We are talking to your patient Ellen tomorrow, and she tells me that you saved her life. Just as a physician, how does that make you feel to be able to learn something and use it and actually help your patient?
Dr. Dutta: That is the biggest reward of what I do. My son, who is becoming a physician also, we spend long hours as physicians and everybody says, “why are you working so hard?” The reward is a happy smile on a patient’s face or their gratefulness that they express in different ways. For me personally, the 2-year-old kid that I talked about a few months ago who was referred from Hopkins again and became well, was just a delight to watch. This little kid who was all dehydrated and tired and exhausted was after 2 days was just running around like a normal child.
That is amazing.
Dr. Dutta: It is amazing. What it can potentially do, this therapy, I think needs to be explored in a very controlled and systematic manner. There are a lot of people that I get calls from who want to set it up. I have tried to give it a little bit more scientific twist rather than just telling patients, “okay, take the crap, blenderize it in a coffee thing, and just push it in.” Instead of doing that, we have tried to make it a little bit more scientific in a more measured way and I hope that in doing so, we might make it more acceptable and also perhaps learn more about the process and make it more applicable to other diseases. We have just done 2 cases of ulcerative colitis now and again to our surprise they are doing marvelously well. How it works I think is going to be unraveled in the next 5 years at a molecular level. What bacteria are particularly important or critical in this improvement will be identified in due course and once we know that, then those are the bacteria that will be given in form of a capsule or a tablet to the patient. Then we will not have to deal with this stool business one day in the immediate future. That is my hope.
How do you get the donors? Is it always family or how do you choose?
Dr. Dutta: Yes. The issue of donors is very critical and we started out with the family members because we thought that would be the most acceptable, to be spouses or children or parents. That has worked very well. Now, some centers have said that the diseases run in the families and so we should not use the stool samples from the same family. When we went at it and did it, it has worked 100%, so I don’t think that argument holds much water. The donors have to be very carefully screened and the new thing in this area is the suggestion from the University of Minnesota group about a stool bank, which is dedicated for such patients who may need it at a given point in time, who are sick in the hospital. If you had in a stool bank, the samples that have been processed and stored at minus 70 degrees, then you can thaw them and give them to the patient. That is the quick way to handle the disease process. Right now I do not have that stool bank but we are in the process of setting one up. The advantage of that will be because it takes about 3 to 5 days before we have the donor properly screened, if we have the stool bank where we have healthy stool samples donated by anonymous people who have been screened then that sample can be used. It’s just like what we do for blood banks or sperm banks or any other bank that we are creating.
That is what I was just thinking.
Dr. Dutta: I think there will be stool banks available in different hospitals. That is particularly relevant to people who are very sick, who need it promptly in the hospital, or those who do not have any relatives because the process otherwise can take about 5 days to a week before a donor is selected and a stool sample is collected.
That will be beneficial.
Dr. Dutta: I think that pretty much covers everything. Any other questions that you may have?
If they can’t get this treatment and their antibiotics fail, what then?
Dr. Dutta: If the antibiotics fail and one has a C. diff infection, it is a very scary thought because one is likely to become malnourished over a period of time, dehydrated, septic, and is likely to die or have the colon taken out. Taking the colon out is a very large operation and has its own morbidity and mortality, and if it happens to be in a patient who is above age 60 to 65 then there is a very high mortality of removing the colon.
Is it serious?
Dr. Dutta: It is very serious.
What are the symptoms?
Dr. Dutta: You are probably going to ask Ellen, but the symptoms are tremendous with abdominal pain, cramps, and diarrhea. Their life is completely out of their control. They have fecal incontinence also, meaning they soil their clothes; they can’t control anything. So, I think Ellen will tell you because she suffered from it for a long time.
How many other patients have been helped now?
Dr. Dutta: Many other patients and not only that, they also have hope now; they are not scared. Also, Dr. Bartlett has always told me that this is the answer to the problem. When I told him there is new antibiotic available he said that is not the answer because we have dealt with antibiotics for 35 years; just killing bacteria is not the answer. We have to grow healthy bacteria to get rid of this unwanted bacteria and I think that is a different approach and that is a paradigm shift in managing this disorder. We have always tried to kill the bad bacteria, but in this one we are not killing them, we are just wiping them out by growing some healthy bacteria and pushing them out and then don’t let them come back again.
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