Sunday, November 23, 2014

Stools Rush In

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A new procedure fights a deadly infection. Don’t ask how.

Carol Giorsetti doesn’t mind being Exhibit A for a new medical procedure. “I’m glad, in fact,” the 65-year-old Dudleyville, Arizona resident says. “I probably would have died if I didn’t have it.”
 


This is a story of life preserved. Of medical science pushing back the veil of ignorance. These are important facts to remember because it’s also the story of a person who got a fecal transplant.
 
Yes, you read that right.
  
“The hardest part is telling the patient,” admits Dr. Andrew Weinberg of Banner Baywood Medical Center in Mesa. “They look at you and say, ‘You want to do what?’”
  
In a world where most implant recipients get cool stuff like pacemakers, titanium hips and Jarvik-7 artificial hearts, a rising number are saved by a dose of something you wouldn’t want on your shoe. The procedure, developed by Weinberg, a gastroenterologist, and Banner Baywood Infectious Diseases Specialist Dr. Joe Zachariah, combats a deadly infection called Clostridium difficile, or C-Diff. “C-Diff is a serious issue,” Weinberg says. “We estimate 300,000 cases a year in the U.S., and 14,000 people die of it. Very often it’s the elderly or the very young.”

Carol Giorsetti’s dance with C-Diff began after she took antibiotics for strep throat. “The problems usually follow a cycle of antibiotics,” Zachariah explains. Three to 8 percent of us carry C-Diff in our bowels, where its toxicity is held in check by the 1,200 other bacterial species down there. Antibiotics can, in certain cases, wipe out nearly all the good bacteria in the gut. Left uncontested, C-Diff goes to town, attacking and destroying colon walls.
 
For Giorsetti, that meant uncontrollable diarrhea and delirium. “I was completely out of it,” she says. Her husband, Johnny, took her to Banner Baywood. “She was severely dehydrated,” he recalls. “We thought we were going to lose her.” C-Diff sufferers can face the loss of their colon, or worse.

“Very often, we’ll treat [C-Diff] with antibiotics,” Zachariah says. “But if the case is advanced or the colon already too compromised for the antibiotic to work, you don’t have much of a window.”

Imagine a situation so crappy that actual crap can save the day. “There’s about 10 billion bacteria per gram of feces,” Zachariah explains. “[Donor feces] not only kills the C-Diff off, it repopulates the normal bacteria in the bowel, which is key to preventing a relapse.” Even so, Giorsetti – who woke in time to hear the idea – wasn’t thrilled.

But eventually, she agreed. “I had my family around me,” she says. “So I had lots of… donors.”

Fecal transplant has been around, in some form, since as early as the 4th Century. But a rising C-Diff infection rate, linked to hospital settings and antibiotic use, has put it in the spotlight. In January, a randomized study in The New England Journal of Medicine found that fecal transplant cured 15 of 16 people with recurring C-Diff. Those stats help Zachariah when he’s pitching it to patients: “I start with the numbers. It helps get them over the ‘ick’ factor.”

“We can’t think of ourselves as pioneers,” Zachariah says about the origin of feces transplant. “My in-laws are ranchers in Oklahoma. When I told them about this, they said, ‘Oh yeah, we’ve been doing the same sort of thing with goats and cattle for 50 years.’”

The donation is usually taken from a relative (not for compatibility; the conversation is just slightly less awkward). “We run saline through the stool,” Weinberg explains, “then coat the colon with it on our way out after a full colonoscopy.” It can also be administered via enema, or a tube through the nose. “No sutures, no knife. And the success rate is about 90 percent. We often see dramatic improvement within the first two days,” says Weinberg, who’s performed 30 such procedures in the last 15 months. “It’s gratifying because we’re helping people who are acutely ill.”

None more than Giorsetti, who still struggles with how to describe it back in Dudleyville. “I’d recommend this [procedure] to anyone in my situation,” she says. “But I wouldn’t go heavy on the details.”

Odd Blood
Other fantastic medical treatments not for the weak of stomach.

Maggot debridement therapy: The use of fly larvae to excise necrotic flesh was a common battlefield remedy until the advent of antibiotics in the 1940s. However, modern antibiotic-resistant strains of bacteria have revived medical maggots as a treatment option.

Urotherapy: Known in India as shivambu, the consumption of urine is alleged by some homeopathic practitioners to kill cancer cells. The American Cancer Society is unconvinced, stating that “no well-controlled studies” exist to support such claims.

Ill liver: In 2010, an Argentine hepatitis sufferer facing imminent death was implanted with a diseased, tumor-ridden liver recently harvested from another patient. The cancerous organ acted as a “bridge” until a healthy donor liver was found and implanted a few hours later.

 

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