NAD means no abnormality detected. It is a common acronym used in medical shorthand along with SOB (shortness of breath), HR (heart rate), RR (respiratory rate), BS (breath sounds), and many many more. Of course, there are some which are crass and crude and unwelcome in 2019. I’m guessing someone will know about FITH and GOMER. These are altogether inappropriate acronyms in any patient health record.
NAD is the most welcome acronym when anxious
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This week past, I was a patient, and being told NAD (no abnormality detected) was sweet music to my ears when my doctor uttered them and handed me the report he’d dictated during the procedure.
FOBT
Over on Yummy Lummy, when that was my only blog, I wrote about the bowel carcinoma screening program undertaken by the Australian Government Department of Health. I also described my first experience not only with the faecal occult blood test (FOBT) but also my first colonoscopy.
In Australia, citizens and permanent residents receive a letter from the Commonwealth’s Chief Medical Officer on or about their fiftieth birthday. The letter is an invitation to participate in the nation’s bowel carcinoma screening program. An FOBT kit is also received and recipients are asked to poke their faeces with the little stick and send that in the mail to a pathology testing laboratory for processing and reporting.
Blood in your stool is not NAD
If evidence of blood in the stool is detected that’s not NAD, the usual follow up requires a referral from your GP to a specialist consultant physician gastroenterologist who will make an assessment on the next best steps for investigating the cause of the blood in the stool.
Many times, the blood is incidental and a result of a bleeding hæmorrhoid (a pile). Sometimes, the cause is more sinister and the result of abnormal cell division in the bowel mucosa which may be malignant (bowel carcinoma).
A colonoscopy involves not just a fibre-optic telescope being inserted through your anus and extended through your rectum and descending colon, transverse colon, and ascending colon to your caecum, but a whole rigmarole of preparation and unpleasantness.
I mean, without the bowel preparation can you imagine the life of a gastroenterologist trying to poke the black snake (as it’s known in some circles) through impacted faeces and not being able to get a good view of the mucosal wall. It would be a wasted effort.
Bowel preparation
The bowel preparation involves a change in habit for the preceding three days of the procedure. I was scoped on a Thursday, so that meant Tuesday was a white food day. I was able to eat white bread, white noodles, or white rice along with eggs and white fish. I needed to drink at least three litres of clear fluids too.
Wednesday was dedicated to clear fluids which could be water, black tea, black coffee, soft drinks, salty clear soup broths, as well as lightly pigmented/coloured boiled sweets or jellies.
Regular readers know my GP earlier in the year recommended a low carb lifestyle so for the two days I enjoyed some carbohydrate laden food and drink in the form of Solo, jubes, snakes, rice, and bread rolls.
White food
On Tuesday, I was participating in an all day meeting in an inner city hotel. The breaks meant cakes and other pastries, sandwiches, and all manner of other tasty morsels. I could eat none of it. Fortunately, the day before I bought three dinner rolls made of white bread. I had one at smoko, one at lunch, and one at arvo tea.
Dinner on Tuesday night was ling with coconut rice because I wanted NAD.
Clear fluids
On Wednesday afternoon, the real business of bowel preparation began with sodium picosulphate and ethtylene glycol. All in all there was 2.5 L of laxative to get through.
An avid stool watcher wants NAD
This was a fascinating exercise for me as an avid stool watcher. With the increase in spinach, silverbeet, and kale in my diet, all the iron in those leafy green vegetables had turned my stools black. In addition, many daily portions of unsweetened passionfruit yoghurt plus all the seeds and nuts I was consuming (to keep me sated during the day) meant my stools were peppered with seeds and fragments of nuts. As I transitioned from my current diet through to white food through to clear fluids and then to the laxatives I kept a close eye on the consistency and appearance of my stools.
Laxatives
The effects of the laxatives didn’t really begin until I had consumed 1.75 L of the ethylene glycol. The effect was explosive and comprehensive. Later in the evening as I clung to a forlorn hope of a victorious result for Queensland and the mighty XXXX Maroons in the third and final game in this year’s State of Origin series, clear fluid was coming away from my anus, yet to my amazement, I could still identify passionfruit seeds. How the hell did I have so many passionfruit seeds in me?
The key test is can you fart with confidence?
I had a sleepless night mainly because I couldn’t fart with confidence and because my bladder was bursting from so much water and other clear fluids, every time I had to urge to emit flatus, I pulled off my CPAP mask, got out of bed, walked to the water closet, and let loose. From what I could see, everything was clear with only the faintest hint of sediment.
How many passionfruit seeds can I have in my bowel?
At 5 am, I took the last of the sodium picosulphate which is a contact laxative and after about 30 minutes felt the urge to evacuate my bowels again. To my horror, there were more passionfruit seeds. WTF (another rude acronym).
