1
Listen to this story of #tuberculosis
Real, not fiction. Even though may sound like super fiction. Of a patient now admitted under me.
56 yr man. Prior #smoker No #alcohol use, no #DRUGS. Family guy. Starts havin cough. Nagging no sputum
Keeps him awake at night
#MedTwitter
Listen to this story of #tuberculosis
Real, not fiction. Even though may sound like super fiction. Of a patient now admitted under me.
56 yr man. Prior #smoker No #alcohol use, no #DRUGS. Family guy. Starts havin cough. Nagging no sputum
Keeps him awake at night
#MedTwitter
https://twitter.com/Charakan/status/1371732181031084032
2
He goes 2 a GP. Clinical examination and blood tests done. Says some chest infection. Puts him on antibiotics for a week. Asks for review. 1wk later some change in symptoms, but not fully ok. GP extends antibiotic course 7 more days. C, no fever and no signs of infection yet.
He goes 2 a GP. Clinical examination and blood tests done. Says some chest infection. Puts him on antibiotics for a week. Asks for review. 1wk later some change in symptoms, but not fully ok. GP extends antibiotic course 7 more days. C, no fever and no signs of infection yet.
3
After 14d course, no change. Patient chucks the GP. Goes for a senior GP. Senior GP does clinical exam,blood tests AND chest X ray. X ray comes back as "not looking normal" 🙄 But no diagnosis. So he says. Let's try a short course of #antibiotics AND antifungal. Again 14 days
After 14d course, no change. Patient chucks the GP. Goes for a senior GP. Senior GP does clinical exam,blood tests AND chest X ray. X ray comes back as "not looking normal" 🙄 But no diagnosis. So he says. Let's try a short course of #antibiotics AND antifungal. Again 14 days
4
Now patient is still coughing his lungs out. It's actually worsening. So they go a long specialist. A #Pulmonologist
He says looks like obstructive lung disease. Let's check. So pulmonary function tests, blowing thru tubes and pipes etc follow. Result. Obstructive lung disease
Now patient is still coughing his lungs out. It's actually worsening. So they go a long specialist. A #Pulmonologist
He says looks like obstructive lung disease. Let's check. So pulmonary function tests, blowing thru tubes and pipes etc follow. Result. Obstructive lung disease
5
Everyone is happy. He puts him on inhaled steroids plus short course oral steroids and nebulizer, inhalers the full package. After 2 wks the patient developed severe breathing difficulty he comes back and gets admitted under pulmonary guy
He nw says. Mayb it's heart.
Everyone is happy. He puts him on inhaled steroids plus short course oral steroids and nebulizer, inhalers the full package. After 2 wks the patient developed severe breathing difficulty he comes back and gets admitted under pulmonary guy
He nw says. Mayb it's heart.
6
Enter the #Cardiologist. Now this patient has night time breathing issues. Cardiologist says, paroxysmal nocturnal dyspnea. Classical #Heart failure. But patient says no I have it in morning also. Doc says very bad heart failure. So echocardio heart scan is on. Scan is normal.
Enter the #Cardiologist. Now this patient has night time breathing issues. Cardiologist says, paroxysmal nocturnal dyspnea. Classical #Heart failure. But patient says no I have it in morning also. Doc says very bad heart failure. So echocardio heart scan is on. Scan is normal.
7
But cardiologist wants a trial. So he puts patient on diuretics to lower stress on heart and some blood pressure medicines even though he has normal blood pressure. But he tolerates it. After discharge, 10 d later, he comes back coughing. Pulmo and cardiologist says Wil refer..
But cardiologist wants a trial. So he puts patient on diuretics to lower stress on heart and some blood pressure medicines even though he has normal blood pressure. But he tolerates it. After discharge, 10 d later, he comes back coughing. Pulmo and cardiologist says Wil refer..
8
..Patient is happy. So they go to a hi fi private center. The first day, after clinical check up, CT #scan of chest (finally!!!) done. It shows both lungs infective changes. The Specialist says. Need to rule out tuberculosis. So they do bronchoscopy washes and send for test..
..Patient is happy. So they go to a hi fi private center. The first day, after clinical check up, CT #scan of chest (finally!!!) done. It shows both lungs infective changes. The Specialist says. Need to rule out tuberculosis. So they do bronchoscopy washes and send for test..
9
..Bronchoscopy test normal
The lung washings showed some cells of infection. No TB bacteria.
He says no TB. Puts him back on inhalers and stuff. Goes on for 2 months. Patient has his good days and bad days. But 6 mo after initial chest symptom nw comes low grade fever.
..Bronchoscopy test normal
The lung washings showed some cells of infection. No TB bacteria.
He says no TB. Puts him back on inhalers and stuff. Goes on for 2 months. Patient has his good days and bad days. But 6 mo after initial chest symptom nw comes low grade fever.
