Do you guarantee cure???

One of my patients asked “Do you guarantee cure?” And I wondered what do I say? Is there a guarantee that if you take the shortcut you will reach your home faster? Or once you move outside my clinic you won’t meet with an accident? or our neighboring nation wont attack us? The answer to all is “NO”.

Last week I answered the question, “How can “I” get TB? Today I answer the second question and talk about the dreadful form of resistant TB, MDR (multidrug resistant) and XDR (Extensively drug resistant) TB. Labeling a person as a TB patient makes some of them depressed, but if it doesn’t, labeling them MDR or XDR surely does! Well as I said earlier, TB is an infection and can be treated if doctor’s advice is followed. When a patient doesn’t respond adequately or totally fails to respond to the standard first line treatment (drugs used to treat patients having the disease for the first time), he/she is called to have something called as resistant TB. It is a more dreadful form of TB because the treatment is prolonged (and sometimes unsatisfactory); drugs are costly and have quite a few side-effects.

            So how do you get this dreadful form? How do you confirm its MDR? What’s so dreadful about it? How long does one take the medicines? Can it be treated completely? Can a person die due to it? And many more questions linger around the topic.

            As they say, man is the most dangerous animal and this dreadful disease is sometimes called man-made. What I mean to say is that one of the most common causes of getting this disease is improper treatment of TB, by the patient or the doctor. If you do not take your TB treatment medicines regularly or adequately, the TB bacteria may become resistant to the treatment you took making those medicines useless for you. Also, you may also spread the resistant TB bacteria to other people. A person can acquire such resistant TB bacteria and for no fault of his/her get this dreadful form of the disease from the beginning. The dreadful thing is that the treatment is longer, the drugs required to manage it are costlier and with quite a few side-effects. If untreated or poorly treated IT CAN KILL a patient, (usually slowly). The sad part is that even in the best of scenarios, not every patient can be cured. The choice of drugs, their dosages and frequency and duration of treatment varies from patient to patient and it is always good to take a specialist opinion. Follow your doctor’s advice, take a healthy diet and you have the best chance of cure.

Once I see such a patient I explain them the whole process of treatment, the expected cost and side-effects and chances of success and answer their 1001 questions that they usually have. But still in the end, nearly every patient asks, “Do you guarantee cure?”. I am still searching for an appropriate response to that question.

How can “I” get TB?

Many a times I have said those three words which causes even an optimistic and cheerful person to frown, worry, anxious, be depressed, angry and most commonly in denial… “You have tuberculosis”.  What follows is a series of questions and doubts on the doctor who dared to utter these words.

How can “I” get TB? I eat well, exercise regularly, live in a plush home with excellent facilities, no dust or dirt exposure and no contact with sick people…basically what they mean to say is I am very rich… How can “I” get TB?

Lets get some facts straight. Tuberculosis aka TB aka kshay rog, is an infection caused by a bug called Mycobacterium tuberculosis. It commonly affects the lung, but can present in any form whatsoever in any organ. You have to take a combination of drugs for 6-9 months to be cured.  So what is so dreadful about it? Why are people afraid of it?

Some studies say that more than 2/3^rd of our Indian population is infected with this bug. But just by infection it does not cause disease. It stays with you and dies with you. It causes disease when your body immunity goes low. Say because of diabetes, kidney disease, certain medicines taken, and most commonly in today’s fast life, poor attention to regular healthy diet and exercise. Even if you follow everything correctly you may still get the disease if the bacterial load to which you are exposed is high. TB is NOT spread through shaking someone’s hand, sharing food, touching bed linens or toilet seats. Most common route of spread is when you inhale the bug from person suffering from TB. TB bug can sometimes stay alive in the air for a few hours, especially in small places with no fresh air. Fresh air and sunlight make it harder for TB germs to stay alive. The fresh air scatters the germs and the sunlight kills them. So that’s why it is common in overcrowded areas, and people with poor nutritional status.

