Sunday, May 3, 2015


        In past we were concerned about many diseases. We had very few antibiotics and very few diagnostic tests, like CT scan , Pet scan or foe that matter even ultrasound. The Ct scan became available for 'average 'hospital in early 80.So we had to diagnose medical conditions with 'clinical' skills and the treatment was equally limited . The antibiotics were limited and treatment of TB was quite difficult. The treatment consisted of injections and pills that were too big and to be taken too often and caused stomach upset. So in patients with TB , who had poor appetite and weight loss , it was more difficult to treat. So now it has become simpler to treat the condition, but what I came across recently was surprising.
       I saw this patient in the office few months ago. He was referred to me for the pulmonary evaluation. He was a 40 years old male with history of smoking. He was having cough for last couple of months and he had chest X-ray done. He was smoker and the chest X-ray was abnormal and so the CT scan was done and so he was referred to me . He had some sputum and no blood in it . He had some fever and was treated with antibiotics. He had poor appetite and had lost some weight. The CT scan showed that there were abnormal cavities in the upper lobes. This could be due to various things. The one possibility was that he had damaged lung in that area ,like emphysema and then it got infected. The other possibility was that he had atypical TB called MAC. And the other one could be that it was cavitary cancer, the cancer in which the center got liquefied.He came with his wife . He also had 2 kids at home.
     I ordered skin test forTB and told him that we may have to do Bronchoscopy. As it turned out when we tried to schedule the tests, his insurance would not allow us to do anything at the hospital that I normally go . So I still ordered the tests that I thought were needed and told patient that he needs to see different lung specialist. I called the other lung specialist personally and left message. When he came back to show me the TB skin test, he told me that the other doctor gave him appointment after 3 weeks. The skin test was negative. I had sent the sputum for TB. I called the lung doctor and left second message. In between I got a call from the lab. His sputum was positive foe TB. Now I did not know as to treat him or do any additional treatment, while waiting for the further identification on the TB bug.I called the health Department and left message . I got a call from the other lung specialist . He did not want to see patient at all. His point was that he did not want to see suspected TB in the office with all the other old and may be 'compromised' patients. I had not had call from the health department . So I called the Infectious Disease specialist. I told them the story. I wanted to see if they could see him soon. They told me that they don't see TB patients any more and they refer them to health department. They gave me different telephone number for the different health department office. So I called them and left message. I got call back from them in less than 10 mins. They took all the information and promised me to not only take care of the patient , but also of his family. (the family members will be needing testing and treatment). I had already given him the prescription for 3 drugs for the TB and done the all the testing done for the TB.
       The 'new' things that I came to know with this experience, is that since the health department treats the TB , no other doctor want to even see patient , let alone treat it.
      As I write this story, I am glad to tell the last twist to this story. This patient did not have the Regular, contagious , infectious TB after all. But the final cultures showed that he had atypical TB , called MAC or Mycobacterium Avium Intracellularae!!!!(which is treated by all the pulmonary and infection specialist doctors.)

No comments:

Post a Comment