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New procedure treats C. difficile
It all began in spring 2010 when Jack Kristensen’s vascular problems led to the amputation of both of his legs, one in April, the other in June.
And last spring, while recovering in hospital from an unrelated illness, Jack contracted what turned out to be the C. difficile infection (CDI), which can cause symptoms ranging from diarrhea to life-threatening inflammation of the colon.
C. difficile is most common among older adults in hospitals or long-term care facilities and typically occurs after use of antibiotics.
“You get worn out, you’re so tired,” said Jack, 88, who is no stranger to difficult situations, having served in the army as a paratrooper during the Second World War.
Jack’s daughter, Suzanne Bailey, is a registered nurse at Vernon Jubilee Hospital who said CDI is very easily transmitted.
“When you go in the hospital with C. Diff, you are isolated and that can be hard on patients,” she said. “But we know how fast it spreads and that it has a stigma; it is spread through contact and the best way to not spread it is through hand washing with soap and water — even hand sanitizers don’t work with this.”
Daughter Kelly Goodwill said it was tough to see her dad unable to do the things he loved.
“We’d try to go for a walk and we just couldn’t get out of the house,” she said. “Now we can go out for lunch and shopping. In the summer, we like to go for a drive or out to Swan Lake, but with something like this, you don’t get a chance to get out and see people.”
When the family found out about a new treatment that could help Jack, they jumped at the chance. A fecal microbiota transplant (FMT), also known as a stool transplant, is emerging as an alternative strategy for treating C. difficile infections.
The treatment is emerging as an alternative strategy for treating recurrent CDI. It replaces healthy intestinal bacteria by placing another person’s stool in the patient’s colon, using a colonoscope or nasogastric tube. Donor stools are carefully and repeatedly screened for parasites, viruses, bacteria and certain antibodies.
“We needed to do something — nothing was working and we were getting fed up,” said Jack’s wife, Marjory.
While Jack’s initial reaction to the idea of the procedure was one of disgust, he said he was willing to try anything to restore his health.
“He said there was a 90 per cent chance of a cure. I did not want it at first, I hesitated and I wondered how the treatment could work. But the doctor said there was a 90 per cent chance of a cure,” said Jack. “And it worked. It was a little uncomfortable but not painful, and in about four days, I was better.”
Goodwill pointed out that people usually don’t give a second thought to the idea of a blood transfusion or a kidney transplant, yet will balk at this type of procedure, due to the “yuck” factor.
In Jack’s case, a family member made the donation, after careful screening, and RN Mary Williamson with We Care Home Health Services, did the procedure in the comfort of Jack and Marjory’s home, repeating it daily over the course of three days.
“It’s done through an enema, you take the bowel movement, add saline, put it all in a blender and strain it and don’t move for four hours,” she said. “As long as we have the doctor’s order, we’re good to go. We pick up all the supplies and then we contact the patient.
“You need a donor, and the donor has to go through a series of tests to make sure they do not have any health problems and they need to be going to the bathroom regularly. The criteria is easy to fill.”
A week after the procedure, Jack was back to his old self, and ready to return to some of his favourite activities. His first outing once he was fully recovered was to the meat draw at the Army, Navy and Airforce.
“When (internist/geriatrician) Dr. Brian Chai phoned to see how I was doing, he said, ‘You’re not a prisoner in your own home any more,’” and that was so true,” he said.
Where it once seemed as though just a trip to the grocery store would be impossible, the couple is now making up for lost time.
Marjory enjoyed a girls’ trip to Las Vegas recently. Jack is content just going out for coffee in Vernon.
“I’ve seen lots on the national news about C. diff but nothing about this procedure, which is so simple and does so much good,” said Marj. “By the sixth day I looked at him and thought his colour is so good, where he was so gray before.”
Marj has been happy to take her husband of 34 years out in his wheelchair for long walks in the fresh air.
With eight kids between them, and numerous grandchildren and great-grandchildren, Marj and Jack are grateful for the support of their families through this long and difficult journey towards recovery.
The family is now on a mission to spread the word about this simple, inexpensive and — most important — effective procedure, which costs a total of $275, including the gown, mask and blender.
“Antibiotics are really expensive, as opposed to a three-day procedure,” said Goodwill. “Not all bugs need drugs.”
The family gives credit to Veterans Affairs for their assistance while Jack was living with CDI.
“They provided adaptive equipment, made modifications to the home, paid for taxis, prescriptions,” said Goodwill. “They did everything they could to keep him in the home. They provided a quality of life.
“And Dr. Chai has been amazing through all this, and we want other doctors to be aware of this procedure.”
Bailey said while the alternative treatment is becoming more of a standard of care, it’s still one that is not well-known even among medical professionals.
“I think it’s still not that common because of a lack of research, a lack of knowledge, but it is becoming more mainstream,” she said.