After 52 years of marriage, Pat Shoop thought she'd shared every intimacy possible with her husband, Bob.
But that was before she became so ill with a Clostridium difficile infection last year that doctors suggested that a spousal stool transplant -- yes, a dose of Bob’s feces -- might be the only way to save her life.
“I'd heard of intercourse, but I'd never heard of 'pooper-course,'" Shoop, 75, of Minnetonka, Minn., jokes now. At the time, though, there was nothing funny about it.
“I was so sick, I didn’t care," she recalled. "It feels like the worst case of flu you could possibly, possibly have.”
Shoop, a longtime schoolteacher, was suffering from recurrent C. diff infection, a potentially life-threatening bacterial illness that causes severe diarrhea, abdominal pain, nausea and vomiting. It comes back again and again, resisting most treatments, except, as it turns out, an infusion of stool from a healthy donor.
A new review of more than two dozen scientific reports involving 317 patients, some dating back 50 years, finds that fecal bacteriotherapy, commonly known as fecal transplant, cured the problem in 92 percent of the cases. Nearly all got better after just one treatment. That's a better record than other treatments, including probiotics, toxin-binding molecules and an experimental vaccine.
The review offers the most comprehensive evidence so far in favor of the repugnant-sounding practice in which stool from a healthy donor is emulsified, usually mixed with water or saline, and transferred via a nasal tube or enema to the gut of a seriously ill C. diff patient.
“It’s considered a treatment of last resort,” said Amee R. Manges, an epidemiologist at McGill University in Montreal, Canada, who led the review published in the most recent issue of the journal Clinical Infectious Diseases.
Once transplanted, the healthy fecal bacteria help restore balance to the patient’s bowels. C. diff infections typically develop after the intestinal flora is disturbed, usually by overuse of certain antibiotics. For most of the last decade, fecal transplants have been regarded as something of a fringe treatment by outsiders, but as a viable treatment by doctors who see desperate C. diff patients every day.
"It validates what we've thought all along," said Dr. Tim Rubin, a gastroenterologist with Essentia Health in Duluth, Minn., whose team performed its 119th fecal transplant last week. "We quote people a success rate of about 90 percent."
Shoop, who was diagnosed in May 2010, believes she contracted the infection either while in a nursing home for a broken arm or in a hospital for breast cancer treatment. Rates of C. diff acquired in health care settings have skyrocketed in recent years, climbing more than 200 percent in people older than 65 between 1996 and 2009, according to the Centers for Disease Control and Prevention. Between 20 percent and 50 percent of those patients may wind up with hard-to-treat recurrent infections, Rubin said.
For Shoop, getting an appointment with Dr. Rubin was a godsend. She and her husband stayed at a nearby hotel, where Bob, 77, was under pressure to produce a usable stool sample within 15 minutes of her scheduled appointment.
“We gave him chocolate, we gave him wine, we gave him steak,” she said.
Bob complied and the pair rushed to the clinic, where Dr. Rubin snaked a tube through Shoop’s nose and into her stomach.
“It was 20 minutes,” she said. “He told me, ‘You’re not going to taste it, you’re not going to smell it.’” And she didn’t.
That was on a Thursday. By Sunday afternoon, Shoop was better. Nearly a year later, she says she still feels fine. Her health is so much improved, in fact, that Shoop has become an ambassador of sorts for fecal transplant, sharing her story with anyone who raises the specter of C. diff.
“I tell them I know of a procedure that works,” said Shoop, who believes she would have died without it.
“Now, I’m disgustingly normal."
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