It has been a couple years since I have touched this blog. A lot has happened. I mean A LOT. Hopefully I will fill some of that in soon/later.

But first, in the interest of the previous purpose of this blog, I have to touch upon something that may concern anyone doing some travel and study abroad.

As part of my preparations to begin graduate school (like I said, more/soon/later...), I again had to get a TB test. They required this of anyone who lived for longer than 4 weeks in a list of high-risk countries. South Africa was on that list. Three years earlier for my visa application, I had to do a lot of medical exams, including a tuberculosis (TB) skin test (or PPD). That is the preferred (and simplest and cheapest) method in the U.S. for anyone who has not previously received one of the vaccinations (of variable efficacy) sometimes administered in other countries.

Well, my test came back positive. While the normal bubble on a clear test almost completely disappears within a few hours of the injection, mine expanded to a red, itchy, sore mound on my arm a couple inches across. Of course, my health forms request it in millimeters, and my doctor was not about to go metric ahead of the rest of the United States. This was then followed up with a chest X-ray and a blood test.

The chest X-ray came back clear. This means that I do not have an active, contagious tuberculosis infection (or consumption, as it was once elegantly referred to). However, my blood work showed a positive culture for the bacteria, meaning I have a latent, non-pulmonary infection.

Besides the fact that I may probably never get to do a quick PPD test for TB ever again, I am now on isoniazid (INH, don't ask me how they hit upon the abbreviation). I will have to be on this strong anti-mycobacterial medication for 6 months, after which blood tests will tell whether additional medication is indicated.

Although overweight, I am in generally excellent health. I am not on (nor do I need) regular medications. As such, this new daily regimen of antibiotics is strange and invasive. The information regarding this medication is diffuse and sometimes vague or contradictory. There are a variety of warnings about diet on this medication. Some of it may just impede the efficacy of the drug. Other things may cause blood pressure spikes, nervous disorders, and hepatitis. My doctor was not a fountain of input on this, and I have chosen (perhaps foolishly) to interpret that as a sign that I should not be particularly worried.

However, I am navigating the side effects and hope to share my experience here for anyone else going through it. From the start, the drug does make me loopy and a bit high for a few hours after taking it. Additionally, I have noticed an increase in my blood pressure at various times, which exacerbates the loopiness and sense of being off-kilter. I have suddenly become aware of my kidneys. To be fair, I am in the midst of an extremely stressful time, preparing to move my family across the country and start a PhD program at one of the nation's leading graduate schools. Therefore, I am likely navigating a series of factors. Embarking on INH treatments may only be one factor, but it is the newest one added to the mix.

The University of Michigan medical seemed to have the most navigable dos and don'ts of the many things I found across the interwebs. These are the rules for consumption I am following:
  1. No alcohol (I do not drink anyways, but it is fun to have a new excuse besides "gets into serious trouble")
  2. No cheese. This one is excruciating for me. Actually, the rule is no aged cheese. So awful things like velveeta and american cheese (the non-cheese end of the cheese spectrum) are allowable. Thankfully, other dairy like milk, butter, and yogurt are allowable.
  3. No aged meats. I try not to eat much meat anyways, but this applies to dried and aged meats like pepperoni or salami. As with above, goodbye pizza.
  4. No fish. Input is split on this one. Some just say no tuna, while recommending anchovies and white fish. The word is split on salmon.
  5. No cultured soy. This means soy sauce, tofu, and miso. As with above, goodbye Japanese restaurants.
  6. Nothing pickled. No kimchi, sauerkraut, or pickles. 
  7. In general, nothing aged or fermented.
  8. Vinegar. I am personally finding that more vinegar-y foods are giving me blood pressure spikes and so am trying to avoid them. This recommendation has not been rigorously tested with appropriate controls, but I do not have time at present to construct a flawless scientific experiment with how I feel.
  9. Lots of dark green vegetables (doesn't everyone recommend this for everything?). 
  10. Some lists on the internet assign different vegetables to the do and do not lists. Broad beans (fava) and snap peas are considered bad. Some places urge avoiding tomatoes, mushrooms, spinach, and eggplant. I am finding that higher vegetable content in my diet has helped but am not consuming pod vegetables (like the aforementioned bean or pea).
  11. Increase vitamin B6 consumption. This has to do with the drug's tendency to impact peripheral nervous systems and cause neuropathy. I am also taking a supplement of this one.
  12. Take INH on an empty stomach, 1 hour before or two hours after eating.
I am not really certain at this point what is forbidden on threat of side effects versus what is recommended to maximize the efficacy of the treatment. Obviously, fewer side effects AND maximum drug effect are desired.

I hope to keep this updated as my journey with this evolves.

It has been a wonder how I contracted tuberculosis. There are two options.

One, I got it working with the kids in the townships. I tutored at an after-school program hosted by a community AIDS clinic. In South Africa, as with elsewhere, HIV and tuberculosis often go hand in hand. Every kid who came in was touched in some way by the AIDS epidemic, either directly or through living with infected family members.

Two, I got it from my accident during a class field research outing. During that trip, I took a spill off a boat (onto a dock) that resulted in some of the most amazing bruising with which I have ever marked my body.

Actually, that looks like a bluer version of my last TB skin test.
In addition, I also broke a rib and sliced my thumb open, necessitating a trip to the emergency room on a national holiday (and I still want to know what lay beyond the doors marked "Casualty Room" and "Mass Casualty Room").

Heads Down, Thumbs Up!
The care I received was very good. They did a good job with the stitches. I never had an infection even though there was often casual talk of going septic. AND I came home with a bitchin' scar. Africa left its mark on my figuratively and literally.

There was a lot of blood during this whole debacle. While I am not well-versed in the life of this little mycobacterium and its extra-host lifestyle, it is possible that I may have been exposed via the massive bloody gash in my hand.

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