Monday, May 20, 2013

Shit just got real.

(To be submitted for consideration for the most groan-worthy blog title of 2013.)

(Also: NOT for the faint of heart or queasy of stomach, this one.)

I have a relative who has been dealing with an on-again, off-again case of C. diff., a form of chronic diarrhea, the likes of which (when you get past the ickiness of that concept) is truly a public health issue, and a scourge for many people, particularly the elderly and immunocompromised. (C. diff. is an abbreviation for Clostridium difficile...a bacteria that is so-named partially because it is so difficult to eradicate.) Dehydration, inability to be more than a few steps away from a bathroom because you have to go NOW goddammit, low energy, imbalanced electrolytes -- the likes of which cause you to fall and smack your head on the ground, then send you to the hospital to get checked out by a cardiac team and placed under quarantine -- these are just a few of the annoyances that C. diff can cause. And -- knock wood -- these will remain the only annoyances said relative must deal with. But I'm dubious.

A year or two ago, I read about an experimental therapy that on paper, sounded so disgusting, so repulsive, that I had a hard time wondering how anyone in their right mind would even consider it. (And believe me, I immerse myself in the realm of the strange and unusual medical practices. The validity of things like maggots for safe wound debridement and topical honey for diabetic ulcers fascinated me, and -- beyond that -- has been proven in repeated studies.) But then I stepped back, put on my I'm-in-anatomy-lab face -- the one that you have to put on when faced with the reality of being a medical student and being freaked out by a preserved specimen of the human body is simply not an option anymore -- and considered the therapy. Hmm...maybe it could work. Theoretically, it might make sense.

Then I read the studies done with said therapy. And all I can say is that if any drug company could promise a 90%+ success rate with eradicating a disease that is a public health scourge with a single treatment, without any side effects whatsoever, that company could sell off all its other piddly little drug offerings, mark up that one treatment, and exist comfortably till kingdom come. Because people? There is no such thing in the drug world.

But apparently there is such a thing that...ahem...exists within us all.

One study done with this therapy was discontinued prematurely because the study designers deemed it unethical to deny any of the study subjects this therapy, when it had proven so effective so quickly and uneventfully. Everyone got the therapy, everyone went home happy.

So at the hospital today, while I was visiting said relative (who, it must be said, looked exhausted and in rather bad shape), the supervising gastroenterologist walked in. So I got to ask him about the possibility of...yep...all together now...fecal transplantation.

He had to tell me that if I had asked him 2 weeks ago, he would have heartily agreed. As it is now, the FDA has put a stop on all fecal transplants unless a doctor really wants to go through a mind-numbing set of bureaucratic hoops, tons of paperwork, and waiting a minimum of 30 days to be approved. In which time a patient for whom antibiotics aren't working, could possibly suffer an infection to the colon and instead need to get a colectomy. (Sorry...told ya this could get tough in here.)

I'm still not sure why the FDA is preventing this sort of treatment right now. Legal stuff? Trying to establish a standardized protocol? I understand the need for that. But in a case like this, you don't stand on the cliff and wait to get your wings right before you fly. You jump off the cliff and build your wings on the way down. Because in the latter case, you're saving lives and helping others to become dramatically better with a single treatment. And in the former, you're basically being unethical, to put it rather euphemistically.

So now we sit and wait and hope and pray that yet another round of antibiotics -- probably months' worth -- could somehow get this flare-up under control. (Me myself, I doubt it. If a month-plus of vancomycin and Flagyl didn't eradicate it entirely last time, when this poor woman was a bit younger and a bit healthier, why would it work this time?)

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