C. Difficile: Old Disease/New Media Darling

C. difficile
"C Diff" periodically makes its way into the headlines, but my family has a long aquaintance with this disease.
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In 1998 I woke in the middle of the night and sprinted into the bathroom in time to vomit, followed quickly by round one of diarrhea, followed by many more. The symptoms were so severe that I passed out on the bathroom floor and woke up later long enough to take some medication for the diarrhea and make it back to bed.

My symptoms were no better in the morning so I called in sick to work, ready to ride out a case of food poisoning or the stomach flu. But as the day progressed my symptoms had worsened. If I ate anything I threw up, if I didn’t eat I still had diarrhea. In the early afternoon I saw blood in the diarrhea and panicked. My aunt had once told me when she saw blood in her stool that’s when she found out she had colon cancer. Since I was too weak to drive I called a friend to take me to my doctor’s clinic.

My doctor wasn’t available so I was seen by a PA who checked me over, did some blood work, and concluded I probably had diverticulitis. My white blood count was so high that she wanted to hospitalize me but instead I was let go with prescriptions for an anti diarrheal and Cipro. Further tests were scheduled starting with a barium enema.

After the Cipro kicked in I felt slightly better but was still weak and not able to eat anything other than liquids and few light solids like crackers. I went in for the barium enema and the conclusion was I did not have diverticulitis. I was sent home and told to finish the Cipro.

About a week later the diarrhea returned and I was able to get in to see my primary physician. She took one look at the previous test results and told me I probably had C. diff. and began asking me a series of questions such as, had a been to a foreign country, did I drink water that could have been contaminated, and had I recently taken antibiotics? Bingo! I had indeed taken about three days worth of left over antibiotics about a month before because I had a sore throat. She immediately sent me to the hospital for a stool test and told me the Cipro was only making matters worse and to stop taking it.

C. diff., or C. difficile, is now in the media along with bacterial infections that have become antibiotic resistant. But C diff. is exactly the opposite, caused by, not resistance to antibiotics. As I was to learn, the small dose of antibiotics I had taken a month before had thrown off the balance of “good” bacteria in my intestinal tract and caused an inflammation of my colon and the resulting diarrhea and vomiting. I was very, very sick from taking a medication that had been prescribed to make me better.

At the time that I was diagnosed I was unable to find any information on C. diff. and have since found no one else that had ever had it and even a few physicians that knew very little about it. I was fortunate I went back to my doctor when I did, and that she knew about C. diff. She got the results from the stool test and immediately put me in Flagyl.

I will go on record that the Flagyl, perhaps because of my weakened state, was almost as bad as the symptoms of C. diff. I made it to work every day but was continuously severely nauseated and unable to eat. At times I was so weak I would lay my head on my desk unable to move. My office mates would run around gathering hard candy and usually an influx of sugar was enough to get me functioning again. I would come home from work, collapse on the bed and sincerely wish I could die. When I complained to my doctor about the nausea she told me I needed to tough it out as the she only had one other medication in reserve to treat the C. diff. and needed to keep it in reserve in case I had another outbreak. The only other treatment option I had was to eat yogurt with live culture to help balance out the bacteria in my colon. I picked some up at a health food store and tried to choke it down.

As I recovered my doctor referred me to a gastroenterologist who performed a colonoscopy since my father had had polyps removed from his colon. Everything checked out fine and eventually I got my strength back and reveled in being able to eat again and trying to make up for the weight I had lost. I now tell any physician I see about the experience and all of them avoid giving me antibiotics unless absolutely necessary, like during a recent surgery.

I thought C. diff. was a really obscure illness and I had just “lucked out” getting it but in 2002 my mother was hospitalized with bronchitis on top of her CPOD. She was extremely ill and put on multiple doses of antibiotics. After three weeks in the hospital the doctors were planning on releasing her to a nursing home on a Friday and a bed had been secured. We were all very relieved, even knowing she had a life attached to an oxygen tank ahead of her.

On Thursday we got an email from my uncle saying that they were holding off releasing Mother because she had developed a slight case of diarrhea. My sister went to see her and every indication was that she would still be out of the hospital in a few days. Instead my sister called on Saturday morning and said the doctor needed to talk to me, as I was the one designated as the decision maker on her health care power of attorney. Her doctor told me Mother had declined to the point that she would need a respirator to remain alive. I asked him what had happened and he said she had developed C. diff.

Mother’s doctor told me there was only a 2% chance that mother would ever be removed from the respirator, fortunately Mother had made it clear that she never wanted to be on a respirator and my siblings and I had already discussed it and agreed that we would abide by her wishes. I told the doctor not to put her on the respirator. She died that evening with my sister and brother at her side.

Though my Mother was seriously ill with COPD she could have lived with it--it was the C. diff. that killed her. Naturally, I attributed the C. diff. to the massive amounts of antibiotics she had been on while in the hospital but my uncle and aunt also noticed that a number of rooms in the hospital, especially on my mother’s floor, were marked with signs indicating they were infectious. We’ll never know where the C. diff. came from, the antibiotics or the hospital, or if any others died during the same time period. Perhaps if my mother had not been so weak she could have survived the C. diff., as I did, but we’ll never know that either.

The recent media attention to C. diff. may be good in getting hospitals and doctors to take extra precautions and to be aware of the threat but I find it ironic that it is the “new” medical story. I have known about it, all too well, for ten years.

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