Brief Answer:
Management requires regular Follow up

Detailed Answer:
Dear
Thanks for contacting Ayurveda with your health concern and patient on anti - TB treatment needs close observation throughout the period of treatment which requires following questionnaire to be answered from your side:

i. Time period from which ATT is started or taken [months/year]
ii. Is it Pulmonary or Extra pulmonary TB
iii. Is there symptomwise improvement: [ improvement in appetite, gain in weight, reduction in cough, fever,breathlessness]?
iv. Are there any side effects of drugs: [giddiness,jaundice, visual disturbances]?
v. Were any Investigations done to know the progression/regression of disease, mainly: chest X-ray, ESR and Sputum for AFB, multi drug resistant TB [MDR - TB]?

2. Avoid: strong purgation,excess physical exertion,sudation,late night awakenings, dry food,water melon,horse gram,black gram,asafoetida, garlic, leafy vegetables,alkalis,sour/bitter/astringent food.

Take: alcohol in medicinal dose, meat/chicken soup, green gram, brown rice, sweet fruits, ripe banana XXXXXXX amla,dates, goat's milk.

3. In Management of Tuberculosis [Rajyakshma in Ayurveda] we first improve the Metabolism [AGNI] of the patient and then provide with the drugs to cure.

i. To improve Metabolism [digestion]: Draksha assav and Chayawanprash are recommended

ii. Sitopladi Churan, vasa arishta, eladi vati, XXXXXXX malti ras, chandanadi taila are recommened/prescribed drugs to reduce the associated side effects caused by allopathy drugs.

PS. regarding cure of soft tissue infection one has to exclude whether this is Primary [cure is possible] or secondary [opportunistic] to some disease [examination is mandatory]

Dr. Munish Sood
Consultant & Physician
Naimittika

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Brief Answer:
Post partum Endometritis & MDR TUBERCULOSIS

Detailed Answer:
Dear
Thanks for reverting back

A. The treatment of MDR tuberculosis should always be supervised by a chest physcian because:

1. The choice of drug is difficult to decide
2. The drugs are costly, treatment is prolonged
3. The effect of drug is unpredictable and results are not guranteed.

B. Regarding your query how to susoect MDR - TB:

. When a patient has received anti-TB drugs in the past and now comes with recurrence of symptoms.
. Suspect MDR-TB if, after 2-3 months of treatment with first line of drugs:
i. There is no clinical improvement - fever and cough persists, there is no weight gain, or new lymph nodes appear
ii. Patient remains sputum positive.
iii. X- ray shows increased lesion.

C. Side effects which you are experiencing could be due to adverse drug reaction of ATT regime:

. Rifampicin causes flu like syndrome and jaundice [slight increase in bilirubin is there]
. Isoniazid causes peripheral neuropathy [are you taking pyridoxine with it]
. Ethambutol causes visual disturbances [check your eye sight]
. Pyrazinamide causes hyperuricemia [slight increase in your blood report]
. Streptomycin causes giddiness [stop if taking it]

PS. give correct dose as per body weight remember if patient weighs > 65 kg, standard 4 drug combi packs do not give sufficient dose.

D. CRP increases in response to infection,trauma,tissue necrosis and inflammation and so is the case with ESR, i.e. both are suggestive of ongoing INFLAMMATION inside the body but not Diagnostic of any disease.

E. Since fellow Doctors have given a good insight about other recommended guidelines and diagnostic procedures which you can follow thus do incorporate them for further follow ups. [to exclude soft tissue infection]

F. Best Ayurveda Medicine which you can take along with ongoing ATT regime is:

. XXXXXXX amrit ras, sitopladi churan XXXXXXX pishti,shring abhra bhasam, XXXXXXX malti ras with honey.

You may contact me directly on: bit.ly/drmunishsood

Dr. Munish
Naimittika

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Brief Answer:
furthter clarification and follow up

Detailed Answer:
Dear
Thanks for reverting back.

1. Dosage of medicinal chart:
XXXXXXX amrit ras: 250 mg
sitopladi churan: 1 gm
shringabhra bhasam: 150 mg XXXXXXX pishti: 250 mg XXXXXXX malti ras [with or without gold]: 125 mg... thrice daily with honey

PS.
i. This is the formulation which I prescribe to my patients along with use of ATT drugs and taking these regularly will not have any side effect BUT they will help lessen the adverse drug effects caused by ATT treatment.
ii. also take ushir assav or vasa arishta: 25 ml with equal amount of water [after meals]
iii. and eladi vati: 5-6 times as lozenges.

2. As explained earlier both ESR/CRP are raised in 'any ongoing inflammation' inside the body, and to know the inflammation in your case, either it has to be from chronic disease [extra pulmonary TB] and/or due to soft tissue inflammation [active disease activity] for which your attending physician is in better position to exclude the possibilities.

3. undergoing CT scan [after treatment] cannot distinguish between scar tissue and tumor and it is for this reason that PET scan [gallium scan] is useful to differentiate active disease from scar tissue.
PS. Abnormal growths—tumors, cysts, abscesses, scar tissue, and accessory organs—can be located and identified with ultrasound but the best procedure is laproscopic surgery.

