Steve - Case History

[Steve]

For all who might benefit, and for any who have advice to offer here's my as
yet unfinished case history in summary and more detailed narrative forms.

=======================
Readers Digest Summary
=======================
Medical Profile: Mid-life male, 6 months of recurrent C. Diff.
Previously healthy aside from IBS, reflux.
GERD has been treated off and on over 4 years.

Precipitating Cause: My modern medical system debacle started with unrelated
treatment for GERD induced minor laryngitis Feb 2011.

Mode of acquisition: 14 days of Augmentin for sinus infection in March

Peak symptoms: Total bowel inflammation / pain, periodic burning /
stabbing pains, regular cramps, D. up to 10+ times /
day, copious M., blood only once or twice ever.

Trough symptoms: Several days to a week or so with only periodic mild to
moderate cramps, little or no burning, near normal
stool 1x to 2x per day, regularity of BM.

Other suspects: Laryngitis prescription of 3x the normal high dose of
acid control drugs (80 mg PPI, 40 mg H2 blocker), and
2 weeks of (discontinued) fluticasone. These, I
believe induced my 1st in a life time upper sinus
infection). Antacids likely contributed to C. Diff.
I discontinued flonase after a few weeks, and tapered
off the anticids over several more weeks.

Medications to date and range in severity of symptoms:

Month Medication Symptom Range (1-5)
========= ================================= ===================
March Acid medications (above), Flonase N/A
April Augmentin (the primary trigger) 2 - 3
May metronidazole 3 - 5
June (toughed it out) 3 - 5
July 1 month of Culturelle (L. GG) 2 - 3
Aug vancomycin, s. boullardi 1 - 3
Sept/Oct refrigerated probiotics 1 - 3

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Detailed Narrative
==================

Brief personal profile:
=======================
I'm a male in my 40's, married with kids, and generally in good health aside
from 20+ yrs mild to moderate IBS, and a 4 yr old diagnosis (at the time
completely asymptomatic) GERD. I'm an engineer by profession, and wish most
doctors were more like most engineers :)

Historical Preconditions:
=========================
Early in March 2011 I contracted a sinus infection after starting in late Feb
on a regimen of fluticasone (Flonase), a nasal steroid, 80 mg pantoprazole and
40 mg ranitidine nightly to treat acid reflux induced (minor) laryngitis. This
perhaps the root cause, but I suspect the laryngitis was also exacerbated by a
10+ week course of bronchitis following influenza in mid December.

I promptly quit the fluticasone after a total loss of smell, and soon dropped
reduced the acid meds when I was diagnosed with the sinus infection a couple
weeks later. To combat the sinus infection, which was not resolving on its
own, I completed a 14 day course of Augmentin, which worked to resolve the
infection, and my sense of smell returned by early April.

Early Signs and Diagnosis:
==========================
By mid April I noticed pains (cramps / burning) primarily in my upper left
chest that I worried were lung issues, but later concluded digestive (pain in
the front rather than the rear of the chest is likely the colon, not the
lungs). I thought about purchasing probiotics, but didn't follow through.

On May 6th, after a couple days of constipation, I had D. w/mucous and a small
trace of blood, contacted my PCP who immediately suspected C. Diff. I was
diagnosed positive on May 7th and started Flagyl 10 days 2 days later. My
stool tested negative in late May several days after completing the
metronidazole (unsurprising-- either poor testing or C-diff was mostly in
dormancy.

Subsequent Treatment to Date:
=============================
I saw a gastroenterologist who said C. Diff cases frequently resolve on their
own. So I toughed it out for the month of June, during which I had symptoms
almost worse than the previous bout, but by July, I was no longer tied to the
bathroom 7 to 12 times / day, had less frequent D. / mucous, and less severe,
and less ubiquitous colonic pains. Prior to this, I was in nearly constant pain
and distress.

However, things got a bit worse in late July, as stress increased at work. I
embarked on a wonderful vacation on the west coast Aug 6th, but 1 week in
symptoms were once again disturbing enough that I went to a doctor in L.A. who
put me on Vanco and Florastor. This allowed me to enjoy the remainder of my
vacation as symptoms approached normal within the week.

Following the vanco, I've had symptomatic relapse, somewhat cyclical in
intensity. Again burning / cramping pain over the entire length of the colon
(ascending, transverse and descending). While my output has been fairly normal
since the Vanco, the periodic cramps, burning and general distress persist.

Probiotic Approach:
===================
In early September, I started on 2 different brands of what I believe to be
quality refrigerated probiotic mixes that include L. Acidophilus and L. Bifidum
among a dozen or so other common lactobacillus strains), 3.4 billion and 25
billion per capsule, respectively. This seems to have made a
significant difference, but it's hard to tell how much is due to the
probiotics, and how much to my own immune system-- my "gut says" they're
helping compete against the C. Diff., but periodic pains / cramps /
spasms, still come and go, with occasional D., and on occasional nights every
couple weeks I wake up due to pain.

I'm convinced the C. Diff. is only held at a lower level, not gone.

Next Steps:
===========
I'm very progressive and open minded, with a psychologically iron stomach (if
not physically-- :), I'm intrigued by the idea of fecal transplant. My PCP
surprisingly agrees, so I'm now researching it more.

My Passion:
===========
Having bottomed out in May / June, and having read stories of others with more
debilitating symptoms than my own, I deeply sympathize with all who suffer this
plague. I aim to be liberated from this cycle of relapse (hopefully in months
rather than years), and to help others through my experience and gained wisdom.

[Steve]

Just a brief update for now. A more detailed one will follow when I have time.

On Wednesday, Jan 25th 2012 I received a fecal transplant from (Gastroenterologist) Dr. Colleen Kelly, one of the few in her field who practice this procedure. The transplant was administered during a colonoscopy which was also intended to check for Chrons. The primary suspicion of Chrons in addition to C. Diff (for which I tested positive again in December) were per-anal fissures (numerous small lesions). Chrons turned out to be negative.

The fecal transplant has been so far an instant success. Within 24 hours, after one night of gas and some minor cramps and tenderness (which I attribute mostly to colonoscopy itself, and possibly heavy new bacterial activity in an pre-cleansed colon), I had my first truly normal bowel output in over 8 months. I had no cramps or gas the next day and have had normal BM's ever since (132 hours and counting...).

I have a follow-up next month, at which time if I am symptom free, Dr. Kelly is willing to declare victory.

I have researched this topic considerably, and have come to the conclusion that fecal transplant is the single most effective form of treatment for recurrent cases, but I will share my views on this topic and explain why later, in a separate forum.

[Bobbie]

Please don't answer each other in the Case Histories Forum. Only the person with the case history is supposed to post there. (See "the rools.")

I have moved several comments by others from Steve's Case History to General Discussion.