Fecal Implants? Seriously?! (Yup.)

rectal bulb syringe

(RECENT UPDATES ARE AT THE BOTTOM OF THE POST.  MOST RECENT UPDATE AS OF 5/2/12.)

I live for this kind of stuff.

Slate online published an article a couple days ago titled The Enema of Your Enemy is Your Friend by Emily P. Walker. It reveals an unusual, frontier-type of treatment for an intestinal infection called Clostridium difficile that’s killed a lot of people over the years, and which 1.3 percent of patients are estimated to contract during a hospital stay.

Death by diarrhea.  Not a fun way to go.

The traditional treatment for C. diff is a course of antibiotics but for the unlucky who fail to respond, fecal implants are another up and coming possibility.  And before you wrinkle your nose and shake your head in disgust please consider that, in the small amount of documented research available so far, the outcomes are surprisingly good.  From the article:

“It’s true there’s been no major clinical trial of fecal transplants, but the procedure appears in the medical literature at least as far back as 1958… Now we’re beginning to see some more extensive studies. Mark Mellow, a gastroenterologist at INTEGRIS Health in Oklahoma City, recently presented a paper showing that 15 out of 16 C. diff patients whom he’d provided with a fecal transplant remained disease-free after five months. Several other papers presented at the meeting showed similar positive effects, and in every case, symptoms disappeared almost immediately after the transplant.”

Evidently, it works because the foreign feces helps to repopulate friendly flora in the infected intestines.  (Want to know the best feces to use?  Borrow it from a person who lives with you.  Their flora and your flora are the most likely to be a good match.)  In a clinical setting the donated matter is first screened for disease and then mixed with a saline solution to the consistency of a “milkshake.”  (The article is not only informative, it’s fun to read.) Then it’s pumped into the colon where it does it’s magic.

But there’s also an alternative:

“And then there’s the do-it-yourself crowd.  All you need is a bottle of saline, a 2-quart enema bag, and one standard kitchen blender. Mike Silverman, a University of Toronto physician who wrote up a guide to homespun fecal transplants for the journal Clinical Gastroenterology and Hepatology, says it’s entirely safe to do the procedure this way, provided that a doctor gets involved at some point to screen the donor sample. He felt he needed to draw up the instructions because administrators at his hospital wouldn’t allow their doctors to perform a procedure that hasn’t been validated in a large, peer-reviewed study.”

But as Ms. Walker points out in the article, these studies are proving hard to come by.  Pharmaceutical companies not only have little reason to shoulder the substantial costs involved (there’s not enough profit potential for them), there’s actually a disincentive; a natural remedy like this would replace an antibiotic treatment.

Gotta love our health care system’s fabulous cast of skewed incentives.

Needless to say, I’m endlessly fascinated when conventional medicine turns off the beaten path to consider the unusual.  If this treatment turns out to be as successful as it looks like it could be, it would place it right up there with the simple elegance of biosurgery; the use of maggots in destroying necrotic tissue in a slow or non-healing wound.

My hope is always that the adversarial stance so often adopted between different healing modalities will eventually soften and reverse.  It sure seems like the more hands we have on deck, the more solutions we’ll find for not only treating illness, but increasing health, thereby enriching everyone’s quality of life.

UPDATE:  October 29, 2011

It looks like this treatment may be starting to get the acceptance (and application) it deserves.  I just found a headline article on msn.com called Sounds gross, works great: Fecal transplants cure nasty C. diff infections citing the benefits and growing use of fecal transplants.  The article mentions a success rate of 90% for the treatment (yowza!) yet says the transplants are still looked at as a “treatment of last resort.”  I wonder how much of that is due to doctor’s skepticism and how much is patient’s resistance?

In any case it’s interesting to note how quickly fecal transplants are gaining traction as a viable treatment.  With C. diff infections on the rise, the availability of a treatment with a 90% success rate is a godsend.

UPDATE:  July 6, 2011

And now, a recent positive write-up in a professional journal!  The journal Pediatrics published an article on June 14, 2011 covering the case of a child who was successfully treated with a fecal implant.

