Gearing Up for Mental Health

For the second year in a row, the Forest City Cycling Challenge sped past its fundraising goal to support youth mental health research and purchase exercise bikes for patients of St. Joseph’s Health Care London.

It was the sound of celebration as the spinning wheels of hundreds of bicycles raced or coasted during the Forest City Cycling Challenge. The final destination was an important one – enhancing care for those living with mental illness. The second annual event held in June was open to cyclists of all skill levels, with routes ranging from 25 km to 160 km. The ride began and ended at the Lerners Lawyers building, where riders were greeted by music, food trucks, and scores of volunteers.

Prizes were awarded to participants who raised the most money. Fittingly, Dr. Gillian Kernaghan, recently retired President and CEO of St. Joseph’s Health Care London (St. Joseph’s) earned bragging rights as the top fundraiser. Event founders Joe DiBrita, Tim Mason and Alfonso Campos Reales hoped to match the $40,000 raised at their inaugural event. But their hard work, paired with enthusiastic riders and dedicated fundraising supporters, turned the event into a runaway success that brought in more than $60,000. “We are totally blown away by the love and support people have shown for the Forest City Cycling Challenge,” says Alfonso, who also sits on St. Joseph’s Health Care Foundation’s Board of Directors. “Mental illness affects so many people in our community, so it’s been an honour to give back to this important cause in such a meaningful way.” Proceeds from the event support mental health care at St. Joseph’s and the purchase of exercise bikes for patients living with severe and persistent mental illness. From the moment they arrived, the bikes have been a hit with inpatients at St. Joseph’s Parkwood Institute Mental Health Care Building. “It’s been a huge benefit to our patients to be able to jump onto the bike whenever they feel like it,” says Kerrie Dewachter, Coordinator of the Treatment and Rehabilitation Program. “Their clinicians can even hop on with them for one-to-one connection while they’re enjoying physical activity.” Event proceeds also support the Mental Health INcubator for Disruptive Solutions (MINDS), a social innovation lab addressing youth mental illness and addiction. Joe, Tim and Alfonso are grateful for the outpouring of support for this year’s event and planning is already underway for next year.

2022 Forest City Cycling Challenge

THE

OF POOP

Fecal transplants are saving lives and their potential is flush with possibility. But there’s a desperate need for donors.

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 at Western University, training 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.

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 antibiotic treatment stops 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 thanks to poop donors like John. 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. I thought I might poop myself to death,” says the Etobicoke woman, whose bathroom humour is intact despite her ordeal. Katharine ended up on antibiotics that had to be continually increased, caused various side effects, and was costing $300 a month even with drug coverage. The diarrhea would make a raging return with every attempt to reduce the medication. After six months with crippling C. difficile and little hope, Katharine came to St. Joseph’s, the only centre in Ontario offering the procedure during the height of the pandemic. It took one treatment.

“Within three days, I started to feel better. My life is now back on track. I had a normal poop today – I’m so stoked! I’m good every day. Hallelujah! Such life-changing stories are common for C. difficile patients who undergo fecal transplants, yet others are left suffering. There is a serious shortage of donors. Criteria requiring only very healthy, local donors, the ‘ick factor’ often associated with donating poop, and the pandemic has created a poop supply crisis. “Our need for London 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. Donations also have to be put on hold after donors travel to tropical countries where bowel infections are common, until we can retest their stool and assure it is safe to donate again.”

My life is now back on track. I had a normal poop today – I'm so stoked!

– KATHARINE GORJUP

HOW POOP SAVES LIVES

Fecal Transplant Step By Step

Poop Collection

Feces, also called stool or poop, is collected from a carefully screened, healthy donor.

2

Processing of Donor Poop

In the lab, the donor poop is mixed with saline solution, then filtered. The finished product contains the good bacteria in a liquid or capsule format.

St. Joseph’s Health Care London is the only hospital in Ontario – and one of only two in Canada – administering life-saving fecal transplants via capsules. Fecal Transplant

The healthy fecal sample is transplanted into the intestines of the patient with C. difficile through either an oral route using capsules swallowed by the patient, or the rectal route via enema. Healthy Gut

The organisms from the donor sample restores the healthy gut bacteria in the patient.

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.

At times, there have been no eligible donors and the team has had to stop treating vulnerable patients, says Dr. Silverman.

John usually donates a few times a month and more often when clinical trials are underway. While he is currently on hold due to a recent bout of COVID-19, John says the donation process is easy and people need to get past the optics. “It’s mind boggling for most people but the more donors we have, the more we can do. We need donors to fuel this exciting and expanding area of research, and to save lives.”

It's in you to become a poop donor

Just like blood transfusions, fecal transplants save lives. Currently there is a critical need for poop donors. To find out about eligibility and how to donate, call 519 646-6100, ext. 61726 or email Seema Nair Parvathy (PhD), Research Coordinator, at SeemaNair.Parvathy@sjhc.london.on.ca. Donors should reside in London.

You can also read how fecal transplants are done and their promising potential to treat an array of illnesses at sjhc.london.on.ca.