But again, how can “I” get TB? Probably the bug was in your body since a long time and was waiting for the right time to cause the disease.

Now what do I do?

Firstly, accept the fact that you have TB. Trust your doctor. Take a second opinion if you like, but accept it. The diagnosis of TB is based on a series of tests, first to confirm and secondly, (if required) to identify the type of TB bug and whether it is the dreadful “Resistant TB bug”. Ask your doctor about the appropriate tests required, about the disease, whether you can spread it to others, treatment options and possible side effects of the medicines. Some lifestyle and dietary changes may be required. Your doctor will be more than happy to clear all your doubts. Cultivate good habits like covering your mouth and nose while coughing or sneezing (do it even if you don’t have TB). Take your medicines regularly and for the duration advised. Report to the doctor immediately in case you experience any side effects of the medicines taken. TB is an infection which can be treated, if you take appropriate and regular treatment. Even the dreadful “drug resistant TB”, has better outcomes with regular treatment.

I am sure that whenever I utter those “three words” again, I will still get that big question with a doubtful expression on the face, and many more questions, as I usually get, but now you know some of the answers.

What specialist are you?

When I visited my village Jakhau (in Kutch, Gujarat), few months back, I introduced myself to a few people and said that I am a chest physician. One of them pondered for a while and said, “oh, so you are a cardiologist”.  I said “no no, I am a lung specialist, a pulmonologist, a respiratory physician”. After a couple of minutes he came back and asked what specialist are you exactly?  So I asked him what is Sachin Tendulkar’s specialty? He gave a shocked look (questioning my intelligence) and said that he is probably the best batsman world has ever seen. So I went on explaining that like in cricket we have specialist batsman, bowlers, wicket keepers, for human body we have specialists for every organ-system. Then I realized that this question is not limited to my remote village!

Today every new thing, new discovery, new inventions have global reach via the newspapers, internet, television and print media. New ideas and upcoming specialties in any field becomes visible to the world in no time. But unfortunately, some things still go unnoticed. In medicine (as a whole) there are newer and newer specialties and sub specialties coming up, in short you will get specialist for every organ in nearby future. Most organs of your body have the privilege of a specialist looking after them. Likewise me and doctors like me are specialists which take care of your lungs. When you get chest pain you rush to doctor thinking (and worried) that it might be related to your heart. You shower them with 100 questions about “your heart”. But what you forget that there is another organ besides “your heart” which needs equal importance, “your lungs”. They are your source of oxygen, probably the most element for your survival!

Lungs not only provide you oxygen, but filter out a lot of impurities (like kidney). It is probably the most exposed organ of your body, to the external environment. Today with rising pollution, overcrowding, poor ventilation, increasing vehicular traffic, and less time to exercise, all your organ systems are getting affected. I feel that the lungs bear the most damage. Thankfully, God has made them miraculously resilient to damage but they are not invincible. Smoking, either by you or your friend/colleague can damage your lungs the most. Improper diet, both in terms of quality and quantity, are making people more prone to infections and lungs are getting affected the most. Tuberculosis, an ancient illness, still ranks in the top ten causes that kills youth. World Health Organization has projected COPD, i.e. chronic obstructive lung disease, to be the number 3^rd killer globally in coming years. Asthma, such a common (and easily managaeble) problem goes un-noticed for many years, been regarded as cough/allergy and many other names. I can go on and on about the lung diseases which kill or atleast reduce your quality of life. But most of you know all this, right?

Then why am I talking to you about it? Sadly, when I see a patient with a respiratory problem, the disease is in its advanced stage and I am left with very few options to treat (most of the chest physicians will agree with me on this). Respiratory medicine is one of the newest specialties and it is growing day by day. Newer inventions and developments in this field are making life easier for patients with respiratory problems.

After a long discussion, finally that gentleman in my village understood who I am, and what I do. I know I still have to be prepared for the same question again “What specialist are you?”, but, well, now you know my answer!