A Short Story about a Little TB

DISCLAIMER:  This blog contains no medical advice, just an innocent nurse turned nurse pracitioner's experience and opinion.  It is not to be used in lieu of seeing an ACTUAL provider if you believe you have symptoms of tuberculosis or have been diagnosed as having TB or latent TB...now on with the story...

Once Upon A Time...

There was a young[ish], possibly pregnant RN, who over the course of one summer had multiple patients with so-called "latent TB" assigned to her.  Apparently someone, patient or family member, perhaps was not as latent as they thought they were. Anywhoslebees that's really of little matter...although, infectious disease experts say that it takes 6 hours of contact within 6 feet to contract TB and said nurse has no memory of being that close to anyone for that long...I digress...

Anyway, 2 years later, this nurse had approximately 1.25 job offers as a new graduate NP, and was going through the new employee pomp and circumstance which includes that ever pesky TB skin test.  Four hours after receiving the TB test, this nurse cannot even see where the bleb had been placed.  She bee-bopped along, but noticed the morning of the day she was to have her test read that her arm had a quarter-sized hot pink weal on it..."Meh" she thought, "it's just my fair skin."

By the time she arrived at the clinic to have her test read by the nurse who administered it to her, she had a large indurated area that was larger than a quarter and red to purple and a little scaly like her skin was having a reaction to it.  To put herself at ease, 'Maybe it's a skin allergy to the vehicle and not a positive test'... However, the visit was converted from lab only to a problem visit and three hours later plus a co-pay, she got to leave after having a chest x-ray and a Quantiferon TB test drawn.  

And lo-after she has accepted a position as an APRN, she has indeed, been diagnosed as having latent TB.  There was shock, despair, an extreme unclean feeling, being reported to the health department, a few crazy phone calls including one to her child's pediatrician thinking 'I've broken my child and he's going to die of TB any second', and a trip to the local health department to turn herself in - Typhoid Mary style.   

Let's Pause and Go Back to Nursing school for a minute...

TB is a contagious and possibly fatal disease that can affect any part of the body, but usually lungs, kidneys, and brain.  Healthcare workers are considered an at-risk population, and according to my nursing and nurse practitioner schooling, latent TB folks should get treated for TB by taking either a 9 or 4 month treatment regimen to prevent developing active disease.  Literally that's about as deep as we went...so flash forward a couple of years...and her thoughts may or may not have included

'I have TB'

'Oh, God! I'm contaminated...my house is contaminated...my child is contaminated...MY DOG*!!! (Her spouse was just going to have to deal with it, apparently)

'I've been breastfeeding and probably have all but killed my child'

'I'm not going to be able to work while I get treated'

'Will I convert to active TB if I decide to have another child?'
'What if I am exposed again?'

*Yes, TB is a reverse zoonotic disease meaning you can give it to your dog. How and why someone someone would remember this when in distress would take a heap of psychoanalysis that, much like latent TB treatment, is just not worth pursuing at this time. *SPOILER ALERT*

So after talking to the super nice nurse with the CDC who...well let's back up again...

So she goes to the local health department where the local CDC office for Communicable Diseases shares a space with the STD clinic.  After several minutes of convincing herself to use the door knob to enter said office she went to the receptionist window where she was asked if she was the patient that had called three times [Maybe...] and "gently" reminded that she did not have to say her name.  She was handed a piece of paper assigning her the identity of "Patient 0".  She responds, "I hardly think I'm patient zero"...Receptionist responds by kindly rolling her eyes and saying, "That's an O"..."Oh," she says...  She then stands in a corner for several minutes, but then decides to sit in a chair because at this point pubic lice is the least fatal of her potential problems on this particular day.

After not responding to the gentle calling of "Oh...Oh...Oh...” the receptionist that was so warm and friendly used her finger to say "That's her!" 'Oh, me!' thought our young heroine of this story...she bravely stood up and walked in for her TB consult, at least I'm sure that's what the other 20 some people in the waiting room thought...[Actually it was more like...'Please strike me dead, right here, I'm ready']

This visit turns out to be very informative...The young[ish] nurse practitioner learned things like only 10% of people with latent TB go on to develop active TB.  If you get pregnant you only have 10% chance of developing active TB.  If you sleep next to someone with active TB when you have latent TB...you have a...you guessed it...10% chance of converting to active TB, yourself.  If you treat your latent TB your chances are reduced to 2.8% which is encouragingly rounded up to an 8% reduction, but by my math is closer to a 7% reduction in chance....and also, that's if you take your meds correctly for 4 months or 9 months.  Also, having worked and continuing to work in healthcare, they encourage you to do the 4 month course of treatment because it covers "most" drug-resistant strains, however that particular drug binds to your hormone receptors, rendering your IUD, contraceptive pill, or HRT useless...which might be more or less important for someone with ovarian insufficiency, hypothetically-speaking of course...not to mention the other side effects like, oh, numbness and tingling a little liver damage, nausea...but don't worry, it's usually not a problem [Note: no numbers of side effect rates were offered by someone how touts 8% as game-changing...] 

So being the brave, strong, used-to-identify-as-healthy heroine she is[was?] this particular young[ish] woman made up her mind to just continue her life with the option to revisit treatment if hormonal support became less crucial to her lifestyle.  One important thing she did ask was, "How will I know if my TB becomes active?" To which the infectious disease nurse responded, "Oh, well, we don't do yearly x-rays anymore, if that's what you’re asking, because we don't want to give you cancer.  We base the diagnosis off your symptoms.  Those would be extreme fatigue, feeling unwell, night sweats, coughing up blood and fevers."  To which our heroine replied, "So basically when anyone who has ever read a Charles Dicken's novel can diagnose me with TB, I'll know I have active TB." The infectious disease nurse laughed and said, "Exactly!"

So she has gone on to live her merry little life until she got her first chest cold.  Her co-workers, a few friends, and even her mother may or may not have referred to her as "Typhoid Mary", attempted to order N-95 respirators for the office, and asked if she knew if this was "it".  The funny thing is, she won't really know if this is it, until it is...IT...  

There was no real point to this blog, other than to rant. Honestly, I had no idea what it was like to live with an infectious disease [and I still don't], but now, as a latent TB survivor...at least until I'm not...I can say that it's mostly irrelevant.  Also, if we ever meet at the STI clinic, I promise I won't wave hello like the people I saw in the waiting room...

Peace, Love, and Consumption,

MK

Knox County Health Department TB Carrier #626