For those researching, here’s an online physician’s resource called HCP Live, with a couple of other potentially valuable links.  Good luck!

UPDATE:  March 24, 2011

Because I’m getting a lot of hits on this post I thought I’d update it whenever new information comes in.  Today, I received a comment from Kathy Suszek who is a nurse case manager “working with a gentleman who just had the fecal implant done, he tells me his results are “wonderful”. Had 1-2 loose bowel movements, in the past few wks, but much improvement.  Just wanted to share news that is positive for a change.  His provider has had 14-out of 14 success stories.”

UPDATE:  May 2, 2012

Here’s a great article titled Fecal Transplants: They Work, The Regulations Don’t published in Wired Magazine, December of 2011.  In it the author talks about a couple of early trial results on fecal transplants as well as some of the regulatory hurdles involved in getting serious studies launched.  The success rates for this procedure so far are absolutely amazing, but it’s difficult for people to find doctors working in institutions that are broad minded enough to allow it.

I did find this video posted by Integris Digestive Health Center in Oklahoma City where they consider administering fecal transplants to those with recurring C. diff.  

copyright 2010 Dia Osborn

24 responses

  1. Dia,
    Not sure I want to eat anything out of the blender…ever again. Sorry, this just grossed me out! Also, will be looking to see if Activia changes the shape of their containers!
    Thanks,
    Cal :-(

    • Yeah…probably store that blender out next to the toilet plunger in the garage. :-)
      This treatment sounded gross to me, too. But I’m fairly sure if I was the one who’d lost twenty pounds, most of my hair, was dying, and traditional methods had all failed, a shit milkshake like this would look like a gift from God. It’s all relative, y’know?
      Diaxxx

    • DONT BE DUMB YOU DO NOT DRINK IT YOU GO UP THE BUTT LIKE GETTING A SCOPE. IT WORKS SOUNDS GROSS. BUT YOU DONT USE ANYONE MOST PEOPLE HAVE FAMILY WHO HAVE NO PROBLEMS WITH THEIR BOWELS AND THEY ARE THE ONES YOU USE. IF THEY LOVE YOU THEY WILL HELP YOU

      • My infinite apologies and thank you for the correction.

        It IS important that people seeking help aren’t confused by any misunderstanding on my part. So for those seeking more information–YES. It’s true. One does NOT drink the infusion, it’s introduced rectally, as Carol has indicated.

  2. hello dia
    just caught up with your “bottom” centred blog entry!
    I had to laugh…. your blog is more eclectic than a bucket of fish!
    Once I got past the nausea I must admit, Iagree with your words… bowels and bowel care was my “forte” in spinal injury nursing….. what I dont know about stools doesnt need knowing……

    lol
    good wolf blog too
    x

  3. Hey there, I am nurse case manager, and am working with a gentleman who just had the fecal implant done, he tells me his results are “wonderful”. Had 1-2 loose bowel movements, in the past few wks, but much improvement, and just to clarify above, it is not administered thru the butt, it is either by Nasogastric tube or Endoscopy via esophagus, just wanted to share new that is positive for a changes.
    His provider has had 14-out of 14 success stories.

    • Hi Kathy – just interested – where are you located ? Trying to find somewhere in California that does fecal implants for Crohn’s patients.

  4. interesting very interesting!!! I enjoyed your post and I learned something new. It’s funny how we go back to the beginnings of medicine to find cures that no doubt have been around for ages. My mom used to cure us with natural remedies back in the day. The only time we went to the doctor was when SHE couldn’t cure us. I’ve resorted to natural holistic methods as much as I possibly can in the recent years.

  5. As someone battling c. diff. right now (since mid-March, actually. I am on my second round of anti-biotics.) I can say that what sounded disgusting the first time I ever heard of it, now sounds like a Godsend. If I thought I could do a fecal transplant and be finished with all of this, I would do it today! What’s amazing is that this month and a half is mild compared to what some people go through (years of antibiotics, pain, and dreaded bathroom trips)!

