it has to be health-related and family, or a lot of times there's a child or a grandchild. Sometimes it could be a diagnosis of some sort that really kind of shakes us to the core and then we decide, "Hey, I'm done. I do not want to be a slave to cigarettes anymore."

But once you have the why, it helps to have a plan of how you're going to do it, anticipate that it's not going to be easy, anticipate that you're going to have the triggers and what to do with that. I think it's helpful to plan things that you think may help, like having snacks or some of the things that we talked about earlier.

And it also is helpful to talk about it and let other people know. This helps us be more accountable to ourselves. It can be a lot of pressure to do that, but I think in your case, Mitch, you mentioned that it . . . And this is the majority of the time. This was helpful for you because you felt the responsibility. You didn't want to let yourself down. You didn't want to say something and not follow through with that.

So even though it's an uncomfortable thing to do, I encourage you to do that because it makes it more likely that you will follow through with that plan.

Scot: So I think I think another round of applause is in order for Mitch. Congratulations on your two-year quitversary.

Troy: Well done.

Edlira: Yay. That's huge.

Scot: I mean, birthdays, we celebrate birthdays, but really, come on. This is bigger than that, right? A lot of effort went into it. It's a daily thing. I love the analogy that smoking is a chronic disease so it needs a solution that also is ongoing.

Quitting can be different for each person. It's hard. It can take up to seven times. You've just kind of got to find your way.

Edlira, do you have a beginning step for somebody that maybe would like to be celebrating their two-year quitversary in a couple of years on how to get started?

Edlira: I think it's great to put some small goal that you can see yourself achieving. Because this is a journey, it's a process, and it's not just an on and off light switch, I think it's helpful to think about . . . If you're smoking 20 cigarettes a day, let's say you want to say, "I want to smoke 18." It's only two fewer cigarettes. But you have to practice non-smoking when you're smoking two fewer cigarettes.

So I think it's great to think about even reducing smoking still helps reduce the harm. Even one fewer cigarette helps. So keeping cigarettes away. If you're smoking outside, just take the one cigarette that you want to smoke or two, but try to limit it. Make it harder for you just smoke.

And think about why you want to do it, because your why is what's going to help you pull through with it.

Scot: And there's no shame in getting help. You don't have to do it yourself. There are a lot of great resources out there.

Edlira: There are. Yeah.

Scot: What would be a great resource that you would drive somebody to as a beginning point?

Edlira: Anyone who's a Huntsman patient, please let us know. We would love to help you. But what normally can help is a combination of counseling and pharmacotherapy. So that is using combination nicotine replacement, like we talked about, and then the two medications that are varenicline and Zyban. Those are prescription, so I do think it's helpful to talk to your provider that you're trying to quit because they can prescribe medications and they can even give you brief counseling.

And also the quitline offers free counseling as well as some free nicotine replacement therapy.

And there are also some apps that are free, like smokefree.gov, which are really nice. You can put your goal, if you want to quit. They can send you text reminders, and that can be helpful as well.

Scot: Well, congratulations, Mitch. Edlira, thank you very much for being on the show and answering some of Mitch's questions. Should we all get together in another year and celebrate three?

Edlira: What a great idea.

Troy: Let's plan for it.

Scot: I mean, should I not have said that, Edlira? Did I just screw things up for Mitch?

Edlira: I think it's great. I think it makes it more likely for Mitch to be celebrating in a year.

Scot: All right. I wouldn't want to be the undoing, Mitch.

Edlira: Thank you for having me.

Scot: Thank you, and thanks for caring about men's health.

Super sweet episode. It's always fun to celebrate things, especially something like somebody quitting nicotine for two years. Again, congratulations to Mitch on his two-year quitversary.

If you want to reach out to Mitch and say congratulations, that would be awesome. Or if you are struggling with quitting smoking and need a little extra help, you want to reach out, that's great too. Or if you have a comment or a thought, lots of ways to get a hold of us at the podcast.

You can email us at hello@thescoperadio.com. You go to facebook.com/whocaresmenshealth. Send us a direct message, or post on our wall. You can also leave a voicemail by calling 601-55SCOPE. That's 601-55SCOPE.

And most importantly, help other men that would find this podcast useful find us. If you think there's somebody in your life that would find this episode useful, share it with them. Listen to it with them together. We'd really appreciate it.

Thanks for listening, and thanks for caring about men's health.

Interviewer: It's estimated that half of scientific studies are irreproducible. They can't be replicated and this is a problem. Today, we're talking about a case study in irreproducibility, up next on The Scope.

Announcer: Examining the latest research and telling you about the latest breakthroughs. "The Science and Research Show" is on The Scope.

