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.

poop in lab

(photo from usnews.com)

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.

Old Man Running

I ran the Des Moines half marathon (13.1 miles) this morning.

Compared to my previous runs (this is my 5th half marathon), this was my least prepared race. I usually start training around 3 months prior to the race. I gradually increase my run and by the time of the race, I should have at least run a 10-miler or more.

But due to interruptions in my training this year, like my unscheduled trip to the Philippines, my extra weekend calls, and other lame excuses, I never really had my training up to par. Though I don’t want to waste altogether the effort I placed on this for the past couple of months, so I still decided to participate anyway, and just have fun.

I never ran more than 7 miles this year. Well, until this morning.

While I was standing in the starting line among the throng of runners (it was estimated that there were about 10,000 participants – for the marathon, half marathon, and 5K), I saw a familiar face. It was one of the cardiothoracic surgeons whom I worked with in the hospital.

When I approached the surgeon, he told me that he was running the half-marathon as well. He asked me what pace I usually run, and I said to him that I’m just going to “go slow” this time, due to lack of preparedness. He then asked me if we can run together. Of course, I obliged.

I told him that I commend the fact that he as a heart surgeon, have the credibility to advise his patients that he performed cardiac bypass on, to live healthy and exercise, for he himself follows that advise. I wish we doctors will all practice what we preach.

So we ran together the whole 13.1 miles. As we ran, we shared stories of our lives and our families in between gasping breaths. It was my first time to run with somebody the entire race, and I enjoyed it. We even finished with a decent time: 2 hours and 35 minutes. Not bad. Not bad at all.

After crossing the finish line, and when I was walking back to my car, I suddenly felt my age. How many more years would I be doing this?

IMG_4576

But did I tell you that the heart surgeon that I ran with was in his mid-60’s and has recently retired from his practice? He’s almost 20 years older than me but still in very good shape. I just wish I can still run when I’m his age.

Although honestly, he kept me going on that race. If I was running alone, I would have run more slowly, or even walked part of the course, or who knows even stopped and quit. But I was too embarrassed to slow down, given the fact that I was much younger than he was.

After getting home and getting some rest, I felt good except for some soreness in my legs and feet. I just moved “slowly” the rest of the day. Just like an old man.

Running the First Mile

Not too long ago, I saw a patient that was referred to me for pulmonary evaluation. The complaint was “shortness of breath.”

Me: What’s going on?

Patient: Doctor, I cannot run a mile. I ran out of air. And I use to run before.

He is in his 40’s and is on the heavy side. OK, overweight. I already reviewed his chest x-ray and pulmonary function test (it’s a stress test of sort for the lungs), and both were normal. My nurse has tested and recorded in the chart his pulse oxymetry (measure of oxygen saturation in the blood) at rest and on walking, and it too was normal. You see, I have all the information I needed even before I lay eyes on the patient.

Me: Do you have chest pains, wheezing, or cough?

Patient: No, no, and no.

Me: When was the last time you were able to ran a mile?

Patient: 25 years ago.

I almost fell off my chair!

You may snicker at him, but I took him seriously. I told him that I do not believe he has anything wrong with his lungs. Although I cannot rule out conclusively any other diseases, like heart conditions, but I am almost certain of the diagnosis.

I told him that his shortness of breath is from being overweight and deconditioning. In more simple terms, he is way out of shape.

I coaxed him that it’s not easy to run that first mile. But I reassured him that with more training and persistence, he should be able to run a mile, and more.

I will be riding a 50-mile bike course tomorrow, as part of the RAGBRAI (Register’s Annual Great Bike Ride Across Iowa). In three months it would be the annual Des Moines Marathon, which I hope I can participate again.

Even though I consider myself fit and have been exercising somewhat regularly, there are days that I struggle to run the first mile. What I am trying to say is, it is not always easy to run a mile. No, let me rephrase that. It is hard to run a mile.

Running a mile and beyond, is not like a faucet that you can turn off for a long time, and then when you turn it on, you expect it to be flowing freely again. No, it is more like a pump, that you need to prime first, before it flows again. Running or any other endeavor for that matter, takes time, training, and dedication.

Long_Distance_Running

For all of you out there, who are struggling to run a mile, don’t lose heart. Many times the hardest part of a long run is the first mile. But the good thing is, it can be done. And it must be done. For your health sake.

As a popular Chinese proverb says, ” A journey of a thousand miles, begins with a single step.” If I may add, that single step will eventually lead to the first mile.

(*photo from here)

Gym Watching

I admit it. I have been slacking!

I have not been to the gym regularly lately. Like in the month of January, I think I only went to the gym three times for the whole month. Well, it was bone-chillingly cold. I was jet-lagged from the Philippines’ trip. I was busy in my ICU rotation. The dog ate my alarm clock (we don’t even have a dog). Black Ninjas barricaded the gym……

No more excuses!

