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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 ÈËÆÞÖгöÊÓƵ Essentials episode of "Who Cares About Men's ÈËÆÞÖгöÊÓƵ," 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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