Night Shift: Eat this, you’ll feel better

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“You’re not going to write another poop story, are you?” my wife said as she saw me at the computer.

“I can’t help it, sweetheart,” I said, shaking my head while tapping away. “You can’t make this stuff up. Some pharmaceutical firm has finally decided to sell freeze dried poop in a capsule to treat c. diff infections.”


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“Nooooooo,” she said walking over to look over my shoulder at the story unfolding on my computer screen. “Is this something you take by mouth?”  Her face was turning pale as her cheeks puffed like she was holding back vomit.

“Yep,” I said.  “I always knew that fecal transplantation wouldn’t catch hold until some big pharmaceutical firm finally took the plunge and decided to sell s–t in a pill.”

I was looking at a guy on a video blog talking with a straight face about this new advancement stating it cured 19 out of 20 cases of c. diff.


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“Well, I guess that’s good,” she said taking a big breath.

Hold that thought. For any new readers of Night Shift, we need to take a stroll down memory lane to put this story into context. Almost 10 years ago, I wrote a non-fictional account in Night Shift of my mother-in-law’s battle with life threatening c. diff that was cured when I did a home fecal transplantation using the stool of a healthy never-to-be identified, current emergency medicine resident relative of mine.

We did the procedure at home because no one in the infectious disease or GI department where she was being treated would do the procedure in the hospital. The story was called “The Ick Factor.” And it was published at least six months before the New England Journal of Medicine published its review of the successes of fecal transplantation for the treatment of c. diff.

I was particularly proud of the fact that Night Shift scooped, pardon the pun, the New England Journal. I got calls and letters from all over the country asking how we did it. Actually it was simple. Using a $15 blender – new for that purpose – in the garage, I mixed 250cc of normal saline with 50cc of my volunteer’s poop. Then my nursing school daughter administered it, via ENEMA, to my desperate, but willing, mother-in-law.


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After six weeks of unsuccessful treatment with Vancomycin, my mother-in-law got out of bed the next day and announced that she was cured. And she has been ever since.

So we knew if worked. But we wondered if the medical community would ever adopt the procedure. The bottom line, pardon the second pun, was that there was no money in it. There was nothing that could be patented. And the procedure itself could be performed by anyone, begging forgiveness from my daughter. Various investigators tried administering the fecal transplant material via endoscopy by getting past the gastro-duodenal junction. It worked. But it was a lot of effort and expense.

However, as the scientific community became more aware of the virtually untapped effects and potential benefits of the gut biota a whole new field of therapy began to unfold. And that brings us to…

“Yes,” I explained. “Changing the gut flora can, as you know, have incredible benefits. For instance, the video blog after this one talks about how cravings for cake in the middle of the night may actually be coming from the bacteria in your gut. The suggestion is, and there is some evidence for this, that obesity is related to your gut flora. And that if fat people had the gut flora of skinny people they would lose weight or at least not have the cravings that they currently do.”

“That’s crazy,” my wife exclaimed.

“No, ‘crazy’ is what my obese patients will call me when I tell them that they need to take a freeze dried poop pill to lose weight,” I said. “Can you imagine that?”

“I know you,” she said with a mischievous smile. “You’d love doing it.”

“Hmmm,” I said, looking into space. “I guess you wouldn’t have to tell them what it was. It’s kind of like the guy who had a terrible burn on his face. The plastic surgeon was a little concerned about telling the patient about the area of his body from which his upcoming graft was to be from — his buttocks. He didn’t like the idea of his butt being grafted on his face. But on one of the follow-up visits the surgeon asked him how he was adjusting to the idea. The patient told him it was the best thing ever.”

“Really,” my wife said unbelieving.

“Yeah, the guy said he didn’t tell anyone. But now he enjoyed going to visit his mother-in-law because she always insisted on kissing him on the cheek.”

“You’re such a juvenile,” my wife said. “I think you’d have to tell the patients what was in the capsule. If you didn’t, they might find out and wait for you in the parking lot with a gun some night.”

“If it worked, they’d be happy right?  Besides, I’m sure the pharmaceutical company could come up with some fancy name for dried poop. I can’t pronounce the chemical name for half the drugs they put out on the market. Did you know that the chemical name for Viagra is really ‘mikoxiphlopin.’”

I held a straight face as long as I could, which was a about a millisecond.

“You’re really having some fun with this one,” she said.

“I know what they could call it,” I said with excitement. “They could call it ‘desicated orally digested organisms’. And just shorten the commercial name to DODO.”

“I’m sure that would be big hit, you moron,” she said starting to walk away from my junior high jokes.

“Seriously,” I started.

“Oh, you’re serious now?”

“Yes, I’m finally serious. This is a great idea. I just don’t think that there is any way you can market it as an oral product. They can make a complicated name. They can have slick multimillion dollar marketing campaign. But at the end of the day it won’t work.”

“Why not?” she asked. “These are pretty serious problems.”

“Yes, but as they say in marketing circles, the best campaigns in the world to sell dog food won’t work if ‘the dogs won’t eat it.’ People aren’t going to take these pills especially if they can get the same effect from an enema.”

“So, you’re saying that they’re just sticking the medicine in the wrong end.”

“Exactly,” I said with a smug smile. “We stick things in people’s behinds all the time.”

“You do,” my wife said with a grimace.

“No, honey, not me,” I said with a smirk. “But people put medicine in their own back sides without any problem all the time. And even if they couldn’t stand the idea, we could still do it. Hey I stop nose bleeds with Rhino Rockets. I could cure c. diff with Ano Bombs. And the billing people would even be happy that they could charge a procedure code.”

“What kind of business are you in?” my wife said shaking her head with utter incredulity.

“It’s the best business in the world, baby,” I said with a smile. “I’m on the front lines of medicine, the only man standing between my patients and death and disease,” I said puffing my chest out like Superman. “And I’m going to continue winning those battles every night …one Ano Bomb at a time.”

 

 

 

ABOUT THE AUTHOR

FOUNDER / EXECUTIVE EDITOR Dr. Plaster has been an emergency physician for more than thirty years, working exclusively night shifts for the past twenty years in emergency departments across the country. During that period he joined the U.S. Navy and served two tours in Iraq. Dr. Plaster is the founder and executive editor of Emergency Physicians Monthly and the founder of Plaster Publishing.

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