In reality I miss going to the gym, not just for the health reasons, but for the amusement as well. Because I am a gym watcher.

My first gym experience was right after I finished my undergrad course in Manila. I asked my father if I can use the refunded laboratory fee deposit of 400 pesos from my tuition, to sign up to a gym for the summer. I then enrolled in a gym located somewhere in Quezon Avenue.

On my first day, I was intimidated by the hunky muscular guys and athletic-looking gals working out in the gym. I was a measly 115-pound in a 5′ 8″ frame person. I was a wimpy kid! In fact, I spent more time in the gym that day, sitting in a corner, watching people.

Fast forward to today (25 years later), I may have gained 40 more pounds of muscles (and bilbil) and I may be more adept now in using the gym’s equipment and machines, but that has not stopped me still from watching people in all sort of shapes and sizes, and the different personalities and their idiosyncracies.

Here are some of the personalities I have observed over the years. Though they are real people, they may not be just one person, as in every gym there is a similar version or so, of them.

1. The gym rat. She goes to every exercise machine, from the treadmill, to the stationary bike, to the elliptical machine. She looks emaciated, like she just got out of the concentration camp. I guess she doesn’t know when to stop. She doesn’t look healthy at all. Just like everything else, even if it something good (like exercise) if it is done in excess, it is not good.

2. The chicken-legs guy. He has big burly shoulders. Heaving chest and pectorals. Hulking biceps and triceps. But thin legs. Chicken legs! I think he forgot that he needs to exercise his legs too. Legs are important you know. They hold you up against gravity.

3. The perfect make-up gal. It is 5:30 in the morning and she looks perfect with her full make-up on. Going where? To the gym! To sweat! I think appearance is so important to her. Aside from exercising, she also socialize, as she seems to know and greet everyone in the gym. Maybe she’s running for a popularity contest.

4. The slob. Almost opposite of #3. He looks like he just rolled out of bed, with his bed hair and clothes that he seems to have worn to sleep. The shirt is an old tattered college shirt with a visible food stain. Maybe he really slept in the gym. Maybe he really don’t care what his appearance is. Maybe I should cut him some slack. What is important is that he gets his exercise.

5. The grunter. He grunts when he stretches. He grunts when he runs. He grunts when he lifts weights. And not just silent grunts, it is a guttural noise that you can hear across the gym. It is as if calling attention to all, how fast he is running or how much weight he is bench pressing. It is kind of uncomfortable to be near him. Sometimes the grunting sounds he makes is as if he’s choking and I wonder if I need to jump behind him and do the Heimlich maneuver.

6. The hog. When he uses a machine, he hogs the equipment and does not let others  use it in between his 21 reps (or that’s how long it seems!). He will definitely make your gym time longer. Make sure you get ahead of him or you’ll wait till kingdom come. He doesn’t know how to share.

7. The silent observer. He seems to be minding his own business yet he is keenly observing all the people around him. He is not a stalker, but beware of him. He will write about you in his blog.

Of Monkeys and Men

Last week, I saw a patient in the hospital that our group was following for consult. Though it was my first time to see the patient, she had been in the hospital for almost a month already. A little longer more and they could have named the room to her.

Our patient was morbidly obese and had constant difficulty breathing. She was on 10 liters of oxygen continuously, and supposed to wear a CPAP at night for her sleep apnea, though she hates it and not compliant with it. She also had decompensated congestive heart failure, poorly controlled diabetes, and unrelenting seizures. We were unable to discharge her home due to her persistent poor condition.

When I entered the patient’s room, she was having breakfast: heaps of bacon strips (I believe it was more than 10 strips), a large serving of scrambled egg, four heavily buttered toast, a good size donut, and 2 small cartons of milk. My jaw dropped in disbelief! How could we allow this in a patient who was already having serious problems, and in the hospital at that?

I was tempted to yank the tray away from her. And I did, but just to examine her. She was obviously annoyed that I interrupted her breakfast, or should I say suicidal meal.

There was a recent research in the UK that found that about 75% of hospital food has more saturated fat than Big Mac, and 60% of hospital dinners have dangerously high salt levels. It is a fact that our hospital food is so unhealthy, that patients might be safer to be at home than to be in the hospital.

I worked in a hospital before in New York city that has a fast food chain in their cafeteria. It was ironic that you can find both McDonald’s and the cardiac cath lab in the same floor of the hospital. So you can eat your fat greasy burger and if you happen to suffer a heart attack, they can just wheel you straight down the hall into the cath lab for your angioplasty.

