Rare surgical procedure saves 88-year-old woman

Published 12:00 am Saturday, May 17, 2014

SALISBURY — Mildred McGee was dying.
Suffering from her fourth serious bout of Clostridium difficile infection, or C. diff, in as many years, the 88-year-old Rowan County woman had been hospitalized and bedridden for two weeks with diarrhea so severe it was nearly constant. She was pale, weak, in pain and could barely eat. None of the antibiotics that doctors were pumping into her body was working, and her white blood cell count had shot up to 50,000.
McGee’s grand-niece Carolyn Isaacson, a nurse from Landis, began researching any possible alternative treatment.
She knew about an ancient cure for chronic diarrhea that was making a comeback in medical journals, offering near-miraculous results to desperate doctors and their patients with antibiotic-resistant C. diff.
After reading more about the unconventional procedure, Isaacson became convinced it was her aunt’s only chance. She approached family members and said they needed to consider fecal microbiota transplantation. In other words, a stool transplant.
“The option is either we are going to do the procedure or call the funeral home,” Isaacson said she told Donnie McGee, Mildred’s son.
On Feb. 3, Dr. Vineet Korrapati, a gastroenterologist who had been at Rowan Diagnostic Clinic for six months, performed the first stool transplant in Novant Health Rowan Medical Center history and one of the first in North Carolina. He took Isaacson’s healthy poo, mixed it with saline in a blender and transplanted it into her aunt’s colon with an endoscope through colonoscopy.
Within hours, McGee’s skin was pinker, her eyes were brighter and she was more alert. After two days, she had regular bowel movements. And a week later, she was discharged from the hospital.
“I told her this was her miracle,” Isaacson said.
After years of repeated use of antibiotics, McGee’s gut had been cleaned out of good bacteria, allowing C. diff to take over, Korrapati explained. The good microorganisms in Isaacson’s poo multiplied in her aunt’s colon and restored the gut’s ecosystem.
“All we did was give someone else’s good bacteria to this lady,” he said.
The procedure took less than an hour, cost a fraction of the price of a hospital stay or antibiotics and has a 92 percent cure rate, based on about 375 cases done worldwide in 2012 and 2013.
The first known record of stool transplant dates back to fourth-century China. Centuries ago, it was a popular treatment method in the United States, Europe and Australia. There are reports of successfully using donor poo to cure gut ailments throughout written medical history across the globe.
“The crazy part is, vets have been doing it in horses for years. We did not pay attention until recently,” said Korrapati, one of a handful of doctors in North Carolina certified to perform the procedure.
The medical community is buzzing about the shocking success of stool transplants to cure C. diff and possible use of the therapy to treat everything from Crohn’s disease to rheumatoid arthritis. Mayo Clinic in Arizona has performed more than 20 fecal microbiota transplants in C. diff patients. In every case, the infection was completely eradicated, often within hours or days.
Researchers in the Netherlands last year had to stop the first controlled trial of stool transplant as a treatment for recurrent C. diff because donor poo was so much more effective at curing the infection than antibiotics, they said it would have been unethical to continue the study. Stool transplant in the study had a 94 percent cure rate, compared to a 31 percent cure rate for antibiotics.
After weeks of such misery that Mildred McGee said open heart surgery in 1992 “was a toy” compared to C. diff, the dramatic change in her quality of life after a stool transplant was nothing short of amazing, Isaacson said.
Sitting next to her great aunt while they shared their remarkable story, Isaacson was happy and proud to take some of the credit.
“They call me the girl with the magic poo,” she said.
And both women erupted into giggles.
Isaacson, 52, has become an enthusiastic advocate for stool transplant but knows what she’s up against when trying to get others to embrace the concept. She said she had a family member who would have gone to her grave before having donor poo in her body.
“There’s an ick factor. I get it,” Isaacson said. “But we have to get medical people to accept this is as a possibility.”
Poo stinks. It’s messy. Humans are trained from a young age to stay away from it, and for good reason. Feces is teeming with dozens of species of disease-causing organisms, ranging from parasites to bacteria, fungi and viruses.
But poo can also be powerfully good, and stool transplants continue to perform better than predicted. The procedure is simply a way to reseed an intestinal tract after antibiotics have killed off the native flora that would have fought off an attack from invasive species, Korrapati said.
McGee contracted her first case of C. diff at a nursing home, where she was undergoing muscular rehabilitation. Doctors cured her with antibiotics relatively easily.
But each bout became progressively more difficult to cure. In 2012, she had to take a $500 pill once a day for more than a week to finally defeat the infection.
