Pictured above: Seema Nair Parvathy (PhD), Research Coordinator with Lawson Health Research Institute, holds up fecal transplant capsules being used at St. Joseph's Health Care London to treat patients with C. difficile and to study their potential use for many other health conditions.
It's quite the conversation starter. At parties or gatherings, when someone asks John Chmiel what he does, he gets a kick out of telling them “I sell poop for money."
It's true. He does. His own poop. John is a poop donor.
Instead of slowly backing away, people are intrigued, says John. They want to know why and how. They quickly discover it has nothing to do with the money and everything to do with saving lives.
At St. Joseph's Health Care London, fecal transplants are now routine treatment for debilitating and life-threatening Clostridioides difficile (C. difficile) – the major cause of antibiotic-associated diarrhea. The treatment makes it possible for people to recover from this destructive infection and holds tremendous potential in the care of various other serious diseases.
John is fascinated by this exciting new frontier in medicine and is invested – both as a donor and as a microbiology and immunology graduate student in Lawson Health Research Institute's Canadian Centre for Human Microbiome and Probiotics at St. Joseph's Hospital.
“As a grad student, when I heard how effective fecal transplants are for C. difficile and how many trials are going on related directly to patient care for various illnesses, I thought I had to help out," says John, who became a donor in 2018.
When you are a regular poop donor like John Chmiel (pictured left), you learn the tricks of the trade when it comes to collection. There are various options to make it easy to provide a sample for fecal transplant research and patient care at St. Joseph's Health Care London.
For many patients struggling with C. difficile, fecal transplants are critical, explains Dr. Michael Silverman, Medical Director of St. Joseph's Infectious Diseases Care Program who has been performing the procedure since 2003 and was one of the first in North America to do so. He and his team have played a key role in the treatment becoming the standard of best practice for C. difficile across Canada and the USA.
Most cases of C. difficile occur in individuals who are taking antibiotics and some acquire it while hospitalized. Antibiotics can destroy the normal bacteria found in the gut, causing C. difficile bacteria to overgrow. When this occurs, the C. difficile bacteria produce toxins, which can damage the bowel and cause diarrhea and other severe complications. Treating C. difficile with antibiotics kills even more of the helpful normal gut bacteria, and when these antibiotics are stopped the C. difficile returns. This can happen over and over again, making relapsing C. difficile a significant challenge to treat.
At St. Joseph's, however, C. difficile patients are being cured. The success rate of fecal transplants performed by the Infectious Diseases Care Program is a staggering 96 per cent. The program is one of few performing the procedure as part of routine care for C. difficile, and the only program in Ontario – one of two in Canada - administering the treatment via capsules.
“Many patients we treat have been ill with multiple episodes of diarrhea or chronic unremitting diarrhea for many months to years, with multiple hospitalizations," explains Dr. Silverman. “Many have lost weight and become malnourished and frail. They often are fearful that they could die and indeed 15 per cent of hospitalized patients with C. difficile do succumb to the illness."
Patients are “delighted" when they see a dramatic improvement after one dose of capsules, adds Dr. Silverman. “For many patients there is really no other alternative except lifelong antibiotics."
Katharine Gorjup, 62, is among those delighted patients. In October 2021, a dental infection requiring intravenous antibiotics triggered C. difficile so severe her weight dropped to 90 pounds. At 5' 8", she became skeletal and unable to care for herself.
“I looked like I was dying and that's how I felt. I couldn't cope. It was never-ending," says the Etobicoke woman.
After six months with crippling C. difficile and little hope, Katharine came to St. Joseph's. It took one treatment.
“Within three days, I started to feel better. My life is now back on track…I'm good every day. Hallelujah!
Limiting this life-changing treatment, however, is a serious shortage of donors. Criteria requiring only very healthy donors, the 'ick factor' often associated with donating poop, and the pandemic has created a poop supply crisis. At times, there have been no eligible donors and the team has had to stop treating vulnerable patients.
“Our need for donors is great," says Dr. Silverman. “COVID-19 has made the maintenance of donors in the program extremely difficult. When a donor gets COVID they cannot safely donate for three months."
With John's help, St. Joseph's and Lawson Health Research Institute are currently educating the public on how and why fecal transplants done, their promising potential to treat and array of illnesses, the patient and donor experience, and the donation process. The hope is to recruit more local donors.
“It's mind boggling for most people but the more donors we have, the more we can do," says John. “We need donors to fuel this exciting and expanding area of research, and to save lives."
Read the full story on St. Joseph's website.