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What Is The Right Dosage Of AKT 4 Kit For Tuberculosis?
Question: cesarean delivery 5.5 months back.post op i had devloped extra pulmonary tb(though it remained unnoticed for 3.5 months as my abdominal discomfort was consideredbpart of my healing process)..in these three months i was given various combinations of antibiotics(list eclosed)..my tb gold test in feb in sputum sample came negative witha clear chest x ray..in month of march mantoux and igra was conducted and now ada..doc is in doubt of uterus tb tht flared upto skin but no tossue biopsy has been done.. i am on empirical att for 5 weeks..my weight is 67 kg and i have beem given akt 4 with bemadon and multovotamin...
Is that the right dose asbper my age and weight...i havent missed a single dose..but in my fourth week as i was unable to tokerate med tpgether i took them after a gap of four five hours,..does change in timings also cause drug resistance..am i on the rightvtrack...does the antibiotics given to me in a span of 3.5 months may have led me to dr7g resistance..as i felt feeling better in 4th week after att ,but afterbone week i felt same...
Also for last one week i m feeling bloating,swelling in my tomach and feels as if intestines(could be my assumtion) are falling down wen i touch my stomach upwards..what could be this..can this be strting of hernia..is hernia visible in ultrasound or ct scan or mri
Is that the right dose asbper my age and weight...i havent missed a single dose..but in my fourth week as i was unable to tokerate med tpgether i took them after a gap of four five hours,..does change in timings also cause drug resistance..am i on the rightvtrack...does the antibiotics given to me in a span of 3.5 months may have led me to dr7g resistance..as i felt feeling better in 4th week after att ,but afterbone week i felt same...
Also for last one week i m feeling bloating,swelling in my tomach and feels as if intestines(could be my assumtion) are falling down wen i touch my stomach upwards..what could be this..can this be strting of hernia..is hernia visible in ultrasound or ct scan or mri
Brief Answer:
Complete the course.
Detailed Answer:
Hi Madam.
Thanks for your query and an elucidate history and discussions with 4 different Doctors on this platform. I could go through all the questions and answers, your interactions with our colleagues.
Now one thin is certain that you are already taking the ATT, although under empirical basis.
Read the history now you have provided as above and let me take the opportunity to discuss the points one-by-one as you have asked and add on some points on the way.
(Please feel free to ask any relevant question and be open to some ideas as these will be out of experience and on-going discussion in innumerable forums.)
AKT-4 kit contains - Ethambutol Hydrochloride 800 mg + Isoniazid 300 mg,
2 (tabs) - Pyrazinamide 750 mg To make this 1500 per day and Rifampicin 450 mg
Per se these are adequate dosages for any adult weight (yours is 67 kg) as per the norms.
But some Doctors expert in TB and of the old school of thought may like to give the medicines as per the weight dosages. The dose of the Isoniazid and Pyrizinamide remains the same to avoid the toxicity. The dose of Rifampicin can be raised to 600 per day and that of Ethambutol to 1000.
(Please read again and try to understand that this is what the old school of thought means our XXXXXXX most Doctors, most experienced in this particular field think and adjust the dosages as per the clinical presentation, evaluation, appearance and investigations and clinical judgement).
Hence to answer your first question: you are on adequate dosages. But an experienced old-timer Physician may be contacted for a second opinion if available in your city.
Otherwise this is adequate dose.
Very nice to know that you have not missed a single dose.
Taking after a gap of 4 to 5 hours will not cause any problems as the effective dose maintenance by the body take care. Stick to the schedule which ever suits you, your stomach. ( this is so as you are not missing a single day). Will not cause resistance.
Other antibiotics will have no effect on these 4 medicines by any means including the drug resistance.
Bloating, swelling, and feeling as if the intestines are falling down when you touch the stomach upwards is not much to worry about.
Hernia is best felt by a clinician. It may be visible in all the three modalities you have mentioned, namely USG, CT , MRI.
I hope these answer your query and give you an insight.
please feel free to ask relevant questions if you need to or if you feel that there is a gap-of-communication.
Since your delivery was 5.5 month ago - I would like to know how is your baby?
Complete the course.
Detailed Answer:
Hi Madam.
Thanks for your query and an elucidate history and discussions with 4 different Doctors on this platform. I could go through all the questions and answers, your interactions with our colleagues.
Now one thin is certain that you are already taking the ATT, although under empirical basis.
Read the history now you have provided as above and let me take the opportunity to discuss the points one-by-one as you have asked and add on some points on the way.
(Please feel free to ask any relevant question and be open to some ideas as these will be out of experience and on-going discussion in innumerable forums.)
AKT-4 kit contains - Ethambutol Hydrochloride 800 mg + Isoniazid 300 mg,
2 (tabs) - Pyrazinamide 750 mg To make this 1500 per day and Rifampicin 450 mg
Per se these are adequate dosages for any adult weight (yours is 67 kg) as per the norms.
But some Doctors expert in TB and of the old school of thought may like to give the medicines as per the weight dosages. The dose of the Isoniazid and Pyrizinamide remains the same to avoid the toxicity. The dose of Rifampicin can be raised to 600 per day and that of Ethambutol to 1000.
(Please read again and try to understand that this is what the old school of thought means our XXXXXXX most Doctors, most experienced in this particular field think and adjust the dosages as per the clinical presentation, evaluation, appearance and investigations and clinical judgement).
