Sunday, December 21, 2008

What Else Can You Transplant Other than Hearts, Kidneys, Pancreases, Lungs and Faces?

I had a patient with severe diarrhea. She had a condition called C.diff colitis. This results from people taking antibiotics that eventually leads into a severe inflammation in their colon (large bowel), and it can be very dangerous.

I went inside the room, and found the daughter, and started explaining.
"You know your mother has that C. diff infection that is causing here to have this severe diarrhea. We have been treating her with several medications for so long and nothing is working. She lost so much weight. So we looked in the medical literature and we have very few options left...."

The daughter opened her eyes, and seemed excited at the potentially good news coming.
"So one thing that has been shown to work, is what we refer to as stool transplantation"

I paused. I was thinking to myself, "Please God I hope she have really heard of the procedure , please God tell don't let me explain it to the lady"

"What is that doc?"

"Ok .... this infection is caused by a sudden alteration of the number and type of bacteria in the colon, so we have to restore that as naturally as possible"

"So how do you do that?"

"We bring a stool specimen from someone else, and give it as an enema: we will give it from behind, up your mother's rectum, in an attempt for the normal bacteria there to overtake the colon. There are some studies showing that this works very well in refractory cases, like your mother's"

The daughter did not look too happy, but she asked, "So where would you get the specimen from?"

"It should be someone who lives with her, so who lives with your mother?"

"It's only me"

"Do you eat a similar diet?"

"Yes"

"Ok so you have to be the donor"

"Uhm OK, but why?

"Because if you eat the same diet, you produce the same feces, so that would match your mother's colon the best"

"So what if it didn't work?"

"Well in another study they dropped an NG tube from the nose to the stomach and they gave the stool in liquid form down that tube. It works"

"And what if it didn't work, what should we do?"

" We can try again. Maybe we can use the same stool sample and give it on different days" - I was able to hold myself from saying ,"hence the term : same shit, different day"

The daughter didn't have any more questions, so I told her that we soon will be contacting her to arrange for the first stool transplantation in our hospital. I left the room thinking to myself, "Well maybe this would be a chance for her to show her true love for her mother".

Morale of the story: Don't take antibiotics unless you really really have to, they can KILL you, or at least place your doctor and family members in some really embarrassing situations.

17 comments:

nizars.com said...

poor family, I hope it will work out for them.

this is one of the things that I hate about a doctors job, explaining situations to other family members and friends.

7aki Fadi said...

but honestly Hareega don't you love it, you can tell someone to eat shit and they would do it, LOL.

sharkooseh said...

lol @ 7aki fadi :P

Roba said...

man thats really hilarious. we cracked up so hard. so much for no inspiration.

Dreamy Villager said...

Can't you isolate the bacteria from stool and culture it then use it ?!

Hareega said...

nizar, yep i hate that too

7aki fadi... hehehe yeah that helps with my ego, but i really felt terrible for that daughter, after we left the room she was looking at our team thinking to herself, "who are those people?"

Roba/sharkooseh: thanks for reading!

Dreamy Villager: that's actually a very good question, to avoid doing stool transplant they're considering giving the non-harmful strains of the C.diff bacteria than can compete with the harmful strains in colonizing the colon. In theory it would be a great solution but it's really difficult to do practically.

Yazan said...

hahaha I bet she was a hypochondriac.
That serves her right for being paranoid about getting sick. You end up eating shit.

Hareega said...

Yazan, nope she's normal, one of those people who take antibioitcs thinking they're gum and she found one of those many doctors who throw antibiotics on their patients for any reason thinking antibiotics are harmless drugs

Batoul A. said...

OMG feces up NG tube! I have a bad case of imagination. Everything you say is registered into tiny movies in my head lool.

I hate C diff with a passion. Its common in our hospital and I always have to be cautious. Thank God MRSA is controlled now.

Our nurses are so horrible I've been exposed to too many diseases lol.

kinzi said...

LOL Hareega, I would be thinking it would be easier to donate a kidney than a stool! There is something noble about a kidney for your mom, but a stool transplant, eeeyyuck, you can't even write about in a Christmas letter.

You sounded like my physio friends joking about dilly-sticks.

Hani Obaid said...

ouch, I was cracking up at "up your mother's rectum".

Good job keeping a straight face while saying that :D

Hareega said...

Batoul, I don't think any hospital in the US will ever get rid of MRSA, in Asutralia however its incidence is pretty low.

Kinzi, I hear you. I'd still donate stool than a kidney!

Hani. I can't always keep a straight face, but after some training and experince it's not as hard anymore!

insomniac said...

as shallow as it sounds, i have just watched a grey's anatomy episode with the same case!

Hareega said...

insomniac, good to know, i don't watch grey's anatomy

yaroushka said...

This is by far the funniest most educational medical story yet. I'm going to use it when I explain to my patients why they shouldn't use antibiotics regularly.

Hareega said...

yaroushka, you should scare doctors they're the ones who write for antibiotics

yaroushka said...

Oh I agree ... but i have more leeway with patients than doctors as a pharmacist. It's sad but you know it's true!