Fecal Transplants

February 17, 2015


A life-saving procedure being performed at Penn Highlands Healthcare called fecal transplants. Shown in the GI Lab where they take place at Penn Highlands DuBois are, from left, Dr. Richard Latuska, g

 

There is something that is life-saving, and most of us are just flushing it away.

Though it sounds unsavory, fecal transplants are being performed at Penn Highlands Healthcare, and they are saving lives.

Fecal transplants are exactly what the name says. Feces is taken from a healthy donor and put into the body of an unhealthy person with the expectation that the healthy specimen’s bacteria and flora will spread and reproduce.

Why do this? The lack of healthy flora and bacteria can be life-threatening for people.

For example, Clostridium difficile, or C diff, is a germ that can occur in patients taking antibiotics. The most common symptoms of a C. diff infection are watery diarrhea, fever and loss of appetite. It can be hard for the person to fight off, and it can spread as C diff spores can live outside the body for a long time.

It can lead to dehydration, and severe dehydration may cause brain damage, seizures or death.

To receive a fecal transplant, a physician makes a referral for a patient to Dr. Richard Latuska, gastroenterologist at Penn Highlands DuBois.

An appointment time is set to use the GI Lab at PH DuBois, and the patient is to find a healthy family member to provide a specimen to use.

The donor doesn’t have to be a family member, but Latuska believes that a patient will have an easier time working with one. Since a health-history and testing is needed from the donor, family members often easily know who is healthy enough to donate.

The screening process also consists of a blood test and a test of a small fecal sample. The screenings look for infections or something else that a patient wouldn’t want passed along to them, Joseph Tegano, RN and director of the GI Lab at PH DuBois, said. 
 
“We have exclusion criteria regarding bacteria, flora, autoimmune disorders, etc.,” Lorie Natoli, physician assistant at Penn Highlands Gastroenterology, said.

The donor also has to:
Be antibiotic-free for the past three months;
Be free of any gastrointestinal illness;
Have a healthy autoimmune system;
Have no chronic pain syndromes, such as fibromyalgia or chronic fatigue;
Have no neurological disorders;
Be of a healthy weight;
Have no history of cancer or other malignant illnesses;
Be out of jail for more than a year;
Not have had a tattoo or body-piercing in the last six months;
Have a current respiratory infection;
Have any allergic diseases or recent ingestion of nuts if the recipient has an allergy;
Not be a hospital or healthcare worker.

Believe it or not, the FDA stepped in once to regulate feces, but that idea was set aside when it was realized it wasn’t possible. Since it is non-FDA regulated, patients will sign a paper saying they understand that.

The donation is brought to the GI Lab the same day as the procedure, Kathy Ellenberger, RN in the GI Lab at PH DuBois, said. It needs to be less than 6-8 hours old, Tegano said. The GI Lab schedules the procedure for the end of its day, so it gives donors time to produce.

Though not an easy request, “if your family member is sick enough, you’re willing to do it,” Natoli said.

Natoli is responsible for turning the specimen into a liquid. She puts the donation in a blender with water and strains it for solids. She only needs the amount equal to a deck of cards.

As for the blender, it is one donated by the patient for this one-time-use, and it is thrown out as hazardous medical waste afterwards. Most people buy them at yard sales and thrift stores at minimal cost.

The procedure is similar to a colonoscopy. The patient is asleep and the tube is inserted through the rectum to the colon. It is sent to the right side of the colon at the end of the small bowel, Ellenberger said. About 500 milliliters are irrigated through the tubing.

Some other procedures done elsewhere use a feeding tube and other methods, but Latuska does not use them.

Patients are given Imodium, a diarrhea prevention medication, one hour before the procedure to slow the process of it coming back out, Tegano said. After a resting period for the patient, he or she is sent home.

“In the colon, the flora recolonizes and normal function returns,” Latuska said. The procedure has a 95 percent success rate usually, but for the 15 cases Latuska has done, the success rate is 100 percent. 

“Most people can’t believe this is for real,” Tegano said. 

But the use of feces to help sick people isn’t new. It has been written about by sailors crossing the oceans to help cure cholera and dysentery, Tegano said. And physicians have always known about its use in theory, but it was never something really used until about 2-3 years ago. 

Latuska read about its successes in medical literature, but he didn’t think he would be using it until a primary care physician called him. The doctor had a patient whose C diff was severe and recurring, and he was hoping for something to help her.

She was the first patient in June 2013, Natoli said.

Natoli recalled that this first patient looked very debilitated and tired. Not long after the procedure, she had color and substance back in her face along with a smile.

 “Within 7-10 days, most people notice a difference,” Latuska said. Follow ups are done with patients within a week of the procedure and then every month for a short time.

“As gross as it is, it is just as amazing,” Natoli said. “Someone who has been sick for so long can look amazing and feel good.” 

“People are surprised by the simplicity of it,” Latuska said. With so many high tech treatments in medicine, “this is getting down to basics...this life-saving procedure is so simple and so important.”

“I’m proud to be a part of it,” Natoli said. “It really does help people.”