Earlier this year I wrote about a 50th birthday gift I received from the Australian Government. It was a faecal occult blood test (FOBT). Well, I collected the specimens as directed (it’s dead easy, not messy and nothing to be squeamish about, if you wipe your backside after defecating you can do this) and sent the specimens in the post to the contracted pathology practice for testing. The result came back within ten days. My test was reactive. That meant blood was in my stool specimen. Blood in the stool can be caused by many things including diverticular disease, ulcerative colitis, Crohn’s disease, hæmorrhoids, fissures, fistulæ, bleeding benign tumours and carcinomas of the bowel. While ulcerative colitis and Crohn’s disease are big deals, most people worry about carcinomas of the bowel. As far as malignancies are concerned, it’s a big killer and men over fifty years of age are the risk group for screening. Given my diet, blood in my stool is not something to ignore. I knew the likelihood that I would have a malignancy was small but I knew I needed a colonoscopy.
I went to see my general practitioner (GP) and asked to be referred to a gastroenterologist (GE) for specialist consultation and consideration of colonoscopy. Both my GP and GE were very good as far as explaining risks and processes. My GE examined me and we had a good conversation about bowel health. Because of my medical history and private health insurance status I was booked in for his list at a private hospital with a specialist anæsthetist in attendance to administer some propofol and to keep an eye on my airway. Propofol is an hypnotic/amnestic agent best known lately as the drug administered to Michael Jackson for sedation and also because some generic products have had problems with bacterial contamination.
Before we get to the procedure I want to describe the bowel preparation. My colonoscopy was booked for a Tuesday so on Sunday I had to start a low residue diet. That means white bread, white rice, no seeds, no high fibre, or highly coloured foods. Vegetables were basically limited to well cooked potato and pumpkin. I went for white English muffins for breakfast, a white rice and crab meat dish for lunch, and skinless chicken thigh and potato for dinner. On Monday I started the bowel preparation proper with three litres of water, copious cups of black tea and black coffee, strained chicken noodle soup and three packets of a laxative preparation. The laxatives work really fast so I was advised not to attend work. I’m grateful for that advice. No sooner had I finished the first litre of laxative drink than I was sitting on the toilet. That night I had that anxious feeling about farting in bed. It was like having diarrhoea without the inflammatory elements and no fever. On the Tuesday morning I was restricted to clear fluids and one more laxative preparation. I fasted from 10.30 am.
As I lay on a bed in the waiting/recovery area of the colonoscopy suite I thought for the first time that clinical white walls, ceiling, floors and curtains are pretty ugly and depressing. Then my mind kicked in and I overrode those silly thoughts with the fact that clinical areas need excellent lighting and light coloured surfaces to ensure high level cleaning can be achieved easily.
Just before my procedure I met the anæsthetist who inserted a cannula into a vein on the back of my dominant hand. I was then wheeled into the theatre and placed onto my left side. The anæsthetist connected the bung to a line and injected the propofol. I felt a tightness in my chest and a warmth throughout my body and some prickling in my chest and then I remember waking up with a sore throat and a sore arse. Apparently I vomited a little in the procedure and my GE had some difficulty inserting the colonoscope. By the time I had woken up and wasn’t feeling groggy I could read the preliminary report which revealed my GE had seen my cæcum and on withdrawing the colonoscope he saw half a dozen polyps in my rectum as well as moderately severe hæmorrhoids. He used jumbo forceps to remove the polyps which were referred to an anatomical pathologist for histopathological examination. I also notice the vein the cannula was in had been pranged which would mean about ten days of a multicoloured hand.
On the Friday morning in the mail I received my results. No dysplasia and no malignancy. I don’t have bowel carcinoma. Happy days!
Given my boss, the Chief Medical Officer of Australia, had sent me the invitation to participate in the screening program by collecting a specimen for faecal occult blood testing I contacted him with the good news. I wonder how many departmental staff contact him about the letter they receive. Yeah…I know I’m a smart arse. On the subject of arses, it took a few days for the pain to abate but I was able to eat normally on the night of the procedure.
I’m grateful to the Australian Government for screening program which I know saves lives. I don’t say that because (in full disclosure) I work for the Australian Government Department of Health, I say that because it is true.
If you’re Australian or an Australian resident and you receive a letter from the CMO of the day advising you to collect specimens for testing I highly recommend you heed the advice. A negative faecal occult blood test has a very high negative predictive value which means the likelihood of you having a malignancy despite a nonreactive result is incredibly small. The program is very sophisticated with very dedicated government officials running it, highly qualified medical laboratory scientists and pathologists performing the testing and a group of highly esteemed medical experts providing advice to the government. If you have a reactive FOBT result, then you can rest easy in the knowledge that the Australian healthcare system is second to none and under our universal health insurance scheme your out of pocket expenses are small when compared with comparable care in other highly developed countries.
We have a good government. It’s good to know our government wants to prevent bowel carcinoma and protect the lives of all Australians.