C. (Things) DIFFerently: Sanitary vs. Sanity

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C. (Things) DIFFerently: Sanitary vs. Sanity

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imageHand-washing is a simple way to avoid getting sick. As a nurse, I know this. According to mayoclinic.org, hand-washing doesn't take much time or effort, but it offers great rewards in terms of preventing illness if done correctly. As a nurse, I know this too but who knew that it can take on a life of its own.

My mom who has vascular dementia has been battling Clostridium Difficile (C. diff). With this GI tract infection, the "pooper" sheds thousands of the C. diff organisms in each stool. The expelled organisms rapidly develop a protective coat and live for months as spores, cocooned from conditions that would normally kill them. Treatment includes antibiotics, probiotics and ongoing prevention.

In July, Mom had belly pain and her MD treated her with antibiotics thinking she may have a bit of colitis. She, at baseline, has an irritable bowel. Sometimes it is quiet; other times, she has cramping and urgency.

Well, after treatment began for suspected colitis, she started with explosive diarrhea. We spent time running back and forth to her doctor's office without any answers. The stool sample did not show C. diff.

In August, I was dragging her to her chair because she couldn't move due to weakness. She was admitted to the hospital and diagnosed with C. diff and had to go to rehab where she continued with the C. diff treatment and then continued for weeks after returning home. We repeated the stool sample and waited for the MD office to call back. I called once a week and the visiting nurse called twice per week. We chased the results for weeks.

Finally, a call back from a medical assistant: "Yes, I spoke to the doctor and he said she has 'something' but she will always have something... I can't remember what it was and I can't find the paper. I will need to ask him again and will have to call you back." At that point, I said "NO, please make an appointment. I need to get answers." Long story short, her repeat stool sample was positive for the infection -- again or still(?). The doctor said, "Oh, she is colonized, she will always have it. If she has diarrhea, we will treat her."

I reminded him that she has diarrhea frequently because of her irritable bowel and that we can not rely on "diarrhea" as a tell-tale symptom. He then ran upstairs to the GI specialist and said, "Okay, we will treat her." The specialist said to treat until it is eradicated. Yeah, right, easier said than done. C. diff treatment is Vancomycin. This is an expensive medication that pharmacies do not stock readily because of the expense.

Two local pharmacies didn't have it but said they would order it. We waited three days only to find out that the order couldn't be filled. However, one pharmacy found it in another branch but we would need to drive 30 minutes to get it. We got two days of the expensive medication then I contacted the original pharmacy for the balance. The pharmacist said, "We thought you were canceling our order, so we cancelled it on our end as well." Another couple of days went by and we had another gap in treatment until a partial order then another gap until the full order was in our hands. The medication must be given every six hours. 6, 12, 6, 12.

Just a couple more reasons to not get eight hours of sleep. Medication on board... CHECK.

So, remember how I opened this blog? According to mayoclinic.org, hand-washing doesn't take much time or effort. Not so easy with an elder with mild to moderate dementia. Since C. Diff bacteria and their spores are found in feces. People can get infected or re-infected if they touch surfaces contaminated with feces, and then touch their mouth. Mom is able to toilet herself most of the time. However, we have the issue of wiping, rising from the toilet with the commode frame over the toilet, and then needing the walker BEFORE she can even get over to the sink. Hand-washing alone has become a full-time job. Mom doesn't remember how to wash her hands properly. She dips her fingertips under the running water for what seems like a nano-second. I am reminding her to rub and scrub her hands under running water while singing Happy birthday. Imagine before touching surfaces, happy birthday to you, happy birthday to you; before eating food, happy birthday to you, happy birthday to you; after activities of daily living, happy birthday to you, happy birthday to you; before exiting the bathroom, happy birthday to you, happy birthday to you; after a diaper change, happy birthday to you, happy birthday to you; after touching touching surfaces, happy birthday to you, happy birthday to you; after touching garbage... Happy birthd..... ( sigh). Ah, just give me a case of Clorox wipes.

I am armed with Clorox wipes at my hips like a pair of six shooters. BANG, BANG, bang, bang, no freaking birthday for those C. Diff spores. We dropped off another stool sample for testing on Monday. I can only hope that I won this duel with C. Diff to the death.

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EllysGdaughter

Thanks for the info! We battled e-coli last year at this time and I only pray we don't get the C. diff! If so, I will stock up on Clorox !!!

chaya

Your management of this is incredible. Getting the lab reports and the correct diagnosis and finding a pharmacy that carried the Vanco sounds like a nightmare. Thanks for the heads up about the Clorox germicide and that c. diff. resistant being to hand sanitizer. I'm going to insist that me husband's doctors and other medical and nursing folks who examine him at home wash up-- amazing how many just use sanitizer . Would love to print and post your description of the # of bacteria in stool on our front door!

Tracey Martin

Thanks for reading, everyone. <a href='http://www.caregiving.com/members/lilmagill/' rel=\"nofollow\">@LilMagill</a>, the link worked! I love how they balanced the facts about fecal transplant with some humor. Hopefully, we will get some news today.

LilMagill

I just read this fascinating article in the New Yorker about FMT - fecal microbial transplant. Some have been able to use it very successfully to treat C. diff. but it's not easy to get. Gross but fascinating. Here's a link - not sure how long it will be active - often New Yorker articles on the site are subscription only. \r\n\r\nhttp://www.newyorker.com/magazine/2014/12/01/excrement-experiment

Lisa

You have my sympathies, Dad has had Cdiff before and it's no picnic for anyone. Some days are better than others for him regarding incontinence. When I checked in on him this morning I asked him if he was ok (he was still in bed). He said I'm not sure. Uh oh. Not a good sign. Not.at.all. Long story short I had an extra load of yucky laundry after I got him up bathed and changed for the day. You never know how it's going to go do you? Glad we have this place to come together with each other. Take care.

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