I had TB 3 years ago. Now I have Anemia. My TLC & ESR is normal. Serum iron & HB has fallen. I did not take R-Cinex regularly. Do I still have TB?
First off, when you have TB, ALWAYS take the medicine “As Prescribed”. As TB treatment is a long course (6 months to ~ 2–3 years), many patients discontinue/ irregularly continue TB medications whenever they feel far better. But, this may cause you TB infections resistant to the medicines. In such case (drug resistant TB) doctors prescribe higher degree/ new combinations of antibiotics.Pathological tests have to be done in order to examine if a patients still have TB after a course of medicine:TB presence in Lungs: Chest X-ray + Sputum test (TB culture, Z-N staining, Microscopic observation + Real Time qPCR (most sensitive))TB presence in Urine, Blood etc: TB culture, Z-N staining, Microscopic observation + Real Time qPCR (most sensitive)(Worked in a research lab [of a hospital] specialized in TB Diagnosis Research)
What is tuberculosis?
In short it is a chronic granulomatous inflamatory disease caused by a particularly hardy slow growing bacterium.Chronic=lasts for a long time. Until the patient gradully becomes weak and frail and die, in those olden days when there was no treatment.Granulomatous=generates cheese like nodules in the body. The lungs are the most commonly affected. But the skin, brain, spine, liver and almost any other tissue can be involved. These granulomas contain dead tissue surrounded by dying tissue surrounded by special types of immune cells called giant cells and epitheloid cells that limit the infection. Bacteria may be abundent or scarcely present depending on the person.Much concern about TB is there becauseIt is a stigmatizing disease. People in some countries still believe it is an incurable condition.It is very difficult to treat if the patients do not follow the regimen tightly.There are only few antibiotics that can be used against it and resistance emerges readily.Vaccine is not even close to 100% effectiveness.It spreads by respiratory droplets and the bacterium dies in sunlight. Transmission does not happen immediately but requires some prolonged exposure. As a result it ii associated with poor dark and dinghy living conditions.The commonest/classical presentation is months of gradual wasting, cough and night sweats.Chest xray, sputum, Mantoux and advanced tests help to establish a diagnosis, but not always a diagnosis so clear cut.
Do Tuberculosis patients have high ESR?
Where I worked and live, The Netherlands, we rarely see tuberculosis: In 2014 823 cases, 73% of the patients are born outside The Netherlands (first generation migrants), and only 1/4 have open (most contagious form of) lung tuberculosis:An elevated ESR is supportive of an infection, in this case tuberculosis, being present, but Erythrocyte sedimentation rate in childhood tuberculosis: is it still worthwhile? foundAlthough an elevated ESR may be expected in children with tuberculosis, this study found that one-third of children with TB had a normal ESR at the time of diagnosis, and consequently there would seem to be little value in using ESR as a diagnostic test for childhood tuberculosis.So the answer is often yes, but sometimes no.
Can we live with one lung?
An informed answer depends on the reason for the lost lung. Based on my experience, you can live a very productive and competitive existence with only one lung. The resiliency of the human body is amazing. I only have one lung. I lost my left lung due to histoplasmosis (fungal pneumonia). My desire to compete in both cycling and racquetball forced my body to compensate for reduced lung capacity. My right lung capacity and my body’s ability to carry oxygen where it is needed compensating for the lost left lung. This reallocation was due to the demands that sports placed on my body.
What kind of evidence do you need to sue your doctor for failure to diagnose cancer?
I am on oncologist. Cancers can cause symptoms ranging from none-the most vague-the very obvious. Often, patients come to me, and it is obvious to me that their dx was missed. Some of these are genuine errors (someone not recognizing a test result to be abnormal, or not seeing the results), and sometimes because the patient believes that 'no news is good news', after coming back from a check up. Just today (2/25/16), I saw a patient with lung ca, who had tumor seen on a chest Xray in July 2015. It was done as a part of a pre-operative exam (for something else), and the surgeon/anesthesiologist must have seen the report. Likely she was told to follow up, but she did not, but claims to me that she was never told. Most patients sue because they are angry, and upset, and there are plenty of lawyers who will happily pile on because this is a lucrative business. To SUE the doctor, you need good documentation to show that a finding was missed, and that it was obvious enough NOT to have been missed (and a willing lawyer, of whom, you will find plenty)...however, there are intangibles that will come in the way of WINNING. Firstly, the patient may have been told to follow up..so, did they?. There may be no documentation of the same, which puts the surgeon (in my example) in trouble (as he ordered the xray). Second, did the delay in diagnosis lead to a meaningful harm (however that is defined)...eg, did you go from being curable to incurable. That is often difficult to prove, however, when facing a distraught family, the jury will often find in favor of the patient.