8 ms·

My wife has ulcerative colitis and it always surprises/annoys me when I ask the doctor about fecal transplants and they bring up the "ick" factor - how they thi

My wife has ulcerative colitis and it always surprises/annoys me when I ask the doctor about fecal transplants and they bring up the "ick" factor - how they think it is disgusting. They usually say something like "you really want someone else's poop in you?" At this point our only other option is for my wife to be cut open and have her intestines removed - which I find much more horrifying and risky, but they mention it as if it is just the normal thing to do.

e40 13y ago
Were I in your shoes, I'd go the DIY route and try our a FMT from you to your wife. The downside doesn't seem nearly as bad as surgery.
- babby 13y ago
  Id imagine one would want to analyze the matter to decern that its composition is conducive with the transplantee, though perhaps thats not strictly necessary.
  - ca98am79 13y ago
    The human body carries about 100 trillion microorganisms in its intestines (10x the number of cells in the entire human body), so little is known about it and our complex relationship with it. Further, we are not even sure if or in what way ulcerative colitis is related to our gut bacteria. So there isn't a way to tell if someone's stool is conducive. The best you can do is test it for disease or parasites.
npsimons 13y ago
Yeah, I initially had the "ick" reaction, but was then quickly annoyed that the article seems to have the "ick" tone throughout. There are already many things in medicine which have an "ick" factor, and many of them we just take for granted because we're used to it.
AlisdairO 13y ago
I know it's relatively early-stage research as yet, but have you come across Helminthic Therapy? I believe that's had some promising initial results for UC patients. Obviously not the sort of thing many people would want to consider before the intestine-removal stage, but at that point it might be worth looking into.
- btilly 13y ago
  Actually not that early-stage research. Just stalled by the FDA that decided it is a medical treatment and needs approval. The FDA approval process usually costs about $150 million, and there is no way to recoup it for anything not patentable. Hence research in this area died because it is not getting through the FDA process. How many other cheap treatments are not available for the same reason?
- tocomment 13y ago
  I couldn't find much information about the treatment details. Do you know if anyone has looked into sterilizing the worms? It seems like the only downside is worrying about the worms reproducing. If you could make them sterile before applying them, and then just take new ones every month or so.
  - refurb 13y ago
    They don't need to sterilize the worms, they just use worms that can't reproduce in humans (i.e. pig whipworms) I'm keeping an eye out for the trial results. If it works, it would greatly expand our understanding of immune diseases. http://biotechtranslated.com/2011/07/30/the-hygiene-hypothesis-goes-on-trial/ http://biotechtranslated.com/2011/07/30/the-hygiene-hypothes...
    - tocomment 13y ago
      I didn't realize that. That's pretty smart. Do you know if you still get weight loss with pig whipworms? I've always thought worms would be preferable to surgery for obesity too.
jpdoctor 13y ago
> but they mention it as if it is just the normal thing to do. As usual, you need to evaluate your doctors' incentives. Do they make more money from 1. Cutting your wife open, with all the associated hospital care or 2. Fecal transplant, for which their competition is free DIY? As Upton Sinclair said a long time ago: It is difficult to get a man to understand something, when his salary depends upon his not understanding it. Edit: BTW, I wish you luck with your situation. I gained familiarity because my wife had recurrent c-diff. During this episode, I saw such non-scientific quack-like behavior that I pretty much lost faith in most of the modern Medical Industrial Complex. And this was for a bacterial infection, for which the literature is accessible to anyone with a high-degree of education and a decent biology background. The takeaway lessons from our episode was: Take matters into your own hands as much as possible. You have 24 hours a day to work on your problems, the doctor has about 20 minutes. So if you're not an expert on your particular situation, then you're pretty well screwed.
- ca98am79 13y ago
  Thank you - yes, I agree. Not sure if this is completely relevant, but I found it very interesting: http://www.radiolab.org/blogs/radiolab-blog/2013/jan/15/bitter-end/ http://www.radiolab.org/blogs/radiolab-blog/2013/jan/15/bitt...
- usefulcat 13y ago
  > As usual, you need to evaluate your doctors' incentives. I would question their background even more. Think about how they were trained, and think about what are likely to be considered "best practices" in the medical field. Doctors tend to err on the side of caution (and usually with good reason). From that viewpoint, it's not surprising that something relatively new and seemingly radical is not likely to be recommended.
- Osmium 13y ago
  > As Upton Sinclair said a long time ago: It is difficult to get a man to understand something, when his salary depends upon his not understanding it. Incidentally, this is one of the many benefits of services like the NHS. Our doctors aren't thinking about their profit margins!
DanBC 13y ago
But with medical fecal transplants there's very little ick factor. Wikipedia has a nice article describing the process. (https://en.wikipedia.org/wiki/Fecal_bacteriotherapy https://en.wikipedia.org/wiki/Fecal_bacteriotherapy) It must be very frustrating for you. Good luck.
- ca98am79 13y ago
  Thank you. Yes, to me, it seems a lot less "icky" (and more natural) than taking chemotherapy drugs, or biologics via IV, or surgical removal of the large intestine - but these treatments are the norm.
- jpdoctor 13y ago
  > But with medical fecal transplants there's very little ick factor. I find the ick factor thing absurd. Again, Which is more likely? 1. An MD, who has been through anatomy lab which cuts off every part of the human body (ever cut off someone's face? Turns out that it is fascinating...), working long hours smelling formaldehyde over a dead body, and realizes that it's been a long time since the last meal so would like to step out for a bite to eat, thinks a fecal transplant is icky or 2. S/He won't make money. I'm gonna go with Occam on this one.
  - Fomite 13y ago
    Except since this isn't a standard procedure, they can charge whatever they please for the testing and prep - why do you think a doctor won't make money with fecal transplants? You seem to be asserting this with absolutely no evidence.
    - wtbob 13y ago
      > Except since this isn't a standard procedure, they can charge whatever they please for the testing and prep - why do you think a doctor won't make money with fecal transplants? Is he allowed to, either by law or his malpractice insurance?
      - 13y ago
7952 13y ago
Its not like you are putting something dirt into a place that was otherwise clean. The contents of my intestine are always icky, but it might as well be functional ick.
wiggins37 13y ago
I might chime in as an internal medicine resident that fecal transplantation is relatively new, and most doctors still only think of it being used for recurrent c diff (clostridium difficile) infections (which is a very bad diarrheal infection that is associated with antibiotic use and just being in the hospital). It sounds like you are doing a good job bringing this up and questioning why your doctors are choosing certain therapies for your wife. There's more and more data coming out on using fecal transplants in Ulceratic Colitis (UC) patients and for the most part it seems well tolerated (there is one case report I just saw of someone getting a fecal transplant for c diff and then having a flare of their UC after it was in remission for 30 years). Keep pushing and when they say no ask them why they don't think this is appropriate to try rather than the risks of surgery. It sounds like you've already done research online about this and are well informed. If her doctors aren't open to trying this (or can't because their hospital doesn't have experience doing this) I'm sure they would be able to refer you guys to someplace that would try it. Of course, there's the whole insurance issues of covering this (new and still experimental) which I won't get into but maybe there is a research study you can join.
cheald 13y ago
This is tongue-in-cheek, but find a doctor who has kids. Once you become a parent, poop becomes Just Another Thing. :)
- vidarh 13y ago
  We celebrated the 150th diaper changed when our son was two weeks. We know it was 150, as we got a 150-pack of nappy sacks, and it was empty two weeks in. Bought a cake and everything...