There was a study conducted more than three decades ago that was funded by the National Institute of Health, about feeding a fatty diet, like the regular hospital food, to a group of rhesus monkeys. The monkeys probably had a blast with all the banana milkshake and crispy bacon instead of their normal diet of bananas and occasional insects. After 16 months of eating the fatty foods, one of the monkeys had a first heart attack.

As the study continued, eleven more monkeys had suffered similar heart attacks. This study clearly demonstrated the relation of diet and heart disease. So the take home message from this study for you is if you get hospitalized, don’t stay more than 16 months in the hospital, or it will kill you. Huh?

Back to my patient, after seeing her breakfast tray, I quickly reminded her that she was not doing herself a favor by continuing to eat all these high fat foods. Just looking at it gave me a chest pain. However after I walked out of her room and changed her diet to a heart healthy one, I was called by the nurse later on, that the patient simply refused to follow my diet order. She just wanted to eat what she wants to eat.

I felt displeased initially, but more saddened afterwards for my patient. She is not an isolated case. Her attitude is the same as the pervading attitude of our society today. We are inundated with advertisement of foods that are rich in fats and sugar, people indulging on the “good life,” and yet our commercials show models with thin and beautiful figures. Somehow there is a great disconnect here.

For the health professionals, we practice salvage medicine, where we kind of put a band-aid in a hole on a dam that is about to explode. Somehow advising people to eat the right food and live healthy to prevent diseases becomes secondary. Besides we can always prescribe Lipitor for their high cholesterol and give them insulin injection for their diabetes. It is good for the business and for the pharmaceutical companies, right?

In our society we are conditioned and deemed it acceptable to crack the chest open to do the coronary bypass surgery for a heart disease, or whack out or staple a part of the stomach for gastric bypass procedure to help patient lose weight as mainstream medical practice. Yet telling patients to adhere to a lifestyle change like converting to a vegetarian or vegan diet to reverse their disease, is considered too extreme and radical.

About the monkey studies again, part of the study was switching back their diet to low-fat diet, perhaps back to their normal food of bananas and other fruits. I am not sure if the monkeys protested, as they got used to the hamburger, fries and milkshakes. But what it showed is that with the healthy low-fat diet, there was a regression of the cholesterol build-up (atherosclerosis) in their arteries – proving that fatty diet can cause the disease and switching to a healthy diet will reverse the disease.

We know we can do something for atherosclerosis or hardened arteries. But can we do something for hardened attitudes?

Now, if I could also curb my cravings for a Whopper…….

(*photo from here)

Take the Photo and Run

It was a perfect autumn day. It was clear and cool, with early morning temperature in the high 40’s but expected to warm up to 70’s Fahrenheit. Excitement was heating up the nippy air. Beautiful day to run the marathon! This was my third half-marathon race. And I even took pictures while running it.

Waiting to start. This was how far I was from the starting line.

There was a sea of people that day. Nice to be in this good company of athletes and wannabe-athletes. This was the annual IMT Des Moines Marathon (which also includes the half-marathon and 5K run). I learned that there were more than 8,000 runners that morning, and perhaps thousands more family and friends who were there to support and to cheer.

It took a few minutes after the official time begun before I even cross the starting line.

Iowa Capitol in the distance. I was trying to follow the pace runner with the red sign 2:20 (that is the goal time I want to finish the half marathon)

Court house building ahead. Can you still see the 2:20 pace runner?

I kept on taking pictures to amuse myself. I also took photos of all the mile markers as motivation for myself of how much distance I already covered. Somehow I missed the mile 2 marker as I was oblivious of other things, like keeping up with the pace runner that I wanted to follow, while watching other runners and not stepping on their toes, for it was crowded.

Mile 3 marker. Where’s the 2:20 pace runner? I think I fell behind already. O well, I’ll just enjoy the run.

After running through city streets we entered Water Works Park, and it was a change of scenery.

Mile 4 marker

Mile 5 marker

I was in mile 5 when there were several runners going the opposite direction, meaning that I was still on my way further and they were on their way back already. Are you kidding me? I must be running slow! The eventual winner of Des Moines half marathon was a Kenyan with a blistering time of 1 hour, 3 minutes and 18 seconds. That was really more than twice faster than my pace.

I was still going upstream, while others were already heading back.

There were several water stations along the way. They offer water and Gatorade. There were even different stations that handed out pretzels, candies, gummy bear, energy gels and power bars. I stopped on most of them and took whatever they offer. Hey, they’re free.  And I don’t even have to say trick or treat!

Gatorade station

Along the route were signs that kind of encourages the runners to go on. There was one that said “Run as if you stole something.” Maybe I should have stolen the prize money for the winner when I passed the starting line and I could have run faster. Playing in my head was the Steve Miller Band song “Take the money and run.” Hoo, hoo, hoo! Here are the other signs.

