Primary Complex Thread 2

[drex]

^doc lelet,nagkaroon po ng hika ang anak ko and were taking the medicines for primary,okay lang po ba na magtake sya ng salbutamol-guaifenesin together with the 2 meds?yung rifampicin and isoniazid na lang po iniinom niya since naka 2 months na kami sa pyrazinamide..yung salbutamol+guaifenecin po ang inireseta ng pedia niya every time na inuubo siya kasi dikit po ang pleghm niya at masakit daw po sa dibdib..pls. enlighten me po..thank you very much.

[leletmd]

@drex:
Ok lang itake ang anti-asthma meds together with the anti - PC meds, but I suggest that you don't self medicate and use it every time that your child has cough just because it was given by your pedia before. It is always better to have your son assessed by your pedia as to the cause of the cough rather than self-medicating.

[leletmd]

@eurickha:
Tb can bring down the immune system, making the patient more susceptible to all sorts of infections. I suggest you bring her to your pedia for regular follow up check ups so that her progress can be monitored.
As to effect on attitude, siguro more on improvement of well being or pagiging masigla ng bata while on treatment.
As to the skin, no direct effect.

[liamlima]

Doc Lelet, i just want to ask some things. My son was diagnosed with PC and started medication last March 2012. In April 10, his supposed 1 month of medication he was confined for 4 days for gastroenteritis and his medication for PC was stopped because he would vomit every time until he was discharged and for about 2 weeks nastop po meds for PC. Pulmo Pedia said its okay to continue as is the previous medication counted basta wag lang daw over a month na nakalipas. I am with new pedia now and new pedia suggested that meds be extended to 3 more months because weight remained 10kg for 3 months. Son is 1 year 8 months old. Prior to being diagnosed with PC, he was first diagnosed with asthma. Hope to hear from you re your insight specifically yung na stop for a while meds. Some moms kasi tell me meds back to day 1 once stopped. Thanks in advance doc.

[leletmd]

@eurickha:
Ok lang maglaro or magjoin sa outdoor activity ang bata na may PC.
Pasensya na, but it would be unethical and irresponsible for me to give you advice on what medications or milk to give to your daughter since I am not her doctor and I do not know her full history. I am not asking you to bring her to me for consult but rather I hope you understand that medications should only be given after a thorough history and physical examination is done. So the best person to ask these questions would be your pedia because she is the one who knows your daughter's medical history.
I also strongly discourage self diagnosis or self medicating, especially with children involved. Mahirap na magkamali.

@lianlima:
I would agree with the pulmo pedia since it really depends on how long the meds were stopped.
If it is only 2 weeks then you need not start over, but rather dapat nacontinue lang, while observing for development of allergies or resistance to the meds.
Aside from fair weight gain, has your child been sickly since starting the meds? Masigla ba siya or magana kumain?

[liamlima]

@leletmd - Doc, nagkaroon naman po ng improvement. Masigla po siya (even now, malikot nga po eh) and okay naman po pagkain nya pero hindi po talaga siya malakas kumain. Sa milk din po medyo mahina din. Siguro from 8am-5pm 12 ounces  lang po (1 in the morning and 1 in the afternoon). Overnight po 10 ounces po nacoconsume nya. After nung confinement recently lang sya nagkaroon ng mild colds and tonsilitis and eventually fever for 2 days. and ambilis po pumayat. before that ang ganda na po ng katawan nya. June 2012 po 9.2 kg ang weight nya, then August, 10 kg up to now po 10 pa din. Yun po basis nung pedia kasi nga daw po di nagbago ang weight. Although sabi nya may tendency talaga maging picky eater yung stage ni baby, at least man lang daw nasa 11 kg sya. No problem with me extending the medication kahit alam kong hirap na din si baby. But, as a mom, I would like to seek more/alternative knowledge on how to manage baby's weight gaining. Can i suggest my son be checked  if positive pa din ba sya for PC? It seems po kasi na ang basis lang na he is well na is if he gained weight. Please enlighten me Doc Lelet. thank you very much. I appreciate so much that you replied. Thank you and God bless.

[leletmd]

@lianlima:
You can have a repeat chest x-ray done to check if there's any change with the previous findings (dapat macompare ang previous sa bagong x-ray plates) pero we don't routinely ask for a repeat x-ray unless we have doubts sa clinical findings kasi there is such a thing as "radiologic lag", which means pwedeng matagal mawala ang x-ray findings pero clinically, magaling na ang patient.
I do not suggest having the ppd repeated because it usually remains positive for about 3 years or so.
Clinical improvement talaga ang basis for stopping or extending treatment.

@ eurickha:
Try to back read sa earlier pages ng thread. I posted the criteria needed to diagnose TB there.
Regarding meds from the health center, what you can do is to ask for a referral letter from your pedia for the meds para mabigyan ka ng health center. Pero suggestion ko is to continue follow up and monitoring of response with your pedia kahit na sa health center pa kayo kumukuha ng meds para at least matutukan ang response ng anak mo sa meds.
Nahanap niyo na ba kung sino ang nakahawa sa 2 bata? Na-xray na ba ang lahat ng kasama niyo sa center? Since 2 kids na ang affected, it is very important na mahanap niyo ang source at magamot rin ito.

