Brief Answer: CONTINUE treatment for a TOTAL of ONE YEAR Detailed Answer: Hi Mr. XXXXXXX Thanks for your query. I have gone through your query thoroughly. * firstly, tuberculosis of lymph nodes and bones, takes longer time to heal as compared to that of lungs or the cavity surrounding the lungs. The course is therefore required to be continued for AT LEAST, ONE YEAR (even more, in some cases). * Hence, you SHOULD CONTINUE Rcinex 450/300 for another 6 months! (If your wife's body weight is MORE THAN 45kg, TAKE RCINEX 600/300 , instead of 450/300. Alternatively, add R-cin 150mg to Rcinex 450/300). * The swelling will take around one year or more to subside. So, please be patient and do not worry. As such, oozing of fluid from the swelling is not a good sign. Stoppage of oozing will indicate efficacy of TB treatment. * Since the treatment for lymph nodes' TB has been given for only six months so far, the tests will be inconclusive. Hence, I do not recommend any diagnostic test at this stage, EXCEPT for ESR (which, if <20) will indicate that the infection is under control. The tests for CURE should be done ONLY AFTER COMPLETING TB course for at least one year. * Lastly, usually, Nodes' TB has no/minimal symptoms. Your wife being symptomfree with increase in weight by 10kg, indicates that she is showing excellent response to treatment (but not fully cured). BUT, THE TREATMENT SHOULD CONTINUE FOR TOTAL OF AT LEAST ONE YEAR. Hope I have addressed to your concerns to your complete satisfaction and you find my response helpful and informative. I will be happy to answer further queries, if any. Please revert back to me (through DIRECT QUERY, addressed to me personally) for follow-up after completing one year of treatment, along with latest condition; state of swelling/lymph node size; and, latest ESR report. Fond regards, Dr. Rakesh Karanwal

---

Brief Answer: Rifampicin, isoniazid, D3 and Calcium recommended Detailed Answer: Hi Mr. XXXXXXX Nice to hear back from you. Firstly, significant weight gain and having no symptoms whatsoever, of tuberculosis, point to the fact that your wife is on ideal treatment and the tubercular bacteria are sensitive to the medicines. Further, when she is showing predictable and favorable response, addition of other drugs would NOT HASTEN recovery. We should not experiment with nature. Additional drugs if given, will not have a synergistic effect, but would complicate the matters due to their side effects. It is just as- in order to grow a sapling overnight- one pours 10kg of fertilizer along with a tankful of water!! For the same reason, ESR is just an clinical indicator of the extent of improvement. So, I will again recommend that you exercise patience and do nothing which would jeopardize your wife's health. In view of the above, irrespective of what other doctors say merely "to please the patient' without bothering about the adverse effects, I- being a staunch believer in medical ethics- would strongly recommend the following treatment. Rifampicin 600mg + Isoniazid 300mg + Ultra D3 1000mcg + Calcium Carbonate tablet daily. The following precautions should be taken:- 1. Monthly Liver function and Kidney function tests; Calcium, Phosphates and vitamin D levels. 2. Rifampicin + Isoniazid should be given EMPTY STOMACH, at least 2 hours PRIOR to breakfast and to be continued for a total of 12 months from the date of initiating treatment for tuberculosis. May I submit that it is your privilege to accept or reject my recommendation. Have a nice day, Dr. Rakesh Karanwal

---

Brief Answer: CONTINUE TREATMENT AS ADVISED Detailed Answer: You are always welcome, Mr. XXXXXXX * If pus is coming out of the infection area, please use an antiseptic ointment such as Puradane/Betadine/Framycin ointment. Streptomycin powder will not have any effect. BUT NOTHING IS REQUIRED TO BE APPLIED LOCALLY IF THERE IS NO PUS/FLUID COMING OUT. * I prefer Ultra D3 1000mcg which acts faster. BUT Calcium Carbonate is a must. * I am sorry to learn that her grandfather died due to TB. But that was because he did not take appropriate treatment. * The standard practice is to give 4 drugs (rifampicin, isoniazid, ethambutol and pyrazinamide) for initial 2-3 months; thereafter, if the response is good, continue with only rifampicin and isoniazid. Only if the improvement is not satisfactory, do we continue with ethambutol or pyrazinamide for another 1-2 months along with rifampicine and isoniazid. I wish you wife a speedy recovery. Fond regards, Dr. Rakesh Karanwal

---