Hence to answer your first question: you are on adequate dosages. But an experienced old-timer Physician may be contacted for a second opinion if available in your city.
Otherwise this is adequate dose.
Very nice to know that you have not missed a single dose.
Taking after a gap of 4 to 5 hours will not cause any problems as the effective dose maintenance by the body take care. Stick to the schedule which ever suits you, your stomach. ( this is so as you are not missing a single day). Will not cause resistance.
Other antibiotics will have no effect on these 4 medicines by any means including the drug resistance.
Bloating, swelling, and feeling as if the intestines are falling down when you touch the stomach upwards is not much to worry about.
Hernia is best felt by a clinician. It may be visible in all the three modalities you have mentioned, namely USG, CT , MRI.
I hope these answer your query and give you an insight.
please feel free to ask relevant questions if you need to or if you feel that there is a gap-of-communication.
Since your delivery was 5.5 month ago - I would like to know how is your baby?
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks for the prompt reply sir,
Here are my further doubts if can be cleared
Sir might be i contracted this tb during my cesaren,but as diagnosis was nt done for 3.5 months is there any chances tht my baby would have contracted this from me,as i dont know tht whtether this waspresent in active state in me during pregnancy also.. i m very scared withthis thought.the gynae who operated on ,e doenot remember anything ..the peadiateian hve got an chest xray and cbc done which are clear for my baby ,also asked for mantoux but baby have had bcg vaccination..intially i have breastfeed him also though not much..
2.in case if i will need to go for diagnosticlaproscopy is it safe if i m having tb in my sto,ach or uterus ..as i feel it has increased in my body..my surgeon was in opinion of taking 6 week treatment ,if works fine else will go for cect followed by diagnostic lap,but i was not in favour of invasive procedure..will cect besfe option wen on att and so will be diagnostic lap(though i really dont want it)
3.is thrre any way to know tht i m not on drug resistance because in all five months i have taken antibiotocs like sweet pills(amikacin and others)and tht too on and off(since nobody was abke to diagnose my prob as they considered as healing and i switche many doctors).since starting att on 1 april for three weeks i felt very bad,followed by a fair amount of improve,ent in 4th week,but in 5th week i had my m8nthly cylce amd for last 10 days the abdominaldoscomfort i mentioned flared up amd for last three days i m feeling nausea vomitingand fevertoo woth genaral malaise..is tht again resurfacing or att shows effect like that,,.i m confused..6th wek of med is going on.
Pls guidw sir
Here are my further doubts if can be cleared
Sir might be i contracted this tb during my cesaren,but as diagnosis was nt done for 3.5 months is there any chances tht my baby would have contracted this from me,as i dont know tht whtether this waspresent in active state in me during pregnancy also.. i m very scared withthis thought.the gynae who operated on ,e doenot remember anything ..the peadiateian hve got an chest xray and cbc done which are clear for my baby ,also asked for mantoux but baby have had bcg vaccination..intially i have breastfeed him also though not much..
2.in case if i will need to go for diagnosticlaproscopy is it safe if i m having tb in my sto,ach or uterus ..as i feel it has increased in my body..my surgeon was in opinion of taking 6 week treatment ,if works fine else will go for cect followed by diagnostic lap,but i was not in favour of invasive procedure..will cect besfe option wen on att and so will be diagnostic lap(though i really dont want it)
3.is thrre any way to know tht i m not on drug resistance because in all five months i have taken antibiotocs like sweet pills(amikacin and others)and tht too on and off(since nobody was abke to diagnose my prob as they considered as healing and i switche many doctors).since starting att on 1 april for three weeks i felt very bad,followed by a fair amount of improve,ent in 4th week,but in 5th week i had my m8nthly cylce amd for last 10 days the abdominaldoscomfort i mentioned flared up amd for last three days i m feeling nausea vomitingand fevertoo woth genaral malaise..is tht again resurfacing or att shows effect like that,,.i m confused..6th wek of med is going on.
Pls guidw sir
Brief Answer:
Combined approach by a ''TEAM'' of Doctors who can interact for you
Detailed Answer:
Hi.
Good morning.
Well it took a lots of reading, taking to colleagues and research in answering this query.
Well, first of all it is impossible to say when TB was reactivated in you.
Do you live in India?
If you live in XXXXXXX or Asian continent, practically everyone has TB bacteria in their body and only those suffer from active disease when it is reactivated. Again it is practically impossible to say when-how-why. I hope you got my point.
That is why the chances of your baby contracting TB when in uterus or during breast feeding are difficult to predict and that now BCG has been given. Fortunately the baby contracting TB in such a way is not known to occur in practice.
The baby can get infected only if you had / have open TB, meaning Sputum AFB (bacteria) positive and fortunately your X-ray chest is normal and I hope you are sputum negative.
So do not worry, if you have extra-pulmonary TB and the X-ray chest and CB are of the baby are normal.
Again in old times all the family members were subjected to test of X-ray Chest to see if someone in your family has open TB but not symptomatic at all. And this is not uncommon to find.
**Diagnostic Laparoscopy:
Done only if required and since you are already under the treatment of ATT, the only major indication is any complication of TB like obstruction, collection, or so on.
Now-a-days it is safe even though you have TB in abdomen.
Your Surgeon is absolutely right, let the medicines work > CECT abdomen if required > Diagnostic Lap SOS.
Yes CECT is safe even when on ATT, get urea and creatinine done before CECT.
