Wednesday, September 5, 2012

Quest Tuberculosis Check; Part 1

Today was a day of much joy. No I didn't turn my samples in. I actually forgot them at home and my nurse was a bit disappointed in me. He is a very good nurse: takes the time to explain everything in his scope of practice, is really good with a needle, and has a calm demeanor. I don't want to disappoint him.

No today I came in for my PPD, it's a skin test for tuberculosis. I've been exposed pretty heavily over the summer while being in direct contact with patients with yes, tuberculosis. Respiratory and otherwise. At the time we didn't actually know this clinic dealt with so many tuberculosis cases, although we should have guessed. So because of that we were never bought the proper masks that are tightly woven enough to protect us from the pathogens. We still used masks. But only the ones we could purchase in the local pharmacy. And we did try to get masks sent in, but they were on the restricted list; they never made it through customs. 

So I've been exposed. But this isn't the first time this has happened. The summer before med school I roomed with a bunch of foreign grad students. None of the guys had cars, and it's safe to say as a grad student you live as cheaply as possible. Food, health, everything. So when one of them told me his friend had some kind of growth on his neck that had broken open multiple times, oozing puss, but now he was worried because his skin had turned black...I pretty much dropped everything and demanded that I take the guy to the hospital. Later we found out he had TB too. He had it as a child and it resurfaced because the guy was trying to save money by eating nothing. No food. Nothing. He became completely immunocompromised and residual TB took over that lymph nodes, turning it into a baseball sized abscess. He got the treatment he needed in the end and went back home if you're wondering. Then in the same week, my boyfriend was working on an ambulance and was exposed to a different case. It was a fun time for everyone.

I'm not unfamiliar with the test. 

They put a small bubble of fluid under your skin that contains an antigen. If your body is good at fighting tuberculosis because it has been exposed to something before, it will mount a measurable immune response. Your skin will get raised around where the needle came in, and it will turn red. It's kinda does that anyway though, but there's no reason to get freaked out because you should expect your immune system to do something. It's best not to over think it, or try to interpret things yourself. Let the nurse do what they do best. Provide you care. 

The needle is small. So small, you could probably practice some kind of exposure therapy with it for people who hate needles. The procedure was virtually painless. I've had nastier mosquito bites. Like a 1 on a scale of 10. 

Now I'm waiting for the 2-3 days to check the response. If it grows to be big, and raised, that still doesn't mean I have TB. Just that I've been exposed and my body has this kind of figured out. They'll send me to get a chest X Ray to confirm the case. If I have healthy clear lungs, I'm good to go. 

If there is too little response to be considered positive, I come back in another 8 weeks and get the test again. Things take time to incubate.

That's it. It's easy to be a good patient with TB tests. Even I can't screw this up. 

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