Tuesday, December 15, 2015

Fun With C-Diff!



Several weeks ago, our infant daughter began experiencing frequent diarrhea. As the stomach bug had recently ravaged our home, we simply assumed that the last holdout had fallen. However, after almost two weeks she had lost 10% of her body weight and we decided to perform a test for Clostridium difficile colitis.

For the uninitiated, Clostridium difficile colitis (C-Diff on the streets) is a bacterial infection of the lower intestine that causes cramping and severe infectious diarrhea. It is most commonly seen in hospitals and nursing homes where a patient’s gut flora (the worst of all flower arrangements) has been wiped out by anti-biotics.

As you can imagine, testing for the ailment requires a stool sample. This becomes exponentially more difficult when the patient is an infant and the infection has transformed her colon into a dung cannon. For the test to be most accurate, the sample should be captured before it hits an absorbent surface (like a diaper).

To compensate for this, we were instructed to Cling-Wrap our child’s nether-regions before applying the diaper so that (in theory) we could simply wrap the unadulterated sample and bring it to the doctor’s office. The logistics of this proved to be more difficult.

For one thing, when you child has explosive diarrhea all the Cling-Wrap does is create a fecal slip & slide that guarantees a hull breach. Regardless, we placed a roll of plastic wrap, some sandwich bags, and some gloves on her changing table. Every time we swapped diapers I felt like I was working at a deli counter.

The first sample was not “substantial” enough so we had to take another one. Three samples in, we finally got a positive diagnosis. With C-diff the testing is almost incessant and the lab procedure is prone to false negatives. This usually meant that while on lunch my wife would hand me a Ziploc bag of excrement and ask me to take it by the clinic on my way back from work. I am just thankful that I was never pulled over and had to explain my cargo.

Since there is no real way to retain your dignity while standing in a line holding a bag poop, I usually would just loudly announce to the receptionist that “with all due respect I would like to hand you a bag of human feces.” The results of this strategy tended to vary based on the receptionist working the window that day. Most of the time this drew a chuckle and I was out the door in a few minutes.

On my final delivery, I utilized the same technique on a rather serious woman who asked that I fill out some paperwork. This was the first time that I had been asked to do so and when the form asked me to categorize my business that day as a “Check-up” or a “Problem” I coyly requested her guidance. She dryly indicated I could write “Other.” She then inquired as to whether or not the nurse was expecting the turd I had placed on the counter. I replied that while I had not spoken to the nurse that day, she was expecting us to bring a sample by today or tomorrow. She seemed unconvinced and for a moment I entertained the idea of asking if they were having an issue with unsolicited deliveries of poo, but thought better of it.

She checked my insurance provider and address (as I assume this would alter the routing of the package) and then said she needed to step into the back for a moment. I asked if I could get a receipt for the stool sample for my records and she starred at me with a mixture of mild annoyance and disbelief. Finally, after several minutes she agreed to take possession of the item.

Ironically, the common treatment for a bacterial infection caused by anti-biotics is really, really potent anti-biotics. Due to her age, the medicine had to be compounded by hand and they flavored it with mango to cover the taste. My daughter has always been a trooper when it comes to medicine, but one drop of this initiated immediate dry-heaves. We began to suspect she was not a fan of the mango flavoring and I thought about asking them if they could remix it with cherry.

Finally I decided to test it myself and placed a small amount on my tongue. It quickly became apparent that the flavoring was irrelevant since all I could taste was sadness. It was like licking a rusted car bumper while watching someone eat a mango on television. It took Listerine to remove final remnants from my taste buds and my daughter watched all of this with what I interpreted as smug satisfaction. I was much more patient with her after that.

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