News topic: Fecal transplants

By Christa Lawler
Duluth News Tribune

Patricia Shoop had chronic diarrhea, she was dehydrated and she had lost 16 pounds. The self-described glass-half-full woman, a 74-year-old from Minnetonka who teaches English as a Second Language twice a week and regularly swims, could hardly move.

She had been diagnosed with Clostridium difficile, a disruption of the bacteria in the colon that can occur when a patient has been on antibiotics. The drugs kill off both the bad and good bacteria in the colon. The walls of the intestines also can break down. It can be fatal.

“I thought maybe I was dying,” Shoop said. “I wasn’t eating. That’s all I did is have diarrhea. It’s pretty yucky. I thought: ‘I don’t care how much it costs. We’ll mortgage the house, do anything to make it better.’ ”

Her situation was so bad that when a childhood friend mentioned the words “fecal transplant,” the rare and somewhat controversial treatment sounded more like a much-needed solution than the punch-line to school bus humor.

In early December, Shoop had a fecal transplant at Essentia Health Duluth Clinic.

Gastroenterologist Dr. Tim Rubin said that in more than a decade, 109 fecal transplants have been performed at the clinic with an 85 percent success rate. He estimated that just six to 12 other hospitals in the country treat C. difficile in this way. Dr. Johan Bakken and Dr. Johannes Aas, both with roots in Scandinavia where fecal transplants are more prevalent, introduced the procedure into their general practices here in 1999. Rubin began work in this area about five years ago.

THE PROCEDURE

The colon is a natural reservoir for bacteria, and when it is thrown off balance, C. difficile is able to grow, leading to uncomfortable symptoms. With a fecal transplant, doctors introduce a donor’s healthy stool — literally a man-made probiotic — to the patient’s body.

In Shoop’s case, her husband, Bob, was in the hot seat.

The night before the procedure, Patricia Shoop said she was worried about the pressure on her husband to be able to go at “go time.”

“I said: ‘You’re going to have steak, and chocolate and wine,’ ” she said.

Bob Shoop’s donation was mixed up in a lab to a liquid that Rubin describes as the consistency of chocolate milk.

A tube was threaded through Patricia Shoop’s nose and down her throat into her stomach. The doctor used a syringe to send the liquid through the tube and into the upper GI tract. Shoop would eventually push it through her colon.

The entire outpatient procedure took about 20 minutes, during which Shoop was awake. There is no smell and no taste. The mixture is cold, she said. The worst of it is the uncomfortable feeling of the tube in the nose.

Shoop felt better three days after the fecal transplant. Within a week, she was eating normally. Last week she was checked for signs of infection and came out A-OK.

“I’ve been pooping like everyone else ever since,” she said, and laughed. “How’s that for a testimony.”

WHY CONTROVERSIAL

Of course, there is a certain amount of yuck involved with fecal matters. Dr. Charles Gessert, a senior research scientist at Essentia Institute of Rural Health, said these are obviously the concerns of people who have never had C. difficile.

“The people who are well have the luxury of such fastidiousness,” he said.

Last week, a report out of British Columbia featured a hospital where administrators had asked doctors to stop performing fecal transplants at the facility.

“Patient safety is our primary concern. The safety of fecal transplants has not been adequately studied,” according to the statement from Burnaby Hospital of Burnaby, B.C. “There must be strict controls to ensure other serious infections are not passed to the patient inadvertently.”

Gessert said these concerns are addressed by finding a donor from within the same household, who has similar flora because they are exposed to the same conditions, people, pets and hygiene.

There has not been a large enough body of research behind the procedure for Food and Drug Administration approval, he said. And getting that research done could be tricky.

“Human stool is never going to be manufactured by a pharmaceutical company,” Gessert said. “No profit is going to be made.”

This story was in the January 23,2011 edition of the Duluth (Minn.) News Tribune.

Essay: Water Works

NOTE: The contents of this post are extremely graphic … even by my standards. But there is nothing here you wouldn’t see on the Discovery Channel or Animal Planet or Jersey Shore. Because of this warning, I take no responsibility for phantom urethra pains or gagging.

Of all the openings in the human body, the urethral sphincter is among the tiniest. So when a stranger, albeit a trained professional stranger, takes a catheter and jimmies it into this particular hole and then threads it into one’s bladder, there is a certain amount of discomfort.

Of course, having a urinary tract infection for three months, the various stings and flames of this vicinity are pretty familiar. Still, there was a high-pitched whinny upon contact, and a sharp uvula-quaking in-take of air. “You have to breathe,” reminded the kind nurse-sort who was playing doting hostess to my early-morning adventure. Then we both ignored the final dribbles of the last liquid I’d consumed as they spread all over the clinic’s linens.

