Pulmonary Tuberculosis

[simon43]

My Thai ex-wife has been recently diagnosed (at Phuket International Hospital) with Pulmonary Tuberculosis. She is 35 years old.

I have advised her many times have medical checks for the constant cough, weakness, tireness and low weight (33Kg ish at 145cm height) that she has experienced for several years, but all previous checks have proved negative.

She has been put on a course of 9 pills per day for the next 9 months. Her doctor has advised that if she follows this regime, then she will be completely cured.

I am working/living in Myanmar and it's not easy to get medical advice/comments. Does anyone have experience of P.T. amongst their family members? Can Shirley (or others) give a medical opinion? I personally find it hard to believe that she can be completely cured.

My ex says she is too weak to look after her small hotel and so I'll need to arrange the sale of this and sort out some form of manageable business for her. She has often joked (half-seriously), that I will outlive her and reading about P.T., I have a concern that she may be right,

I'd appreciate advice from forum members.

Simon

[Sheryl]

If she complies with the full course of treatment she should attain a full cure, it is a curable condition. However it requires a long course of treatment (6-9 months depending on the drugs used, apparently in her case 9 months) with close follow up as the drugs can have significant side effects.

Patients cease to be infectious anywhere from ab out 3 - 8 weeks after startuing treatment, that point can be determined by sputum test.

Until then, she is infectious to others and needs to be very c areful to cover her mouth when coughing, wash hands frequently and dispose of tissues etc in a sanitary manner.

You should get a tuberculin skin test yourself. If it is positive, prophylactic treatment with INH may be indicated.

[jrtmedic]

+ To the above.

As Sheryl indicates TB is curable .........HOWEVER,

1)It is vitally important that your wife complies with the prescribed treatment

2} Her condition should be reviewed by her physician on a regular basis.

3) Failure to adhere to the treatment regime may (and commonly does) result in the condition becoming extremely difficult to treat with the usual anti-tuberculous medication.

You may find this information from the World Health Organisation of interest

http://www.searo.who...n2100_10639.htm

Edited September 2, 2012 by jrtmedic

[smokie36]

Excellent advice. I just want to add that when she feels well enough to start doing some exercise....and to keep that up as well as eating healthily. Obviously if she smokes then quitting will help her immensely. This is equally important after finishing the course of treatment.

Best wishes.

[Ijustwannateach]

Something to take super-seriously. And also a good reason to look at other lifestyle factors affecting the immune system- time to cut out smoking, drinking, etc.

[simon43]

Thanks for all the good advice. I personaly think that she has had TB for many years, since he has a very bad cough for many years, also weakness etc. She does not smoke or drink, so those are not factors.

Sheryl, what are the typical side effects of the drugs?

Simon

[Sheryl]

Liver toxicity is the biggest concern. The doctors will monitor her liver enzymes. Any sign of jaundice and she should go in at once.

Has she been tested for HIV?

[simon43]

Liver toxicity is the biggest concern...

Your concern has already come to fruition

I just got an email from my ex. She has been admitted to hospital and the doctor has told her that the medication has caused (is causing) damage to her liver. She says that she is getting weaker and weaker now, which really does not sound good.

Is there any alternative treatment that will not kill her in the process?

I don't think she has ever had an HIV test. Knowing her previous relationships over the past few years (since we divorced), I would be surprised if she has HIV. Would the doctor normally test for this?

Simon

[Sheryl]

Normally yes, since TB often coexists with HIV infection. in fact HIV is often first picked up as a result of the person developing active TB.

Management of patients with TB who have liver impairment is extremely challenging. There are some modifications to the drug regimen that can be made, and sometimes it is necessary to temporarily stop treatment or switch to a less toxic but also less effective regimen.

It is impossible to make any general statements about what to do as treatment has to be highly individualized.

[bina]

simon is the ex that is/ws getting all the psychiatric meds at one time; poor thing, she's had a rough life, at least you are still concerned about her....what about your kid? and you?

bina

[simon43]

Sheryl, thanks for your good advice. I suppose that if she knew she had HIV, she probably would not tell me, but I suspect that she has never been tested. (In my own case, it's about 3-4 years since we divorced, so I guess that I am no longer at risk if she were previously infected with HIV - I had an HIV test maybe 7 years ago and all was fine).