e40 13y ago

Were I in your shoes, I'd go the DIY route and try our a FMT from you to your wife. The downside doesn't seem nearly as bad as surgery.

babby 13y ago
Id imagine one would want to analyze the matter to decern that its composition is conducive with the transplantee, though perhaps thats not strictly necessary.
- ca98am79 13y ago
  The human body carries about 100 trillion microorganisms in its intestines (10x the number of cells in the entire human body), so little is known about it and our complex relationship with it. Further, we are not even sure if or in what way ulcerative colitis is related to our gut bacteria. So there isn't a way to tell if someone's stool is conducive. The best you can do is test it for disease or parasites.

npsimons 13y ago

Yeah, I initially had the "ick" reaction, but was then quickly annoyed that the article seems to have the "ick" tone throughout. There are already many things in medicine which have an "ick" factor, and many of them we just take for granted because we're used to it.

AlisdairO 13y ago

I know it's relatively early-stage research as yet, but have you come across Helminthic Therapy? I believe that's had some promising initial results for UC patients. Obviously not the sort of thing many people would want to consider before the intestine-removal stage, but at that point it might be worth looking into.

btilly 13y ago
Actually not that early-stage research. Just stalled by the FDA that decided it is a medical treatment and needs approval. The FDA approval process usually costs about $150 million, and there is no way to recoup it for anything not patentable. Hence research in this area died because it is not getting through the FDA process. How many other cheap treatments are not available for the same reason?
tocomment 13y ago
I couldn't find much information about the treatment details. Do you know if anyone has looked into sterilizing the worms? It seems like the only downside is worrying about the worms reproducing. If you could make them sterile before applying them, and then just take new ones every month or so.
- refurb 13y ago
  They don't need to sterilize the worms, they just use worms that can't reproduce in humans (i.e. pig whipworms) I'm keeping an eye out for the trial results. If it works, it would greatly expand our understanding of immune diseases. http://biotechtranslated.com/2011/07/30/the-hygiene-hypothesis-goes-on-trial/ http://biotechtranslated.com/2011/07/30/the-hygiene-hypothes...
  - tocomment 13y ago
    I didn't realize that. That's pretty smart. Do you know if you still get weight loss with pig whipworms? I've always thought worms would be preferable to surgery for obesity too.