    • I know. When I first read about this it sounded really bizarre, but after I learned what a nightmare c. diff. is, I realized this treatment is more like a godsend than a joke. If you pursue it, I wish you all luck.

  6. I just want to know where I get this done. My mother who is 83 is on her third round of Flagyl and 2nd of Vancomycin. They want her to take Vanco for 21 days more or Difficid. Both treatments will cost $4,000 and the cure rate is not as high as the Fecal Implant. She does not have drug insurance and is slightly over the poverty limit so she doesn’t qualify for free meds. We need help!

    • Hi Pam. Evidently, it’s still a challenge to find doctors and institutions broad minded enough to administer fecal implants but on a quick Google search I did find the Integris Digestive Health Center in Oklahoma City who considers the treatment for those with recurring c. diff. like your mother. I don’t know where you are but if you’re not in Oklahoma it would involve travel. You could Google around and possibly find a doctor closer to your mom, or some people have successfully performed the transplant on themselves. Here’s the story of one of those:
      this man did
      If you went this route you’d want to study all the information you could get on it, as well as having the sample stool tested for parasites and other infections first. Good luck and I sincerely hope your mother finds some relief soon.

  7. My Mom has gone through 2 bouts of Cdeff while in the hospital. This was very painful for her and she suffered tremendous weight loss. My sister and I are in the process of testing our fecies and bloodwork to see if we are candidates for the fecal implant for our Mom. If all the tests are positive and there are no parasites or bacteria issues, we are not hesitating to move forward with the implant. Keeping my Mom alive and out of pain and hopefully returning to a normal life is the most important thing right now. She has been through the antibiotics of Flagyl and Vancomycin and it did not work. We are hoping for a very positive outcome and no more suffering.

    • The more I learn about the success rates with fecal implants, the more I’m thinking it should be the first line of treatment for c.diff., rather than the last. I sincerely hope this brings your mom back to health!

      BTW, I had a previous commenter ask where she could take her mother (suffering similarly to your mom) for a fecal transplant and I Googled it but couldn’t find much. Was it easy to find a facility where you could take your mom for the treatment?

      • We are working with a Dr Silverman, Internal Medicine doctor located in Ajax, Ontario. He is the specialist that suggested family members be tested.for C Diff toxins, stool parasites, Hepatitis A, B and C antibody along with other things. If results are perfect we are candidates for a possible implant.for my Mom. Once we have results I’m assuming the implant will be done at the Rouge Valley Hospital in Ajax, and I’m assuming we will meet with Dr. Silverman at some point. I agree the antibiotics are always not the right source to combat this problem and consideration should be given for a fecal implant as a first line of defense. It would seriously arrest the pain and unnecessary suffering. I also wanted to let you know because the C Diff returned 6 days after my Mom was released from the hospital on Dec. 8th and then readmitted, Dec. 14th that is when Dr. Silverman got involved. It was obvious my Mom’s case had not cleared up when she was released from the hospital the first time.

      • Thanks so much Linda. Hopefully, this can help other people who are exploring the option. I’d also love to know how your mom does, if you wouldn’t mind. Good luck!

  8. I completed my Fecal transplant on Friday and am anxiously awaiting the results. I had mine following two years of C Diff infection from taking the antibiotic Clindamycin (Brand name: Cleocin) in July of 2010. The drug immediately upset my stomach to the point where I could not tolerate it but had no idea how much havoc it raised with my entire flora. To make a very long story short it went totally undiagnosed for over a year although I complained to my PCP and my GI doctors about the ongoing upset stomach, serious loss of weight, loss of appetite and constant and urgent diarrhea. I was tested for everything, and the C Diff never showed up in the tests and colonoscopy performed by Dr. Stephen Laird, Gastroenterologist in Vail Colorado. Even after I went to the Mayo Clinic in Rochester, MN, where it was properly diagnosed, Dr. Laird refused to believe their diagnosis and tested me again with a negative result. It just would have been nice if he had listened to me talk about my symptoms. In any case the C Diff was again properly diagnosed at the University of Colorado Hospital in Denver in December 2011 and again at the Vail Valley Medical Center in the same month. Treatment was begun with Flagyl on several occasions and twice with Vancomycin on two occasions. Once for two weeks and once for 30 days. No relief from the C Diff … including the introduction of many forms of probiotics, which actually seemed to make it get worse, not better. At the same time I was reading all of the literature that I could find about a fecal transplant, but found it very difficult to get information about who was actually doing the procedure, where it was being performed and how much it actually cost? Finally my new PCP in Denver discovered Dr. Stephen Freeman at the University of Colorado Hospital who was extremely professional and performed the procedure on May 25, 2012. I don’t know if works yet, but stay tuned and I’ll bring you all of the nasty details. What is clear to me however, is that because this is a relatively low risk and low tech procedure, not involving any expensive drugs, yet, that there is not much interest in the medical community. I would be happy to work with anyone who has an interest in raising the awareness of this terrible disease and this very useful and sensible treatment that should be readily available for everyone. Anybody hear me? j