Why can’t they hand them now in the water station?

I am a Filipino, and I can run fast too. Specially if I am being chased by a rabid dog! (see previous post here)

Besides the spectators on the side of the road cheering the runners, there were also several singers and local rock bands playing, boosting our moods and electrifying the air.

local rock band

Mile 6 marker

I need a break. This kind of break. A breath-holding break, if you know what I mean.

water station

A different kind of station.

They even have an ambulance ready. But not for me. Not today.

Mile 7 marker. I am more than halfway!

Another music band

Mile 21 marker. Huh? Oh, that’s a marker for the full marathon.

Here’s the right one for me, the half marathon marker.

I am not Dave, but I’ll take the motivation. Thanks doggie!

Downtown Des Moines in the distance. That’s how far I need to go still?

Mile 9 marker

Gray’s Lake in downtown Des Moines. A beautiful day indeed!

Still in Gray’s Lake

Mile 10 marker. That’s the farthest I ran training for this half-marathon. It would be sheer determination from here on.

I was on my 10th mile, when a motorcade passed, alerting us to give way. It was the lead runner for the full marathon. He already ran 23 miles in the same time period that I was running! The next marathon runner that passed me was almost 5 minutes behind the leader.

The lead runner for the full marathon.

I learned that this was James Kirwa (#1), a Kenyan runner. He eventually won the race with the time of 2:16:54. It was his third consecutive year winning the Des Moines Marathon.

Mile 11 marker

Mile 12 marker. The next marker will say “FINISH”

This band was blaring heavy rock music when I passed by.

Finish strong? My legs were like jelly. The spirit is willing but the flesh is weak.

I can smell the finish line!

Finally! Finish time was 2 hours 29 minutes. Still close to my goal,while taking photos to boot.

I think I deserve one of those, please.

wearing it proudly

See you again next year! For now I need more ibuprofen.

******

(*all photos taken with my iPhone)

Marshmallows and Delayed Gratification

It is hard for us humans to purposefully delay a pleasure, that we know we can possibly have now. We live in a day and age that we want rapid results, immediate benefits, and instant gratification. We want everything and we want it now. Pronto! ASAP! And we don’t care about its future consequences.

Studies have shown though, that the ability to delay immediate gratification is link to a successful life. In one experiment conducted by psychologist Walter Mischel years ago, he offered marshmallows to a group of 4-year old kids. He told them that if they want a marshmallow they can eat one now, but if they could wait several minutes, they can have two. Some of the kids immediately grab the treat though some were able to hold off. Mischel followed these kids until they were adults and he found that those who were able to wait were generally more self-motivated, more successful in school, and more emotionally stable. I just wonder though if the kids who ate two marshmallows got to see the dentist more. Sorry, I digress.

Looking at the things that we do now in our everyday routine, I know that some of the benefits from our efforts, we would not rake until much later. At least that’s what we hope for. There may be grinding days that we ask ourselves, what’s the point of doing all of this? But let’s keep reminding ourselves that someday we will have our gratification. So hold off gulping down that marshmallow, for someday you will have a whole bag all for you. What? Sorry, I digress again.

In four weeks, I will be running the half-marathon. This will be my third. And I am up to par with my training schedule. Last weekend I ran 10 miles, the longest distance I ran for this year so far. Training experts say that if you can run 10 miles, you can finish the half marathon which is 13 miles (21 km). I hope so. For that’s what I’m training for, right? That’s also the reason I’m not eating marshmallows. Huh?

So as I make the final push for my preparation for the half-marathon, I wonder would it be worth all the efforts – the early morning rise, the long, lonely and grueling runs, the buckets of sweats, and the muscle sores. Would the medal (which is probably worth $2) hanging on my neck, signifying that I finished the 13-mile run, the ultimate prize? Would having my name in the list of finishers the final goal? Would finally cooling off my heels, hanging up my running shoes, and just taking it slow after the half-marathon, and eating all the marshmallows I can eat, the delayed gratification I am alluding to? Heck, no! I don’t think I will stop running anyway even after the event.

By keeping on running today, what I am hoping for is in 15 years, when I am 60 and my son will be 24, that I can still play basketball one-on-one and keep up toe-to-toe with him. Or in 25 years when I am 70, and my grandson is 7, that I can still teach him how to dribble and shoot the ball, or show him how to do a lay-up or even a forceful dunk. Or in 45 years when I am 90, and my great-grandson is 1, that I can still guide and support him as he take his first steps, or perhaps just witness him bite a marshmallow.

That will be gratifying. Really gratifying. And it will be all worth it.

(*photo from here)