Her family members are 'making light' of her illness, which also does not fill me with confidence. From my location in Myanmar, it is almost impossible to make any international phone contact back to Thailand, even over the internet.

Bina, my ex has much improved on her previous episodes with bipolar etc, and I rank her at only 20% 'mad' now, which puts her alongside most Thai women I am very much aware of her poor physical health for many years, with constant coughing and short stays in hospital for intraveneous treatment to 'top up' her energy levels. This is why I am very concerned.

Our son remains living in Bangkok, where he has stayed since birth, (due to my ex's mental issues). He is doing well at private school and BKK is only 90 minutes from Yangon, (where I work).

Simon

[Sheryl]

Simon,

From what i recall of your wife's story and actions and associates during her "mad" period, I don't share your confidence that she couldn't have contacted HIV.

If she has HIV and this has compromised her immune system enough to allow latent TB to become active (a typical pattern in HIV+ Thais), she has probably been positive for 4-5 years. So your negative test 7 years ago is not really relevant here.

I doubt a Thai hospital would have failed to test her for HIV, but she might not tell anyone if the result was positive. (If it was, she would need antiretroviral drugs as well as TB drugs, and the combination would be especially toxic to the liver).

For her, there is not much you can do, it is up to her doctors. The Thai public health system is quite experienced with this type of thing. But there are things you can do for yourself and your child. You should get an HIV test. And also, as mentioned before, a tuberculin skin test.

[jrtmedic]

Simon

I am sorry to learn of the difficulties associated with your ex- wife's treatment.

In parts of Asia there is a high prevalence of Hepatitis B and C as well as HIV which tends to pre dispose individuals to the toxic effects of anti tuberculous medication.

As Sheryl has indicated it is likely that the hospital has undertaken the necessary investigation(s).

Thai Doctors have much experience of managing difficult cases and you should not become to despondent. The medical staff will , I have no.doubt, do their best to establish a treatment regime which your ex can tolerate.

Please follow Sheryl's advice in relation to your own well being, Get tested !

Best wish's to you and your ex --- I do hope everything turns out well.

[simon43]

she has probably been positive for 4-5 years...

That still puts me in the clear But it would do no harm to get an HIV check.

Simon

[simon43]

I was finally able to get a voice call to my ex from Yangon. She has been discharged from the hospital because she cannot afford the cost to remain as an inpatient, and because her liver is currently unable to accept the medicines which she had been taking.

However, her doctor has specified a daily regime of injections at the local clinic until she is strong enough to go back on the full treatment program.

Sheryl, do you have an idea of what these injections might be? I think they are a direct treatment for P.T., not just some vitamin injecttions.

My ex sounded better than before, although she still coughs a lot. I'm just trying to understand the recommended treatment program where a patient's liver is unable to accept the 'standard' medications

Simon

[lopburi3]

Be aware that Sheryl is on the road without much internet so replies may be delayed.

[Sheryl]

Simon, it is impossible for me to say. he may have suspended some drugs and continued others, or they may just be vitamin injections.

[jrtmedic]

Simon

I agree with Sheryl any attempt to guess what medication is being provided would only amount to speculation.

Has your wife considered going to the Vachira Hospital in Phuket town. Vachira is a a large government hospital and your ex would be treated free or at very little cost.

Edited September 10, 2012 by jrtmedic

[simon43]

@jrtmedic - she was being treated in Vachira, but it is not free - she must pay for 9 different daily medications.... the cost adds up

Simon

[jrtmedic]

TB is a major threat to public health.

Thailand has for many years been active in seeking to control, in conjunction with the WHO, the incidence of TB. Thai doctors including doctors from Vachira Hospital have contributed to ongoing research into the effectiveness of the treatment programs provided in Thailand.

An employee of the local Or Bor Tor, to whom I have just spoken, assures me that Thai people suffering TB are eligible for free treatment.

It would appear that some confusion has arisen in the case of your ex. I would suggest that your ex contact the local Provincial Admin. organization to ask for their support and guidance. Contact details are below.

Phuket Provincial Administrative Organisation

5 Narisorn Rd., Talad Yai Muang, Phuket 83000

Tel: 076 211 877

Edited September 11, 2012 by jrtmedic