    • Hey Jay…I hear you. :-) Please, please, please, keep us updated on how the treatment works for you! I can only imagine your frustration with the time that had to elapse before you got a correct diagnosis. I sincerely hope that, after the failure of the other treatments, your fecal transplant will take care of the problem. My understanding is that the success rate is extremely high. It’s been a while since I first wrote this post and the amount of serious reporting on the efficacy of fecal transplants has multiplied rapidly since then. Awareness is definitely rising and there seems to be a genuine desire on the part of a lot of people suffering with C. diff to give it a try, but I think you’re right. Getting the medical community to embrace it could be an uphill battle for a lot of different reasons. You’re fortunate to find a doctor in your area willing to do it.

      Have you tried doing a search for C. diff/fecal transplant forums or something like that? If not you could always start one and I’d be happy to link to it from this post which is still consistently getting hits. I’ve seen a lot of articles and write-ups but not much in the way of personal support and info-sharing sites. I think you’d be doing people a service. Just a thought.

      • Jay would want you to know the procedure worked PERFECTLY, he continued to comment on how well things had turned out. He planned to post more later. Unfortunately, he passed away unexpectly, Nov. 23rd at the Denver hospital, due to a complication (blood clot) from a robotic laparoscopic surgery the previous week in Denver. He really wanted to push for more people to know about this procedure. Obit online as well as numerous tributes to a wonderful, successful and kind man.

      • Cindy–I was startled, saddened, and moved by your comment. I’m so sorry for Jay’s loss, and so grateful you took the time to track his movements online and let me know what happened to him. It’s one of the stranger aspects of this little online world we create together that it’s so easy for someone to disappear without a trace, no way for anyone to know for sure what happened to them. Great news to know that the transplant procedure worked so well and it provides valuable information for others who land here looking for answers with their own C. diff. Please accept my sincerest condolences. Dia

  9. Pingback: Could Fecal Implants Be A Cure All? | The Odd and Unmentionable

  10. I have had c dif since Aug 2012. Been seeing a GI Dr at the VA clinic who has given me metronadazole 2 mos and I have had 4 more relapses after finishing doses of vancomycin. We tried rifaximin but after 3 days I had severe diarhea and had to give up on that. Now back on vancomycin for the 5th time. Getting weaker. My hair has thinned. My nails keep breaking. I eat an extremely healthy diet but all this depletion is taking a toll. I want to find a Dr in NC that will do fecal transplant. I heard that it has been done at Duke Hospital in Durham but need info on contacting a Dr if anyone can help. I have no insurance which may also be a problem but I have got to try. I don’t know where to begin seeking help. My VA Dr keeps saying she doesn’t really think its c diff and wants me to have a colonoscopy but they can’t seem to get it scheduled. It would be great if I could have the transplant when they do the colonoscopy. This is an awful disease that I caught from taking ciprofloxicin prescribed for an undiagnosed abdominal pain that caused me to visit the VA Salisbury ER in Aug.

    • Hi Bonnie–I’m so sorry to hear about your struggles with c. diff. It can be such a nightmare of an infection. I have a couple ideas for you.

