Successful fecal transplant gives DeKalb woman her "life back"

A unique transplant helped Hannah Carmack tackle recurring infections in her colon and led her to be an advocate for others who struggle with gastrointestinal (GI) issues.

Originally from Rockford, Hannah can trace her issues back to 2015 during her freshman year at college in Minnesota. Severe stomach pains and abdominal cramps would cause diarrhea, leading to frequent bathroom trips. She sought treatment initially at the student health center, but she eventually landed in the emergency room.

"I was losing blood, so I knew these were not normal stomach problems," she recalled. "It was terrifying."

According to Hannah, health care providers at the time thought the dorm environment – maybe bad food or living with people with varying degrees of personal hygiene – might have made her sick. They thought it might be lupus or Crohn’s disease, and at one point, diagnosed her with fibromyalgia.

Eventually, she was diagnosed with Clostridium difficile, or C. diff, which is an infection in the large intestine, or colon, caused when this bacterium overpowers the normal healthy bacteria in our colon and takes over. The first line of therapy for this infection is taking specific types of antibiotics. Hannah would take these antibiotics, which helped for a bit, but the C. diff kept returning.

C.diff causes varying degrees of symptoms, from mild, frequent diarrhea to severe abdominal pain, nonstop diarrhea and dehydration. In severe cases, C. difficile infection can be a life-threatening surgical emergency that requires complete removal of the large intestine (colectomy) and an ileostomy bag.

In 2015, Hannah established her care with Rockford Gastroenterology Associates (RGA) after moving home and transferring to Northern Illinois University. Further testing led her to a diagnosis of ulcerative colitis, a type of inflammatory bowel disease (IBD).

Ulcerative colitis (UC) is a chronic condition that affects patients young and old, causing symptoms such as severe cramping pain, bloody diarrhea and urgency to go to the bathroom. Because the lining of the colon was already inflamed from the colitis, there was a higher risk for developing C. difficile infection.

"C. difficile is one of the first things we check for in our patients with UC who describe having a flare-up of symptoms, and UC moves higher on our list if we see young adults with C. diff infection," said Dr. Clinton Snedegar, who cares for Hannah at RGA. "Usually if we can treat UC effectively, then the C. difficile infection responds to treatment with medications. Hannah’s presentation was more challenging because the infection kept coming back."

It was at RGA that Hannah learned more about a procedure called fecal microbiota transplant (FMT) and its success related to treating patients with recurrent C. diff.

FMT, commonly called a stool transplant, is a process where stool from healthy donors is delivered to the large intestine of patients suffering from C. difficile infection. There are several methods for delivering the stool to the colon, but the most commonly utilized technique is with a colonoscopy.

"RGA has performed over 40 FMTs since 2015, with an overall success rate above 90 percent," said Dr. Sunil Patel, Director of Research at RGA and founder of its FMT program. "Donor stool is obtained from a verified, licensed vendor that screens and processes the specimen. It gets shipped within two days and is ready to use. This has been a game changer for our patients because, until recently, donor stool would often have to be obtained from a patient’s family member or close friend. This is not only cumbersome and potentially awkward, but also could be costly as the donor would have to undergo extensive screening which wasn’t often covered by insurance."

Dr. Patel added, "A recent study showed that 82 percent of patients who had fecal microbiota transplantation did not have Clostridium difficile recurrences after almost two years from the time of their stool transplant. These findings build on other recent research that has shown FMT is very effective in treating C. diff."

Insurance eventually greenlighted Hannah to have the procedure, which was performed by RGA’s Dr. Sumeet Tewani in September 2016 at SwedishAmerican Hospital. Hannah said the prep work was like prepping for a colonoscopy.

"It was weird to be at the hospital, but then I saw the faces of the RGA docs that I recognized," she recalled. "(The procedure) was simple and quick. If you have had a colonoscopy, you are fully equipped to handle FMT."

Dr. Patel explained that "the only difference between a standard colonoscopy and a stool transplant is that it takes an extra few minutes to disperse the liquid stool in the large intestine."

Because previous treatments had failed long-term, Hannah had moments of self-doubt that the FMT would work. For about the first month after the transplant, she had no major change in symptoms. But then she did.

"It hit me like a semi-truck. I woke up one day feeling healthy, and I’ve been healthy since," she said. "I’ve had a few flare-ups since the transplant, but I’m no longer losing blood and I’m not running left and right to the bathroom all the time."

"It’s the best thing I did for my health. I have my life back again."

Hannah also hasn’t had a positive C. diff test since then. And the whole experience has made her more passionate about helping eliminate the stigma associated with GI disorders.

Now 22, Hannah successfully graduated a year early from NIU in May 2017. She is an author, and she volunteered as a counselor last summer for Camp Oasis, a camp for children with Crohn’s disease and ulcerative colitis in Elkhorn, Wisconsin.

"When I was first diagnosed, I was terrified to tell anyone," she recalled. "Now, I want to promote the normalization of disabilities."