10 November 2018

Performing a fecal transplant at home

Excerpts from an interesting case report:
I’d had intestinal distress before, but never like this. I was excreting not just waste, but blood and bits of my colon’s lining — up to 30 times per day. My abdominal pain hit deeper and felt less productive than the pain of giving birth, epidural-free, to my second child. Even shingles, which stung like a dental drill against my face, paled in comparison. Such was the agony of Clostridium difficile...

Things started innocently enough. In early 2013, my doctor diagnosed me with a bacterial infection and prescribed an antibiotic. I had lived antibiotic-free for nearly four decades — a streak I was not inclined to break. But my doctor insisted on antibiotics, and I reluctantly complied.

Soon after, my stomach turned against me. I went to an emergency room and was sent home with a prescription for vancomycin, an antibiotic reserved for serious bacterial infections. But the drug proved little match for the microbes that had bum-rushed my colon. My weight and fluid loss accelerated. My colon risked perforation.

Because C. diff. spores can live for months on bedrails, doorknobs, and linens and easily shrug off common detergents and sanitizers, my master bathroom became my biohazard containment unit. There, I alternated between sitting on the toilet and lying on the floor. My husband, Esteban, brought me supplies and emotional support...

So, when I called around about the possibility of treating my C. diff. with a fecal microbial transplant, a sensible doctor might have offered to refer me to one of those approved practitioners. Instead, everyone I talked to refused to even entertain the idea, seemingly out of disgust.

“Yuck, you don’t want that. Just stay on the vancomycin,” my first doctor told me. A second, a gastroenterologist, simply substituted “gross” for “yuck.” A third, more tactful, expressed relief that FDA policy absolved him from having to offer the procedure...

And so it happened that when my C. diff. roared back, worse than before, after the end of my 10-day vancomycin course, my doctor’s response was to simply prescribe more vancomycin. With each subsequent treatment, however, my likelihood of recovery dropped dramatically. I started the ordeal with an approximately 70 percent chance of recovery. After months of failed antibiotic treatments, my chances had sunk below 10 percent.

My last trip to the emergency room was a grim formality. The C. diff. battle now raged beyond my colon. “You may want to tell loved ones about your dire circumstances,” my gastroenterologist said. It dawned on me that my doctor would sooner let me die than discuss a fecal transplant. That’s when I decided to do the transplant myself...

A New England Journal of Medicine article offered some procedural clues. For instance, my ideal donor would have a microbiome that was untainted by antibiotics. That ruled out Esteban, who had recently been administered antibiotics during an eye surgery. Ultimately, I turned to my 11-year-old daughter.

She responded openly and inquisitively, asking more questions than any of my doctors had. “Is this like in Clash of Clans when you have no troops left in your clan castle and you need someone else to donate some?” she said, referring to a popular multi-player video game.

Yes, it’s exactly like that.

She agreed to do it, and at around 10 pm on a Tuesday, Esteban collected the sample. He dropped it into a blender, added saline, blended it, strained it, and poured the concoction into an enema bottle, as I lay depleted on the floor. My gut drank up the infusion as if it were dying of thirst. My colon, after five months of near-constant spasms, recovered in one transformative instant. Overnight, I went from having 30 bowel movements a day to having one. For breakfast the next morning, I ate a quesadilla loaded with black beans, cheese, salsa, lettuce, and guacamole. I’ve had no recurrence of C. diff. since. 
There's more at the link.


  1. I think that the last 2 paragraphs (which were left out of the excerpt) are very important to note. It is very regrettable and unfortunate that this woman endured what she did and ultimately felt forced to undertake this treatment herself, but as she notes in the full version, times have changed since her ordeal. Fecal transplants are more readily accepted and available, and I would not advocate for anyone self-administering treatment the way she did. Oral vancomycin remains the most effective treatment for C. diff, but in cases where this and other treatments fail, fecal transplantation is definitely an available option at many major medical centers now.

    1. "Oral vancomycin remains the most effective treatment for C. diff"

      I wholeheartedly disagree unless you can show some numbers to back this up. From what I have seen the REOCCURRENCE rate for the 'transpoosion' is unmatched with numbers in the high 90's.

      It is absolutely ridiculous that something so effective is so quickly dismissed (hard to patent healthy poo, I guess). It took off in Europe and they do a different version that I must admit makes me squirm, they run a tube through the esophagus and stomach and insert the poo culture into the small intestine.

    2. Thank you, Rose, for catching that. What I meant to say was that oral vancomycin is the most effective treatment for C. diff when you factor in availability and cost. Fecal transplants have been shown to be somewhat superior, but they are still much less readily available (certain medical centers) than vancomycin (virtually any pharmacy). At present, vancomycin is still a very reasonable first-line therapy, effective in the majority of cases. Perhaps in time the standard of care will shift.

  2. Replies
    1. Fixed by revision; I didn't like the original anyway since one needs help. Thanks.

  3. https://www.goodreads.com/book/show/18377999-gulp

    Funny, I was talking about fecal transplants at work yesterday.

  4. Is it any wonder that many people no longer believe the medical community when they tell us we should get flu shots?

    1. Yes. Yes, it is a wonder. There will always be outlying horror stories for any procedure. The point is that it wouldn't be approved for use if the benefit didn't far outweigh the risk.

  5. Doctors have taxing regulations to adhere to, and everything that includes transplanting living organisms from one person to another is a smorgasbord of legal liabilities. A doctor will "follow the book" because this is what helps most people, but this also means that individual cases are treated less effectively.

    Unfortunately, this is a slippery slope for quackery. In this case, the procedure has a significant background and it's been proven to be effective in some cases, but it's a nightmare to implement clinically.

  6. A single anecdote from someone that already resisted (refused) antibiotics for 40 years. This story does NOT mean that fecal transplants are better than antibiotics. Let's get some real medical data.

    1. Is this good enough for ya?



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