      1) There was a very positive article on the success of fecal transplants for treating c. diff. in The New England Journal of Medicine last month that you can direct your doctor at the VA to read. She may not know that much about it yet, and could possibly get on board trying to help you find a way to obtain a transplant through the VA if she understood how well the procedure works, and how medically acceptable they’re becoming. Here’s the link to the article:

      http://www.nejm.org/doi/full/10.1056/NEJMoa1205037

      Also, c. diff can be tested for. Maybe you could request a formal test at the VA to eliminate all doubt that you’re infected? Here’s a run down of the different ways currently used to identify it:

      (found at Harvard Health Publications: http://www.health.harvard.edu/newsletters/Harvard_Mens_Health_Watch/2010/June/clostridium-difficile-an-intestinal-infection-on-the-rise)

      Diagnosis

      An experienced nurse may suspect CDAD (c. diff) because of the diarrhea’s foul odor. But even with this clue, more precise testing is mandatory.

      Although microbiologists can culture C. diff from the fecal specimens of patients with CDAD, the test is rarely employed because it’s slow, cumbersome, and expensive. Instead of identifying the bacterium itself, the standard way to diagnose CDAD is to detect C. diff toxins in the patient’s feces. The first tests were based on the fact that C. diff toxins produce visible damage to cells maintained in tissue culture. This cytotoxicity assay is a more sensitive and specific test for C. diff, but many labs have abandoned it because it takes 48 hours and is expensive.

      The newer immunologic tests can identify C. diff toxin in a matter of hours. Most labs rely on these simple tests, but since a relatively large amount of toxin must be present to register positive, the enzyme immunoassays can miss a substantial minority of CDAD cases. If a doctor still suspects CDAD despite a negative immunoassay, he can order a repeat test or send a specimen to a lab that performs the cytotoxicity assay. And in the near future polymerase chain reaction tests may combine the sensitivity of cytotoxicity assays with the speed and simplicity of immunoassays.

      If a patient’s toxin test is positive, doctors need look no further to establish the diagnosis of CDAD. But if the assay is negative, they can sometimes make the diagnosis by looking a foot or two farther — in this case by inspecting the lining of the patient’s colon through a sigmoidoscope or colonoscope. Expert technique and care are required, but in moderate to severe CDAD, the colon lining often displays a telltale series of yellowish plaques called pseudomembranous colitis. In such cases, CT scans often demonstrate thickening of the colon wall. And although imaging tests are not necessary in milder cases of CDAD, they are important in patients with moderate to severe disease who are at risk for toxic megacolon.

      2) I don’t know of any national database at this point where people can find a local gastroenterologist who does fecal transplant procedures. I think most people are having to do footwork to chase one down. I couldn’t find anyone in North Carolina directly but I found a woman doctor in Rhode Island who does them, and she might be able to help you track down a closer doctor. She could at least give you an idea of cost. Her name is Colleen R. Kelly, MD, a gastroenterologist at the Center for Women’s Gastrointestinal Medicine at the Women’s Medicine Collaborative. Here’s a link to her website:

      http://www.womensmedicine.org/oth/Page.asp?PageID=OTH133043

      And 3) If all else fails and the VA can’t help or you can’t find someone local or can’t afford them when you do, there seem to be a growing number of people doing fecal transplants for themselves at home. I just Googled “DIY fecal transplants” and found some interesting forums and articles. You could do the same search. However, please, please, PLEASE, read up on it before you try doing it yourself. I’ve heard you’re supposed to have whatever feces you’ll be using tested for bacteria and disease beforehand in a lab, or you could wind up catching something even worse than you already have. I’ve posted a link to some instructions posted on how to do it yourself below. I haven’t read them myself and I’m in no way recommending that you do it this way, mind you! Please, please, please do a LOT LOT LOT of research on it, including any and all possible dangers, before you even think about going this route!

      http://forums.phoenixrising.me/index.php?threads/fecal-transplants-fecal-bacteriotherapy-diy-home-version-very-straightforward.13744/

      Good luck Bonnie, and if you can, please keep us posted on how things progress. I hope with all my heart that you can soon return to a normal, healthy life!

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