Detroit - Minnesota - Spain: Brandon's Stem Cell Story

By: Brandon Pomish
Companion Contributor
Twitter: @bpomish

Starting in November of 2014, I was suddenly hit with a half-dollar sized enormously painful perianal abscess.  Not knowing what an abscess was, or where the perianal region was, I went to my internist who directed me to a colorectal surgeon who insisted that he immediately cut and drain the abscess. 

After two surgical attempts, he surrendered to the uncontrollable buildup of fluid and recommended me to another surgeon.  This new surgeon was more tactful in his approach; however, he could not control the abscesses (yes, now more than one) that manifested into an intersphinctetric fistula arising from the 12:00 position coursing inferiorly posterior to the penile bulb to communicate with the skin surface at the perineum. 

After four more surgical cut and drain attempts, he could not cut any longer because the skin was too raw.  By July, I had two wounds underneath my scrotum about one and a half inches in length and about three-eighths of an inch deep. 

The nuclear option of an ileostomy was recommended and performed.  The first ileostomy failed and caused massive full blockages inside of my small bowel requiring an NG Tube to be administered and many emergency visits to the hospital.  After more complications, an ileostomy revision was performed and I was admitted to the hospital for twenty-three nights.

After my release in September, I was introduced to the head GI at the University of Michigan and he put me on Remicade and Imuran that was supposed to heal my fistulas.  At this point, I also had been introduced to a highly regarded GI at The Mayo Clinic in Rochester, MN.  She has written many influential papers on clinical practice for IBD and has written a highly praised book on patient management in IBD.  I was also introduced to a new surgeon who would manage my surgical treatment. 

For the next eight months, I visited Mayo dozens of times in hopes that my fistulas were healing which included Pelvic MRI’s every time I visited.  The MRI’s continued to show each of the fistulas corresponding to the previous MRI with no improvement.  At this point, after more surgeries for anal fissures and continued pain at the fistula/seton drain sites, I asked: “When is this going to end?” 

The answer I was given changed my life forever.  I was told that complex perianal fistula (cpf) healing isn’t measured in days, weeks, or months, but, rather years.  Not taking this answer lightly, I went home that evening and went onto clinicaltrials.gov in search of something that could accelerate my healing.  I found numerous trials around the world on almost every continent for cpf’s and started reading up on the studies.  Some trials were higher risk with a higher reward and some lower risk with a lower reward. 

I took into consideration the country and its medical establishments, time of healing, number of treatments, cost, and many other factors into my decision. 

The trial I was most fascinated with was the efficacy of a stem cell procedure being performed at Hospital Universitario Fundación Jiménez Díaz in Madrid, Spain.  The two leading doctors behind the study had excellent credentials (one of the surgeons completed her fellowship at Mayo Clinic in Minnesota).  I spoke to several contacts who validated high standing reputation of the institution and I set out to try and make contact.  I first emailed the author (Spanish) of a synopsis I had read who emailed back almost immediately and gave me the contact information of the head researchers behind the study.  I emailed them explaining my condition, my research on their trial, and my eagerness to fly to Spain to get their treatment (also pointing out that I was a patient at Mayo which I thought couldn’t hurt).  Again, almost instantly received a response back. 

I went through some formalities in sending them some of my medical information and MRI’s so they could validate my condition.  After a few weeks of back and forth, the group accepted me as a patient and I was off to seek approval from my quarterbacks at Mayo.  Since I was not a European Union citizen, I did not qualify for the actual trial, so the understanding was that I would have to pay cash to get this done.  The efficacy of the treatment also took two visits to the hospital spread out about six months apart.  I took all the trial information to Mayo and presented my case to my GI and surgeon.  If they had any reservation about me going, I was ready to do whatever they instructed.  If they advised against the treatment, I would not go. 

They could not have been more open, excited, and encouraging for me to try this.  In fact, my GI had just in the last year had sent a patient to this group.  Because of our rules and regulations, she could not inform me of this trial which is a whole other matter.  Nevertheless, I was booked to go to Spain in late September of 2016.  My experience in the European medical system was mesmerizing.  I was considered a “private” patient instead of a “public” patient (because of the cash) and was given an itinerary of preliminary exams and meetings before the procedure. 

The hospital was a beautiful and very clean facility.  I immediately felt a sense of comfort at how sterile the environment was and how “normal” the hospital looked in comparison to ours here in the USA.  The dress code is a different story.  Many of the female doctors walked around in blouses, jeans, and open toe shoes, while the men were very sharply dressed in nice suits and ties. I would call it business casual. 

I went straight to the front of every line and experienced some very different (positive and negative) approaches to testing and meetings than here in the USA.  The hospital cafeteria had better food and coffee than 99% of the restaurants here!  After some shopping and sightseeing, I was ready for my procedure. 

First, I was to have liposuction performed to extract the adipose tissue to extract the cells for replication.  This happened first thing in the morning and I was put under general anesthesia while the plastic surgeon performed the procedure.  The surgical room was very sterile and had all of the modern equipment inside of hospitals in the USA.  

I woke up to my stem cell surgeon running over in excitement!  He had a small vial of about five million stem cells and he was as animated as if this was the first time he was going to perform the procedure. 

A few hours after the liposuction, they surgeons injected four million stem cells into the branch fistula and one million into the main trunk.  Eight weeks later, and back home in the USA, I visited Mayo to see the results.  My GI and surgeon were anxious to exam me and did so together.  With confirmation from my MRI earlier in the day, they concluded that the results revealed a closed fistula at the branch! 

The stem cell worked! 

I went back to Spain in April of 2017 for my second treatment which consisted of about forty-five million cells into the remaining fistula.  I did not have liposuction performed as they were able to culture enough cells the first time to keep reproducing. 

After a few visits back to Mayo which included a questionable period not knowing if the stem cells worked, the conclusion in July was that my fistulas were officially healed!  This finally gave me the opportunity to get my ileostomy takedown on November 8th and I haven’t looked back since. 

I am recovering terrifically and owe my success to my family’s unwavering commitment to my health and success, my team of doctors who never gave up on me no matter how many times I asked them to throw in the towel and make my ostomy permanent, and of course, I must give credit to myself, The Patient.  I don’t say that in a narcissistic way, well maybe a little, but, I fought and battled, did my research, asked the right questions, educated myself to question how I was being medically and surgically managed, and never gave up hope. 

If you want to get healthy, you must believe that there is light at the end of the tunnel no matter how dark, cold, and damp that tunnel gets. 

I am uncertain if my disease will ever resurface, however, if it does…I AM READY!                   

Brooke Bogdan