* With the proper ''management'' of TB, the chances of requiring Lap is reduced to minimum. You may not need one.
**The so called flare up is due to the congestion caused as a result of periods. Periods cause changes n uterus and the surrounding tissues, and should settle with time.
The present problem of fever, malaise, nausea and vomiting can be due to viral fever or so, your attending Doctor on examination can tell you the best. This is the season of viral fever going on, and many people come to see you, meet and greet you can have viral fever / flu which you can catch easily.
3 days history does not tell about resurfacing or ATT not working.
*Now there are labs equipped with testing whether you have MDR or not and the availability of such labs and requirement of which material is to be talked to your Doctor.
I would have a personal opinion after detailed study of your case:
Since you are already under ATT, continue on.
Take full normal diet, many so-called special things to eat and drink can actually kill the appetite and I hope you agree with me.
Go for natural proteins like eggs and sprouts.
Continue Benadon, Multivitamins containing lycopene and ginseng (if you are not breast feeding the baby) help in good recovery.
Exercises in mild form (ambulation as we say), get involved in daily activities, hobbies, distraction of mind from the disease and such positive activities help a lot in a very good activity.If you mind is involved 24/7 in the disease, there is no way for a good recovery.
If you think your Doctors are trustworthy and sincere in their efforts, believe in them, tell them to do the best for you and stick to a ''TEAM'' of a Gynecologist+Physician and a Surgeon who can ''discuss'' together your case and give the best possible treatment in combined approach. This is the best way when a TEAM works for you and this is the one people miss on.
Please let me you opinion on this / these points.
Well, I hope this helps you a bit in a different way too.
We the Doctor community want the patient to get a cure.
All the best.
Please feel free to ask for further relevant queries if you have or if you feel that there is a gap-of-communication.
Combined approach by a ''TEAM'' of Doctors who can interact for you
Detailed Answer:
Hi.
Good morning.
Well it took a lots of reading, taking to colleagues and research in answering this query.
Well, first of all it is impossible to say when TB was reactivated in you.
Do you live in India?
If you live in XXXXXXX or Asian continent, practically everyone has TB bacteria in their body and only those suffer from active disease when it is reactivated. Again it is practically impossible to say when-how-why. I hope you got my point.
That is why the chances of your baby contracting TB when in uterus or during breast feeding are difficult to predict and that now BCG has been given. Fortunately the baby contracting TB in such a way is not known to occur in practice.
The baby can get infected only if you had / have open TB, meaning Sputum AFB (bacteria) positive and fortunately your X-ray chest is normal and I hope you are sputum negative.
So do not worry, if you have extra-pulmonary TB and the X-ray chest and CB are of the baby are normal.
Again in old times all the family members were subjected to test of X-ray Chest to see if someone in your family has open TB but not symptomatic at all. And this is not uncommon to find.
**Diagnostic Laparoscopy:
Done only if required and since you are already under the treatment of ATT, the only major indication is any complication of TB like obstruction, collection, or so on.
Now-a-days it is safe even though you have TB in abdomen.
Your Surgeon is absolutely right, let the medicines work > CECT abdomen if required > Diagnostic Lap SOS.
Yes CECT is safe even when on ATT, get urea and creatinine done before CECT.
* With the proper ''management'' of TB, the chances of requiring Lap is reduced to minimum. You may not need one.
**The so called flare up is due to the congestion caused as a result of periods. Periods cause changes n uterus and the surrounding tissues, and should settle with time.
The present problem of fever, malaise, nausea and vomiting can be due to viral fever or so, your attending Doctor on examination can tell you the best. This is the season of viral fever going on, and many people come to see you, meet and greet you can have viral fever / flu which you can catch easily.
3 days history does not tell about resurfacing or ATT not working.
*Now there are labs equipped with testing whether you have MDR or not and the availability of such labs and requirement of which material is to be talked to your Doctor.
I would have a personal opinion after detailed study of your case:
Since you are already under ATT, continue on.
Take full normal diet, many so-called special things to eat and drink can actually kill the appetite and I hope you agree with me.
Go for natural proteins like eggs and sprouts.
Continue Benadon, Multivitamins containing lycopene and ginseng (if you are not breast feeding the baby) help in good recovery.
Exercises in mild form (ambulation as we say), get involved in daily activities, hobbies, distraction of mind from the disease and such positive activities help a lot in a very good activity.If you mind is involved 24/7 in the disease, there is no way for a good recovery.
If you think your Doctors are trustworthy and sincere in their efforts, believe in them, tell them to do the best for you and stick to a ''TEAM'' of a Gynecologist+Physician and a Surgeon who can ''discuss'' together your case and give the best possible treatment in combined approach. This is the best way when a TEAM works for you and this is the one people miss on.
Please let me you opinion on this / these points.
Well, I hope this helps you a bit in a different way too.
We the Doctor community want the patient to get a cure.
All the best.
Please feel free to ask for further relevant queries if you have or if you feel that there is a gap-of-communication.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks for the sound medical advice,
I knw sir,my case seems to be very unique as i visited so many docs intially and nobody beleived me and then one expert radiologist found it in a ultrasound.
Sir pls guideme whether i have taken a right decision by starting att,,as it was e,piricaly based on usg report , and my confusion is that if it can seen on usg then y not in mri and why was my cjest x ray and afb was negative,,my esr was not tht high too(as told by one of my gynae),i hve had mildfever on and off,with no weight loss,.y mri says its pid....i seriously dont know what actually is going in my body..but yes i can sense there was something weong which could not be healing.
