I think that a lot of people from the Himalayan
region are having increased access to proper health care nowadays.
More people are undergoing routine screening physical examination
as part of the immigration process. One common denominator seems
to be the TB skin test. You get the TB skin test on your forearm
and — lo and behold — after two to three days you
have a nice little plum growing on your forearm that hurts,
gets red and itches. You go to the doctor's office and the nurse
reading the test gives you a suspicious look and runs to get
the doctor. She might come back wearing a gas mask or might
just talk to you from across the room. Does it mean that you
have tuberculosis? YES & NO!
Historically Tibetans and all people who live
in the Himalayan belt are predisposed to acquiring TB due to
various factors. Moreover India, Nepal and Tibet are countries
where Tuberculosis (TB) is prevalent and endemic. Children in
India and Nepal are also routinely vaccinated with BCG vaccine
to prevent TB. So almost everybody coming from these countries
has been exposed to TB at some point in their life — unless
you lived your entire life in a bubble! It's a very common thing
to have someone in your family who has had TB and its subsequent
treatment.
| Don't
worry — they inject only proteins derived from TB.
They are not injecting any live bugs in you." |
The skin test is done to check whether you
have TB, been exposed to it, or to rule out TB. It's an injection
on your forearm, which gets marked, and you have to come back
in 2-3 days to get it read. They check to see how much of a
reaction you have to the stuff they inject under your skin.
Don't worry — they inject only proteins derived from TB.
They are not injecting any live bugs in you.
One has to measure the size of the induration
(lump), not the size of the redness. If you don't have a reaction,
you can rest in peace and stop reading the rest of this article.
For people coming from endemic areas i.e.
India, Nepal, Tibet, China, if the lump on the forearm is more
than 10mm, it is considered a positive test. BUT that still
does not mean that you have TB — don't start sweating
yet. The doctor will ask you questions as to whether you have
had TB in the past, exposure to people with TB, coughing, coughing
up blood, fevers, night sweats, weight loss, loss of appetite.
The next step is a chest x-ray. If the chest
x-ray shows signs consistent with TB then one undergoes treatment
for it. If the chest x-ray is normal, it is considered that
you have been exposed to TB in the past and would be termed
as having latent tuberculosis that could potentially
turn into active TB later. This is treated with a single drug
(INH — Isoniazid) for nine months on a daily basis. The
drug itself can cause side effects like liver dysfunction. Therefore
I would advise people to avoid drinking alcohol while on this
medication.
I have tried to make it as simple as possible
by minimizing use of medical jargon. There are exceptions and
variations to how the test is read. Getting into those details
would make it confusing.
If you have any further questions, please
direct it migyul@yahoo.com and the editors can forward
it to me.