jpdoctor 13y ago

> but they mention it as if it is just the normal thing to do. As usual, you need to evaluate your doctors' incentives. Do they make more money from 1. Cutting your wife open, with all the associated hospital care or 2. Fecal transplant, for which their competition is free DIY? As Upton Sinclair said a long time ago: It is difficult to get a man to understand something, when his salary depends upon his not understanding it. Edit: BTW, I wish you luck with your situation. I gained familiarity because my wife had recurrent c-diff. During this episode, I saw such non-scientific quack-like behavior that I pretty much lost faith in most of the modern Medical Industrial Complex. And this was for a bacterial infection, for which the literature is accessible to anyone with a high-degree of education and a decent biology background. The takeaway lessons from our episode was: Take matters into your own hands as much as possible. You have 24 hours a day to work on your problems, the doctor has about 20 minutes. So if you're not an expert on your particular situation, then you're pretty well screwed.

ca98am79 13y ago
Thank you - yes, I agree. Not sure if this is completely relevant, but I found it very interesting: http://www.radiolab.org/blogs/radiolab-blog/2013/jan/15/bitter-end/ http://www.radiolab.org/blogs/radiolab-blog/2013/jan/15/bitt...
usefulcat 13y ago
> As usual, you need to evaluate your doctors' incentives. I would question their background even more. Think about how they were trained, and think about what are likely to be considered "best practices" in the medical field. Doctors tend to err on the side of caution (and usually with good reason). From that viewpoint, it's not surprising that something relatively new and seemingly radical is not likely to be recommended.
Osmium 13y ago
> As Upton Sinclair said a long time ago: It is difficult to get a man to understand something, when his salary depends upon his not understanding it. Incidentally, this is one of the many benefits of services like the NHS. Our doctors aren't thinking about their profit margins!

DanBC 13y ago

But with medical fecal transplants there's very little ick factor. Wikipedia has a nice article describing the process. (https://en.wikipedia.org/wiki/Fecal_bacteriotherapy https://en.wikipedia.org/wiki/Fecal_bacteriotherapy) It must be very frustrating for you. Good luck.

ca98am79 13y ago
Thank you. Yes, to me, it seems a lot less "icky" (and more natural) than taking chemotherapy drugs, or biologics via IV, or surgical removal of the large intestine - but these treatments are the norm.
jpdoctor 13y ago
> But with medical fecal transplants there's very little ick factor. I find the ick factor thing absurd. Again, Which is more likely? 1. An MD, who has been through anatomy lab which cuts off every part of the human body (ever cut off someone's face? Turns out that it is fascinating...), working long hours smelling formaldehyde over a dead body, and realizes that it's been a long time since the last meal so would like to step out for a bite to eat, thinks a fecal transplant is icky or 2. S/He won't make money. I'm gonna go with Occam on this one.
- Fomite 13y ago
  Except since this isn't a standard procedure, they can charge whatever they please for the testing and prep - why do you think a doctor won't make money with fecal transplants? You seem to be asserting this with absolutely no evidence.
  - wtbob 13y ago
    > Except since this isn't a standard procedure, they can charge whatever they please for the testing and prep - why do you think a doctor won't make money with fecal transplants? Is he allowed to, either by law or his malpractice insurance?
    - 13y ago

7952 13y ago

Its not like you are putting something dirt into a place that was otherwise clean. The contents of my intestine are always icky, but it might as well be functional ick.

wiggins37 13y ago

I might chime in as an internal medicine resident that fecal transplantation is relatively new, and most doctors still only think of it being used for recurrent c diff (clostridium difficile) infections (which is a very bad diarrheal infection that is associated with antibiotic use and just being in the hospital). It sounds like you are doing a good job bringing this up and questioning why your doctors are choosing certain therapies for your wife. There's more and more data coming out on using fecal transplants in Ulceratic Colitis (UC) patients and for the most part it seems well tolerated (there is one case report I just saw of someone getting a fecal transplant for c diff and then having a flare of their UC after it was in remission for 30 years). Keep pushing and when they say no ask them why they don't think this is appropriate to try rather than the risks of surgery. It sounds like you've already done research online about this and are well informed. If her doctors aren't open to trying this (or can't because their hospital doesn't have experience doing this) I'm sure they would be able to refer you guys to someplace that would try it. Of course, there's the whole insurance issues of covering this (new and still experimental) which I won't get into but maybe there is a research study you can join.

cheald 13y ago

This is tongue-in-cheek, but find a doctor who has kids. Once you become a parent, poop becomes Just Another Thing. :)

vidarh 13y ago
We celebrated the 150th diaper changed when our son was two weeks. We know it was 150, as we got a 150-pack of nappy sacks, and it was empty two weeks in. Bought a cake and everything...