By Pankajbala R Patel

And combat the side effects of TB medicines which are powerful anti-biotics…

IF you are a TB patient you are more or less a lost soul. Despite the reported considerable funds allotted to eradicate tuberculosis (most common is pulmonary TB) something somewhere is not working. Most of us still do not think tuberculosis warrants closer supervision of patients. Not even if realize that TB is a serious serial killer of epidemic proportions (although mortality rates have dropped and this is seen as a success story with WHO patting India on the back).
This said India still sees 2.8 million plus, plus new cases of TB annually. It should be a matter of concern in a country which leads the world in TB statistics and mortality and we’re still far away from saying goodbye to TB by the targeted year of 2025. As on November 9, 2023 there were 3,42,000 TB-related deaths in India (3,31,000 among HIV-negative people and 11,000 among those with HIV). India accounts for 27% of total TB cases in the world…two deaths every three minutes. We are talking registered cases here and reportedly up to a million cases go missing reportedly, so where are these patients are not on the treatment register officially?

POST-COVID TB CASES
WE got so hyperactive when the engineered Covid-19 unleashed itself on us and yes, now we hear that Covi-19 pandemic itself has increased the harm from a much older continuing pandemic – right, tuberculosis! I have been reading up TB in the UK which has been making a comeback post Covid-19 pandemic and targeting the elderly. In fact, they’re considering bringing back the BCG vaccine for the elderly, never mind that it is proved to be effective only on children and there’re no clear indications that if the elderly get the vaccine they will be safe from TB infection.
HOW much do we know about tuberculosis regardless of whether we’re a victim or not? The poor are never really educated about TB and how they can better protect themselves. Most don’t have the infrastructure for basic sanitation. Of course when the educated and especially someone from the medical profession itself falls victim to the TB bacteria there is considerable alarm.
In one case we were reading in British TB records there’s the case of a Seargeant Carrianne Franks who was a flight nurse in the RAF. At the height of the pandemic, Carrianne worked on the Nightingale Hospitals providing intensive care unit support alongside her National Health Services colleagues. When she fell ill in July 2021 she was incorrectly diagnosed with Covid and pneumonia. The truth was uncovered tragically too late – Carrianne died just one day after receiving a TB diagnosis!

PULMONARY TB MOST COMMON
SO why does it take too long to diagnosis TB despite all the urging to come early for a check-up if you’re been coughing for more than two week? You may report early but it may as long as a year to confirm TB, pulmonary TB is easier to detect – the rarer cases go unconfirmed and patients are treated for everything else but TB. There’s a lot of differential diagnosis nowadays.
Some TB strains are not easy to detect and confirm although clinical evidence says it’s TB and start treatment immediately. For example most medical people in the business don’t even read MIR correctly for skeletal TB early enough to make a difference to the patient! Do you know that skeletal TB starts with some serious back pain which many patients put up with saying it’s the chair they need to change.
If you don’t believe this go and ask the most famous victim of skeleton TB, the famous film star Amitabh Bachchan who’s one person not afraid to tell the world how he was diagnosed with skeleton or skeletal TB after a year had passed…he is in remission now of course and mercifully hasn’t lost the use of his legs.
Most often in the case of the rarer skeletal TB (some reports say it’s 4% while some say 10% of all TB cases) the bacteria feeds away into your bones and bone marrow presumably till your immunity is compromised — and yet you may think it’s only back pain. We forget the skeleton is the scaffolding on which the muscular and nervous system hangs and TB may spread to lungs or throat (pulmonary forms of the infection, also to kidneys, brain, bones.

POOR RICH INDIA!
WE think only in poor developing India TB kills but since 1990 it has been also in the rise in the UK. But at least in the UK there’s a very meticulous program where health workers will come home to supervise TB patient and dugs intake, along with dietary arrangements required. In the UK a Cabinet minister got TB, as did a famous singer and an archbishop – the rich too are not immune to TB as we have come to see for ourselves although most folk hide the truth about themselves and TB for fear that they will be treated as outcastes once the word gets around.
Never mind that TB can affect any part of the the body although only TB of the lungs or throat is infectious. Even here a couple of months of treatment pretty much clears the patient from being infectious; worst case scenario is when latent TB patients spread the disease — they themselves remaining unaffected and unburdened by the active form of the disease!
Truly it is said there is more passive TB than active TB in the country and we all need to be in the picture to fight TB at ground level in home with better sanitation and nutrition. Under the circumstances it is not at all a bad idea to have smaller TB hospitals locally so that patients may be treated under supervision as well as get the diet they need to recover from the malnutrition they suffer from courtesy the poverty and ignorance in their lives.
It’s a fact that TB is not easy to treat because it takes anything from two to six months to a year to be finally free from the Mycobacterium tuberculosis. Needless to say because of the challenge of such a long-drawn out treatment many patients, depending on their age perhaps and especially senior citizens, face multiple problems to do with TB medication and associated geriatrics problems which largely go marginalized or neglected or paid scant attention to.
Redressing these problems would go a long way towards ensuring a faster elimination of this king-sized disease in India in which the bacteria sets up home in sputum (phlegm), cells, fluids, tissues, bones, brains too, just any part of body beautiful.