As McGee’s condition deteriorated in January, Isaacson started looking for alternatives. Simultaneously, doctors at Rowan Diagnostic began talking about the potential of a stool transplant, which would be a first in Rowan County.
Korrapati first saw a stool transplant being performed in 2010. He studied with Dr. Lawrence Brandt, professor of medicine and surgery at Albert Einstein College of Medicine and an early proponent of the procedure. Korrapati eventually performed stool transplants during his residency at Winthrop University Hospital in New York and became certified.
“We live in constant flux with the bacteria in our body,” he said. “The majority of people think of bacteria as bad but there are 30,000 species of bacteria within your body that live in symbiosis with you and keep you healthy.”
When Korrapati approached McGee about the procedure, she had already heard about stool transplant from Isaacson.
“She was at the stage where she was willing to try anything,” he said. “She was asking me if I could to it that day.”
Unlike blood and breast milk, poo is not yet collected from donors and banked, so most patients use a family member. Because donors cannot have taken antibiotics within six months, Isaacson and one of McGee’s grandsons were the only potential donors living nearby.
On Jan. 28, a lab screened Isaacson’s poo to rule out parasites, HIV, hepatitis C and more. While she waited for the test results, Isaacson called her cousin, a Baptist preacher.
“Bruce, I know you’ve never prayed for poo, but pray for my poo that it is clear and I don’t have a disease,” she said.
Determined to be a perfectly healthy donor, Isaacson showed up to give her sample with a brand new blender in her backseat, hoping to speed up the process. Doctors politely declined.
McGee received the transplant on Feb. 3, and family members were stunned by the results that appeared within hours.
“It was like you watered a lily,” Isaacson said.
Dr. Chris Agner, McGee’s longtime physician, returned from a trip in time for McGee’s 88th birthday on Feb. 8, which she celebrated at Novant Rowan. When Agner saw McGee and the remarkable turnaround, he belted out “Happy Birthday.”
“You have never heard a doctor sing like that,” McGee said.
She left the hospital two days later.
The effects of the stool transplant continue today. McGee says she feels better now than she has in years and is down to one pain pill a day for rheumatoid arthritis. Before the transplant, she had been taking five.
Before the transplant, she needed assistance with almost all tasks. Now, she can bathe and dress herself. She can get out of bed on her own and move around her tidy home easily with help from a walker. Family members have to remind her to take it easy and rest.
As Isaacson describes it, her great aunt has a new lease on life and can enjoy her golden years without having to suffer.
When advocating for stool transplants, it helps to have a good sense of humor. Isaacson can rattle off poop puns like a standup comedian.
In Melbourne, Australia, transplant recipient Tracy McGowan recently launched a pro-transplant website called the Power of Poop.
Transplant recipient Catherine Duff of Indiana has created the Fecal Transplant Foundation to connect patients with providers, encourage more doctors to offer the treatment and push for clinical trials aimed at other digestive disorders. The foundation plans to use the website to sell T-shirts, tote bags and more with “unique and possibly hysterically funny slogans that we have had a wonderful time creating,” such as “Poop is the Sh*t!” and “Give a sh*t. Donate to the Fecal Transplant Foundation.”
Like many other groups, the foundation has an awareness ribbon. This one is brown.
Not every C. diff patient is right for stool transplant, Korrapati said. Antibiotics continue to be the treatment of choice in most cases. Korrapati said about one in 10 people referred to him could be a candidate, and he has several considering the therapy.
But for people with recurrent, hypervirulent C. diff, stool transplant makes sense.
“It’s a no-brainer when you look at it from a cost-effective point of view,” Korrapati said.
Researchers are looking at fecal microbiota transplantation as a potential treatment for all kinds of autoimmune disorders. Clinics are considering how best to store feces and looking for the best way to do the transplant, which Korrapati believes is currently colonoscopy.
Some researchers are experimenting with a pill form, although Korrapati said doctors may “have a hard time telling people you are swallowing poop.”
Isaacson’s first experience with stool transplant was about 48 years ago. Her uncle, a farmer, had a cow suffering from diarrhea.
He handed 4-year-old Isaacson a bucket and sent her to follow a healthy cow and collect a cow patty. She watched him mix the dung with fresh goat’s milk, which he used to give the sick cow an enema.
The next day, the cow was cured.
It wasn’t much of a leap to realize that the same concept could help alleviate her great aunt’s suffering and potentially add years to her life, Isaacson said.
“All the education and drugs in the world can’t produce something as good as nature can,” she said.
Contact reporter Emily Ford at 704-797-4264.