In my mind, I was hoping my gastroenterologist wouldn’t be too upset with me if he had to stop and wait for seeds to move about. I didn’t want passionfruit seeds to prevent a NAD outcome.
Why was I anxious?
My first colonoscopy revealed half a dozen polyps, all of which were removed and all of which returned an histopathological result of hyperplasia and no evidence of malignant change. That gastroenterologist died shortly after of a malignant disease (not a gastroenterological one if you’re interested) and I was lost to follow-up. While not a bad result it wasn’t NAD.
About two years later, a close first degree relative was diagnosed with a large malignant tumour on colonoscopy after a previous colonoscopy had reported NAD. This resulted in a subtotal colectomy, post-operative complications, severe metabolic acidosis, ten days in an intensive care unit, and all told, four weeks of hospitalisation.
A mate at work, who had been ‘scoped’ by the now dead gastroenterologist a couple of years past had started feeling tired and went to see his GP. A full blood examination (FBE) revealed anæmia and he was referred to a new gastroenterologist as part of the process to determine the cause of his anæmia. He was scoped and a dirty big tumour was found. In all likelihood, it had been missed by the dead gastroenterologist. Now in all fairness to my now dead colleague. Neoplasms can be missed especially in sites which are difficult to visualise. There are many reasons why a small lesion can be overlooked or missed and I am in no way laying blame. However, it was disconcerting for me to have this story shared with me.
As a result, when I went to see my GP, I asked for a referral to my work mate’s new gastroenterologist.
My new gastroenterologist is an awfully nice bloke. He put me at ease as soon as I walked into his consulting room.
Fast forward to this week, and you can appreciate why I was quite anxious and why I had made the most of my time with family in Brisbane recently.
“NAD (no abnormality detected) see you in five years” was like sweet music to my partially deaf ears.
Toilet paper 
Four rolls of toilet paper and box of matches 
Toilet paper 
Toilet paper
You may wonder why the featured image for this post is a shot of four rolls of toilet paper. The bowel preparation was a four roll effort. I don’t waste paper either, I’m a folder and not a scruncher, so I’m economical with my dunny fax sheets. You can appreciate how many times I had to visit the water closet. The matches represent the need to light many during my visits.
What have I watched this week?
Stargate SG-1
Stargate SG-1 Season 1 Episode 20 “There but for the grace of God” Mirror universe time. Carter: What makes you think the Goa’uld are even going to attack your Earth? Jackson: Oh, I’d say we’ve pissed them off at least as much as you have.
Farscape
Farscape “The Flax” D’Argo gets propositioned by Rhys Muldoon (Staanz the garbologist) who has unexpected genitalia.
Master Chef Australia
Sadly one of the Queenslanders has been eliminated. Christina is gone leaving Tessa and Nicole. Simon got the better of Christina unfortunately.
Star Trek The Original Series
Star Trek TOS “Shore leave” Captain Kirk has a sore back and Yeoman Barrows attempts to alleviate his condition 😉 Spock tricks Kirk in taking shore leave. Bones gives Barrows a lascivious smile. Bones dies and returns with two chorus girls and NAD. A classic episode.
Star Trek The Animated Series
What a coincidence, after watching “Shore leave” the next TAS episode to drop was “Once upon a planet“.
Star Trek: Deep Space 9
I didn’t get a chance this week
National Rugby League
Game 3 of the State of Origin series was played on Wednesday evening while I was taking laxatives. We, that is, Queensland lost to New South Wales, as I was losing my guts down the toilet bowl.
LAW & ORDER
LAW & ORDER “New York Minute“. Illegal aliens who help convict criminals of murder still get deported and DA Branch won’t help because it would create a perception of buying testimony. A sad human cost.
What have I listened to this week?
The Fry Chronicles
An autobiography. Read by Stephen Fry.
What have I eaten and photographed this week?
This is a gallery of photographs. Click on one image and scroll through the rest of them.
Monday tea. Curry salmon and green vegetables in coconut cream and lemon juice. #YummyLummy #FoodPhotography #LowCarb #noaddedsugar #MasterChefAU Salmon, Tomatoes, Spring onions, Coriander, Parsley, Silverbeet, Lemon juice, Almonds, Coconut cream, Curry powder G’day food lovers, In a hot frypan I cooked and wilted some silverbeet leaves and stems plus the green part of the spring onions. After the silverbeet stalks were soft I added in a couple of tablespoons of curry powder and stirred everything to ensure the powder was coating everything. I then added in some diced salmon and half a tin of coconut cream. Once the coconut cream was mixed through and bubbling I added the lemon juice. After a couple of minutes, the salmon was cooked so I turned off the heat and tossed in the slices of the white part of the spring onions, plus the chopped coriander and parsley leaves, stems, and roots. I garnished with slices of cucumber and almond flakes. It was delicious. Have a good night. Catch you later. 
Leftover MEATER made chicken maryland. Monday lunch. 
