Tuesday, July 27, 2021

TB

     Yesterday's test tally was over 700. Total 97,100 plus. Pizza party coming soon.

    I bumped into Tommy in the hallway today. We've got a doozy. Sputum was 3+ he said. Mtb probe was positive. That's only the second one this year. We are overshadowed by Covid, but there are other bugs. I took note of the patient name, and looked it up in the chart. The TSpot is negative, I called and told him. They are doubting your PCR test. We are right, he said, the TSpot depends on a healthy immune system, and it isn't always right. False negative. The Mtb Riff is much more sensitive.

    They are depending on the cultures, according to the notes. But wait. There's a new note today. The ID doc contacted the health department and they said they had a bunch of false negative TSpots. Tommy and I commiserated. The TSpot was developed in part by Bill Gates to help developing countries diagnose TB cheaply, and more efficiently, but it isn't foolproof.The health department recommended we start her on RIPE therapy and discharge her for outpatient follow up. 

    Two late Conway Zoom meetings sucks when I'm not on call, post call. Covid is flooding the system. People seem glib. It will be interesting to see what the next few weeks portend. There seems to be a tentative plan for alternate care in place but I worry it's too little too late.

    MRI in am at 6:00 to figure out this right deltoid issue - I tried to find a time that wouldn't inconvenience my partners. A little worried - got beta blockers at the ready - but I was reasoning  myself on the way home that if I could cave an MRI shouldn't be too bad. Happy Tuesday, much love, Elizabeth.

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