What we don't know can, and does, hurt us

Knowing one's weight is very important in healthcare.

I always know my weight. There are many drugs in this world are dosed by body weight.

Vancomycin, a potent antibiotic that kills a multidrug resistant bug, is dosed by actual body weight. If one day i am infected by this bug, I always know what kinda dosing i will give myself because calculating by 15mg/kg 12hrly dosing, the dose is ard there.

Sometimes, I think it's a healthcare-acquired disease - that subconsciously, when you are dosing your patients certain dangerous but life-saving drugs, you tend to help yourself calculating the doses that you need too - just in case you might need them in future. And no one knows how to dose it better than you do.

Eptifibatide - another drug that is used in acute cardiac events, is also dosed by body weight. Ask me next time and I will tell you the dose. This drug costs a bomb too. So the heavier you are, the more expensive it gets.

If you have followed by blog before, I once briefly touched on TB regimen. When one's diagnosed with TB, they will be started on 4 drugs, all dosed by their body weights. In general, it's > 10 pills a day for just TB treatment and for a minimal duration of 6 months. Next time you should tell me your weight, so that I can calculate for you. Have that figures stored in your head just in case... touch wood!

Anyways, if you have known me well enough, perhaps you have heard me talking much about TB.

My eldest brother, a houseman officer in Hospital KL, is recently hospitalized and the primary diagnosis to date is pleural TB. TB is an infection caused by a bug called Mycobacterium tuberculosis. [If you have watched tv, sometimes you will see people in the past got sicked and coughed out blood - that's a TB representation, sort of]

It started with episodes of cold and cough which didn't resolve despite antibiotics (for cough and cold), and when he went for a Chest X ray, it was realized that there's fluid accumulation in his lung. I asked him the presenting symptoms - no shortness of breath, no fever.

Because of the fluid in lung (which is very uncommon), he was hospitalized. A series of test include blood and sputum culture showed negative so far. To put things in perspective, it's extremely hard to grow TB bugs and may take4-8 weeks before any result could be seen. The skin test (Mantoux), another diagnostic test, however told us otherwise.

Some information about The Mantoux test: a small amount of a substance called PPD tuberculin is injected just below the skin of your inside forearm. You should feel only a slight needle prick. Within 48 to 72 hours, a health care professional will check your arm for swelling at the injection site, indicating a reaction to the injected material. A hard, raised red bump (induration) means you're likely to have TB infection. The size of the bump determines whether the test results are significant, based on your risk factors for TB.

My brother has that raised bump.

Because of the fluid in his lung, today he had some painful procedures. The fluid in his lung needed to be drained away so a chest tube was inserted from the back to the lung to drain the fluid away - 1.5L(can u imagine??) of fluid was drained out. At the same time, he had a lung biopsy.

My dad kept asking us that we should call my brother and check on him more often. Daddy said I should talk to brother more cos I am the only one in the family knows what's going on due to the complexity of medical information which can be at times, and after I got the information I can update them so that they understand the whole picture. I guess me and my brother are spiritually-sicked. We always thought that we need to be accountable for our own affairs, bear our own responsibilities without needing to tell people, not even our own family, about the good and bad going on in us.

My sister gave me a serious talk on saturday which really touched me. She mentioned, we(my brother and I) often being too "independent", always think that we are living by ourselves alone out there, often don't care enough to update and communicate to our own family about our own lives. When shit happens to us, we deal with them most of the time ourselves; when we could have shared, leaned on our own family members who really want to care for us, whether we ask for it or not.

I know. I hate being like this, yet I am still like this.

Anyways, I only told them that the hospitals do all these test on my brother so that they can try to grow the TB bugs and if the TB bugs really can't grow much later, that's means he's not actively infected with TB. If it grows then it's TB.

But I didn't tell them that the lung biopsy and lung fluid test were done also to rule out the possibility of cancer. Because one of the reason of fluid accumulation in lung can be malignancy and lung biopsy can tell us if it is. I kept saying it's darn hard to get a TB because we are all immunized since young, unlike the older generation. But if it's not TB it has to be something else. The skin (Mantoux) test can be false positive under some situations, and given the negative results for the rest, honestly, I am worried.

Yet how am I supposed to convey these information to the already so darn worried parents. A simple word like 'maybe' can send them down with a few sleepless night. I wonder if I am too rationale, too healthcare professional-liked, to digest all the information myself.

People asked me if I am afraid of TB.

I said no. Because it can be treated, and it should be treated with properly dosed TB drugs (no under-dosing please!). The course is tedious and painful, with side effects etc, but it can be treated. I will not be worried if it's TB.

What if it's not? I wonder if this is going through in his brain right now.

On a positive note, I don't think it can be cancerous stuff. For he's too young for that, and I know that there's so much in him that God wants to use and will definitely use. I guess he must have created a legacy in his hospital - a houseman down with ?TB - off duty for ? months. It's an atypical path that God is already subjecting him to, and I know that He is in charge of his life. But if it happens, I really hope to be able to see the good out of the difficult things that my brother and my family will have to go through.

Wonder if you ever encountered things that you've never thought will ever occur to you? I did have a fair share of them, including this. I must say, what we don't know can, and does, hurt us. It hurts people who doesn't know Christ even more significantly. I feel that so strongly from my parents.

Dad has been coughing and unwell for near a month.

All I can say is, I can only release the burden of all the difficult things that are on my heart into His hands, cos He is the only One who can lift it off and carry it for me. I hope things go well, really. And if things have to happened, I pray that the timetable of this family is therefore hastened.