10
Patient is now tired
So he goes to a #naturopathy guy
He says nature will cure.
So he eats leaves and plants and berries and does yoga all the while coughing for 2 more months
Then he stops
Hears about new chest specialty hospital. Goes there. The specialist sees him, examine
Patient is now tired
So he goes to a #naturopathy guy
He says nature will cure.
So he eats leaves and plants and berries and does yoga all the while coughing for 2 more months
Then he stops
Hears about new chest specialty hospital. Goes there. The specialist sees him, examine
11
Doc goes thru all tests. Says too any tests done. I don't want want repeat any of this. I want to repeat only 2 tests. Patient says ok. One more CT chest - radiologist says looks like TB. Specialist says need to confirm. So they post patient for VIDEO ASSISSTED THORACOSCOPY!
Doc goes thru all tests. Says too any tests done. I don't want want repeat any of this. I want to repeat only 2 tests. Patient says ok. One more CT chest - radiologist says looks like TB. Specialist says need to confirm. So they post patient for VIDEO ASSISSTED THORACOSCOPY!
12
After VATS PROCEDURE, new specialist says, we have biopsied the lung. Now patient goes double crazy. Did all the other stupids miss my cancer???!! He's going bonkers. The biopsy came back as Bronchiectasis. Non specific, a long term effect of smoking. Doc says it's fine.
After VATS PROCEDURE, new specialist says, we have biopsied the lung. Now patient goes double crazy. Did all the other stupids miss my cancer???!! He's going bonkers. The biopsy came back as Bronchiectasis. Non specific, a long term effect of smoking. Doc says it's fine.
13
So patient is put back on same inhalers, breathing exercise and what not. He's inhaling steam more than a pressure cooker is making steam. No use. So down and out, he discuss with neighbors. Neighbors son is doing MBBS trianing. He says let my prof take a look. So he goes ther
So patient is put back on same inhalers, breathing exercise and what not. He's inhaling steam more than a pressure cooker is making steam. No use. So down and out, he discuss with neighbors. Neighbors son is doing MBBS trianing. He says let my prof take a look. So he goes ther
14
Old prof examines, does ultrasound of chest and abdomen. He finds something and takes a step back. He tells the #MBBS neighbor. Take this guy to a liver doctor
Looks like #Cancer of liver spread 2 lung. Patient comes 2 our unit.
Aftr 1yr.
Ready for #palliation
#livertwitter
Old prof examines, does ultrasound of chest and abdomen. He finds something and takes a step back. He tells the #MBBS neighbor. Take this guy to a liver doctor
Looks like #Cancer of liver spread 2 lung. Patient comes 2 our unit.
Aftr 1yr.
Ready for #palliation
#livertwitter
15
We review all records.
Low grade fever, chronic non expectorant cough, severe wasting, loss of weight, loss of appetite. One proper contrast CT of abdomen and chest.
Voila. Radiologist says. It's TB. I say he's evaluated multiple times over 1 yr for that. He says TB.
We review all records.
Low grade fever, chronic non expectorant cough, severe wasting, loss of weight, loss of appetite. One proper contrast CT of abdomen and chest.
Voila. Radiologist says. It's TB. I say he's evaluated multiple times over 1 yr for that. He says TB.
16
And the nodule of the liver, it was just focal fat. Normal finding.CT chest was terrible. Lots of changes associated TB chest infection. We discuss the findings and our concern with patient. He now hears everything we had to say. We reassure him. He will live long
And the nodule of the liver, it was just focal fat. Normal finding.CT chest was terrible. Lots of changes associated TB chest infection. We discuss the findings and our concern with patient. He now hears everything we had to say. We reassure him. He will live long
17
Tuberculosis treatment started. Few weeks down, patients cough is reduced. His disability is low. He's not using inhalers. His chest Xray has cleared. He feels better. Appetite is good. From a referral for #Liver cancer, we finally make a diagnosis of tuberculosis 1yr later.
Tuberculosis treatment started. Few weeks down, patients cough is reduced. His disability is low. He's not using inhalers. His chest Xray has cleared. He feels better. Appetite is good. From a referral for #Liver cancer, we finally make a diagnosis of tuberculosis 1yr later.
18
Tests nt always confirmation. Disease confirmation comes frm treating doctor. 4 tat, 1 must B open 2 giving THE PATIENT, BENEFIT OF DOUBT
Do U kno wat TB was called in Olden Days?
Consumption
A gud term wen investigative #medicine & not #clinical medicine is practiced
End
Tests nt always confirmation. Disease confirmation comes frm treating doctor. 4 tat, 1 must B open 2 giving THE PATIENT, BENEFIT OF DOUBT
Do U kno wat TB was called in Olden Days?
Consumption
A gud term wen investigative #medicine & not #clinical medicine is practiced
End
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