This blog is a continuation of my 15th August 15 2011 blog, Physician’s Susceptibility
I had my fourth doctor three years after I was diagnosed with having PTB (pulmonary tuberculosis). She became my attending physician in November 2004 when I was hospitalized due to hemoptysis (coughing up of blood or bloody sputum from the lungs or airway).
Since then, she managed my treatment. I used to buy 4D (a blister pack of HRZE - H = isoniazid, R = rifampin, Z = pyrazinamide, E = ethambutol) and vividly remembered that she suggested that I could give the R (rifampicin) - since I was already resistant to the said drug - to the person who I had frequent contact with to serve as his/her prophylaxis. It was not the first time that I heard that idea.
This photo was taken during the time when I was under TB medication with my 4th doctor. © Mildred Fernando
My first doctor, who was also my (deceased) father's doctor, also suggested the same. When I was newly diagnosed with TB, I told myself that if only I had taken Rifampicin as a prophylaxis I would have been spared from the disease even if I had frequent contact with my father. Further, I learned from my 4th doctor that she also took oral prophylaxis. As she would always have a LBM (loose bowel movement) whenever she took Rifampicin, she instead took Co-amoxiclav as her prophylaxis. Later on, I learned from other doctors that there are no preventive medicines for TB and that one should not take rifampicin if she/he does not have TB because there is a great possibility that the person who takes TB-drugs as prophylaxis will eventually get resistant to it.
September 2005: My doctor learned from my DST (drug susceptibility test) results that I was already resistant to Isoniazid (H), Rifampicin (R), and Ethambutol (E). She changed my medicines. My new regimen was composed of Pyrazinamide (PZA), Clarithromycin, Ofloxacin, and Ciprofloxacin. Streptomycin, my injection, was changed to Amikacin. Amikacin, I think, was five times more expensive than Streptomycin and was like 10 times more painful than streptomycin. Its side effect was far too damaging. I had Amikacin for 8 straight months. My tinnitus became worse because of that drug.
My hearing loss was one of the many things that I mourned for. I was dying each day. My life was approaching its natural death. My dreams were fading. My hopes were failing. I had every reason to mourn, to grieve, to weep…And I did mourn for those things that I lost because of this chronic disease. I mourned for the career opportunities that had gone my way. I mourned for my shattered relationship with my first boyfriend believing that it was this TB that turned a once beautiful love story into a painful letting go. It was not only this part of my body that was being destroyed. It was starting to ruin my life. I sometimes wish I was dead.
As there was no clear improvement on my health on 15th March 2006, a repeat sputum culture and DST was requested, this time at Philippine General Hospital. In May 2006, after 2 months, the DST results revealed resistance in Isoniazid, Streptomycin, Rifamipicin, Ethambutol and PZA “even if given in high dose”. In short, all 1st line drugs were not working anymore in fighting the disease. An expected six-month treatment had turned into a five year medication. The more agonizing part was that I was never declared cured. Mine was not a case of treated and then relapsed. I didn’t know what else to do. I took my medicines every day. I did my regular follow-up check-up.
What else was needed? I prayed every day, not just once, but several times. I found myself bargaining with the Lord. I sometimes asked Him for a trade off from my list of dreams in life in exchange for a good health… I even asked Him to just make me well and I would never ask Him at all for an opportunity to practice my profession as a Certified Public Accountant. I’d been through so many ups and downs with my faith in the Lord. I remembered when I was in college, I have this college friend that would always ask me to pray for her. She would always tell me, “Mildred, please pray for me to the Lord to help me pass our exams. God seemed to be always in favor of you and He always answers your prayers.” Remembering that, I realized that things had changed. Was it me that had changed? Was it my faith? Or was it my God that changed? Why did He suddenly stopped answering my prayers? Why wasn't my five-year-long prayer to become well again answered by the Lord?
My fourth doctor had always been straightforward in telling me the status of my disease. When the DST results came on May 2006, she gave me two options. The first option was for me to undergo a lung surgery to cut out the part of my lungs that was affected by the disease. The second option was to undergo treatment at the Tropical Disease Foundation, Inc. at Makati City where I had to go to the said institution every day to take my drugs in front of the clinic staff, a program called DOTS (directly observed treatment short course). I was ready for a surgery. After five years of medication, all I wanted was a fast, almost instant, result. But my doctor informed me that after the surgery, I would still be required to undergo oral medication. This changed my mind and I became more determined to have option two.
After five year of medication, I was again faced with another chance of being finally treated. My fifth chance of being freed from the disease was now at the hands of the Tropical Disease Foundation, Inc. I was hopeful yet anxious of the uncertainties. "What was there for me?" was the lingering question playing in my mind.