Yes i reside in XXXXXXX
Sir pls guideme also the symtomps of crohn disease and relevant informations and tests to identify..i know i have asked thos to others doc too,,but can there be a possibility of beginning of cancer of intestines or some other inflammation becoz yestetday i got my usg done,and radiologost said the area that i m having prob is called as ileum ..is there something else and i m taking treatmwnt for tb..
I m taking benadon as multivitamin.,is it fine or can u suggest some othe
rcan i take zinase d as a pain reliver..earlier i have taken that in a month of feb for 20 days which was followed by cipzen forte for 15 days
Also i feel somethomes numbness in my hand and head..i was earlier given meganeuron od plus,..,can i again contine that with my att on
My current medic8nes are
Rablet d,akt 4, benadon,folvite ,bevon,sorbilin,liv 52
Supracal,darolac
Sofetron z ,duplahac,natuolax trphala sos
I feel a discomfort and a bulge in lowerabdomen wen i laugh cough and before faeces,y could tht be so..if there is beginning of hernia,will it reflect in usg
Attaching my latest blood reprts ,in which crp was elevated..
I knw sir,my case seems to be very unique as i visited so many docs intially and nobody beleived me and then one expert radiologist found it in a ultrasound.
Sir pls guideme whether i have taken a right decision by starting att,,as it was e,piricaly based on usg report , and my confusion is that if it can seen on usg then y not in mri and why was my cjest x ray and afb was negative,,my esr was not tht high too(as told by one of my gynae),i hve had mildfever on and off,with no weight loss,.y mri says its pid....i seriously dont know what actually is going in my body..but yes i can sense there was something weong which could not be healing.
Yes i reside in XXXXXXX
Sir pls guideme also the symtomps of crohn disease and relevant informations and tests to identify..i know i have asked thos to others doc too,,but can there be a possibility of beginning of cancer of intestines or some other inflammation becoz yestetday i got my usg done,and radiologost said the area that i m having prob is called as ileum ..is there something else and i m taking treatmwnt for tb..
I m taking benadon as multivitamin.,is it fine or can u suggest some othe
rcan i take zinase d as a pain reliver..earlier i have taken that in a month of feb for 20 days which was followed by cipzen forte for 15 days
Also i feel somethomes numbness in my hand and head..i was earlier given meganeuron od plus,..,can i again contine that with my att on
My current medic8nes are
Rablet d,akt 4, benadon,folvite ,bevon,sorbilin,liv 52
Supracal,darolac
Sofetron z ,duplahac,natuolax trphala sos
I feel a discomfort and a bulge in lowerabdomen wen i laugh cough and before faeces,y could tht be so..if there is beginning of hernia,will it reflect in usg
Attaching my latest blood reprts ,in which crp was elevated..
Brief Answer:
The medicines you are taking is alright - pl post the USG reports.
Detailed Answer:
Hi.
Thanks for your appreciations.
Please post the report of USG who found out the disease as TB and the one which you have got it done yesterday.
To repeat, you have to believe in the team of Doctors. It looks you are still in doubt and not in a position to believe anyone hence trying to find the solution on your own. If you start finding the why and how on your own you will be never satisfied and always in disbelief directly affecting the positive outcome.
The treatment of ATT is started on empirical basis but must have started on some basis like in your case the USG. We have already discussed the prones and cons.
You may please ask this question to the Doctor who started you on ATT because he must have examined you, considered many other factors which I am not aware of and can not be. Here the my answers are based on a very limited knowledge that you have provided.
All the investigations have their limitations; the limitations of hte machines, every machine has different techniques, the man behind the machine: his experience, exposure, his ability to coordinate what he sees in the machine and the symptoms and signs you have, technical expertise and so on,. Hence everything is not seen on every machines. They just help in clinical diagnosis.
The question is, ATT once started, continue it for the stipulated course. And these are antibiotics anyways.
Please post the USG which say problem is in the ileum, this is the commonest site of TB in XXXXXXX
Crohn's: not at all common in XXXXXXX It is always the histology diagnosis done on the biopsy specimen of the tissues for which you have to undergo Colonoscopy and biopsy. The symptoms and signs will be same as TB or any other granulomatous disorder. I think you must have already read about Crohn's on internet.
You may please go for colonoscopy and biopsy to rule out or confirm your fears of Chroh's and Cancer.
You may please continue Meganeuron as before very safely, no problem.
You are already under a good combination of the medicines as you have noted.
Why would you think of so many varied diseases.
Discomfort and bulge in the lower abdomen may be due to previous surgery / TB / Hernia is obvious on coughing . This again is a diagnosis best made on clinical examination, confirmed by a simple test of bulge felt on straining or coughing . There is an ''impulse'' on coughing. No other test like USG would detect it at an early stage. It may detect only in late stages where the neck and the sac is well formed.
Reports are fine and in accordance with the treatment you are already going through. It is not very high or alarming.
The medicines you are taking is alright - pl post the USG reports.
Detailed Answer:
Hi.
Thanks for your appreciations.
Please post the report of USG who found out the disease as TB and the one which you have got it done yesterday.
To repeat, you have to believe in the team of Doctors. It looks you are still in doubt and not in a position to believe anyone hence trying to find the solution on your own. If you start finding the why and how on your own you will be never satisfied and always in disbelief directly affecting the positive outcome.
