Spinal TB: Onset and Diagnosis

November 2011

You’ve got to be kidding.

How the hell does someone like me get spinal tuberculosis? I’m a US citizen, with a master’s degree from Columbia, a rich ex-husband. Before that, the love of my life was a celebrated author. I wear beautiful clothes and have a dazzling collection of ethnic textiles and costume jewelry. I own at least 200 pairs of shoes. I’ve stayed at the Tawaraya and dined at some of the most exclusive restaurants on the planet. I’ve spent a fortune on white Burgundies. I know caviar, sashimi and spices, and I’ve eaten food that is so fresh it’s still moving. I read 3-8 books a week and I’ve visited more countries than most people can name.

This all sounds obnoxious. Maybe TB is a punishment from God. Maybe it’s all those countries I visited. Or, perhaps, I have the“tuberculosis temperament,” like all those characters in The Magic Mountain. I enjoy idleness, reflection, aesthetic novelty and having too much time on my hands. I like to be thin—NYC-Bergdorf-Goodman skinny. Tuberculosis makes that a lot easier. At 174cm and 52kg and 51 years of age, I look pretty good in super-skinny jeans. It’s a good thing too: I don’t know when I’ll get back to the gym. Yesterday I had an MRI to clarify what x-rays had already revealed: something has partially eaten away my spine. The preliminary report I received prompted my orthopedist to suggest that the destructive process that had already destroyed one intervertebral disc and eroded the adjacent bones was tuberculosis. He persisted in this hypothesis despite the fact that my PPD skin test was normal. This is not uncommon with cases of TB that occur outside the lungs.

I went back to the office and looked it up. I used to be medical librarian and spent some time in nursing and pre-med courses in my late twenties, so, for a layperson, I have a pretty easy grasp of medical literature. Moreover, diseases fascinate me. I've been reading about pathophysiology since I was a little kid with an encyclopedia. Infectious diseases are my favorite and my travels have exposed me to the sight of conditions we don't often see in the developed world. I've seen leprosy, beriberi, scrofula (another extra-pulmonary form of tuberculosis) and cancerous tumors crawling with maggots. I've sat on buses next to people suffering from elephantiasis to goiters the size of throw pillows. I've passed coins and torn bank notes to every variety of disfigured beggar, including, I assume, those crippled by spinal TB.

Not contagious?

I was working in a school when I first heard the diagnosis, so, of course, my first concern was that I might make someone else sick just by being near them. My doctor confirmed what the literature stated and something I already knew: in the absence of an active pulmonary infection, spinal tuberculosis is not contagious. I'd had no respiratory problems, my chest x-rays were clear and my sputum test (you cough into a cup) was devoid of mycobacterium tuberculosis, the bacillus that causes TB. But that didn't stop my employer from imposing a "quarantine" until I'd been under anti-tubercular treatment for a month. After four weeks on the drugs, even Mimi in La Bohème could no longer infect Rodolfo. 

Stigma:

No, I wasn’t contagious, but I submitted to the imposed isolation anyway, even though the administration at my school used an opinion from a doctor who is not treating me and who did not have permission to review my records to banish me from my work and society. 

Then they fired me.