What the Lab Actually Found On My Patient’s Implants

Welcome to the holistic and scientific podcast with board Certified plastic surgeon Dr. Robert Whitfield, Austin's natural choice for plastic surgery and the expert in smart laser and energy treatments.

Today's episode is about testing and how I unraveled the mystery of the patient who had BII symptoms but completely clear lab results. In our previous episode, I talked about my first case experience with BII and how the lab at the hospital found E. Coli despite nothing showing up in her laboratory analysis before her explant surgery. After that, different patients started coming in and there was one in particular who confounded me and I'll tell you her story in just a moment. In my early experience with breast implant illness patients, I would have patients routinely come in complaining of the standard symptoms. Brain fog, memory loss, cognitive decline, anxiety, depression, weight gain, hair loss, joint pain, muscle pain, fatigue. And so, having been shaped by my early experience finding an infection with E. Coli, I looked at every patient as well. What if they have an underlying implant infection? It's just not been recognized. And so we would do regular laboratory testing like I did that initially identified the E. Coli case and that went on for over a year and a half. And I started to get clients coming from out of state. One client in particular was an ICU nurse who traveled from New Orleans and she had incredible amounts of fatigue. She said it was hard for even to get out of bed. And so I was very concerned with her being a nurse obviously and having that extreme fatigue that she had an underlying breast implant infection and that was responsible for her symptomology. So we did her case and I'll tee it up by saying I was very suspicious when I did her case that I was going to find an infection, something more significant in her. This was early on in my experience with breast implant illness. So I was trying to perform an en bloc capsulectomy and really do my best to not cause any other disturbance of the tissues. This was already a large procedure for the patients to go through. In this particular case, I did the explant on both sides. There was this kind of sliminess to the tissues. Every time I had encountered this in the 20 year history or more of my career at that point, it led me to believe there's bacterial contamination of some variety. I confidently went out to her husband afterwards and I said, hey, she's going to do a lot better. I feel very confident this was infected. We'll just wait for the laboratory analysis to reveal what the organism is, then I'll put her on the appropriate antibiotic therapy and we'll get her. Hopefully good as new, feeling better, able to get back to work and function properly. I waited about the traditional week to get her results back, came back normal flora, which means there weren't enough copies of bacteria in a CLIA based lab system to prove an infection. Or alternatively, the lab was not testing for the right thing. And so that was a very, very frustrating experience for me. And we had started from a research standpoint in plastic surgery, seeing cases of anaplastic large cell lymphoma, of which they had done PCR testing on the capsule and found some bacterial contaminants. So I contacted colleagues and I said, well, what lab or which labs could I contact to do PCR testing on the specimens I have? That led me to contacting this lab, getting back to the patient, I was very frustrated. I had drains in this patient and she was just putting out copious amounts of fluid, meaning that it was obviously there's something going on. I couldn't tell her what it was in terms of is it a bacterial contaminant, is it a fungal contaminant? Most likely it would have been bacterial. I chose to place her on oral antibiotics given my background with both breast cancer, breast cancer reconstruction, implant infections, and my experience with BII patients spanning this career of mine already. And her drainage slowly decreased over the next couple of weeks and she went back to her home and subsequently have drains removed. That reinforced that I need to get on a different path to figure out what's wrong with these. I started contacting these labs like I mentioned and settled on MicroGen DX out of Lubbock, Texas. It took a period of time for me to get PCR testing online in my practice that really began in 2019. Now I have over 400 PCR tested Explat capsules in my series. I think initially I had a lot of people pre Covid coming from all around the United States to visit Austin and have us see them consultation and hopefully provide services for them. In that series, I had about 60 to 70% of the patients have a contaminant that was mostly predominantly bacterial on PCR analysis in my audit. And so I thought I was really onto something. I felt good that if I found that I checked a huge box for them, basically we had an underlying infection and once the stimulus was removed from their body, the immune response would normalize. Sometimes this would take a short period of time, other times it would take months. But we saw a definite improvement. So PCR testing, polymerase chain reaction. We're just looking for the The DNA of the contaminant, whether that's a bacterium, mycobacterium or fungus. And there's obviously hundreds of these. So we want it tested against as many DNA as possible so that we can get the answers. And this just instead of it being a run of the mill staph or strep or E. Coli or pseudomonas or something, we'll get some very interesting results that you otherwise wouldn't find because they wouldn't be tested for, but you just need one copy of DNA for it to be present on a specimen to be identified in the analysis. And these all, I share all these with our clients and they have the reports and they're in their charts. Their charts are available