The treatment of ATT is started on empirical basis but must have started on some basis like in your case the USG. We have already discussed the prones and cons.
You may please ask this question to the Doctor who started you on ATT because he must have examined you, considered many other factors which I am not aware of and can not be. Here the my answers are based on a very limited knowledge that you have provided.
All the investigations have their limitations; the limitations of hte machines, every machine has different techniques, the man behind the machine: his experience, exposure, his ability to coordinate what he sees in the machine and the symptoms and signs you have, technical expertise and so on,. Hence everything is not seen on every machines. They just help in clinical diagnosis.
The question is, ATT once started, continue it for the stipulated course. And these are antibiotics anyways.
Please post the USG which say problem is in the ileum, this is the commonest site of TB in XXXXXXX
Crohn's: not at all common in XXXXXXX It is always the histology diagnosis done on the biopsy specimen of the tissues for which you have to undergo Colonoscopy and biopsy. The symptoms and signs will be same as TB or any other granulomatous disorder. I think you must have already read about Crohn's on internet.
You may please go for colonoscopy and biopsy to rule out or confirm your fears of Chroh's and Cancer.
You may please continue Meganeuron as before very safely, no problem.
You are already under a good combination of the medicines as you have noted.
Why would you think of so many varied diseases.
Discomfort and bulge in the lower abdomen may be due to previous surgery / TB / Hernia is obvious on coughing . This again is a diagnosis best made on clinical examination, confirmed by a simple test of bulge felt on straining or coughing . There is an ''impulse'' on coughing. No other test like USG would detect it at an early stage. It may detect only in late stages where the neck and the sac is well formed.
Reports are fine and in accordance with the treatment you are already going through. It is not very high or alarming.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks for the elaborated reply and your efforts sir
I wanted to ask sir,what are granulomatas and its disorder,as i desribed earlier that while coughing laughing ceying or before passing stools ,i face a weird discomfort in my left lowrr abdomen area ,below navel and above scar,feels like a lump has been formed there wen i touch,is this what is tht.in aday i feel 7...8 times approx mvements there that last for a second and then disappears,as if something jumped
Are these visible in usg,or mri or ct
Pls tell me is it possible tht after starting att if it is indeed tb,can it spread to other organs or more area in my abdomen i m having much giddiness for last 4 5 days, can this spread to spine or lungs with att on..
Can i take zinase d once a day..the dose o have taken of zinase d os mentioned in my previous query.
If there is any lesion which is tube4cular or not, will it settle by att..
Pls guide
I wanted to ask sir,what are granulomatas and its disorder,as i desribed earlier that while coughing laughing ceying or before passing stools ,i face a weird discomfort in my left lowrr abdomen area ,below navel and above scar,feels like a lump has been formed there wen i touch,is this what is tht.in aday i feel 7...8 times approx mvements there that last for a second and then disappears,as if something jumped
Are these visible in usg,or mri or ct
Pls tell me is it possible tht after starting att if it is indeed tb,can it spread to other organs or more area in my abdomen i m having much giddiness for last 4 5 days, can this spread to spine or lungs with att on..
Can i take zinase d once a day..the dose o have taken of zinase d os mentioned in my previous query.
If there is any lesion which is tube4cular or not, will it settle by att..
Pls guide
Brief Answer:
keep no doubts- Go for enteroclysis
Detailed Answer:
Hi.
Oh, my !
Granulomatas are the reactions that the body shows to a group of diseases like TB.
Simple (although unrelated) example is a corn that develops due to some foreign body (FB) enters the soles. The body tried to guard against it by forming a layer of strong tissues around it, hoping that FB will no trouble the body.
All the diseases which act like or recognized like FB by the body's defense mechanism are acted upon by the body in the same way to form granulomas.
TB is the commonest cause in XXXXXXX and the 'old adage' was unless proved otherwise the granuloma should be ''considered'' as TB if the person is a resident of XXXXXXX
I hope you understand what I mean by.
The weird feeling may be 'subacute' intestinal obstruction not causing any major symptoms and can best be seen by Enteroclysis done by an expert Radiologist under fluoroscopy guidance to see the movement of the barium through the intestines and get the point you have mentioned, as you acn the feeling again ob barium and you can tell the Radiologist when you have the pain as this is real-time examination.
Please get this one.
TB should not spread to other organs once you started on ATT.
Why do you want to take Zinace D, is not there hot climate in Delhi? Avoid, you must have taken enough of it.
If there is any lesion which is tube4cular or not, will it settle by att.. >> could not understand the meaning of your this question.
How is your baby? Son or daughter?
How much time are you spending with the baby and the family members ?
Any household work that you do?
What is the diet are you taking?
keep no doubts- Go for enteroclysis
Detailed Answer:
Hi.
Oh, my !
Granulomatas are the reactions that the body shows to a group of diseases like TB.
Simple (although unrelated) example is a corn that develops due to some foreign body (FB) enters the soles. The body tried to guard against it by forming a layer of strong tissues around it, hoping that FB will no trouble the body.
All the diseases which act like or recognized like FB by the body's defense mechanism are acted upon by the body in the same way to form granulomas.
TB is the commonest cause in XXXXXXX and the 'old adage' was unless proved otherwise the granuloma should be ''considered'' as TB if the person is a resident of XXXXXXX
I hope you understand what I mean by.
