Brief Answer:
Please see a specialist.

Detailed Answer:
Hello Ms. XXXXXXX

Thanks for writing to me.

I have gone through your attached reports. Apart from raised ESR, CRP, your SGPT levels are also higher than normal. I think you should consult a gastroenterologist and also a rheumatologist for further suggestions, more so as you mentioned that your symptoms are resurfacing. Your treatment also should be reassessed for improvement and also the need for further continuation.

CECT being an invasive procedure, is better done only if absolutely needed. There seems to be not much of difference in advantage of higher versions as compared to 16 slice MDCT; a radiologist can give a better opinion a I am not well-versed with these.

Diagnosis of intestinal tuberculosis or cancer is based on the symptoms and investigations. While intestinal cancer can give symptoms like unexplained weight loss, loss of appetite, black tarry stools and a mass, diagnosis can be confirmed by endoscopy and biopsy. Tuberculosis, on the other hand, can give varied symptoms based on the structure involved.

Diagnosis of multi-drug resistance can be done through genetic tests, culture methods and so on. I have attached below some links for you to go through.
http://www.medscape.com/viewarticle/529589_3
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC0000/

Hope your query has been clarified. Please feel free to contact for further information. I will be happy to help.

regards,
Shanti.V.

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Brief Answer:
Vitamin D supplement may not be necessary.

Detailed Answer:
Hi,

Thanks for writing back.

CECT involves injection of contrast and any procedure that involves injection is considered invasive, in the sense that it invades the inside. Any procedure is better avoided while ATT is on. The clarity of the lesions is based on the presence or absence of contrast; mostly it is good. You can contact a radiologist for a better opinion.

You did not say for how long you have been taking Pegalup and for what reason. Unless specifically prescribed, there is no need for regular use of this medication.

If your vitamin D is 128 ng/ml., you need not use any supplements.

In the links I have provided in my earlier answer, genetic tests also have been described to detect MDR TB. You can go through them for a detailed description of the procedure. Culture methods also have been described. Please open the links and go through them.

Hope your query has been answered. Please get back if you need more help.

regards,
Shanti.V.

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Brief Answer:
Detailed below.

Detailed Answer:
Hello,

Thanks for writing back.

If I remember your earlier queries, adhesions have already been detected. these could be the possible reason for the pain and discomfort, as I mentioned earlier.

The need to continue with ATT should be confirmed by the specialist who has put you on ATT. If you are not multi-drug resistant, there is no need to go through all those tests. I sent the links for the sake of your information. If you cannot understand them, please do not bother.

The radiologist who has observed the scans can determine the scope of the investigation and the help it can provide in detecting necrosis.

It depends on the indication for which you were prescribed the medication, so, please ask the doctor who gave you Pegalup if you should continue using it.

Hope this helps.

regards,
Shanti.V.

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Brief Answer:
Culture of menstrual blood is useful.

Detailed Answer:
Hello,

Thanks for writing again.

The sample of menstrual blood can, of course, be sent for culture and PCR tests to help in detecting genital tuberculosis. Multi-drug resistance also can be known from culture and sensitivity.

The raised CRP and ESR as per your hematology report suggest inflammation. An immunologist would try to sort out the cause of these raised values. They can be elevated in several infections and inflammatory changes in the body.

If you have been put on the six-month regime, AKT 4 is given for 2 months followed by AKT-3 for 4 months.

Hope this helps.

regards,
Shanti.V.

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Brief Answer:
Best time to give a sample is within 12 hours of onset of menstruation.

Detailed Answer:
Hi,

Thanks for writing.

The best time to provide a menstrual sample is within 12 hours of the onset of menstruation. Endometrial biopsy or curettings also done during the last phase of the menstrual cycle or within twelve hours of the onset of the menstruation are considered better for diagnosis.

You need to take the advice of a rheumatologist as I suggested earlier to get relief from these symptoms.

Reaction of contrast material is based on its type and the patient's response. However, body aches have not been reported. Mostly, it is the allergic manifestation that is observed.

You can have serratiopeptidase, as it can help the antibiotics to reach the site of infection. Blood culture cannot detect type of inflammation per se', but can identify if there is any serological infection. CRP indicates inflammation and can be controlled by attending to the cause.

You can continue with protein supplements and fresh fruits and vegetables. Please try to have adequate sleep.

Hope this helps. Please contact if you need any more information.

regards,
Shanti.V.

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Brief Answer:
Detailed below.

Detailed Answer:
Hello,

Thanks for posting your query.

I have gone through the attachments and the medications given are good enough and in accordance with your physical condition. The lab reports are mostly normal, except for the raised SGPT level as earlier and slightly elevated fasting blood sugar.

Vitagreat and Nuroday contain methylcobalamine and mecobalamine respectively. These medications are used to treat neuropathies. Common side effects include nausea, vomiting, diarrhoea, skin rashes etc.

