Give a crap | Diabetogenic

Poo, poop, crap, shit – whatever you want to call it, it’s not really a topic for polite dinner table conversation. So, if you’re at a polite dinner table, bookmark this and come back later. If you’re, say, on a flight to Orlando, stick around. I’m writing this on a flight to Orlando. The topic feels somewhat appropriate, but I digress. 

This is the one about bowel cancer screening. 

It all started back at the end of last year. I turned fifty and was suddenly on government watch lists for screening different parts of my ageing body. I wrote about my breast cancer screening a couple of months ago. Bowel cancer screening was next. I’m writing about this because I know people around my age have been putting off doing this. I get it. This sort of stuff scares the shit out of people, so I’m writing about my experience and hope that might encourage others to stop avoiding things.

Let me tell you something about the people who run the Australian bowel cancer screening program. They are stalkers. They start by sending you a letter. It’s friendly enough, just a little heads’ up (tails up?) that you should be on the look out for their next correspondence: a bowel cancer screening kit to do in the privacy of your own bathroom. Sure enough, it arrived a couple of weeks later, just as the silly season was in full swing and we were planning a trip to Italy. 

The kit sat on my desk for a couple of months, and I kept meaning to do it, but travel, work, life and an utter lack of desire to actually collect samples of my poo meant that the kit taunted me every time I sat at my desk. During that time, I received reminders from the bowel screening program. Eventually, I got my shit together and stopped putting it off.  

It was all very easy: you run a swab over your stool (which is sitting in the toilet on a piece of biodegradable, flushable paper) and then shove the whole swab in a little container with fluid and cap it tightly, pop the sample in a zip lock bag and then into a padded envelope. Probably the worst thing about it is that you need to send in two samples, from two different trips to the bathroom meaning you have your sample in your fridge until you next need to take a crap. (Because I’m germ phobic, I wrapped the padded envelop in three more zip lock bags, shoved into a brown paper bag. Totally unnecessary.) 

The next day after collecting the second swab, I posted my sample and rewarded myself for being compliant (ha-ha) by having a massage. 

About two weeks later, my stalkers friends from the screening program sent me another letter. There was blood in my sample, and I needed to urgently go see my GP. On the same day, my GP started sending me text messages and emails urging me to go see him. Now. Today. I was, of course, panicking because of course this meant THE WORST, even though the screening program letter assured me that in most cases there was nothing to worry about. BUT SEE YOUR GP NOW. 

In Australia, we have an awesome public health system, but I decided to go private because it meant that I could see the gastroenterologist my GP referred me to, and I got an appointment within a week. I want to check my privilege here, because this option means there is a co-pay. I don’t know the time frame to see someone in the public system. (My breast cancer screening was all done through the public system and that was super quick, so that may be the case with bowel cancer screening too, but I can’t speak to that.)

The gastroenterologist was delightful. He apologised for being exactly seven minutes late. I laughed in diabetes and with the experience of someone who has spent too many hours in doctors’ waiting rooms told him he was, in fact, early. He looked all of about seventeen years old, but I could tell immediately that this was a doctor who knew his shit. And mine too, based on the report he had in front of him.

This was the sort of consultation that goes perfectly. Sensible questions about diabetes; super clear explanations about what was going to happen, and he did all he could to alleviate my concerns, reiterating what my GP and the screening letter had said – in most cases, a positive result is nothing. But blood in a sample will always trigger follow up, and that means a colonoscopy. He scheduled one for three weeks later. I had it on Monday. 

It’s hard to put a positive spin on needing a colonoscopy, but I tried. I told myself that I would be getting an excellent afternoon nap on a Monday, and I could pretend I was a rubbish influencer doing some rubbish detox. After twenty-four hours of colonoscopy prep, I was reassured that I am no rubbish influencer and rubbish detoxes are, well, rubbish. 

If you’ve not had a colonoscopy, or not familiar with how the prep works, let me explain: The week before the procedure, I was told to stop eating nuts, seeds, beans and red meat, and aim for a low fibre diet. Two days before, my food choices were limited further to white bread, eggs and grilled, skinless chicken and fish. The morning before, I could have breakfast of white bread and then nothing solid after that. But lots of clear fluids including tea and coffee (no milk), lemonade, apple juice, and jelly (but not red or purple). My mum, ever the Italian mamma, made me chicken broth, strained a million times so it was clear and full of nutrients, and that sustained me while I couldn’t eat. 

I started taking the preparation at 4pm the day before the procedure. I mixed the first sachet into a glass of water and drank it down over about 10 minutes. It tasted like a fizzy orange drink. I put on some elastic-wasted trousers (I was warned that I didn’t want to be fiddling around with a belt or buttons), sat down in front of episodes of Grand Designs and waited. ‘You will experience extreme diarrhoea’ said the information leaflet. No shit, Sherlock. (Except, lots of shit. Obviously.) The solution kicked in after about forty-five minutes. 

At 8pm, I mixed up the second sachet in a litre of water and drank that over an hour. I spent about six hours all up needing to head to the loo very quickly as everything was flushed out of me. Unpleasant, but exactly what was meant to happen. 

By 10pm, I felt that I was going to be okay going to bed without having to keep running to the loo, and I slept through until my alarm went off at 7 the next morning. I made up the final prep sachet (same as the first), skulled it and, fasted from 8am until the procedure at 1pm. 

Through it all, my diabetes was perfectly behaved. I increased my glucose target on my AID from 5.0mmol/l to 7.5mmol/l and entered a slightly reduced temp basal. My glucose levels remained steady the whole time. There were a couple of instances when there was an arrow trending down, but nothing that a couple of sips of clear lemonade couldn’t fix.  

At midday on Monday, we headed to the hospital for what was an exceptionally positive experience with wonderful encounters the whole way through from the admission staff and all HCPs. I laughed at the amazed reaction from the anaesthetist when I handed him my iPhone with the instructions, ‘Swipe right to see my glucose levels’.

I walked into the procedure room, climbed on the table, chatted with what seemed like a cast of thousands and the next thing I knew, I was in recovery waking up. The gastroenterologist popped by to tell me everything went well. I love that he didn’t bury the lede: ‘Renza, you don’t have cancer. It all went well. There was one polyp that we removed and have sent away for pathology. I’ll call you in a couple of weeks, and you’ll need another colonoscopy in three years’. He commended me on the way I’d diligently followed the prep instructions. Apparently, I can be deliberately compliant!

The anaesthetist came by too, still slightly enthused with my tech and told me that my glucose levels were steady throughout the procedure. Diabetes was the least of my concerns and, as I do daily, I thanked the very clever people behind Open-Source AID for making things just a tiny bit easier. 

And so, that’s the tale of my bowel cancer screening and subsequent colonoscopy. Absolutely something I would have preferred to not do, but glad that I did. How lucky we are to have these screening programs! It’s the same equation as with diabetes-related complications screenings: early detection, early treatment, best possible outcomes. Plus, peace of mind that comes with knowing there isn’t anything to worry about right now. And isn’t that a really good thing?

Shit yeah!