Week 2 of my Fecal Microbiota Transplant ~ It's Groundhog Day!

**Sorry for the delay in posting these updates!**

After a weekend filled with friends, food, and plenty to drink, we headed back for Week 2. It seemed like we had to duplicate everything from Week 1 (minus the lavage), so we joked about being trapped in the movie Groundhog Day. We had late morning appointments every day so far. Monday, at last, we were scheduled to begin later at 3 pm. The nurse asked me to increase my Oxyklenz Sunday night so I greatly appreciated the extra time. The increased gut-blasting Oxyklenz meant I was up a few hours through the night. We had planned to head to Cambridge that morning; instead, Landon and Bill went trekking across farm fields while I caught up on missed sleep until almost 11 AM.

Monday's trip up the stairs went well -- much, MUCH better than Friday! I also held the transplant for 90 minutes -- well beyond the 20 minute minimum.

We spent a lot of time chatting with Glenn Taylor, the clinic microbiologist. He told us our gut microbes can reproduce in as few as 6 minutes. When they copy their DNA to make an exact duplicate of themselves, the process is called replication. However, each time they divide, there's a small chance they can mutate. Glenn puts the odds of a mutation at about 1 in 100 replications. Even though the chance they mutate is small, there are TRILLIONS of them dividing every 6+ minutes. Each mutation can result in a positive, negative, or neutral outcome.

Bacteria can also pick up genetic matter from passing probiotics or from each other in a process called conjugation (makes you aware of just how similar we are with other forms of life!).

DNA travels down a tubule that forms when bacteria come in close contact with each other. We can see this process through electron scanning microscopes and it's fascinating:

Replication does not increase the diversity or robustness of a species, whereas mutation and conjugation both have the potential to make a stronger species better adapted to survive (of course, these processes can result in less fit species, which simply do not survive). Thus, over time, mutations and conjugation result in stronger and stronger species. Over time, our gut becomes a "survival of the fittest" training ground through the Darwinian process of natural selection. Our microbes are tuned to survive and thrive in each of us -- our genes, our diets, our lifestyles, and (unfortunately) our exposure to drugs and toxins.

When we expose our gut microbes to drugs and toxins, the ones that survive become resistant to drugs and toxins.  Remember, natural selection is working to make the most robust of them survive, NOT the ones who help us in the most beneficial ways. Through my 275 courses of antibiotics in my life, I developed a microbiome that was VERY good at surviving assaults by antibiotics and maybe not-so-good at functions I need to survive, such as modulating my nervous and immune systems and deriving nutrition from my food. Although the biggest indicator of this is confirmation of antibiotic-resistant bacteria, you don't have to go anywhere near that far to severely impair your microbiome. I got confirmation twice that my bladder had developed resistant bacteria and was not responding to antibiotics. The first time, I got a bladder infection despite taking once daily, prophylactic antibiotics to stop UTIs. The second, my urologist said the inside walls of my bladder looked like "a teenager's pimply face" despite being on full strength antibiotics for 5 days. I can only assume the same natural selection was happening in my gut.

If we want the good guys to thrive, we have to protect them. Their beneficial attributes are a result of evolutionary symbiosis -- a mutual "I'll scratch your back if you'll scratch mine." This requires us living up to our part of the bargain and providing a nutritious, safe environment for microbes to thrive. In return, they modulate our immune and neurological systems by providing a gut neurovascular interface. Win-win! If we give them an environment that requires them to become defensive (toxins, drugs, poor nutrition), the microbes that survive will be focussed on beating the odds, not on maximizing the health of their host (us). It has taken me far too long to learn -- and live -- this lesson.

Many microbes die along the way, which is a global and growing problem. Humankind is losing gut diversity because of our toxic and drug filled lifetimes. We simply don't know how this decay in microbial diversity will affect future generations. We have driven many beneficial species of microbes to extinction, potentially throughout all human populations. A drive is underway to catalogue and preserve gut microbes from isolated human communities that host the last of these disappearing varieties. Wow. Here I am so focussed on my health and I learn that there's a much larger issue brewing. I knew about the risk of drug resistant bacteria, which already kill so many immunocompromised people. I didn't realize antibiotics and toxins also are eliminating species of microbes that, collectively, are vital to the health of our population and probably that of all species on earth.

Day7

New day, best trip up the stairs yet! Maybe it's because I wore my boots? My energy is so much better this week.

Today, Landon and I observed each other getting our transplants. We will take some transplant microbes home, so we need to know how to insert them. The nurses went through the procedure slowly and answered all our questions. Landon stayed with me through my 30 minute resting period, which made time pass quickly. I managed to make it until he was through his appointment, almost two hours later, before I lost some of my transplant! Could things be improving? Fingers crossed; butt clenched! Tomorrow, the nurses will supervise Landon doing my transplant. This must be true love!