[eurickha]

Doc Lelet

Yes yung sister ko ang carrier doc after niya makuha yung result ng xray niya hindi niya agad nasabi sa akin na yun ang result kasi lumalabas ang result after niya mag stay ng 3days sa house namin ,dinala ko na din siya sa pulmonologist para sa treatment niya since malayo ang house niya kaya medyo at ease na ako na wala ng carrier , nakapag pa xray na kami lahat and clear naman kami liban lang kay shenaia, nakakahawa pa din ba doc kahit na nag start na ng meds yung sister ko? maganda ang response ni althea upon treatment yngat lang talaga sa possible hawa like yung sipon at ubo para maiwasan magkasakit, healthy foods veggies,fish,fruits pampalakas ng immune system magana na ulit siya kumain yung ate shenaia niya sumasabay lang din sa kanya since kaka start pa lang nito ng treatment,thank you so much doc for your response nakakagaan ng loob yung may tao napagtatanungan esp. pag ganito hindi pa masyado aware sa sakit na to. GOD BLESS always Doc Lelet 

[leletmd]

@eurickha:
You're welcome!
Once nakapag 2 weeks na ng treatment, hindi na considered nakakahawa ang patient pero syempre, dapat macomplete pa rin ng 6 - 9 months ang treatment para considered na cured na.

[wifey_ali]

my almost 4years old son just tested positive for Primary on skin test. my problem is based sa research ko, the medicine can suppress appetite. Eh ang payat na nga ng son ko and mahina kumain, eh what will happen now that the medicine will suppress his appetite further?
To those kids na na-suppress appetite, is this for 6months or the first few days/weeks lang? can we combine appetite stimulant while on treatment?

[liamlima]

@leletmd - Doc, thank you so much for replying. Will visit my son's pedia soon for follow-up lang. Thank you so much.

[leletmd]

my almost 4years old son just tested positive for Primary on skin test. my problem is based sa research ko, the medicine can suppress appetite. Eh ang payat na nga ng son ko and mahina kumain, eh what will happen now that the medicine will suppress his appetite further?
To those kids na na-suppress appetite, is this for 6months or the first few days/weeks lang? can we combine appetite stimulant while on treatment?

So he is just PPD positive and negative on chest x-ray?
Not all patients who take anti - TB meds have suppression of appetite. Usually those who have underlying liver problems are the ones who experience this, along with nausea, abdominal pain and vomiting. If you want to be sure that your son has no underlying liver problem, you can have his liver enzymes checked prior to starting treatment.
It is more common for the patient to regain his appetite as he gets better and the infection gets eradicated.
Also, multivitamins are commonly given to patients on Isoniazid since the medicine has a tendency to deplete Vitamin B6.

[france0220325143]

doc, yung po bang low apetite ng bata na possible candidate na may PC eh sa solids lang? yung anak ko kasi, mahina ng kumain ng rice ngayon di kagaya dati. pero lagi naman syang humihingi ng milk. she's 21 months po.

[leletmd]

^ Appetite loss for both solids and liquids. Hindi kaya wala siyang appetite for solids e because nabubusog siya sa milk? Yun kasi ang most often na nangyayari pag malakas magmilk. Nadidisplace ang appetite for solids since busog na sa nainom na milk.

[bluewater5897]

@doc lelet, ano po side effect ng HRZ pedia?

[leletmd]

@bluewater5897:
HRZ = Isoniazid, Rifampicin and Pyrazinamide

Side effects:
Isoniazid - nausea, vomiting, tummy ache, elevated liver enzymes, jaundice, Vit B 6 deficiency (kaya may kahalong Vit B6 ang isoniazid syrup), rashes/possible allergic reaction,
Seizures may present if there is depletion of Vit B6

Rifampicin - reddish orange body fluids, nausea and vomiting, tummy ache, diarrhea, elevated liver enzymes, jaundice,  flushing, possible allergic reaction

Pyrazinamide - anorexia, nausea, vomiting, increase in uric acid levels leading to arthralgia or arthritis, elevated liver enzymes, possible allergic reaction

Lahat ng medications, meron side effects, kahit organic or naturopathic medications, but not all patients will manifest with side effects. Kaya it is important na while ongoing ang treatment, merong regular follow up with the doctor para ma-assess if patient is suffering from side effects and if there is a need to adjust dosage or check for labs.

[france0220325143]

^ Appetite loss for both solids and liquids. Hindi kaya wala siyang appetite for solids e because nabubusog siya sa milk? Yun kasi ang most often na nangyayari pag malakas magmilk. Nadidisplace ang appetite for solids since busog na sa nainom na milk.

thanks doc.. usually naman kasi rice muna kami then biscuits/fruits for snacks.. kaso lately ilang subo lang sya, ayaw na agad. then hihingi na ng milk. 

[leletmd]

^ Try small frequent servings of solid food and do not increase her milk intake para may appetite pa rin siya for solids. If persistent talaga, I suggest you have her checked by her pedia.

[france0220325143]

Thanks so much, Doc! worried lang talaga ako kasi minsan niluluwa yung rice kpag naka3-5 na subo na sya. eh dati matakaw naman.

[luveeduvs]

hi! doc lelet, can you please interpret the result of my daughter's chest x-ray. Thank u very much.

STREAKY DENSITIES AT THE INNER LUNGFIELDS WITH FULLNESS OF THE PRETRACHEAL SPACE.
HEART IS NOT ENLARGED
DIAPHRAGM IS NOT REMARKABLE.

IMPRESSION: CENTRAL PNUEUMONITIS
                     CONCURRENT EARLY PRIMARY KOCHS INFECTION NOT RULED OUT.


I'm very worried kasi nagpa x-ray na din ako and her yaya and we both negative. thanks again.