While Gabaneuron is Gabapentin, used to treat post-herpetic neuralgia, Pregabalin is a natural supplement used to treat neuropathic pain. The symptoms you experienced are the side effects of the medication. They may be taken along with ATT, but spaced apart. Side effects of Gabapentin include several systems with nausea, vomiting, dizziness, in coordination, night blindness, fatigue and so on. Side effects of Pregabalin include edema, weight gain, tremor, dizziness, dry mouth and so on.

Petrin plus is an anticonvulsant. Ganaton total and Rabonik plus have an almost similar effect.

Pegal up is ideally given by the specialist as per the need.

Your delayed cycles are perhaps due to the several medications you are using at present.

Please consult an ayurvedic specialist for further help.Mostly, ayurvedic medications which are nutritional supplements can be prescribed to be taken along with ATT on.

Hope this helps.

regards,
Shanti.V.

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Brief Answer:
Detailed below.

Detailed Answer:
Hi Ms. XXXXXXX

Thanks for writing back.

I have gone through both the prescriptions and I feel both are mostly similar. You can take any of the vitamin supplements along with calcium. Anti-inflammatory and Pegalup have to be taken as needed.

Serratiopeptidase can be taken as long as you are on antibiotics. It helps the drug to reach the site of infection better and helps to treat infection faster.

Firstly, nerve damage and tissue injury are two different things and manifest in different ways. Detection of tissue necrosis can be done clinically, through tissue biopsy, CT and MRI, apart from sonogram. Necrosis, is mostly progressive unless accurate and prompt treatment is given. The symptoms vary based on the type of necrosis. I am giving you a link to go through an elaborate description; please concentrate on post-surgical infections.
http://cid.oxfordjournals.org/content/41/10/1373.full

Petri plus with ATT needs to be taken with precaution as suggested below.
http://www.drugs.com/drug-interactions/escitalopram-with-isoniazid-pyrazinamide-rifampin-1013-0-1394-0.html

Pyridoxine is given as an additional supplement in ATT as Isoniazid causes peripheral neuropathy. The recommended dosage is 10 mg./day.

If I were to treat such a case, I would go for observation of the presenting symptoms, see how genuine it is, if it is a common postoperative feature, order for surgeon's opinion if I feel it is needed and proceed with management, active, if required and conservative, if the tissue healing is delayed but progressive.

Hope this helps.

regards,
Shanti.V.

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Brief Answer:
Can use any one combination of Pyridoxine.

Detailed Answer:
Hello,

Thanks for writing.

Sorry for the delay in answering as there was a total power shutdown here. Giddiness can be due to the medication, vitamin and electrolyte imbalances, rarely due to peripheral neuropathies and so on. If it is troublesome, you can get help from a general physician or neurophysician.

Alprazolam has not been shown to have significant interactions with ATT drugs, which you have been prescribed. Yet, please do not self medicate in view of the several medications you are having.

B long is used when deficiency is suspected. Excess is always excreted in urine. Please ask your consultant and take only one preparation at a time.

TNF-Alpha test is used to detect excess amount of the factor in the serum and this can be seen in chronic infections, certain cancers and hepatitis C. This should not be used as a diagnostic test. As this gives a broad opinion, it may not be helpful in your case to pinpoint the diagnosis.

If you have discomfort that is serious while using Pregabalin, please inform your consultant right away and get treated.Dizziness is a side effect of the medication, but it should not turn serious.

Bevon is composed of some B-complex vitamins and minerals while Vitagreat contains methylcobalamine and pyridoxal phosphate. Your consultant has to decide which is a better combination in your case as visual impression is always the best.

Hope this helps.

regards,
Shanti.V.

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Brief Answer:
Please attach the specified reports.

Detailed Answer:
Hi,

Thanks for writing.

Please attach the said reports as I did not find the MRI and sonogram that you mentioned.

Pressure is usually given on the upper part of the abdomen on the fundus of the uterus during a cesarean section as the baby is being delivered out of the uterus. This is to help push the baby out faster to allow proper oxygenation to the baby. I did not get what you meant by rc 26; please elaborate.

Either Meganeuron or Bevon can be taken. There is no need to take both at one time.

Hope this helps.

regards,
Shanti.V.

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Brief Answer:
I have not received any reports on my page.

Detailed Answer:
Hi,

Thanks again.

I am unable to see any MRI or ultrasound reports on my page apart from the hematology reports and three prescriptions. Please contact customer care to sort out the issue.

I do not understand what the term rc 26 means. If you can elaborate on the context of its use, I can try to clarify. RC 26 pill is used in the treatment of Alzheimer's disease.

Hope this helps.

regards,
Shanti.V.

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Brief Answer:
Please refer to the very first answer in this thread.

Detailed Answer:
Hello,

Thanks for writing back.

I have already seen the reports you have uploaded. Please refer to the very first answer given in this thread.

Meprate is Medroxyprogesterone, a progestogen used to induce withdrawal bleeding in hormonal imbalance when a period is needed. It can also be used to supplement hormone deficiency. There are no known significant drug interactions with anti-tuberculous drugs. It has been prescribed several times with combinations, but, precaution should be executed by monitoring the vitals every now and then.

Hope this helps.

regards,
Shanti.V.

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