I started my consultation with my 3rd physician on May 2004. She was already 70 years old and was the older cousin of my second physician. Just like her cousin, she also told me that I needed to submit sputum specimen for culture (TBC) and drug susceptibility test (DST).
During those times, though I was infected of the disease, I didn’t have cough. This made it difficult for me to produce the required sputum specimen. I remembered that they made me breath in fumes from a nebulizer to induce sputum collection. They did the procedure twice but I still wasn’t able to collect sputum. Later that night, I coughed out blood again. I blamed that nebulizer for another episode of hemoptysis. The doctor prescribed the usual set of oral drugs for TB while I still hadn’t submitted a sputum specimen. After a series of attempts on inducing sputum collection, finally, I was able to collect the needed 3 sputum specimen.
On November 11, 2004, two months after I submitted my specimen, my first DST results revealed resistance to Isoniazid (H). Because of this, the doctor decided to add streptomycin in my regimen aside from the first line drugs to which I was still sensitive (Rifampicin, Ethambutol, Pyrazinamide). She also prescribed 2 weeks of Ciprofloxacin to me. Also, to counter the side effects of streptomycin she added B-complex tablets in my medication.
A few days after my DST result was released, another episode of hemoptysis recurred. Since the hospital where my doctor was affiliated is far from our house, I was admitted in another hospital near our place and was attended by another female doctor. When I was released from the hospital, my family and I decided to continue my treatment under her management. She became my 4th doctor.
I continued taking the prescribed medicines to me but I was not getting any better. As the doctor noticed that I was not responding on my medication, she requested for another TBC and DST. On September 2005, my second DST results showed resistance to Isoniazid (H), Rifampicin (R), and Ethambutol (E). My doctor changed my medicines. My new regimen was composed of Pyrazinamide (PZA), Clarithromycin, Ofloxacin, and Ciprofloxacin. Streptomycin, my injection, was changed to Amikacin.
This is how DST helps in the management of tuberculosis. It provides valuable information as to which drugs can kill the TB bacteria. It determines which drugs a patient is supposed to take to make her well again. But then, no matter how accurate the DST is, the application of the DST result by the physician in the management of TB will still be the major turning point of the patient’s treatment outcome. Sadly, in my case, though I was diagnosed to have multiple drug resistance, my doctor, despite of her incapacity, decided to continue on managing my disease instead of referring me to an institution that is capable of giving me the proper treatment. Though it was comforting to know that my new doctor now knew that the medicines I was taking should be changed because they were not potent at all, it was, in a way, devastating to learn that after continuously and religiously following all the doctors’ prescription, everything I did in the past 4 years were all just a waste of time, money, and effort.
Another treatment regimen from another new doctor. My introduction to more expensive new line of drugs made me more doubtful this time. Would this be another waste of time, money and effort? Were these medicines the right and effective medicines for my disease? Were new good medicines enough or do I need a new good doctor as well?