A Stinky Cure

Several days ago, I was called to co-manage a patient that was admitted in the hospital. The patient was quadriplegic, paralyzed from the neck down, due to a neck injury he sustained several years ago.  Our service was consulted for he had a tracheostomy and has been on a home ventilator.

However, he was hospitalized not for a primary pulmonary issue. He was admitted for a scheduled transplant.

In this day and age of modern science, organ transplantation is almost an ordinary phenomenon. Kidney, liver, pancreas, heart, lung, bone marrow, cornea and skin are among others that are being transplanted. There’s even recent news reports of patients receiving total face transplant.

Not too long from now, brain transplant will be a reality. Do you need one?

But the patient that we were consulted was not scheduled for any of the organ transplant that I mentioned above. Do you care to guess what he was planned to have?

Spinal cord? Spleen? Appendix? Nah.

By the way, maybe someday we will find out what appendix are really for, and not just for the surgeons to operate on.

Back to our patient, what transplant did he need?

He underwent a fecal transplant.

Yes, you read it right. Feces, as in stool or poop. In vulgar term, sh*t.

But why you may ask, anybody needs a fecal transplant. Can’t they make their own poop?

Fecal transplant is now an available treatment for people who are suffering from severe and refractory Clostridium difficile infection. What the poop on earth is that?

Clostridium difficile is a bacteria. It’s infection can happen when a patient has been on antibiotics. The strong antibiotics that we use, kill the “bad” bacteria, but unfortunately, it can also kill the “good” bacteria we have in our colon. Yes, many of the bacteria in our body are considered “good” bacteria, especially in our gut, that keeps us healthy.

So once these good bacteria are killed, this can cause overgrowth of these super evil bugs, the Clostridium difficile, and they wage a coup d’ etat in the gut’s bacterial colony. This cause the problem. The takeover of these rogue bacteria is manifested by severe diarrhea, nausea, vomiting, abdominal bloating, fever and sometimes overwhelming sepsis, shock and even death.

Clostridium difficile can be treated with specific antibiotics, but then again, antibiotics are double edge sword as it may cause more problems. So one of the newer method to fight this is providing a new bacterial colony.

Thus the fecal transplant, or also known as fecal microbiota transplant. The good bacteria in the donated stools restores the healthy colony and community of bacteria in the colon.

Currently, there are undergoing studies evaluating this treatment for other gastrointestinal disorder besides Clostridium difficile infection.

How is it done? Do we tell them to eat sh*t? No, it’s more sophisticated than that.

The fecal material from a donor, is inoculated or sprayed directly inside the colon through a colonoscope. However, under development right now is fecal material in pill form. Poop pills! What a stinker.

Where do we get the donor feces? Good question.

The donors are healthy volunteers who out of the goodness of their hearts (or guts?) want to share their…..you know what. No kidding. My gastroenterologist friend told me that most of the donors of the fecal matter available in the US are from college students of a prestigious university in Cambridge.

Maybe you want to be a donor too. They may even pay you for your precious donation. Some people donate blood, and some donate sh*t.

Fecal transplantation most of the time is done as an outpatient, and does not need hospitalization. However, since our patient was on a ventilator, it was felt that the rigorous colonic prep plus the conscious sedation during colonoscopy may be too taxing for him, so he was admitted for observation.

I would say he had a successful transplantation. He went home the next day, pooping happily ever after.