Trisha Cooney finds her diagnosis of bowel cancer also brings revelations that alter her approach as a practice nurse
On 24 April 2013 my life was turned upside down. I was the fittest I had ever felt and was planning my 50th birthday party. The plans did not include being diagnosed with bowel cancer at age 49.
I went from being a practice nurse who knew only the basics about colonoscopies and bowel cancer to being very well informed, eager to share my knowledge and passionate about helping to prevent others going through what I did.
I knew why we did colonoscopies but, until I researched bowel cancer in New Zealand, I had no idea our statistics were some of the worst in the world. New Zealand has one of the highest rates of bowel cancer (colorectal cancer). Around 3000 people are diagnosed and about 1200 die from it each year.
More people in New Zealand die from bowel cancer than from breast and prostate cancers combined. New Zealand women have the highest bowel cancer mortality rates in the world.
How is it, with statistics like this, so few of us know the signs and symptoms? Many are too embarrassed to go to their GP and discuss their bowel problem despite, like most health problems, prevention being better than cure.
I had gone to the doctor after having a few bowel motions with a small amount of blood – so small that, at times, I wondered if I was imagining it. I had no other symptoms common to bowel cancer (eg, weight loss, abdominal pain, change in bowel habit).
From colonoscopy recalls at work, and reading a lot of the reports, I knew polyps are common and that they need to be removed as an adenoma polyp can turn to cancer.
I had seen and heard too often about people who had signs and symptoms something was wrong but did not act until it was too late. I did not want to be one of them. I opted for a private colonoscopy (despite not having health insurance); at that stage, I did not know the cost. I now know why I have trouble getting my patients to undergo follow-up colonoscopies – at $2500 they are not cheap.
I had the option of going public but I knew there would be a wait and I am not a patient person.
My colonoscopy found one large polyp, not considered suspicious looking. Ten days later, I received a call from the specialist to say it was cancer. He stressed it was only a small amount, and I thought it can’t be that serious as he’s telling me over the phone. He kept stressing how small it was (3mm of cancer).
I went to my next appointment thinking I knew what he was going to say: a colonoscopy every six months – how annoying. I was brought down to earth quickly when he talked about removing 30cm of bowel, including the rectum, and having an ileostomy bag, albeit temporary.
By now I was no longer a nurse looking after others, I was the patient.
Before surgery, I was introduced to the stoma nurses – an amazing bunch of women who do a fantastic job and make it seem normal to walk around with a bag hanging off you. It took a few weeks to get used to the bag but it was not really any trouble.
After spending nearly a month in hospital over the last year, it has inspired me to be a better nurse and to never underestimate how much a smile and kind word means to a patient who is at their lowest.
On returning to work, I resumed the job of colonoscopy recalls, but with a lot more knowledge and enthusiasm. I wanted to do what I could to prevent my patients going through what I had.
The bowel preparation and colonoscopy are nothing compared with the surgery involved to remove bowel cancer. At times, I feel I got off lightly, as I did not need chemotherapy or radiation treatment. At other times, I think the treatment and recovery is brutal.
Now, when doing recalls, I start by sending out the first reminder letter but, instead of a generic letter, I read the patient history and personalise each letter so, from the start, the patient knows why they are being recalled.
If they don’t act upon the letter, I ring them and discuss with them the reason we are asking them to have one done, and to find out what is holding them back. If cost is the issue, we offer the faecal occult blood test, as used in the bowel cancer screening programmes. Polyps are known to bleed and the presence of blood can be investigated further.
It is high time bowel cancer gets the exposure other cancers do. The rates are higher and yet the awareness is much less. This needs to change. Far too many New Zealanders are dying from a cancer which is both preventable and curable in 75 per cent of cases.
In primary healthcare, we need to ensure we are aware of the high morbidity rates of bowel cancer in New Zealand and play our part in educating and informing patients.
Trisha Cooney is a part-time practice nurse at City Medical Centre, Wellington