This past summer, things have whizzed past “frequent urinary tract infections” and double-jumped “chronic urinary tract infections” and now just seem to be a permanent state of being. On my first visit with a urologist, he apologized that I had to go through this and said: “I know it can really affect your quality of life” vocalizing something I knew, but hadn’t made a thought for yet. Basically I’ve developed a Pavlovian grimace to everything that happens or might happen in this specific southern region. Even the carbonation from s can of Coke or a PBR makes me recoil in horror when I consider the way the bubbles will leave my body. And that, frankly, is the least of my concerns. I can live without Coke and PBR.

Our friend Cath recently described for Chuck a scene from a college-level biology class where a petri dish filled with infection was dosed with a drop of Cipro that mangled the infection on impact. A perfect antibiotic for saving factions of the universe after a global catastrophe. Just not in the case in my body, where I imagine cartoon-ish images of cigar wielding germs bumping knuckles with tiny Cipro pellets. I’ve tried a gamut of drugs beyond Cipro. Fail. Fail. Ouch. Fail. Yet some UTI-ignorant soul always cocks her head and says: “Have you tried drinking Cranberry Juice?”

Yes. I have. The expensive organic kind that is so bitter it doesn’t even register. It just attacks the tongue and leaves behind a dry fecal aftertaste. The drink has broken down my senses to the point where I something-close-to-almost-like-it.

It is one of about 9 gazillion things I have tried. I’m a model student in the world of urinary tract care and hygiene.

Fact: I drink upward of 90 ounces of water a day.
Fact: I go to the bathroom at least every waking hour. Before I go to bed, and when I wake up.
Fact: I void, then cuddle — as a former Urgent Care doctor once eloquently suggested.
Fact: I monitor what I expel to make sure it is clear and not cloudy.
Fact: Sometimes I drink Cranberry Juice.
Fact: I do not sit on cold stones, which is a bunch of hooey but something my Norwegian friend swears causes UTIs in her adorable country.

The doctor showed me a glass bottle filled with about 10 ounces of fluid dangling hamster cage style. It was going to hurt, my hostess confessed. She’d had a catheter. The important thing, she told me, was to drink a lot of water afterward to get my pisser back to normal. Then they slowly emptied the liquid into my bladder. I watched on a grayscale monitor as the purse-shaped pocket darkened.

“Tell us when you can’t take it and really have to go,” the doctor said.
“I wouldn’t need a gas station yet, but I’d definitely be looking for an exit,” I told him.

When I finally conceded that I couldn’t wait another minute, that I would actually go on the shoulder of the road, they cranked my bed from horizontal to vertical and handed me a hard plastic crotch sized box with a baggie attached. I drained my bladder, reluctantly, into this contraption. The inside of my body was filmed and photographed by one of the three people in the room.

The word “dignity” played on a loop in my mind. It didn’t help that I had my gown on backward.

After that, they took a CT scan of my torso and I got a little snippy with a tech who asked me to remove my belly button ring. It’s been there for more than 15 years. It might be soldered there permanently. I don’t usually get snippy with people. Especially not medical specialists. But I also don’t usually start the morning by getting catheterized, either. Frankly, that’s a mood dampener.

I dressed, and threw a wan smile at a woman in the waiting room.

I limped into the urologist’s office like a bruised and beaten rodeo clown about three hours later for the results from the tests. A woman clicked away at the computer and mentioned that they were going to be looking in my bladd-

“Nuh uh ohh you aren’t,” I said to her. “We did that already. This morning. I’m just here for results.”
She shook her head.
“No,” she said. “We’re going in with a scope to look at your bladder.”
“Again through the urethra?” I crossed my legs.
“Yes.”

At this point I started weighing my options. What was a urinary tract infection, even a 90-day infection, compared to being jabbed in a place that has never known human nor animal contact. But I had come this far, so I stripped down into the gown and crouched into the stir ups. I was tended to like a newborn on a changing table.

This time when I got the decisive jab, I started crying. Real tears. I grabbed the doctor’s sweater. This scoping seemed to last forever, and I’d lost the directions to my happy place. Every time the scope moved it was like being stung by a bee in a very tender place. Afterward I jumped off the table, leaving a trail of spilled liquid leading to the toilet, breadcrumbs for the next patient.

The results? Inconclusive. There is nothing physically wrong with me that they could find. I didn’t think there would be: My mom has chronic UTI’s, my grandmother had chronic UTIs. I imagine somewhere is an old bible filled with black and white family portraits including thin-haired ladies wincing. Although, the urologist told me, I have a freakishly large bladder. Like 20 to 30 percent bigger than normal. For some reason this makes me proud.

“I can’t wait to tell my friends,” I told him.

Meanwhile, if you’re looking for me I’ll be on antibiotics for the next six months.

“Sorry for the water works,” I said to the urologist as we left the office. “Ha! Water works.”

He just groaned.