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A young man called Ramesh, aged 24 years, got a tubercular infection in his left lung. He had complaints of weakness, persistent fever, and loss of appetite. As usually happens in India, people suffering from fever think it is either a seasonal fever, typhoid infection, or malaria, and therefore, they go to unqualified medical personnel or quacks and start their treatment. Ramesh too did the same thing.

He also tried home-made concoctions for the first fifteen days to get rid of the fever, and after that, he consulted a local unqualified so-called medical practitioner. This continued for one more month.

When his health continued to deteriorate, he followed the advice of his family members and consulted a qualified M.B.B.S. doctor, who after conducting some required investigations, gave him anti-tubercular treatment.

Thereafter, he showed some improvement in his condition that continued for the next three months. After that, he became irregular in taking medication and stopped consulting his treating doctor, thinking that he had become alright. After a few days, he stopped taking anti-tubercular medication altogether and never went to see his doctor for the next three months.

When his condition started deteriorating rapidly, he consulted another doctor, and this time anti-tubercular treatment was started again, but he did not get the desired result as the anti-tubercular medicines became ineffective.

At this time, he consulted a chest specialist who prescribed a second line of anti-tubercular treatment, which turned out to be very costly. Initially, he showed mild improvement, but a complete cure was a distant dream. He took treatment for one year, and when his health showed no significant improvement, he changed doctors one after the other, thereby repeating changes in medications.

Finally, Ramesh had persistent high-grade fever and started coughing out blood, and he became very thin and emaciated. At last, when he went to a big hospital in a major city, he was told his left lung was totally destroyed, and the infection had reached his right lung too. In other words, he had reached the threshold of death.

You might be thinking that the case history of Ramesh is an isolated and unique one. No, in our country, millions of people like Ramesh are suffering and visiting one place or the other. They do not know where to go and what to do.

According to one estimate, every year 30 (thirty) lakh new patients of tuberculosis come to light, and about eight lakh patients die of tuberculosis every year, and out of them, a destroyed lung due to tuberculosis is the culprit in the deaths of five lakh people. This statistics show a destroyed lung as a harbinger of death.

Why does a lung get destroyed?

In our country, the main important cause of the destruction of the lung is the tubercular infection. Irregularity in treatment, the use of ineffective medicines, and incorrect assessment of the stage of lung infection play a major role in destroying the lung infected with tuberculosis. What happens generally in India when a small part of the lung is destroyed due to infection is that no promptness is shown for the removal of that dead portion of the lung. On the one hand, physicians, in general, do not strongly advise surgery to get rid of the knocked-out portion of the lung; on the other hand, patients do not easily agree to an operation, even if strongly advised. Finally, this results in the complete destruction of the whole lung.

The second important reason for the destruction of the lung is the collection of pus inside the chest. If timely removal of pus from the chest is not done, the infected lung starts getting destroyed. The third reason for the destruction of the lung is the tumor of the membrane covering the lung, which is called in medical terms 'Malignant Mesothelioma'. This tumor begins forming from the inner wall of the chest and gradually compresses the lung substance and finally destroys the whole lung.

How to prevent the destruction of the lung?

If your physician has been treating tuberculosis of your lung for the last six months, and chest x-ray shows no improvement instead of an increased whiteness or haziness in the lung, you should immediately consult a thoracic or a chest surgeon. Because this directly means that some portions of the lung are totally destroyed, and thus medicines will have no effect on the destroyed portion. If a patient during his treatment starts coughing out blood, consult a thoracic surgeon without fail because a delay in consulting a chest surgeon in such a situation will lead to the destruction of the whole lung, and the risk to life will increase.

If you had an infection of pneumonia, and now a collection of pus inside the chest is suspected, do not forget to consult a thoracic surgeon because a delay in treatment will cost him very dearly. If your physician has told you about the appearance of a thick membrane around the lung, the possibility of a tumor of a covering membrane called 'mesothelioma' cannot be ruled out. You should seek advice from a chest surgeon, as delay in treatment will lead you nowhere.

Where to go for treatment of a destroyed lung?

If some portion of the lung or the complete lung is destroyed, one should go to such a hospital where 24 hours availability of a thoracic surgeon is there. Before entering a hospital, make sure whether surgery of the lung and heart is done there regularly or not. It is also essential to know whether facilities for special investigations, like CT scan, 64-slice CT angiography, and digital subtraction angiography, are there in that hospital.

For a correct assessment of the lung and windpipe, Bronchoscopy (investigation of the windpipe through a telescope) may be required. After surgery on the lung, the services of a critical care specialist may be required, therefore the existence of a critical care unit in the hospital is always in the patient's interest. In the ICU, the availability of artificial breathing machines (ventilators) should be in sufficient numbers. One should keep all these factors in mind while selecting a hospital for surgery.

Surgery is the only choice

One should understand very clearly that the best course of treatment in such cases is to get his destroyed lung removed through surgery as early as possible by an experienced thoracic surgeon. If a delay is done, the infection and germs emanating from the destroyed lung will keep on going onto the normal lung of the opposite side and will destroy that lung too. This ultimately will result in the loss of life. Always remember if even a part of the lung is dead due to infection, that portion must be removed through an operation, otherwise, the whole lung will be gradually destroyed.

Sometimes in a serious situation when the patient cannot tolerate surgery, a window is created in the chest surgically so that collected pus and infected material keep on exiting out of the chest. This small initial procedure, on the one hand, will temporarily protect your healthy lung of the opposite side, and on the other hand, the patient can be medically prepared in advance for a final major operation.

The author is a Senior Consultant, Dept. of Thoracic and Cardio Vascular Surgery, Indraprastha Apollo Hospitals, New Delhi.

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