COULD IT BE TB?

April 11, 2017

Had appointment with my family doctor Scott Haydel today.  Felt so comforting to be back in friendly and familiar territory.  He had received and reviewed my reports from the ENT clinic and we discussed the procedures that had been done in the last 5 weeks.

I told him how the ENT doctor did not tell me much and that I sometimes did not know what to ask.  Told him how frustrated I have been with my care.  He asked if my biopsy had been cultured for various things to see if bacteria, viruses, or fungi have grown.  If certain microorganisms grow, more tests will be done to identify them. This helps determine the best treatment.  I said I didn't know as he did not tell me.   He said he would call the ENT doctor.

I asked that when he speaks to the ENT doctor to relate that I would like to have the next procedure done here in Houma by the Diagnostic Radiology doctors with Dr. John Steigner's office who accept my insurance and not at Thibodaux Regional Medical Center.  He said he would talk to Dr. Beyer and then call me today or tomorrow with some explanation as to why I was referred out of town.

He also told me that he was seeing a couple of other patients that were going through the same thing as I am with having no biopsy results and no diagnosis in order to be referred to the proper medical professional and receive correct treatment.  That is sad.  I have read many testimonials from cancer survivors who have experienced years of testing before they were finally diagnosed with cancer in the late stages.

I forgot to mention to him about seeing the Gastro doctor David Pellegrin on February 16th for a colonoscopy due to seeing blood in my stool a couple of days before while camping in my RV.  A small amount once then the next day a lot of bright red blood.  The procedure was scheduled for the following week but I had to cancel the appointment due to the oral surgery the ENT doctor suggested to me on February 22 and scheduled for March 6th.   I will inform him of this when he calls me.  I do want to have the colonoscopy.  It may help rule out some other type of disease I might have.  I do have problems with loose stool and diverticulosis.

I told him about the pain I am having on my left back area under my shoulder blade and he examined the area.  It is sensitive to touch and also hurts when not touched.  I just thought it was arthritis and he asked me if I was ever exposed to tuberculosis.  I informed him that I have been positive since I was a teen (but inactive) and can no longer be tested.

This was something that I had not thought about for many years.  I opened my wallet and showed him a paper given me that stated that I was positive.  That was the end of our visit.  He said he would call me later.

When I got home I did some more research on the Internet and after about an hour I came across this.

Both systemic and local factors play a role in incidence of oral lesions. Systemic factors include lowered host resistance and increased virulence of the organisms.  Local factors comprises poor oral hygiene, local trauma, chronic inflammation, tooth eruption, extraction sockets, periodontal disease, carious teeth with pulp exposure and presence of lesions like leukoplakia, dental cysts, dental abscesses, and jaw fractures. 

Any breach in the mucosal lining predisposes toward oral involvement.  Oral tuberculosis affect the gingiva, floor of the mouth, palate, lips, buccal folds, tooth sockets, and jaw bones, with the tongue being the commonest site.  Sometimes, oral ulcers may follow opalescent vesicles or nodules which may break down as a result of caseation necrosis to form an ulcer.

Ulcers apart, tubercular tongue lesions present as tuberculoma, tuberculous fissure, tubercular papilloma, diffuse glossitis, or atubercular cold abscess.  Diagnosis of tuberculosis is based on clinical findings, sputum microscopy and radiography.  Recent development of DNA probes, polymerase chain reaction assays, and liquid media now allow more sensitive and rapid diagnosis.

Oral TB lesions may be either primary or secondary in occurrence. Primary lesions are uncommon, seen in younger patients, and present as single painless ulcer with regional lymph node enlargement. The secondary lesions are common, often associated with pulmonary disease, usually present as single, indurated, irregular, painful ulcer covered by inflammatory exudates in patients of any age group but relatively more common in middle-aged and elderly patients.

Oral TB may occur at any location on the oral mucosa, but the tongue is most commonly affected. Other sites include the palate, lips, buccal mucosa, gingiva, palatine tonsil, and floor of the mouth. Salivary glands, tonsils, and uvula are also frequently involved. Primary oral TB can be present as painless ulcers of long duration and enlargement of the regional lymph nodes.

TB of the oral cavity frequently simulates cancerous lesions and others like traumatic ulcers, aphthous ulcers, actinomycosis, syphilitic ulcer, or Wegener's granuloma.   The chronic indurated ulcer has to be carefully distinguished from a carcinoma, as with other TB lesions of head and neck, they can resemble each other and frequently coexist.

The diagnosis of pulmonary tuberculosis is confirmed both microscopically and radiographically and the ulcer on the tongue can be concluded as a tuberculous ulcer secondary to pulmonary tuberculosis. The patient can be prescribed antituberculosis therapy (ATT) consisting of isoniazid (300mg), ethambutol (1000mg), pyrazinamide (1500mg) and rifampicin (600mg).

Administration of standard antitubercular therapy, with antibiotics such as isoniazide, rifampicin, pyrazinamide, and ethambutol for six months, is essential for the complete eradication of tubercular lesions.

This is something I will discuss with my family doctor.  It does make sense to me that this all started when I was having dental work done back in July of 2016.   It explains alot.