TUBERCULOSIS

…thankfully latent though, discovered by a positive skin test with an induration measuring 15 mm.  The Filipino man whose arm I was examining had never tested positive and was dismayed that I wasn’t able to give him the normal paper indicating that there was no evidence of TB that he would be able to present at his work place.  He is employed by the organization here that cares for children who have been either temporarily taken from their parents or given up.  Children stay there while their parents undergo treatment and prove that they’re able to parent successfully and others who have been given up, until others in the community are approved to foster or adopt them.  Having TB would prevent him from working with children, so he was relieved when he learned that I’d also screen him for symptoms of TB, coughing accompanied by blood, night sweats, weight loss, and chest pain, and if none were present, give him clearance for work and that he would be required to have chest x-ray and three sputum collections analyzed.    

He patiently answered my screening questions and also the ones regarding his date of immigration to the U.S., history of positive chest x-rays, recent foreign travel and known contact with someone with active TB.  He agreed to cough into the tubes I gave him for the next three mornings and return them to me when I would send them to a lab in Anchorage where they would be cultured for TB bacteria growth.  I emailed Samuel Simmonds Memorial Hospital and sent a hard copy of his questionnaire and my encounter notes to the person there who approves chest x-rays.  After hearing back, I contacted the man to let him know that he could go in anytime soon for an x-ray.  

Results of both the sputum collections and the chest x-ray are reviewed by an infectious disease physician in Anchorage who then makes a recommendation for the person to begin taking a nine-month daily regimen of INH (Isonazid).  Some people find it difficult to adhere to the daily schedule, so if the recommendation is received, an appointment is made to discuss the medication, its side effects and the importance of taking it every day on an empty stomach.  I think I mentioned in a previous post that I’ve gotten skilled in the art of persuasion, describing how latent TB can become active if not treated and that it can infect not only the lungs, but travel to other parts of the body, including the brain, bones, etc.  My educational session is pretty convincing and I have the feeling that taking the daily medication is just about the first thing on my client’s minds when they wake in the morning.  I’m very happy about this as it would be extremely sad if someone developed TB and possibly spread it to others when a treatment was readily available and as simple as taking a small pill on an empty stomach once a day.

There is currently a shortage of State-supplied INH, so a medication order that is faxed to the Alaska State Pharmacy in Anchorage is not always fulfilled.  We feel sure that there is good logic behind determining who will receive medication and who won’t until the supply if INH is high again, but we haven’t determined it to date.  Those who don’t receive it are put on a list for when it is available again.   We’ve found an approved way to get around this though and are able to offer the medication to everyone in need.  Our nurse practitioner is able to independently order a supply of INH from a source outside of Alaska for which we’re all extremely grateful.