We left for PGH when it was still dark, around 5:40 am, and yet we couldn’t get a parking slot when we arrived there 1.5 hrs later. I had to drop off Twin A at FMAB so I can park at Robinsons Manila, which was a bit a of a walk…

This is Twin A’s 6th month full abdomen MRI with contrast to check whether there is still omental caking, nodular peritoneal thickening has subsided, and there are no enlarged lymph nodes anymore. Praying everything is fine and there are no other underlying issues…I’m still scared, you know.

Because for some bizarre reason, the infectious diseases lab wasn’t able to culture any TB bacteria. Nothing came out after 8 weeks. 😱

But the thing is, her histopathology pointed to TB and she is getting better. Her last MRI showed no thickening of the colon, lymph nodes have shrunk, ascites have resolved and all symptoms that were thought to be cancer are gone that’s why we were cleared by our hemato-oncologist. She is still communicating with our IDS who went on leave to take care of her son with leukemia.

This situation might be bizarre for developed countries but very common for the rest of the developing world. My cousin’s TB culture and AFB tests were also negative and her IDS’ only proof that it’s not cancer is her histopathology and her response to the anti-TB meds.

My colleague in Singapore, who writes for a sister publication, told me in late November (when I flew there last year) about her frustrating experience with the healthcare system in that country. She said the doctors there are “textbook doctors.” She and her son spent two to three months in the hospital (and good thing her husband’s insurance coverage was good) because the doctors couldn’t figure out what was wrong with the boy. They already did surgery on the leg and so on but they couldn’t cure him. Nothing fits in the checklist that was based on their textbooks so they couldn’t treat him according to protocol.

She’s Indian and her doctor back in her home country told her to bring her son to him, to their top national research hospital (an equivalent to PGH, she said). Her doctor suggested treating him for tuberculosis. Right off the bat, my colleague’s son responded to the treatment. In no time he got well.

She said it would have saved her from a lot of stress, tears, and money if she had just gone straight home to India for her son’s treatment. The surgery in Singapore may or may not have been necessary at all, just like the bone marrow biopsy for Twin A was not needed.

My colleague and I concluded it’s because doctors in developing countries are more flexible and more experimental when it comes to treatments. It’s because cases that may be uncommon or not textbook in first world countries are very common in countries like ours. They had to take chances because most patients in our countries cannot afford regular MRIs or the hospitals nationwide are not equipped with enough/right diagnostic reagents. All forms of TB infections (brain, bone, GI, larnyx, etc) are ever present in our countries, that’s why my IDS told me, “believe me, I’ve seen them all.”

I told my colleague our first IDS in the private hospital we first went to also said the same thing. He said he has seen the same thing over and over that’s why he was confident that it was TB. He had his training at the Philippine Children’s Medical Center—the go-to hospital for indigent pediatric patients after PGH. But I guess he began doubting when Twin A’s high fevers were not abating so he was also working hard to have her admitted to PGH or PCMC. Our IDS in PGH—who knows our first IDS—said the latter was correct, but Covid just messed up the situation that’s why our first team of doctors were thrown off-balance. Symptoms of different diseases were overlapping. She said the previous team was only looking for respiratory symptoms of Covid that’s why they were blindsided. Twin A’s high fevers, vomiting, and continuous diarrhea without the usual cough and colds or pneumonia were consistent with Covid in pediatric cases. If it were not for Covid, Twin A’s case wouldn’t have been that baffling. But kudos to our first IDS for starting Twin A with the anti-TB meds soon while waiting for biopsy to be done. Or else she would have deteriorated quickly and God knows what could have happened.

I also told my colleague about how my dad’s orthopedic surgeon was able to save his diabetic foot:  Zonrox (sodium hypochlorite) with saline solution. At that time (almost 30 years ago) it was an experiment at PGH. My dad’s leg was gangrenous up to below his knees. It took us three months of twice-daily cleansing of his leg with this solution until his leg grew back the flesh. Mom and daughters took turns in cleansing the leg. After that, the doctor grafted my dad’s skin over the entire shin—skin from his butt. This study published in 2013, also conducted in the Philippines, showed that the Zonrox+saline solution was more effective in cleaning diabetic foot wound than just hydrogen peroxide. My dad was one of the lucky 10% who suffered from diabetic foot and didn’t have to lose his leg.

You see, not all third world countries’ healthcare institutions are pathetic. If only we could keep healthcare professionals from leaving the country…But I can’t blame them.

Anyway, back to Twin A’s negative TB culture, I’m very thankful that our doctors were not by-the textbook kind and they think outside the box. Imagine, if Twin A got hospitalized in Singapore—she wouldn’t have been treated for TB just because the culture and AFB tests were negative. Our doctors here are used to seriously bizarre situations so they had to consider all possibilities.

This reminded me of fairy gaymother’s dad’s case in the US. He was very close to dying and out of desperation only did they think of testing him for TB. Turns out he had TB meningitis.

While we were at PGH FMAB, a corp comm team sent me this Valentine’s gift.