Healthy, Happy Poop — My FMT and Me

Fun Fact

Canada tops the world in smiling poop emoji use. I love this amusing irreverence. Our text messages reveal that we Canadians are not quite as polite as the rest of you perceive us to be. Nudge, nudge, wink, wink.

Not-so-fun fact

Most of my life has centered around the desire to have happy poops. A diagnosis of Inflammatory Bowel Disease (IBD) brings with it a necessary fixation on the simple act of having a bowel movement. This otherwise innocuous affair of eating and defecating is fraught for a person with active IBD. Most IBDers will at one point suffer from a relentless and pathological fear of eating because eating is sure to result in tenacious cramps that muscle their way through a colon already inflamed and ulcerated resulting in an agony so visceral and deep, just thinking of this ordeal makes me want to curl up fetal and sob. But there’s more. I haven’t got to the worst part yet – namely, the trauma of witnessing the bloody mess exiting your body…if you’re lucky, into the toilet. If not, into your pants.

Yup, shit just got real. I will never forget the emotional and physical anguish Crohn’s has caused, and that makes having gained the upper hand on a notoriously difficult-to-treat disease all the sweeter.

As most of you know, I’ve used food as medicine to some degree throughout the 20+ years I’ve had Crohn’s. More recently I found just the right combination of diet, lifestyle, and conventional medicine. This combination was so spot-on that I had reached a long-time goal – regular, unimpeded, blissfully happy poops. Until I contracted Clostridium difficile.

And then shit got really real.

Celebrating a Milestone and My Microbiome

But before I get to that C. diff-related nasty and sordid chapter in my health history, I want to celebrate today – a pretty special and exciting milestone.

Two weeks ago I had a fecal microbiota transplant (FMT)! And I’m slowly but surely winning the battle against a superbug so serious and so powerful it takes hundreds of thousands of lives every year.

In a way, I’ve had an organ transplant. In a recent Balanced Bites podcast, Dr. Perlmutter called the human microbiome a 3-pound organ. I’ve got a whole new set of diverse and healthy flora making friends in my colon.

You can well imagine how eager I am always to nurture my microbiome but especially now in these early and sensitive days following the FMT. This is why I declared the day of my FMT as Day 1 of The 21 Day Sugar Detox program. I didn’t want to give any remaining bad bacteria fuel for acting up again. I don’t eat a highly refined diet anyway. I certainly don’t consume any refined sugar and very minimal naturally occurring sugar, but in the interest of this second chance at gut health, I’ve embarked on a temporarily stricter version of grain/gluten-free, dairy-free, legume-free, sugar-free way of eating.

But back to how this all came about. It’s no surprise I ended up with C diff. I really should have seen that monster coming.

Risk Factor No. 1: Antibiotics

Earlier this year I wrote about my decision to consent to surgery to deal with an ongoing complication of Crohn’s – a perianal abscess. That abscess had been dogging me for about two and a half years, during which time I required on-and-off (but more on than off) broad-spectrum antibiotics.

Risk Factor No. 2: Hospitals and Healthcare Workers

Although I was only in the hospital one day, not even requiring an overnight stay, that brief duration left me at risk for contracting C diff, which thrives in hospitals. Alcohol-based cleaners do not kill C. diff. C. diff spores are gritty buggers, surviving for months on hard surfaces. Bleach apparently does the job, though.

What is more, I required daily homecare for wound packing for two weeks following the surgery. I read one statistic that up to 75% of healthcare workers had C. diff present on their hands.

Risk Factor No. 3: Underlying Medical Condition

I have Crohn’s.

What C. diff Felt Like

C. diff causes brisk (at times bloody and mucousy) diarrhea. C. diff is painful, as the bacteria invades your colon and causes inflammation. C. diff robs you of energy. C. diff causes weight loss. C. diff has a stench like nothing else (okay, it reeks of a frigging barnyard). C. diff strips you of confidence, as daily activities become increasingly difficult and you start to question where and when you’ll need an urgent visit to the washroom.

C. diff was miserable, and it derailed my life.

Ironically, the very thing – antibiotics – that made me susceptible to this bacteria, is the very thing used to treat C diff. But I failed three rounds of Vancomycin. Each time I finished a course of Vancomycin, the C. diff symptoms returned more quickly and viciously than before.

You can well imagine my devastation and terror when the biggest of big-gun antibiotics didn’t eradicate the bacteria.

My FMT

A lovely lady, a kind and rather giddy gastroenterologist here in Edmonton, is conducting a study on the use of FMTs to treat C. diff. And get this: they are having a 100% success rate! I met with her and the FMT nurse in the middle of August. They deemed me an appropriate candidate for the study, and I was told after some routine bloodwork that I’d be randomized to either the oral-delivery route or the endoscopy-delivery route.

I was randomized to take the FMT in the form of pills. So on August 19, I started my bowel prep (as unpleasant as ever). The FMT team said the bowel prep (a.k.a. cleanout) is an important part of the process because they don’t even want any lingering Vancomycin hanging around; they want that colon as squeaky clean as possible for all the healthy bacteria getting introduced. On August 20 I showed up at the clinic (with my best shit-eating grin) to swallow 30 pills packed with poop (five of which are seen below) made from one of four healthy, anonymous donors (I do know that they are all nurses). Apparently I’m one of the lucky ones, as the average number of pills falls between 40 and 60. Yaaaay for my efficient donor!

Recovery: The Days Ahead

I don’t feel miraculously well following the FMT. I don’t, however, feel any of the overt C. diff symptoms, which is a liberation so big and wonderful, I swear the universe is sighing her relief right along with me.

The nurse told me that my energy will be the second last to return. Because C. diff caused frequent bloody diarrhea, I also became quite anemic and so require a few more iron infusions to bring iron stores and hemoglobin back up. Last to return, she said, will be my mental wellbeing. C. diff induces anxiety, and it takes time to recover from the psychological impact this bacteria has.

I’m also experiencing some post-infectious IBS symptoms, so I need to be extra diligent in listening to my body. Some days I need low residue to feel well; other days I need loads of fiber. I’m finding my new balance as I recover, but I continue to vigilantly feed my body all kinds of nourishing and real food. After all, those organisms in our microbiome are commensal and eat what we eat. It’s like I’m eating for me plus 100 trillion other little guys!

My bowel function isn’t back to normal, but I’m not panicked. I’m so grateful to friend and fellow IBD/food blogger Jaime of Gutsy by Nature who bravely battled C. diff recently and who kindly became my sounding board for what to expect after a FMT.

The recovery will be longer than expected, and no one really talks about that part, which is frustrating. So I am talking about it. I will continue to document how things are going for me in the days ahead. Overall, though, I’m continuing to do well and improve a bit each day.

And I will continue to text family and friends the cute smiling poop emoji. Not just because I’m a proud Canadian, but because someone else’s healthy poop made me smile. In fact, someone else’s healthy, happy poop saved my life.