From the Old Doctor’s Scrip Pad

marionbrowningwasatherwitsendtheseventynineyearoldretirednur
sesufferedfromchronicdiarrheaforalmostayearitbeganafterdocto
rsprescribedantibioticstotreatherdiverticulitisapainfulinfec
tionofsmallpouchesinthewallofthecolontheregimenalsokilledfri
endlybacteriathatlivedinbrowningsintestinesallowingatoxinpro
ducingorganismknownasclostridiumdifficiletotakeoverabegineat
ingawayattheentireliningofhergutformonthsbrowningwasinandout
ofherdoctorsofficegettingbiggunantibioticstosuppressthecdiff
icileinfectioneachtimeacourseoftreatmentendedshewouldfeelbet
terforawhilebutherstrainofcdifficilewasstubbornafewofthedest
ructivebacteriaalwayssurvivedwithinafewdaystheywouldbeginmul
tiplyingandtherackingdiarrheawouldrecurrecurrecurrecurrecura
fterfourroundsofantibioticshergastroenterologisttoldherthath
ehaddoneallhecouldthinkofherecommendedthatsheseecolleenkelly
aclinicalfacultymemberatbrownuniversitysmedicalschoolwhowast
ryingsomethingnewkellyproposedatreatmenthatsoundedbothlogic
alandstrangelyunmedicalnormallyshetoldbrowningthefriendlybac
teriathatresideinthehumanintestinemaintainaseesawingbalancet
hatkeepspathogenicbacteriaincheckthatequilibriumcanbetempora
rilydisruptedaswithstandardantibiotictreatmentbutitnearlyalw
aysreturnstostabilitybrowningsownbacteriacommunityhadlosttha
tabilityprobablyforgoodstilltheewasawaytorestorenormalitykel
lysaidshecouldreplacebrowningsbacteriacompletelybyinsertingi
ntohercolonadilutedsampleofstoolfromsomeonewhoseintestinalhe
althwasgoodifthegoodbacteriainthedonatedstooltookholdandreco
lonizedherintestinethecdifficilewouldbecrowdedoutandshewouldbecured

browninghadneverheardofsuchaprocedurevariouslycalledfecaltra
nsplantfecalbacteriotherapyorfecalflorareconstitutionbutshew
asreadytotryanythingkellyaskedhertorecruitahealthydonorbrown
ingchoseherfortynineyearoldsoninthefalloftwothousandandnineb
rowningperformedthebowelcleanisingroutinethatprecedesacolono
scopywhilehersontookanovernightlaxativekellydilutedthedonati
onthenusedcolonoscopyinstrumentstosquirtthesolutionhighhighh
ighupbrowningslargeintestinethediarrhearesolvedintwodaysandh
asneverreturnedicantunderstandwhymoredoctorsarentdoingthissa
ysbrowningnoweightybrowningisnotaloneinbeingasuccessstorymos
tclinicianswhoperformfecaltransplantsasktheirpatientstofindt
heirowndonorsandpreferthattheybeachildsiblingparentorspousef
ormeitsaestheticsayschristinasurawiczaprofessorofmedicineatt
heuniversityofwashingtonwhohasdonetransplantsontwodozenpatie
ntsandpublishedanaccountofthefirstnineteentheressomethingver
yintimateaboutputtingsomeoneelsesstoolinyourcolonandyouarea
lreadyintimatewithaspousetoensuresafetythephysiciansperformi
ngtheprocedurerequirethatdonorshavenodigestivediseasesandput
themthroughthesamelevelofscreeningthatblooddonationwouldrequ
irethatprocessimposesacostintimeandlogisticsbecausestandardr
ulesformedicalconfidentialityrequireadonortobeinterviewedsep
aratelyfromapotentialrecipientitalsocarriesinherentfinancial
penaltiesthedonorslabworkmostlikelywillnotbecoveredbythepati
entsinsuranceproponentshavecomeupwithworkaroundsforthoseposs
iblebarrierskhroutsnolongerusesrelateddonorswhichrequiresfin
dingadifferentindividualforeverycasebutinsteadhasrecruitedac
adreofuniversaldonorsfromamonglocalhealthcareworkershehassee
nnochangeinhowoftentransplantstakelastyearmichaelsilvermanof
theuniversityoftorontoboldlyproposedayetmorestreamlinedsolut
ionhavingpatientsperformthetransplantathomewithadrugstoreene
makitadrawbackhecautionedinclincalgastroenterologyisthattoom
uchofthestoolsolutionmightleakoutforthetransplanttotakenevertheless
sevenpatientswithrecurrentcdiffhavesafelyperformedthehomever
sionhewrotewithahundredpercentrecoveryrateevenwithoutlargesc
alerigorousinvestigationsoffecaltransplantsthemedicalcommuni
tyappearstobecomingaroundtothepracticeitisclearthatfecalbact
eriotherapyhasusingdonorstollhasarrrivedasasuccessfultherapy
alberteinsteinsbrandtrecentlysuggestedthatfecaltransplantssh
ouldbeafirstratherthanalastresortincreasingresearchinneresti
ntheinfluenceofgutfloraontherestofthebodyandonconditionsasva
riedasobesityanxietyanddepressionwilllikelybringpressurefort
ransplantstobeadoptedmorewidelytheolddoctorandhiscollaborato
rshopetofilewiththefdabeforemuchlongerkellyadmitsthatsomeoft
hemareapprehensiveabouttheoutcomewehopetheywillnotaskthingst
hatwecannotanswershesaysmedicalcentersneedtobeabletostudythe procedurekellyarguesbecausepeoplearetryingitontheirown