Tuesday tea. Today is all about white food. Steamed ling with coconut rice. #YummyLummy #FoodPhotography #NotLowCarb #WhiteFood #MasterChefAU #BowelPrep Ling, Rice, Coconut cream, Vegetable stock G’day food lovers, I’m having a colonoscopy on Thursday and I’ve started the bowel preparation by drinking lots of water and eating white food. I ate eggs for breakfast and bread rolls for smoko, lunch, and arvo tea. Tomorrow I start the laxatives to flush out my bowels and clean the mucosa so the gastroenterologist can have a good gander and not miss anything important like a malignant tumour. So for tea I cooked some rice and put it into a frypan with a little vegetable stock. Once the liquid was bubbling I tossed in some ling cubes and put the lid on for five minutes to ensure the big thick pieces of ling were cooked. I then added in half a tin of coconut cream and let that simmer for five minutes before serving and eating. It was delicious. Have a good night. Catch you later. 
The Owl statue on Saturday morning 
Pay day tea. Roast pork belly with kale sprouts, tomatoes, and avocado. #YummyLummy #FoodPhotography #LowCarb #porkbelly #MasterChefAU #OldBay Pork belly, Kale sprouts, Tomatoes, Spring onion, Coriander, Parsley G’day food lovers, Today I had a colonoscopy and it was all clear. I’m celebrating with pork belly and kale sprouts. I took the pork belly strip from its packaging and patted it dry with kitchen paper. I then seasoned it with iodised salt and black pepper. I put it on a baking sheet and into a hot oven at 200 °C for 45 minutes. I tossed the kale sprouts and tomatoes into a mixing bowl with some rice bran oil, iodised salt, black pepper, Chinese five spice powder, cumin seeds, coriander seeds, Old Bay seasoning, and slices from the green part of a spring onion. I made sure the kale sprouts and tomatoes were well rubbed with salty oily goodness. I put the kale sprouts, tomatoes, and spring onion onto a baking sheet and when the pork belly had 15 minutes to go, I put the kale sprouts, tomatoes, and spring onion in the oven. I garnished the dish with slices of the white part of the spring onion, and the leaves, roots, and stems of coriander and parsley. It wasn’t too bad. Have a good night. Catch you later. 
Chicken salad with Avocado, Balsamic vinegar, Black pepper, Feta cheese, Iodised salt, Lemon juice, Lettuce, Olive oil, Pumpkin seeds, Rocquet, Spinach, Sunflower seeds, and Cherry tomatoes 
Happy Friday tea. Roast pork belly with kale sprouts and cauliflower. #YummyLummy #FoodPhotography #LowCarb #porkbelly #kalesprouts Pork belly, Kale sprouts, Cauliflower, Butter, Cream, Curry powder, Horseradish cream G’day food lovers, Today I made a simple meal of roasted pork belly with pan-fried curry kale sprouts and cauliflower and some burnt butter. I took the pork belly strip from its packaging and patted it dry with kitchen paper. I then seasoned it with iodised salt and black pepper. I put it on a baking sheet and into a hot oven at 200 °C for 45 minutes. In a hot frypan I tossed in the kale sprouts and cauliflower along with some curry powder. I turned the heat down and put a lid on the frypan for ten minutes. As the pork belly was nearing the end of its cooking, I added some chilli flakes and butter to the curry kale sprouts and cauliflower. I then poured in some cream and a dollop of horseradish cream and let the simmer for about five minutes. It was pretty good. Have a good night. Catch you later. 
Wilted spinach, steamed egg and Coon cheese 
Wilted spinach, steamed egg and melted Coon cheese 
Happy Saturday breakfast. Bacon and eggs. Fried speck, wilted spinach, steamed egg and Coon cheese. #yummylummy #foodphotography #lowcarb #baconandeggs 
Happy Saturday lunch. Warm chicken salad #YummyLummy #FoodPhotography #LowCarb #NoAddedSugar Warm chicken salad with roquette, spinach, lettuce, Coon cheese, and Worcestershire sauce Chicken, Roquette, Spinach leaves, Lettuce, Coon cheese, Worcestershire sauce 
The Owl statue on Friday morning 
Westfield Belconnen 
The Owl statue on Saturday morning
Yummy Lummy this week
The Spirit House Cooking School
I wrote about a cooking class I took with Ms22.
Postscript! A second Yummy Lummy post this weekend
MEATER made Roast Rump
To celebrate my NAD result I cooked a lump of rump.
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Final thoughts
- Have you undertaken a screening faecal occult blood test?
- Did you know that NAD meant no abnormality detected?
- Have you experienced bowel preparation before?
It sounded like a good week on food and a very thorough poking and proding of you. Good that that it was all good in the end. Now back to your usual diet 😀
Thanks, Mabel, I was very relieved to be given the all-clear for now. Now I can fret about another colonoscopy in five years time.