TB

[puzzlebobble]

; My "concern" is that we are told that (a) drug resistant TB strains, in other countries, are on the increase, (b) immigration has increased, and (c) those in the PHC industry who are charged with increasing public awareness and promoting care are not doing their jobs.

Have you tried the BMA website?..maybe India/Asia medical sites might have somehting to offer...they are probably more clued up on it than we are.

Therein lies my point.

My experience is that doctors are very much aware of tuberculosis. At medical school they will have had TB covered thoroughly and in far more depth than many other infections. The exams for entry to the Royal College of Physicians also have a very large number of questions on TB. In this country if you do get a diagnosis of TB you should get to see a specialist. TB often effects poorer people and although the standard of medicine in some asian countries can be very high often the care of the poor is substandard. The development of resistant strains is often a result of poorly treated disease.

So IMHO I don't think the standards of treatment of TB within the medical profession are low. However you mention the need to increase public awareness- that is harder.

I think you'd agree that a campaign to increase public awareness would have to be designed to improve diagnosis/treatment without causing panic.

In the case of meningitis there are typical new symptoms and a rash that is easily described and so facilitates a campaign; to contrast in TB the symptoms tend to develop over months and are often more variable. Furthermore if you look at the symptoms of TB-most people would seek medical attention even without a campaign (eg. coughing up blood, night sweats so bad you have to change the bed sheets, significant unexplained weight loss or even lumps in the neck/groin- would you not see your doctor if you had any of them? All of which could also be lung cancer/lymphoma/leukaemia etc. too). So I think you'd agree that it's not an easy campaign to design.

In addition the TB bacteria divide and grow slowly (it takes 4- wks to grow them in the lab) resulting in a relatively slow disease progression in most (but not all) and this reduces the importance of quick diagnosis- contrast this to meningitis where the time in minutes to getting antibiotics can mean the difference between life and death.

I think most parents have seen the meningitis posters and know about the non-blanching rash but did you know that that is typical of meninigits caused by one particular bacteria (neisseria meningitidis) and not found in most other types of meningitis? Do you think anyone has ever delayed taking their kid with meningitis to A/E because there was no rash? My guess is that it has happened. I mention this as evidence that public awareness campaigns have the potential to do harm as well as good.

Even if one were to start a campaign many of the newspapers are not able to handle the information responsibly and start scare stories- just think of the kids getting brain damage from measles now because of the MMR scare stories.

So really what I'm saying is it's not easy. My personal experience is that there are some very good physicians working in public health/respiratory medicine. Do we give too little priority to preventative medicine in this country? Undoubtably yes but thats true of all western medical systems because there's more money in treating people than preventing illness and it's easier to show you've cured someone than prevented someone getting something.




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[Softus]

My experience is that doctors are very much aware of tuberculosis.

My experience, which I suspect is by far the lesser, is that they are not.

So IMHO I don't think the standards of treatment of TB within the medical profession are low. However you mention the need to increase public awareness- that is harder.

How hard can it be?

My local surgery has my telephone number, address, and Email address.
Has anyone there 'phoned, written, or Emailed me?

No.

I think you'd agree that a campaign to increase public awareness would have to be designed to improve diagnosis/treatment without causing panic.

I disagree.

Furthermore if you look at the symptoms of TB-most people would seek medical attention even without a campaign (eg. coughing up blood, night sweats so bad you have to change the bed sheets, significant unexplained weight loss or even lumps in the neck/groin- would you not see your doctor if you had any of them?

One of the people I know, who had TB, presented her symptoms to her doctor, and asked the local pharmacist, and neither of them suggested, or even appeared to consider, TB as the cause. In her case TB wasn't diagnosed until she went under the knife to take a biopsy.

The same idiot doctor, some years later, with the same patient, diagnosed an ovarian cyst as "summer 'flu". Within 24 hours she had to be rushed to hospital with imminent scepticaemia.

You can see why I have little faith in our PHC.

All of which could also be lung cancer/lymphoma/leukaemia etc. too). So I think you'd agree that it's not an easy campaign to design.

I disagree.

In addition the TB bacteria divide and grow slowly (it takes 4- wks to grow them in the lab) resulting in a relatively slow disease progression in most (but not all) and this reduces the importance of quick diagnosis- contrast this to meningitis where the time in minutes to getting antibiotics can mean the difference between life and death.