all the time on our Simplast health app, as well as their pictures of explant specimens and other reports. And I've been extremely happy with microgendx work. They also when I needed help with COVID because, you know, obviously Everybody's learned about PCR testing because of COVID MicroGen DX was one of the first companies in the world to provide saliva testing, which is obviously very attractive. The shed of the virus through the saliva is a predominant finding. We knew this early on, but they were one of the few labs in the world to be released to perform saliva testing. And so my company has done PCR testing with saliva for Covid really since the beginning and been very, very happy with how much effort and work they put into helping us. So the reports are very detailed. Once again, what I said was if there's just one copy, it'll show up in a report. For instance, I had a challenging case. I had a really top athlete, does triathlons, came in very difficult symptoms consistent with bii, high functioning, was just beside herself, been to every doctor known to man, even had a surgery over concerns one of her joints. And so we did her explant and I received her report back and it was astonishing. But when you think about what she does, it makes sense. So I get asked commonly, how did certain bacteria get on implants? And so obviously we all think about infections. A cold, a urinary tract infection, a colitis, something that gives bacteria to our own bloodstream and then that seats itself on whether it's a knee, hip or breast implant. That's the common teaching for clinicians. But in this case it's like being on episode of House. So the triathlete now has four types of fungus and multiple types of bacteria. And so I had to start looking up some of these because I didn't recognize some of the, the fungus and they're all consistent with water. And so if you think about how this would happen, a triathlete swims, gets out of the water and runs. Many of them run barefoot and you get little micropunctures in your foot or your foot's cold because the water's cold, you can't feel things, you get a little puncture. It's easy to see how you get a bloodborne contaminant this way that then will subsequently end up in a joint or in an implant and cause a inflammation infection. And so for her it made a lot of sense to me. Conveniently, about two weeks later I had a patient show up with a report after an explant that had Acinetobacter. And so for those who don't know what Acinetobacter is, it's a bacteria commonly found infecting severely burned patients or immunocompromised patients. My experience having done burns for a large portion of my career, I most commonly saw it in burn patients. Nobody's sicker than a severely burned patient. Really, really challenged nutritionally. Skin envelopes damage has to go. Have you know, their skin excise that's been burned, replaced with cadaver skin temporarily before they can skin grafted. They develop infections because the immune systems severely compromised the integument or our skin which protects us from infections severely compromised. So I asked this client of mine like what was she doing that she could have possibly got asked needle back to. I'm like were you gardening or digging in soil or what exactly are you doing? And she said well, I just stay at home or stay at home mom. And I was like okay, would you have been in mud for any reason? And she's oh, I used to do Spartan racing. And there you have it. So this is a soil bacteria gets under your nails or once again you puncture in your hand, it contaminates you and this is how you get it into your bloodstream and it affects your, like I said, your joint or whether it's a knee, a hip or a breast implant. So these all made sense now. And we would never have known these things without using PCR testing because regular lab testing you would get in like I mentioned a CLIA based lab like Quest or Labcorp or some of these other places. CPL in Austin, they're not performing PCR testing. It's just a swab and a growth on a auger plate. And that's traditional. So you know, having made these inroads with PCR testing to, you know, as definitively diagnose something as possible is giving me great comfort. So when I see these reports I'm like, well, this is basically why you're having your problems and then it's not the end of the story. But for that portion we can help close that chapter. In summary, if you remember, for our first podcast we talked about on a CLIA based lab or a lab done in a hospital setting, which basically is like taking the Q tip, swabbing the inside of the area you're trying to culture and then that goes to the lab. The laboratory personnel will then wipe it on a blood agar plate or whatever culture medium they're using in a petri dish, cover it and put it in the incubator to grow. And so this takes time, obviously, but it's not testing for a large number of bacteria. It's going to be testing for a smaller number of bacteria that are most commonly found in the setting. You know, staph, strep, E. Coli, Pseudomonas bacteria, things that are commonplace here. I'm trying to provide the most evidence based solution to this problem. And so PCR testing against over 150 types of bacteria, Mycobacterium and fungus is a more appropriate and decisive way to get this information. So I PCR test pretty much everybody. I don't like regular lab CLIA testing done with those specimens anymore because I want the answer. I don't want to say, oh well, there weren't enough bacteria, so that didn't give us an answer. Here we're going to get an answer. It just helps us check boxes and help these patients who are desperately looking for answers provide answers to their questions. On our next episode we'll talk about what breast implant illness actually is and try to help answer the question how do I know if I have it?

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