The weird feeling may be 'subacute' intestinal obstruction not causing any major symptoms and can best be seen by Enteroclysis done by an expert Radiologist under fluoroscopy guidance to see the movement of the barium through the intestines and get the point you have mentioned, as you acn the feeling again ob barium and you can tell the Radiologist when you have the pain as this is real-time examination.
Please get this one.
TB should not spread to other organs once you started on ATT.
Why do you want to take Zinace D, is not there hot climate in Delhi? Avoid, you must have taken enough of it.
If there is any lesion which is tube4cular or not, will it settle by att.. >> could not understand the meaning of your this question.
How is your baby? Son or daughter?
How much time are you spending with the baby and the family members ?
Any household work that you do?
What is the diet are you taking?
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks for the reply doc,
My baby boy is doing fine..and i m spending pretty much gud time with him..i know my questions can bother u ,but its been a lot of suffering for last six months,intially because of operation followed by this problem ,late diagnosis and then confusions created by others.
1
Pls tell me if u can tht if it is indeed tb and has gone into drug resistance, can there be possibilty then to spread it into head or spine,,and even if it has does the medic7nes remain the same for its treatment..since i have done some timungs mistake in taking themlike gaping ofv4 5 hours(though i have not missed a single dose,expect wen i had vomit sometimes)
2
By lesion i meant tht the radiologist who conducted mri told that there is a soft tissue track exactky above the complete scar area..i wnated to ask tht whether that track if tubercular or not will settle by att
3
My diet was intially fine with att but for last days becausebof vomiting is not upto the mark
4
How much time does att takes to begin its effect..i m in 7th week now.
5
And one imp question can thos tubercular load be made less by giving ,ed7cines thru iv,will it make any difference.
6
And what if it is just a intestinal obstrution or somrthing else and not tb,,is it safe then to take tb medicines,,this is my biggest worry. As i have been on lot of antibiotocs for last 6 months.my treatment was startrd on basis of usg,positive igra and mantoux,since on physical examination there was just swelling and red strech marks.pls guide if it os possible
7
Is intestinal obstruction or tb is visible in cect..is a 16 slice mdct is useful in abdoimnal analysis
Pls tell
My baby boy is doing fine..and i m spending pretty much gud time with him..i know my questions can bother u ,but its been a lot of suffering for last six months,intially because of operation followed by this problem ,late diagnosis and then confusions created by others.
1
Pls tell me if u can tht if it is indeed tb and has gone into drug resistance, can there be possibilty then to spread it into head or spine,,and even if it has does the medic7nes remain the same for its treatment..since i have done some timungs mistake in taking themlike gaping ofv4 5 hours(though i have not missed a single dose,expect wen i had vomit sometimes)
2
By lesion i meant tht the radiologist who conducted mri told that there is a soft tissue track exactky above the complete scar area..i wnated to ask tht whether that track if tubercular or not will settle by att
3
My diet was intially fine with att but for last days becausebof vomiting is not upto the mark
4
How much time does att takes to begin its effect..i m in 7th week now.
5
And one imp question can thos tubercular load be made less by giving ,ed7cines thru iv,will it make any difference.
6
And what if it is just a intestinal obstrution or somrthing else and not tb,,is it safe then to take tb medicines,,this is my biggest worry. As i have been on lot of antibiotocs for last 6 months.my treatment was startrd on basis of usg,positive igra and mantoux,since on physical examination there was just swelling and red strech marks.pls guide if it os possible
7
Is intestinal obstruction or tb is visible in cect..is a 16 slice mdct is useful in abdoimnal analysis
Pls tell
Brief Answer:
Needs tissue diagnosis for most of your answers.
Detailed Answer:
Hi.
Nice to know that you are enjoying your motherhood nicely, all the blessings for your XXXXXXX
I think we are discussing some points over and again and again.
I am sure you must have asked these questions to the Doctors who are treating you, directly responsible for you well-being and that they have answered you. Some questions are better asked face-to-face. This is just to make sure that you do not get confused and get trapped into some point of no-return misunderstanding, which has direct bearing on the healing process, recovery and most important, the faith.
Please do not go into such details that you will be entrapped into stress and anxiety which I can feel into your list of questions.
I am here to assist you, always be standing by you.
1. I can not know for certain till I examine you and have all the reports in front of me. This will be very premature on my side to give opinion based on lesser facts. Please excuse me on this point.
I has explained in previous discussions that time lag of few hours will not cause any problems.
It is great to know your sincerity that you have not missed a single dose.
2. radiologist who conducted MRI told that there is a soft tissue track exactly above the complete scar area.
>> The best and only options is to get a biopsy of the tract and send it for histo-pathology examination and part of it subjected from tests to detect whether this is MDR or not.
3. There are other factors also, which may be affecting your diet:
The stress, anxiety, phobia, effects of medicines and so on.
Get LFT (liver function tests) done immediately.
4. ATT usually shows effects within 3 weeks to 3 months.
5. All these medicines are available only as oral medicines only.
There was time when Streptoerbazide was available for intra-muscular injections.
Now only Streptomycin is available and that can be given if your treating Doctors feel so. You have to discuss this point in person with your treating Doctor.
6. It is better to get an appropriate diagnosis first, then only the discussion be fruitful, get Enteroclysis done.
7. yes, possible in some cases.
I hope these clear your some more doubts with the limitation of the ''virtual world'' of internet.