Interviewer: I'm talking with Dr. Heidi Hanson from the Huntsman Cancer Institute in the Department of Family and Preventive Medicine at the University of Utah. It's been estimated that up to half of scientific studies are irreproducible. They can't be replicated and this is a big problem. Dr. Hanson, you've actually published a study that feeds right into this conversation. The study calls into question a correlation that has gotten a lot of attention in the past few years.

Dr. Hanson: It's previously been reported that cancer and Alzheimer's disease have an inverse association. So basically, what's been said up to this point is that if you have cancer, you're protected from getting Alzheimer's disease later in life. If you have Alzheimer's disease, it protects you from having cancer.

Interviewer: And this got a fair bit of attention. There was a report in USA Today, there were reviews and nature of reviews, neural science and several other publications. How did the authors of those studies come to that conclusion in the first place?

Dr. Hanson: There have been a couple of studies where they've looked at individuals that have had cancer, and followed them for a period of time, and look at their Alzheimer's disease risk. And then, they also look at patients with Alzheimer's disease and look at their cancer risk later on in life. It's been published using a couple of bigger studies. They did the normal statistical methods that you might be doing just to come to that conclusion.

Interviewer: So basically, for those people who have cancer, fewer of them are found to develop Alzheimer's disease?

Dr. Hanson: Yeah, that's correct.

Interviewer: And what about that result set alarm bells off for you?

Dr. Hanson: I'm trained to think a lot about selection, and in particular, mortality selection. So what that means is I think about how processes that lead to different rates of death can affect the results that we see. And part of my demographic training is to think through some of those things. So I'm constantly looking at a result and asking if I really think that that's what's going on or if there is something underlying the result that we're seeing. So yes, it may be what the data is telling you, but is what the data is telling you actually what's going on? Are we missing something bigger?

Interviewer: Keeping that in mind, what was it that you found in your study?

Dr. Hanson: Our study replicated some of the previously reported results. And then, we showed, once you start to think about these things, and think about how mortality is affecting the rates of Alzheimer's diagnosis in these patients, you actually see a different story. It's not that there is not that inverse association that exists, but it's that mortality is driving that inverse association. It's not because there is some underlying cellular genetic mechanism underpinning both diseases. It's because if you have cancer, you have higher mortality. You're not going to go on to live long enough to be diagnosed with Alzheimer's disease.

Interviewer: It certainly makes sense. And that's actually really important, you've said, when you're thinking about aging-related disease and the aging population. Can you talk about that a little bit more?

Dr. Hanson: Yeah, absolutely. So when we're aging, there's a lot going on. You aren't usually suffering from a single chronic disease. There are multiple thing going on at the same time. And if you think of aging in a single context or aging with a single disease and you're ignoring all of those other things that are going on, you're missing the bigger story.

Interviewer: Do you think someone could come along a few years from now and find that maybe you didn't consider something in your analysis?

Dr. Hanson: Absolutely, and that's why I like science so much. We're not coming up with the best answers all of the time. It's an iterative process. We should all be considering each other's work, and we should all be critical of each other's work and figuring out how we can really understand what's going on. And to do that, it's necessary to be critical and to try to decide, okay maybe if we look at this a different way, we will be seeing something else. So maybe there is this underlying mechanism and if we're able to look at it this way, we can get more into what's going on. And that's what should be happening.

Interviewer: Yeah, that's a really good point. I think one of the issues that you had brought up is that you're really trained to really look at the data and consider all the factors that might go into some of these correlations or some of these results. What do you think can happen to make sure that some of these people who are trained in the life sciences might consider some of these other types of analysis or other types of questions?

Dr. Hanson: Yeah, one of the biggest things that I think can really help that is working interdisciplinary. If we are working across our own disciplines, naturally we are trained to think different ways, naturally we're going to approach problems from a different direction, and naturally we want to start to question different things. Things where I've been trained to somewhat ignore them through my training, someone else may look at the same problem and say, "Wait a second. You're not thinking about this. You need to be really critical of this."

And that's what's so fascinating and fun to work with individuals from different disciplines. It's how really good science is done, in my opinion. And really good science can't be done without that difference of thought. I think it's absolutely necessary. And I'm seeing a lot more of it, which is exciting.

Interviewer: So do you think this is a common problem that people aren't considering their questions carefully enough?

Dr. Hanson: I do. I think it's a very common problem. I think that people find the results that they're looking for a lot of times, and I think that's unfortunate. And I think that publication bias leads into the kinds of problems that we are seeing where people are only reporting certain things or things are only getting published if they are of interest to the public. I think that causes problems. I also think the really big push to publish fast causes huge problems. And it's unfortunate.

People just aren't as thorough with their statistics, with their methods, with their thinking through the problem as they should be because there's such a push to get the publication out. It's this huge push. Everybody wants to move things quickly, do one analysis and send it off. And that's what you do. And I think it's unfortunate.

Announcer: Interesting, informative and all in the name of better health. This is The Scope Health Sciences Radio.