In the ongoing saga of the TB lawyer, we now hear he might face surgery to remove the TB.

In some ways, doctors are glad about this lawyer’s immature behavior, including his manipulation of the press, because at least he was only minimally infectious, but the soapopera like press story has brought the importance of drug resistant TB to the public attention.

In summary, the next time, instead of being polite and saying we advise you not to travel, (knowing the law makes enforcement impossible and knowing some patients will balk at cooperation if they are given a direct order) we will be able to say: don’t travel or we’ll get you arrested by Homeland security and placed into jail.

But the next stop is treatment. How do you treat Tuberculosis when medicine doesn’t work?

Ah, back to the good old days.

You put the person at rest, either at home or somewhere he or she won’t spread the germ, give them good nutrition, and if the disease is localized, you can consider surgery.

The tuberculosis germ is usually walled off by the body, sort of like a boil with cheesy stuff inside.

If you’ve ever had a boil, you know what I mean. It’s pretty nasty. But when boils burst, the germs go out and you get better. If it bursts in your lungs, it spreads germs through your lungs and you cough out germs. Bursting the wall can also lead to you bleeding to death (hemoptysis) but that’s another story.
IF you want a gory picture of what it looks like, checktuberculosis…

The holes are areas that used to be full of germs and white blood cells (actually t cell macrophages) but have emptied out…the photo shows the gentleman coughing germs galore all over the place. Usually tuberculosis likes the upper lungs, and the danger is that as you cough it out, it spreads down to the rest of the lung, which is why the picture shows holed in the top and grey-yellow areas (tubercules that haven’t burst) in the middle of the lung.
But our lawyer didn’t break down the walls, so wasn’t that infectious…yet. He isn’t a malnourished Asian like the photo, but a healthy lawyer. So how do you keep him from getting worse if you can’t treat the infection?
In the good old days, if you only have one or two tubercules/ puspockets/areas of infection, it was removed surgically. Usually these people do well–I had a couple little old ladies patients who had it done in the 1930’s, and they were still going strong fifty years later.  Indeed, this is how we treat certain fungus infections. And for our lawyer, it sounds like a good idea, although I worry about those in the operating room…
Like an abcess (boil, pimple) you can just take the tubercule out and voila, the infection in that area is gone.

Since this cuts down the number of germs that can get lose, and if the gentleman is lucky he doesn’t have a bunch of other tubercules elsewhere,, essentially it allows your own body defenses to kill the few remaining germs.

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Nancy Reyes is a retired physician living in the rural Philippines. Her website is Finest Kind Clinic and Fishmarket, and she writes essays on medicine at HeyDoc Xanga Blog

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