4. Since adhesions are internal I personally doesn't have any medicine to treat/cure/manage the same BUT I particularly lay stress on 'Massage Therapy'
PS. Consult your attending physician or a qualified massage therapist.

5. Since your weight is 69 Kg thus I usually increase the dose of rifampicin to 600 mg instead of usual 450 mg.
PS. Take Opinion of your attending physician or second opinion from chest specialist

6. In Pulmonary TB one asks for sputum to find the bacterium likewise in extrapulmonary TB I think biopsy is the standard procedure to locate the bacteria which will also help to identify the problem of MDR - TB.

Dr. Munish
Naimittika

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Brief Answer:
does not have any known side effects

Detailed Answer:
Dear
Thanks for reverting back.

1. Although these medicines does not have any known side effects but adverse drug reaction can be seen when not taken as recommended:

i. If your cough is productive then take sitopladi churan BUT if it is dry then replace it with Talisadi Churan.

ii. Shringabhra BHASM: check with your renal test before including this in treatment chart, since mostly people suffer from pre existing kidney condition and then wrongly attribute abnormal renal function to presence of metal ( bhasm) in medicine.
PS. same is with XXXXXXX malti ras.

iii. The said assav(s) should be
mixed with water and to be taken after meals since taking empty stomach and without water results in heart burn and nausea.

iv. Eladi vati should be sucked and not chewed since crushing it results in extreme bitter taste in mouth (nausea feeling)

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Brief Answer:
further clarifcation regarding Medicine prescribed

Detailed Answer:
Dear
Thanks for reverting back.

1. Sitopladi although is mainly given in conditions of productive cough but if that is not the case one can give it or mix with other said medicines in condition of:
. burning sensation in hands/feet
. pain in ribs
. fever

2. By adverse drug reaction I mean that the combination of drugs will not have any side effects BUT if the dose is increased (self medication) then one can experience drug effect otherwise there is no reason to think of any substitute.

PS. Check with a local qualifed Ayurveda Physician regarding the previous mentioned dosage who will decide whether the said combination and dose is sufficient for you or it requires some modification

3. XXXXXXX malti ras is mainly given as an IMMUNOMODULATOR ( to increase Immunity) since TB itself is an IMMUNOCOMPROMISED disease and also helpful in fighting against the tubercle bacilli

4. You may attach your further reports for assessment andcan directly contact me on:
bit.ly/drmunishsood

Dr. Munish
Naimittika

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Brief Answer:
further clarification

Detailed Answer:
Dear
Thanks for reverting back.

1. Suvarn XXXXXXX malti can be given with honey or milk and since we know that 'suvarn' [gold] has anti bacterial action thus is very helpful against tubercle bacilli and can safely be taken with ATT without any side effects.

PS. since you are suffering from extra pulmonary tuberculosis thus it is helpful to increase the metabolism of liver by decreasing 'AAM' [undigested food] and increasing the digestive fire.

2. Immunocare by [BACFO] is given in people with decreased immunity and TB is one such disease thus can be taken safely since it acts as an IMMUNOMODULATOR but my preferred medicine for such cases is/are: CRUEL capsules from UAP Pharmacy.

3. Amlycure DS: is mainly given as a hepato protective [increasing liver metabolism], so is a good choice.

4. since you have been ask to take suvarn malti ras: twice daily do let me know whether you will be taking it as single or mixed with formulation described above.
PS. suvarn malti ras of baidyanath is good.

Dr. Munish
Naimittika

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Brief Answer:
follow up in tuberculosis

Detailed Answer:
Dear
Thanks for reverting back

1. There is no need to get confused, just remember:

i. ATT is the mainstay of treatment and all other XXXXXXX will only ameliorate the side effects of ATT, so taking Ayurveda prescription alongside ATT will not do any harm to the system.

ii. Seratiopeptidase can be used safely [by mouth ] after food and only think to look out for is coagulation profile [bleeding time/clotting time] since it interferes with blood clotting

iii. The most common symptoms of ‘necrosis inside abdomen’ will be: fever,diarrhea,vomiting,abdominal pain.

a. In blood work one can go for: TNF [tissue necrosis factor] and platelet count
b. Either CT or MRI is better for further investigation will depend upon your attending physician, but ‘histological examination’ is what I do with my patients

iv. [petril plus] i.e. Escitalopram also effect coagulation thus keep check on coagulation profile and also ask from your doctor about ‘Serotonin Syndrome’ which can occur with use of ATT particularly interaction of isoniazid with SSRI’s [selective serotonin reuptake inhibitors] one example being escitalopram.

v. Benadon [pyridoxine] can be used in a dose of 10/20 mg per day, and since Isoniazid blocks pyridoxine metabolism resulting in peripheral neuropathy thus pyridoxine is given to REDUCE the side effect of medicine

vi. My approach toward my patient would be:

A
. confirm symptomwise improvement
. look for side effects of the drug
. investigate to study the progress of disease
. motivate the patient to complete the full course of treatment

B
If symptom wise and radiological improvement is not seen will check for blood sugar,H.I.V,hemoglobin, is he taking all the drugs regularly and are the drugs of good quality

C
If all the above factors are checked and found normal. Then is he ‘drug resistant’: will ask for AFB culture and sensitivity test and ask for Specialist opinion.