TB medicine side-effects to watch out for…

The long drawn-out treatment for TB is not easy for patients or doctors treating them. Treatment revolves around four drugs, namely Rifampicin, Isoniazid, Pyrazinamide and Ethambutol, they’re mostly powerful antibiotics which will make a mess of the good bacteria in the stomach. In the UK they have TBAG or TB Action Group, a patient support and advocacy network available around the clock to listen to TB patients’ woes with side-effects of medication or any other woes.
Abroad the medications come in four separate plain white tablets but in India we have all packaged in one big oblong magenta tablet not easy to swallow. However, even in TB programs abroad they do have a one-in-all tablet, for example, Voractiv. After two months if the medication is working fast patient may reduce the dosage of Rifampicin and Isoniazid but under medical advice and review of course.
This means if one of the medicines in the tablet is causing a side-effect it is not easy to deal with. Side-effects of TB medications to watch out for are majorly jaundice (yellowing of skin or eyes which means the liver is protesting), patients may feel constantly sick, dizzy, acquire skin rashes, a pins and needles pain bothering them, also flu-like symptoms manifest.
Rifampicin may turn urine, sweat, even tears, semen an intense orange color. Ethambutol may cause visual disturbance, watch out for a patient blinking far more often and check it out. Patients are constantly told to eat more, more heavy protein-rich food including protein supplements diluted in beverages like milk or water.
It is true that many vegetarians cannot tolerate the sudden onslaught of protein in their diet and especially seniors whose intake of food has decreased courtesy a gamut of health issues. When the immune system is down with malnutrition be sure you are vulnerable to TB bacteria in the air and from those who are described as “sleeping TB” patients, that is they may spread TB but are immune themselves. TB is latent in many people in India.
All this and much more is in need or review but suffice it is to say that if you are a TB patient what is crucial and will help you recover faster is: Protein is crucial for the growth, repair and maintenance of tissues in the body. Remember TB is a catabolic state in the body and therefore protein is a vital key to recovery.
Protein-rich foods are eggs, lean meats, poultry, fish, beans, lentils, think “sattu” or gram flour of Orissa or Bihar fame (remember the rikshawallah of old running the streets in Calcutta fed their strength with “sattu” flour mixed in water and today various gym kitchens offer sattu shakes!). There is also peanut butter, very protein rich. There are other nuts with best fruit being papaya, oranges, guava, kiwi, berries. There are also amla or Indian gooseberries, mango, carrots, tomatoes, sweet limes, lemons and capsicum, all vitamin C rich fruit. It is widely accepted now that upping dozes of vitamin C helps any patient heal faster. Organic vitamin C is naturally superior.
Vegetarian TB patients are also advised constantly to check their vitamin B intake as also sit in the sunshine early mornings out in the balcao for half-an-hour for vitamin D (believe it or not many Indians suffer majorly from lack of vitamin D)! Drink more water and be positive to recommendations of alternate naturopathy which does help faster recovery. But if only you or someone can swing it for you!
One of these days some nutritionist must design the perfect do-or-die diet for TB patients — and poor patients must get it on a platter if they cannot get it themselves. Has anyone started a TB-friendly diet kitchen or catering service? Why not!
NOTE: India recorded 2.8 million (28.2 lakh) TB cases in 2022, fatality rate is 12%. A TB patient dies every three minutes. There is cause for more concern at both community as well as government level State-wise. Unless of course we think life is dirt-cheap in India, let them die.
…all are low-GI food. Go check it out or read up some more of Dr Neil Barnard’s books. He has proved that fat-laden greasy meals today mean insulin resistance and diabetes tomorrow!