My interest in persistently comparing TB to other diseases is wearing very thin now.

I think most parents have seen the meningitis posters and know about the non-blanching rash but did you know that that is typical of meninigits caused by one particular bacteria (neisseria meningitidis) and not found in most other types of meningitis? Do you think anyone has ever delayed taking their kid with meningitis to A/E because there was no rash?

And now it's worn right through.

My guess is that it has happened. I mention this as evidence that public awareness campaigns have the potential to do harm as well as good.

How can a "guess" be any kind of "evidence"?

So really what I'm saying is it's not easy.

Is that why they appear to be doing absolutely nothing? And do you consider the criticism of that apparent lack of effort to be unjustified?

My personal experience is that there are some very good physicians working in public health/respiratory medicine. Do we give too little priority to preventative medicine in this country? Undoubtably yes but thats true of all western medical systems because there's more money in treating people than preventing illness and it's easier to show you've cured someone than prevented someone getting something.

That's an exceedingly good point. This reasoning alone is enough to explain the lack of concerted effort.

 

[Zampa]

The same idiot doctor, some years later, with the same patient, diagnosed an ovarian cyst as "summer 'flu". Within 24 hours she had to be rushed to hospital with imminent scepticaemia.

Very much know the feeling at the moment..just before christmas my wife was diagnosed with a 'bad back' by her occupational health officer..

Two weeks later after an x ray she has a ovarian cyst the size of a tennis ball..merry christmas!

Where do they get these clowns?

 

[Softus]

Truly sorry to hear of that, Zampa. I'll be thinking of you both.

 

[puzzlebobble]

I think you'd agree that a campaign to increase public awareness would have to be designed to improve diagnosis/treatment without causing panic.

I disagree.

Why do you disagree?

One of the people I know, who had TB, presented her symptoms to her doctor, and asked the local pharmacist, and neither of them suggested, or even appeared to consider, TB as the cause. In her case TB wasn't diagnosed until she went under the knife to take a biopsy.

Unless a person has lung TB and a productive cough then it can be very hard to firmly diagnose- often the diagnosis is made though biopsy. Where was the biopsy taken from? -if it was from a lump then I'd be surprised if TB wasn't very high on the doctors list of differentials- although they may not have mentioned TB beforehand as they may have thought something else was more likely. Not that I"m not saying there aren't bad doctors around- I've personal experience of several.

All of which could also be lung cancer/lymphoma/leukaemia etc. too). So I think you'd agree that it's not an easy campaign to design.

I disagree.

So who would you contact and what would you tell them? And what do you think it would achieve?

My guess is that it has happened. I mention this as evidence that public awareness campaigns have the potential to do harm as well as good.

How can a "guess" be any kind of "evidence"?

you're absolutely right- bad choice of words.

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[Softus]

Why do you disagree?

I don't agree that a campaign to increase public awareness would have to be designed to improve diagnosis/treatment without causing panic.

Where was the biopsy taken from?

Pelvis. However, I don't see that as being very important in this context.

So I think you'd agree that it's not an easy campaign to design.

I disagree.

So who would you contact and what would you tell them? And what do you think it would achieve?

I'm not the medical PR professional, so it isn't my job to prescribe the campaign.

Or are you saying that the PCTs have been charged with a hollow remit for raising awareness? Or that the remit is specific, but not appropriate? Or what?

 

[puzzlebobble]

Why do you disagree?

I don't agree that a campaign to increase public awareness would have to be designed to improve diagnosis/treatment without causing panic.

To be clearer I should have written 'HAVE to be designed to improve prevention/efficiency of diagnosis/treatment without causing panic' but I guess you would still disagree.

But then I guess that is where you and the public health officials disagree and explains why you would have a different approach to theirs. They are mostly trained as doctors and see it as their job to improve the health of the population rather than as educators of the public. They would also want to design such a campaign as to be not panic inducing. I would agree with you that we should increase public understanding of diseases but that needs to start in schools and although doctors would be happy to play a role they should concentrate on trying to improve peoples health.

 

[Softus]

To be clearer I should have written 'HAVE to be designed to improve prevention/efficiency of diagnosis/treatment without causing panic' but I guess you would still disagree.