Dr. Munish
Naimittika

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Brief Answer:
further necessary evaluation

Detailed Answer:
Dear
Thanks for reverting back.

1. Yes cow’s urine can be given/taken in tuberculosis because of following benefits:
. In recent study, Cow’s urine distillate [gomutra ark/kamdhenu ark] has been credited with having Bio enhancing properties and increases the effectiveness of antimicrobial, anti fungal and anticancer drugs.

PS. Gomutra ark enhances the transport of antibiotics, e.g., Rifampicin, Tetracycline, and Ampicillin, across the gut wall as well as across artificial membranes [ two fold to seven fold.]
a. When starting for first time: take 2-3 drops.
b. You may increase the dose, after a week
c. If you want to collect it fresh, drink it within 15 minutes after collecting it.
d. Since TB is a chronic inflammatory condition thus can be safely used till 3-4 months

2. XXXXXXX malti ras properties has been described earlier, adding triphala will help cleansing the system, since it is the best detoxifying medicine in Ayurveda along with Laxative properties

3. No I don’t have any clinic in XXXXXXX and do not know anyone personally there, you have to do some goggle search yourself or try to find out information from your relatives for any qualified/good Ayurveda physician there.

4. Serratiopeptidase available here are: biodase- 10 [Biomedica], Bidanzen [GSK], C-Serra [Corona], Cipzen [Cipla], Pepzen [Cadila], you can ask for the same there.

5. Propidium iodide staining along with FDA staining is a best method that can be adopted, it will differentiate between live and dead cells and cells undergoing apoptosis, another is TUNEL technique.

6. Since sensitivity of menstrual blood culture is very low thus Biopsy is more preferable but in cases where AFB is positive with menstrual blood culture subsequent laproscopy examination can reveal genital tuberculosis.

7. If you think it can be damaged nerve pain, there can be impairment or loss of sensation in the area of its disturbution. [check with your reflexes and sensory and motor sensation with a Neurologist]

Dr. Munish
Naimittika

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Brief Answer:
answers based on judgement

Detailed Answer:
Dear
Thanks for reverting back.

1. Yes, godhan ark is prescribed by me to patients suffering from T.B. ( pulmonary or extra pulmonary) since it is given for protective and not for curative purpose.

2. Take Trifla churan with XXXXXXX warm water (half hour before going to bed) at night time and chayawanprash with milk in morning, other measures which you can try are:

. Take purgation of olive oil (free of side effects) or castor oil with milk at bed time.
. Early morning ( empty stomach) eat 10 cashewnuts + 4 raisins
. Drink water after coming out of bed or stored overnight in copper vessel.

PS. If constipation is unusual (intensity/ duration) consult your doctor first.

3. You may go ahead with MUD therapy which when applied/done correctly stimulates bowel movement and relieves constipation.

4. Inflammation/Infection is necessary for the TNF test to come positive, since if the person is healthy TNF is blockex naturally, as a result blood test will yield no result

PS. Fasting is not necessary.

5. 125 mg once daily or twice daily (250 mg) is sufficient andat this dose side effects are not seen.

6. With high uric acid in body:
. Pain in big toe
.Pain in joints are common complaints and since maximum of patients are asymptomatic thus requires high clinical suspicion.

PS. IN Ayurveda we treat the patient on line of " VAAT RAKTA". You may contact an Ayurveda Physician there if the same happens.

7. FDA with Propidium iodide: Fluorescein diacetate ( FDA) determines healthy living blood cells from dead ones.

PS. Haematologist/Pathologist will bein better position to explain the whole assay.

8. As described earlier, the side effects of drug, the treatment has to be symptomatic and one has regularly check with the kidney functions and liver tests.

9. Stress is a major cause of not getting good sleep ( which can be there), so:

. Eat 2 spoons coriander seeds with 2 spoons of sugat candy.

Dr. Munish
Naimittika

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Brief Answer:
Relevance and Interpretation.

Detailed Answer:
Dear
Thanks for reverting back

1. Pro peritoneal space is more important for Radiology professional in helping them:
. outlining the ascending and descending colon.
. and loss of this space/fat helps them to differentiate certain pathologies like appendicitis, and rupture aortic aneurysm of abdomen from pneumoperitoneum and/or pneumoretroperitoneum.

2.
i. traverse supra pubic incisional scar [Pfannenstiel incision/supra pubic incision]: this incision is used when surgery is planned for pelvic organs [LSCS in your case]

PS. more important from cosmetic point of view in females.

ii. Since there is minimal/asymmetrical collection which at this moment seems to be insignificant thus keep regular follow up with your doctor for complications like: wound infection, sepsis, localized/generalized peritonitis, endometriosis, abdominal hernia.

Dr. Munish
Naimittika

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