Laura Butler is one of only two donors for fecal transplants at the Ridge Meadows Hospital.

‘Pretty stinking amazing’

Ridge Meadows Hospital is the only one in Fraser Health currently performing fecal transplants.

Laura Butler is an organ donor, a blood donor. If you need a kidney, she would gladly hand one over. And now she’s giving, to those in need, her poop.

Butler donates her stool to patients suffering from clostridium difficile infection, most commonly known as C. difficile.

Ridge Meadows Hospital is the only one in Fraser Health currently performing fecal transplants, and Butler is one of only two accepted donors there.

So far the development officer with the Ridge Meadows Hospital Foundation has made two such donations, to three patients at the hospital, and her specimen cured two of them, within hours.

Her first donation was transplanted three weeks ago.

C. difficile is a bacteria that causes diarrhea and other intestinal conditions, such as pseudomembranous colitis, or inflammation of the colon, and can be fatal.

Those suffering from it can have multiple episodes of diarrhea a day, with few signs of onset.

Risk factors of contracting C. difficile include being on antibiotics, being over 65, or taking strong antacids, called proton pump inhibitors.

The Fraser Health Authority sees 700 to 800 in-patient cases of C. difficile a year, with a mortality rate of 24 per cent in intensive care unit patients

Dr. Edward Auersperg is the only doctor at Ridge Meadows Hospital performing fecal transplants.

They are less expensive than drug treatments, more healthy, and more successful.

“In numbers of cells, [we are] about 95.5 per cent bacteria and other microbes and 0.5 per cent human. And when you mess with that by pouring in antibiotics, you totally disturb the eco-system,” he said.

Until now, doctors tried to kill C. difficile with antibiotics, but such drugs also kill many normal bugs.

“That’s like pouring napalm into the forest to try to make the eco-system normal again,” explained Dr. Auersperg.

C. difficile patients are first administered Flagyl for two to three weeks. It is the cheapest drug at $15 to $20 per treatment.

If unsuccessful, they are put on Vancomycin for two weeks.

Again, if not successful, they are tapered off that drug with six weeks of Vacomycin, which can cost up to $500 per treatment.

With drugs, the recurrence rate after a first episode of C. difficile is 15 to 35 per cent. There is a 40 per cent chance of recurrence the second time, and a 65 per cent chance the third time.

A single patient could have as many as 26 relapses.

Each time the drug is less effective.

A new drug, Fidaxomicin, which is more selective in the bacteria it kills, costs $2,300 per treatment, and its success rate is around 30 per cent.

Fecal transplants have an 80 to 92 per cent success rate per single dose. And if needed a second time, the success rate climbs to 95 per cent.

Butler’s stool costs only a fraction of the conventional drug therapies.

She is screened every six months to make sure she hasn’t contracted anything that could be passed on through her stool.

Each screening costs around $500, but she can donate as many times as needed within those six months.

Having just a few donors saves costs.

“If I had to screen every patient’s spouse or roommate, it would get a lot more expensive,” Dr. Auersperg said.

He sends Butler a text message the night before he needs a donation.

She places a special cup over the toilet bowl and collects her sample as one cleans up after a dog – in a plastic bag.

She will bag her stool three times, place the plastic bags inside a paper one, then delivers it to the hospital the following day.

Dr. Auersperg takes a stool sample, mixes it with two or three parts water and put it inside a plastic shaker cup with a metal ball, like those used to mix salad dressing. He shakes it, filters it through three layers of gauze, puts 60 millilitres into a syringe and gives it to the patient as an enema.

To qualify for fecal transplants, patients must have already tried conventional drug therapies.

Dr. Auersperg first performed fecal transplants three years ago, but was told by Fraser Health to stop.

“Fraser Health has always been very cautious in letting new medical programs start, especially when the evidence for them and the literature isn’t great,” he said, “and their feeling was very definitely, at that point, that the evidence wasn’t sufficient.”

Health Canada approved fecal therapy solely to treat recurrent C. difficile in October 2015.

“We don’t know what causes Crohn’s, colitis, obesity, multiple sclerosis, depression, and it’s not stupid to think that, in some cases, it’s the bacteria in the gut,” Dr. Auersperg said.

“When I transplant Laura’s poo, there are thousands of species, and we don’t understand them individually, let alone as a mob. It’s simply the unknown.”

With Health Canada approval, Dr. Auersperg expects fecal transplants will eventually become the second resort, not the last, for C. difficile treatment.

He also believes that, within a few years, donations could be frozen and preserved rather than needing fresh samples to conduct the treatment. He think samples could also be freezer dried, put into capsules and ingested orally.

If the exact bacterial species needed to fight C. difficile can be identified, he said it could be grown  in a lab and mixed for patients to drink.

Currently, there are no patients being treated for C. difficile at the local hospital, but Dr. Auersperg has two people on his waiting list.

“I just have to find a time,” he added. “You have to coordinate my availability, the patient’s availability, Laura’s stool’s availability and space in the hospital to do it. And the logistics of that are not as easy as you think.”

But the results are exciting for Dr. Auersperg.

Last week he received a message from one of his C. difficile patients, who, having not felt well enough in months, was able to go to breakfast on Mother’s Day.

“The really cool thing is, a majority of patients with C-dif who suffered for months on end would say they would rather get another fecal transplant than another course of antibiotics, because the antibiotics make them feel lousy,” said Dr. Auersperg.

Butler feels good that she is able to help.

She has had to modify her diet some, avoiding certain foods that patients are allergic to, but that is all.’

“This is poop. If it will make a difference, my body makes it, I’m not using it, go for it,” she said.

“These people have had instantaneous results from a debilitating, stay-at-home, can’t-do-anything lifestyle. It’s pretty stinking amazing.”

 

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