Please feel free to ask further relevant queries if you need to or if you feel that there is a gap of communication.
You may please continue on or rate this answer before closure of the discussion and can certainly contact me on the bellow link in future, whenever you may need me.
http://bit.ly/askdrtchandrakan
Needs tissue diagnosis for most of your answers.
Detailed Answer:
Hi.
Nice to know that you are enjoying your motherhood nicely, all the blessings for your XXXXXXX
I think we are discussing some points over and again and again.
I am sure you must have asked these questions to the Doctors who are treating you, directly responsible for you well-being and that they have answered you. Some questions are better asked face-to-face. This is just to make sure that you do not get confused and get trapped into some point of no-return misunderstanding, which has direct bearing on the healing process, recovery and most important, the faith.
Please do not go into such details that you will be entrapped into stress and anxiety which I can feel into your list of questions.
I am here to assist you, always be standing by you.
1. I can not know for certain till I examine you and have all the reports in front of me. This will be very premature on my side to give opinion based on lesser facts. Please excuse me on this point.
I has explained in previous discussions that time lag of few hours will not cause any problems.
It is great to know your sincerity that you have not missed a single dose.
2. radiologist who conducted MRI told that there is a soft tissue track exactly above the complete scar area.
>> The best and only options is to get a biopsy of the tract and send it for histo-pathology examination and part of it subjected from tests to detect whether this is MDR or not.
3. There are other factors also, which may be affecting your diet:
The stress, anxiety, phobia, effects of medicines and so on.
Get LFT (liver function tests) done immediately.
4. ATT usually shows effects within 3 weeks to 3 months.
5. All these medicines are available only as oral medicines only.
There was time when Streptoerbazide was available for intra-muscular injections.
Now only Streptomycin is available and that can be given if your treating Doctors feel so. You have to discuss this point in person with your treating Doctor.
6. It is better to get an appropriate diagnosis first, then only the discussion be fruitful, get Enteroclysis done.
7. yes, possible in some cases.
I hope these clear your some more doubts with the limitation of the ''virtual world'' of internet.
Please feel free to ask further relevant queries if you need to or if you feel that there is a gap of communication.
You may please continue on or rate this answer before closure of the discussion and can certainly contact me on the bellow link in future, whenever you may need me.
http://bit.ly/askdrtchandrakan
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks doc for ur well guided support,highly appreciable
1..I can very well understand the limitations of virtual world,just need one reassurance rrom u and that too if u can (else no issues)is that of spreading it into another parts of body,if already on att and the medicines that i have taken in XXXXXXX month(that is amikacin which i read is second line drug)has led me into drug resistance,just asking this because of swelling and bit of symptoms resurfacing,apart from tissue biopsy if there is any blood test that can tell me if i m on drug resostance,,i will deeply appreciate that..i can understand ur limitations but hope u can understand my conecern too..(its just because i dnt want my problem to aggravate further and incorrect later diagnosis and regrets.)
2..i have been asked for a ct cervical, and a med called enzoflam given bd for five days
3...Also i have been asked to take akt 4 for another one month..is it fine doc to take akt 4 for 3 months,am i on right track,becauce i heard tht akt 4 is given for 2 months,which is followed by akt2 for another six months,,is giving it for 3 montjs safe enough.as pe3 the side effects..pls guide sir
1..I can very well understand the limitations of virtual world,just need one reassurance rrom u and that too if u can (else no issues)is that of spreading it into another parts of body,if already on att and the medicines that i have taken in XXXXXXX month(that is amikacin which i read is second line drug)has led me into drug resistance,just asking this because of swelling and bit of symptoms resurfacing,apart from tissue biopsy if there is any blood test that can tell me if i m on drug resostance,,i will deeply appreciate that..i can understand ur limitations but hope u can understand my conecern too..(its just because i dnt want my problem to aggravate further and incorrect later diagnosis and regrets.)
2..i have been asked for a ct cervical, and a med called enzoflam given bd for five days
3...Also i have been asked to take akt 4 for another one month..is it fine doc to take akt 4 for 3 months,am i on right track,becauce i heard tht akt 4 is given for 2 months,which is followed by akt2 for another six months,,is giving it for 3 montjs safe enough.as pe3 the side effects..pls guide sir
Brief Answer:
Facts about TB treatment
Detailed Answer:
Hi.
How are you?
1. Amikacin was not given for TB, even though TB Bacteria develops resistance to Amikacin, does not matter as the current line of treatment will not include Amikacin as ATT.
TB should not ideally spread to other parts of the body as you are already taking 4 drugs.
Other than tissue diagnosis- the only way is to see the progress is based on Clinical grounds as observed by you, your family members, friends and your Doctors and ultrasonography / CT scan .
2. Please get this done as your Doctor wants to either rule out or confirm .
3. There is always a balance between the potential side effects and the benefits of a particular medicine / group of medicines for the well being of the patient. It is the prerogative of your treating Doctors to decide, which medicines and for what period. Since this is an extra-pulmonary disease some Doctors might have the experience as they have prescribed for 3 months.
Better to follow your Doctors who are treating you.
I hope this answer helps you. Please feel free to ask relevant queries if you need to or if you feel that there is a gap-of-communication .
Facts about TB treatment
Detailed Answer:
Hi.
How are you?
1. Amikacin was not given for TB, even though TB Bacteria develops resistance to Amikacin, does not matter as the current line of treatment will not include Amikacin as ATT.
