Recurrent C-Difficile: A Tenacious Germ

This post isn’t related to pediatric stroke, but to other medical complications we have gone through!  Specifically, recurrent clostridium difficile (C-diff) infection.

C. difficile is a bacteria that can asymptomatically reside in anyone’s GI tract.  It generally doesn’t cause any problems as long as your normal bacterial flora keeps it in check.  It is extremely easy to “catch” from medical facilities (long-term care, hospitals) as it forms spores that are notoriously difficult to kill.  Trouble arises if it is lurking in your bowels when you take broad-spectrum antibiotics for some other unrelated infection.

There are only 2 common antibiotics that effectively treat C. difficile: Metronidazole and Vancomycin.  Metronidazole is cheap, but affects your body systemically (doesn’t just stay in your guts).  Vancomycin is horrendously expensive, but stays in your GI tract if taken orally (doesn’t go into your bloodstream, doesn’t have side effects).  There are potential other antibiotics listed here (which weren’t available to me).

I was prescribed broad spectrum antibiotics (Cephalexin) for a mastitis infection the week after one of my children was born.  Since it had been a 5-day hospital stay, I unfortunately likely acquired C.diff at this time (which had been asymptomatic and controlled by my normal flora).  With my normal flora wiped out, I began to experience antibiotic-associated diarrhea a few days into treatment – the C. diff (unaffected by cephalexin) began to flourish.  After a trip to the ER, some hydration and a fecal test, I was prescribed oral vancomycin since I was breastfeeding (metronidazole passes into breastmilk).

How do you know it’s C.diff?  One of the symptoms of C.diff is a “psuedomembrane” (pus) of mucus, dead cells, and bacterial toxins.  It comes out in your stool looking just like this…

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After my vancomycin course was finished, the C.diff recurred within a few weeks.

I was started on another course of vancomycin.  The C.diff recurred DURING my course of antibiotics this time.

Since there are no infectious disease specialists where I live, I googled recurrent C.diff infections and found a taper-pulsed dose regimen that I convinced the ER doctor to prescribe for me…  Something like the one in the chart found here; published paper about it here.

During my vancomycin taper-pulse dose regimen, I also took the probiotic (a friendly yeast) S. boulardii, which has been shown to be effective specifically against C.diff.  (See papers here and here).  (It is available at local pharmacies if you phone around.)  However, you don’t want the vancomycin to kill the S. boulardii, so you have to space it out between the antibiotic doses (but as a yeast I am not sure it would be killed?  I spaced it out anyways).

I.E.   6:00 Vancomycin

9:00 S.boulardii

12:00 Vancomycin

3:00 S. boulardii

(etc.)

This was exhausting to follow around the clock with a newborn!

I ended up recurring again, during the lower-dose taper while I was on the vancomycin.  At this point I was desperate… And found fecal transplants for recurrent C.diff through google searching.  (Note they are currently working on generic fecal transplants, nicknamed RePOOPulate – produced by a RoboGut – no word of a lie.)

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I was once again prescribed 2 days of high dose Vancomycin, while my family bundled up and traveled to meet with a doctor (I’m not even sure what his specialty is – GI or infectious diseases?) who agreed to perform a fecal transplant for me.  Likewise, my sister bundled up and traveled to meet us with her family, as she agreed to be my donor (they required a close blood relative with no known communicable diseases).

On day 3, I had the fecal transplant my sister lovingly donated for me that morning with the help of some strong coffee….

Yes, you read that right.  When you’re desperate and think you are going to die from septic shock and leave your newborn behind, you will do anything for a cure.

I thank the Good Lord that the doctor I found was trialing a new method of fecal transplant which involved ingesting “poop pills” instead of the more traditional routes of top down (liquified poop infusion via nasogastric tube) or bottoms up  (poop enema – going in rather than coming out).  My sister’s donation was carefully processed and strained to make a bacterial slurry (gut-friendly normal flora), that was packaged into triple-coated pills.  I had to eat 32 of them on an empty stomach.

And….it totally worked.  Cured, no more diarrhea.  So, if you are struggling with recurrent / chronic Clostridium difficile, there is cure!

I credit my Heavenly Father for leading me through all the steps above – from the vancomycin, to the pulse-dose regimen, to the doctor willing to perform a fecal transplant (which was then very experimental), to the cure.  God does not spare us from the hardships of life, just as He did not spare Himself from life’s hardships when He lived among us.  Instead, He helps us through.  This gives us an opportunity to grow our faith muscles as we learn to rely on Him for the day’s strength.

Therefore, since we have a great high priest who has passed through the heavens, Jesus the Son of God, let us hold fast our confession. For we do not have a high priest who cannot sympathize with our weaknesses, but One who has been tempted in all things as we are, yet without sin. Therefore let us draw near with confidence to the throne of grace, so that we may receive mercy and find grace to help in time of need.  (Hebrews 4:14-16)

I strongly believe that in this life, nothing happens by accident or coincidence – things aren’t determined by fate or luck (good or bad).  I believe there is an overarching story – a beautiful picture of love, loss, and redemption – and that there is Someone who cares and is in control.  You are already a part of this story, whether you know or believe it or not.  While the end of the story has already been written, your own part lays open before you for you to choose your ultimate destiny.  Perhaps our coinciding struggles have been finely orchestrated to lead you to this one moment: The Bridge to God.

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“Praise be to the God and Father of our Lord Jesus Christ. The Father of compassion, the God of all comfort, who comforts us in all our troubles so that we can comfort those in any trouble with the comfort we ourselves have received from God. For just as the sufferings of Christ flow into our lives, so also should the comfort of Christ overflow.” (2 Corinthians 1:3-5)

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