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Surprise, surprise - TB!


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So, Dad had a CT last Tuesday, and we saw the oncologist last Fiday. The CT showed no change or perhaps slight shrinkage of the main nodule in the R upper lobe, but significant growth in the left lower lobe lesion. But the latter was different-looking, not a nodule, but more webby, with two small cavities inside. The surgeon had told us it was funny-looking before, hence the plan to do two cycles of chemo and then invasive staging with mediastinoscopy and possible open biopsy of that LLL lesion. Now even the oncologist thought that the rapid growth and appearance was more suggestive of infection or inflammation rather than cancer. So we planned to finish the second cycle of chemo, get another CT, and see the onc and surgeon again at that point.

That was Friday. Today the onc's office calls, just as my Dad is leaving for chemo. Chemo has been cancelled - Dad's sputum sample grew out tuberculosis.

I don't know if I'm on my head or my @ss. On the one had, it's sort of good - lung cancer + TB sounds better than lung cancer, stage IV. OTOH, it really complicates his treatment. He'll have to go on TB meds, I don't know how long it will be before he can get chemo. I don't even know how this affects our plan for surgical staging - I would think no one will be in a rush to operate on someone who's harking TB bacilli. So everything is up in the air.

We see an infectious disease guy and the surgeon again on the 30th. I'm hoping that we'll be able to develop another battle plan, and won't have to delay his lung cancer treatment too much.

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Nina is right. The family and anyone else in close contact with your Dad should get TB skin tests - they are pretty simple. Just a tiny needle prick. The good news is that repeated contact with the infected person is required to transmit TB to a healthy person. Once treatment is underway, the risk of transmission declines.

TB is transmitted through the air, so he should cover his mouth or nose with any coughing or sneezing. When going out in public, he should wear a TB mask specially fitted to filter all the air he breathes out. Ask his infection doc about it.

TB's resurgence is strongly linked to immune system compromise - and the fact that those clever little bacilli have mutated themselves into a new drug-resistant form. Some people have the old-fashioned run-of-the-mill TB; you may want to ask which one he has.

Sorry about this newest shot across the bow, but it's good news that it can be treated. Best wishes to you, Teresa

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Len has a family history of tb -- his dad died of it when Len was 2 years old, then his older brother came down with it 15 years later and recovered. Len always reacts violently to the tuberculin skin test but when he's had a follow up lung xray, everything seemed fine. Then, after the lc diagnosis, when he was in the hospital before surgery, the pulmonogist told us that the xray/ct scan showed something in the OTHER lung (the left, non cancerous one) that looked, to her, like an old tb scar. We told her his history and she thought that probably he might have had a small case of tb without realising it somewhere along the way.

Then, when we met with the medical oncologist to discuss chemo, we told him about all this. He was concerned that if Len had indeed been exposed to tb and was carrying around live, but quiescent, tb bacilli, depressing his immune system with the chemo might bring them to life. He brought up the possibility of Len's going on the full year tb treatment cycle simulataneously with the chemo but then said he would discuss the case with several infectious disease specialists who might advise us on the appropriate measures to take. He talked to two, one of whom said "Don't bother; likelihood of tb is minimal", the other, of course, saying he thought Len should definitely take the tb treatment. We talked about it with the oncologist at some length and then agreed that we would go ahead without tb treatment. Len had gone through three previous surgeries (back surgeries) and had survived a case of legionnaire's disease 15 years earlier; his immune system must have taken a whailing at those times but there had been no active tb that we knew about.

So he went through the chemo and did just fine. But this longwinded story does show you that you can take tb treatment AND chemo at the same time. Let us know what course they decide to follow.


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Wow, I can't believe your poor Dad. i may have been exposed by a coworker, who works wirh a TB patient. She doesn't need this because she can't hardly eat anything due to the meds she is own to control her seizures. I sure don't either due to the cancer. Please keep us informed on how he is doing!


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