TB should not ideally spread to other parts of the body as you are already taking 4 drugs.
Other than tissue diagnosis- the only way is to see the progress is based on Clinical grounds as observed by you, your family members, friends and your Doctors and ultrasonography / CT scan .
2. Please get this done as your Doctor wants to either rule out or confirm .
3. There is always a balance between the potential side effects and the benefits of a particular medicine / group of medicines for the well being of the patient. It is the prerogative of your treating Doctors to decide, which medicines and for what period. Since this is an extra-pulmonary disease some Doctors might have the experience as they have prescribed for 3 months.
Better to follow your Doctors who are treating you.
I hope this answer helps you. Please feel free to ask relevant queries if you need to or if you feel that there is a gap-of-communication .
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Thanks sir,
I read an article on net,regarding diagn9stic lap,as my 5reating doc yesterday was in a opinion of getting it done,if my swelling does not improve,i m attaching my report as well as that article,pls tell me about this regarding safety for me,,moreover sir if at all diagnostoc lap is done,will ot be safeafter six months of delivery,though my healing is pretty much delayed as i delivered in mid november and started my att in april,.my abdominal wall is still very loose and flabby..or should i wait
2.is pegalup a safe laxative touse for some time...
3.sir is it possible tht i have devloped incisional hernia(just asking for possibilities)..does that happen post cesaran delivery(lscs),and if it is there can it be corrected while performing diagnostic lap,,or hernia if there can be treated with medicines.....what are the precautions that can be taken while fiagnostic lap,so that future complications can b (like adhesions further ) can be totally minimised
I read an article on net,regarding diagn9stic lap,as my 5reating doc yesterday was in a opinion of getting it done,if my swelling does not improve,i m attaching my report as well as that article,pls tell me about this regarding safety for me,,moreover sir if at all diagnostoc lap is done,will ot be safeafter six months of delivery,though my healing is pretty much delayed as i delivered in mid november and started my att in april,.my abdominal wall is still very loose and flabby..or should i wait
2.is pegalup a safe laxative touse for some time...
3.sir is it possible tht i have devloped incisional hernia(just asking for possibilities)..does that happen post cesaran delivery(lscs),and if it is there can it be corrected while performing diagnostic lap,,or hernia if there can be treated with medicines.....what are the precautions that can be taken while fiagnostic lap,so that future complications can b (like adhesions further ) can be totally minimised
Brief Answer:
as detailed.
Detailed Answer:
Hi.
Thanks for the reports.
Both the reports are showing the tracts to be ''like cold', meaning not showing signs of acute inflammation, MRI suggested adhesions; as is the report of USG - Hypoechoic tract with avascularity.
Much more suggestive of TB and you should complete the courses.
** Diagnostic Lap: your Surgeon has suggested rightly to go for diagnostic Lap if the swelling does not improve.
Article not attached. Please attach or give a link here.
With the expertise and improved instruments and visual aids, Laparoscopy is very safe now a days and you can safely go for it if it is required.
Loose and flabbiness of abdominal wall is in fact a good thing for Laparoscopy.
You can go for it the day your Surgeon feel so.
**Use laxatives only if advised by the Doctor. Which one is the one you mentioned - was it Peglac , what is the dose you will take / taking?
**Incisional hernia can develop after any surgery and your surgery is no exception.
This is better left alone if it is near the tract as you are still undergoing treatment. Infection of whatsoever reason can cause recurrence. Mesh should not be used at the moment hence it will be a just a anatomical correction is the hernia is there. Do not worry about the hernia at teh moment as most important is to get out of the TB.
There are no medicines that can cure hernia.
-Precautions:
Maintain a good hemoglobin and serum albumin in normal range. Maintain proper hydration;
Take liquid diet and prepare a good bowel as will be asked by your Surgeon.
Till then take a full normal home-made diet.
I hope this helps you, please feel free to ask further .
as detailed.
Detailed Answer:
Hi.
Thanks for the reports.
Both the reports are showing the tracts to be ''like cold', meaning not showing signs of acute inflammation, MRI suggested adhesions; as is the report of USG - Hypoechoic tract with avascularity.
Much more suggestive of TB and you should complete the courses.
** Diagnostic Lap: your Surgeon has suggested rightly to go for diagnostic Lap if the swelling does not improve.
Article not attached. Please attach or give a link here.
With the expertise and improved instruments and visual aids, Laparoscopy is very safe now a days and you can safely go for it if it is required.
Loose and flabbiness of abdominal wall is in fact a good thing for Laparoscopy.
You can go for it the day your Surgeon feel so.
**Use laxatives only if advised by the Doctor. Which one is the one you mentioned - was it Peglac , what is the dose you will take / taking?
**Incisional hernia can develop after any surgery and your surgery is no exception.
This is better left alone if it is near the tract as you are still undergoing treatment. Infection of whatsoever reason can cause recurrence. Mesh should not be used at the moment hence it will be a just a anatomical correction is the hernia is there. Do not worry about the hernia at teh moment as most important is to get out of the TB.
There are no medicines that can cure hernia.
-Precautions:
Maintain a good hemoglobin and serum albumin in normal range. Maintain proper hydration;
Take liquid diet and prepare a good bowel as will be asked by your Surgeon.
Till then take a full normal home-made diet.
I hope this helps you, please feel free to ask further .
Note: For further inquiries on surgery procedure and its risks or complications book an appointment now
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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