What the Lab Actually Found On My Patient’s Implants [Episode 4]
Dr. Rob tells the story of a patient whose labs were normal but her health wasn’t, and how this case led him to analyze implants in a new way (and the shocking findings).
So many women with breast implants experience the same symptoms of extreme fatigue, general malaise, and chronic aches and pains, yet their tests routinely come back with nothing.
In this second episode of our series about Breast Implant Illness, Dr. Rob describes how PCR testing (the same that detects COVID-19) delivers the long-needed answers that finally put BII sufferers on the road to recovery.
About our Breast Implant Illness series
Since 2016, more than 500 women have asked Austin plastic surgeon Dr. Robert Whitfield for help removing their breast implants.
This series is a journey through Dr. Rob’s experience with breast implant illness, from the first shocking discovery through hundreds of unusual cases and surprising clinical breakthroughs.
New episodes are released every Thursday. Subscribe to our private BII email list for updates and case reports at https://holisticandscientific.fireside.fm/bii and follow the show wherever you listen to podcasts.
Speaker 1 (00:04): 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.
Dr Robert Whitfield (00:21): 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 infections that's just not been recognized?"
Dr Robert Whitfield (01:18): And so we would do regular laboratory testing like I did that initially identified the E coli case, and that went on for a little over a year and a half. And I started to get clients coming from out of state. And 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 her 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 symptomatology. 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.
Dr Robert Whitfield (02:21): This was already a large procedure for the patients to go through. And in this particular case, I did the explant and on both sides, there was this kind of sliminess to the tissues. And so 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. So 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." So 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.
Dr Robert Whitfield (03:23): 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, for which labs could I contact to do PCR testing on the specimens I had?" I had drains in this patient and she was just putting out copious amounts of fluid, meaning that it was obvious 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've 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.
Dr Robert Whitfield (04:22): And her drainage slowly decreased over the next couple of weeks. And she went back to her home and subsequently had her drains removed. That kind of reinforced that I need to get on a different path to figure out what's wrong with these. So I started contacting these labs and settled on MicroGenDX out of Lubbock, Texas. It took a period of time for me to get PCR testing online in my practice. So that really began in 2019. Now I have over 400 PCR tested explant 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 in 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.
Dr Robert Whitfield (05:21): And so I thought I was really on to something. I felt good that if I found that, that 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. PCR testing, polymerase chain reaction, we're just looking for 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.
Dr Robert Whitfield (06:34): I share all these with our clients and they have the reports, they're in their charts. Their charts are available all the time on our Symplast Health app, as well as their pictures of explant specimens and other reports. I've been extremely happy with the MicroGenDX work. They also, when I needed help with COVID because obviously everybody's learned about PCR testing because of COVID, MicroGenDX 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 I've been very, very happy with how much effort and work they've put into helping us. The reports are very detailed.
Dr Robert Whitfield (07:27): 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, 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 of concerns on one of her joints. We did her explant. I received her report back and it was astonishing. But when you think about what she does, it makes sense. I get asked commonly, how does certain bacteria get on implants? Obviously we all think about infections, a cold, something that gives bacteria to our own bloodstream. And then that seeds itself on whether it's a knee, hip or breast implant. That's the common teaching for clinicians. But in this case, it was like being on an episode of House. The triathlete now has four types of fungus and multiple types of bacteria.
Dr Robert Whitfield (08:33): I had to start looking up some of these because I didn't recognize some of the fungus. And they're all consistent with water. 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 micro punctures 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 blood borne contaminant this way that then will subsequently end up in a joint or in an implant and cause an 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.
Dr Robert Whitfield (09:32): 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 their skin excised that's been burned, replaced with cadaver skin temporarily before they can skin graft it. They develop infections because the immune system's severely compromised, the integument, or our skin, which protects us from infections is severely compromised. So I asked this client of mine what was she doing that she could have possibly got acinetobacter? I'm like, "Were you gardening or digging in soil? Or what exactly were you doing?" And she said, "Well, I just stay at home or stay at home mom." And I was like, "Would you have been in mud for any reason?" And she's, "Oh, I used to do Spartan racing." And well, there you have it.
Dr Robert Whitfield (10:26): So this is a soil bacteria that gets under your nails. Or once again, you get a 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. And these all made sense now, and we have never 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, some of these other places CPL in Austin, they're not performing PCR testing. It's just a swab and a growth on an agar plate. And that's traditional. Having made these inroads with PCR testing to as definitively diagnose something as possible has given me great comfort. So when I see these reports, I'm like, "Well, this is basically why you're having your problems."
Dr Robert Whitfield (11:15): And then it's not the end of the story, but for that portion, we can help close that chapter. So in summary, if you remember for our first podcast, we talked about on a CLIA based lab or 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. 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. Staph, strep, E coli, samonas, bacteroides, things that are commonplace. I'm trying to provide the most evidence based solution to this problem.
Dr Robert Whitfield (12:18): And so PCR testing against over 150 types of bacteria, mycobacteria, 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 that 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?
Speaker 1 (13:08): Take a screenshot of this podcast episode with your phone and show it at your consultation or appointment or mention the promo code PODCAST to receive $25 off any service or product of $50 or more. Dr. Robert Whitfield is a board certified plastic surgeon located in Austin, Texas, near 360 and Walsh Tarlton in Westlake. To learn more, go to DrRobertWhitfield.com, or follow Dr. Rob on Instagram @drrobertwhitfield. Links to learn more about Dr. Rob's smart procedures and anything else mentioned on today's show are available in the show notes. The Holistic And Scientific Podcast is a production of The Axis. Theaxis.io.