If you'd written that then I wouldn't know whether or not I agree, because I wouldn't be able to make sense out of it. "Prevention of diagnoses/treatment" just looks like gobbldigook to me.

But then I guess that is where you and the public health officials disagree and explains why you would have a different approach to theirs.

I don't know about that. There are an awful lot of "public health officials" roles - tell me which ones you're referring to and I might be able to say whether or not I agree with the people in that set.

They are mostly trained as doctors and see it as their job to improve the health of the population rather than as educators of the public. They would also want to design such a campaign as to be not panic inducing.

This still seems to be a far cry from my original question. Some people would call the path you're following "a wild tangent".

I would agree with you that we should increase public understanding of diseases but that needs to start in schools and although doctors would be happy to play a role they should concentrate on trying to improve peoples health.

Do you have a reset button? If so, please could you get someone to press it and then put in front of you a sheet or paper with these words on it:

I know what you're thinking - did Softus ask "Does anyone have any information on understanding and mitigating the risk of TB infection when working in other peoples houses, esp. on drains and any other disease-laden locations?", or was it "Roll up! Roll up! Come right up and spout forth with all yer guesses! Only tuppence per assumption! Come on gents, don't be shy!!" ?

Well, to tell you the truth, in all this excitement I kind of lost track myself. But being as this is a Trade Talk forum, the most powerful question-answering Internet-based resource in the world, and would blow your head clean off, you've got to ask yourself a question: Do I have the slightest clue as to the answer to the original question?

Well, do ya, puzzlebobble?

 

[Bahco]

I reckon so!

 

[puzzlebobble]

ok Softus, it would be a pleasure. You will find much of this already written above but here it is anyway:

Your question is:

"Does anyone have any information on understanding and mitigating the risk of TB infection when working in other peoples houses, esp. on drains and any other disease-laden locations?"

first of all the ONLY disease-laden location is people (as I explained before that the bacteria becomes aerosoled following a cough by an infected person which is then inhaled). That is unless you encounter a lot of badgers (and even then it's not real mycobacterium tuberculosis but mycobacterium bovis).

Information on understanding the risk of TB when working in other peoples houses:

1) the average risk is very low
2) the risk is higher if the client has TB, currently has a cough and you spend prolonged periods in an area where the are in a location where ventilation is poor and there is little UV light.
3) the clients that are most likely to have TB are immigrants, intra-venous drug abusers, AIDS patients, prisoners, the homeless, patients in hospital and those living in crowded conditions. Working for these people increases the risk.

Information on mitigating the risk of TB when working in other peoples houses:

1) Avoid working for people who are likely to have TB.
2) If they may have TB do not spend prolonged periods around them and ensure good ventilation/open blinds.
3) You can reduce the risk of transmission by wearing an appropriate face mask to prevent you inhaling the aerosoled TB.
4) If you are working for people who are at high risk of having TB then you should consider a BCG vaccine. Before this you would need to have a mantoux test as there's a reasonable chance that you have already been exposed to TB and the vaccine would do no good. Even if you haven't I don't know how old you are but I doubt you are an adolescent and so the benefits would be small.
5) Stop being so fu**ing grumpy!

OK, I made the last one up. The bacteria would probably get ****ed off with you and go and infect someone else.

"I tried being reasonable, I didn't like it." (Clint Eastwood)

 

[Softus]

An excellent, informative, and specific reply, puzzlebobble - you're a good sport and have a marvellous sense of humour.

All power to you.

 

[Paul Barker]

I have nursed on paediatric infectious deseases unit. Been exposed to all body fluids including blood and vomit and airborne particles of children with multi resistant TB HIV Malaria Niseria Meningididus and many other killer diseases.

Neither I nor any of the nurses who did it for a lifetime caught anything.

You must never put your hand to your mouth especially after shaking hands with an ill person, wash hands thoroughly after any contact. Don't kiss them or have sex with them.

Go about your job keep your distance and you should be fine.

Of course as a nurse it was a given you did it altruistically if you copped it bad luck but you were there to help people who had to be helped by someone and you were prepared to risk your life for them. But taking the right precautions a normally healthy person doesn't catch these diseases all that easily.

 

[puzzlebobble]

it was a pleasure Softus.