Lazy NHS doctor nearly kills little girl

No diagnostic tests for peasants! Just take an aspirin. She's half blind now but the doctor will suffer no consequences. And what nobody is mentioning is WHY TB has resurfaced in Britain: "Refugees" from Africa bring it with them. Being kind to such refugees has sent a little British girl half blind

For three days, Katie Roberts lay unresponsive on a paediatric ward. The two-year-old's eyes were shut, her face sallow, and the drips taped to her arms only accentuated her wasted limbs. Katie had been ill for nearly a month with a high temperature, sickness and weight loss which her GP had repeatedly blamed on a virus. "It all started when Katie developed a slight temperature and came out in a rash,' says her mother Sarah, 27, from Grantham, Lincs. "The GP diagnosed mild chickenpox. But a week later, Katie had a high temperature and was vomiting. The weight fell off her. "The doctor's answer was always the same - it was a virus. I remember sitting in my car after yet another appointment, in floods of tears and so frustrated," recalls the auxiliary nurse. "My child was dying and no one cared. No one took her temperature, let alone did blood tests."

After three weeks, in desperation, Sarah and her husband Martin, 27, took Katie to A&E at Grantham Hospital. Katie was immediately transferred to a specialist paediatric ward in Lincoln where she had a brain scan, a lumbar puncture to check for meningitis and dozens of blood tests. "Doctors suggested she had everything from chickenpox to cancer, but all tests came back negative," says Sarah. Despite being on large doses of antibiotics, Katie was showing no signs of recovery.

Three days later, a doctor asked if she'dcome into contact with anyone who had TB. That question probably saved her life. She had indeed been exposed - through her aunt's boyfriend, James. He had been diagnosed with pulmonary tuberculosis, TB of the lungs, 18 months earlier - although he never found out how he had contracted it. Before the era of antibiotics and vaccinations, tuberculosis was responsible for thousands of deaths in the UK every year. But while many think the disease had been eradicated, around 8,000 cases of TB are still reported in the UK every year, mostly in major cities (just last month, 30 pupils at a secondary school in Birmingham were diagnosed with TB). Not all tuberculosis is infectious, but pulmonary TB is.

Two weeks after James started his antibiotic treatment, he was no longer infectious. But it had taken four months to diagnose him, meaning he'd had the potential to infect others during that time. Katie was moved into isolation.

Doctors explained she could have TB meningitis, a complication caused when the bacteria - mycobacterium tuberculosis - migrates to the lining of the brain and forms When these abscesses burst, they create inflammation which puts pressure on the brain. Without antibiotics to combat the bacteria, and steroids to reduce the swelling - the consequences would be catastrophic. There was a serious risk of brain damage, sight or hearing loss and septicaemia, leading to loss of limbs - and if the infection got out of control, organ failure and death.

Although doctors weren't certain, no time could be wasted. Katie was started on four antibiotics specifically for the disease via a gastric tube. She was also given steroids to reduce the inflammation in her brain and blood was sent off for analysis. It was then a waiting game. Gradually, after a few days, her fevers lessened and she stayed awake for longer - the results of the tests confirmed she did have the disease.

As their daughter recovered, Sarah and Martin foundthemselves increasingly angry about the needlessness of their ordeal - and how the doctors' lack of awareness could have killed Katie. Since James's diagnosis of TB 18 months earlier, Sarah had been anxious that Katie could catch the disease. But her GP had insisted there was no risk, because James saw Katie only once a week, for a few hours.

According to the UK charity TB Alert, the doctor's reaction was typical, demonstrating the general lack of awareness among healthcare professionals. "Because tuberculosis has been dealt with so effectively in the past 50 years, many GPs, particularly those away from the high-risk areas such as London, will never have seen the disease," says Melanie Matthews, of TB Alert. "But it's on the increase, and as people travel can spread to socalled unaffected areas. There is also a complacency that it can be easily treated with antibiotics and is no longer dangerous. "In fact, for those who have weak immune systems, such as infants or elderly people, left untreated it can be fatal."

Another problem is that Government guidelines for screening those in contact with a sufferer are open to interpretation. The Department of Health makes it clear that the decision is down to individual clinics, while The National Institute for Clinical Excellence guidelines state that people who are in close contact with the TB sufferer should be tested and given precautionary antibiotics. Screening can be in the form of a blood test, a skin test or a chest X-ray. Katie had been exposed to active tuberculosis and was showing classic symptoms. Yet no one put the clues together until it was almost too late.

After three weeks, she was discharged from hospital, but was so weak she needed physiotherapy to build up her muscles. Fighting the disease is a long journey - Katie will take antibiotics for a year, until at least November this year. The family initially thought Katie might have got away unscathed, but this wasn't the case. Two weeks later, Katie was bumping into things or reaching out for a toy and missing it.

"The consultant ophthalmologist agreed Katie's sight was deteriorating, but felt it might be a repairable side-effect from one of the antibiotics," remembers Sarah. "We stopped giving her the drug but her sight kept deteriorating and a few days later she couldn't even see her hands. A scan confirmed the worst. "A few TB abscesses had swollen up again and were pushing onto the optic nerve - she was virtually blind. She was given 30mg of steroids a day to reduce the swelling." For two weeks, the family watched desperately for any sign of improvement, but her eyesight didn't improve. They were then warned their daughter's sight was unlikely to recover. "We were basically told to start organising our home around the needs of a blind child," says Sarah. "It all seemed so unfair. The one person I didn't blame was James. He'd done nothing wrong except become ill."

Unbeknown to the family, the consultant tracked down a doctor in Newcastle who'd had some success with a similar case by giving the child a huge short-term dose of steroids. "She called and said she wanted to double the dose from 30mgs to 60mgs a day," says Sarah. "We knew there might be side-effects such as liver damage and growth retardation, but if it saved her sight it would be worth it." And after three days, Katie's sight began to return. "To our relief, by the end of the two weeks it was back to 50 per cent of normal," recalls Sarah. Despite this, no one knows if Katie will have any long-term neurological damage. She has also gained weight from the high doses of steroids.

But having regained 50 per cent of her sight, Katie - who is now three-and-a-half - will be able to attend mainstream school and live a relatively normal life. "I hope that everyone who reads this realises the danger of underestimating TB," says Sarah. "It's on the increase and is not just confined to the inner cities or high-risk groups. And, as this story shows, it can still wreck lives."

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Wal-Mart expanding its low-priced drug program

Wal-Mart Stores Inc expanded its low-priced drug program, saying on Monday that it is now offering more than 1,000 over-the-counter items for $4 or less and selling some 90-day generic prescriptions for $10. It also increased the number of women's medications that it offers at a discount. "We expect that today's extension will generate additional pharmacy volume for the company, especially given the current weak consumer environment and rising health-care costs," wrote Uta Werner, a retail analyst with Sanford C. Bernstein & Co, in a research note.

In 2006, Wal-Mart began selling some generic drugs for $4 per monthly prescription in Florida, and it quickly extended the program to all its U.S. pharmacies. Last year, it added more medicines to the program and said in September that $4 prescriptions accounted for nearly 40 percent of all prescriptions filled in its Wal-Mart, Sam's Club and Neighborhood Market pharmacies.

The world's largest retailer said pharmacies at its U.S. discount stores, Neighborhood Markets and Sam's Club warehouse locations is now filling prescriptions for up to 350 generic medications, like diabetes drug metformin and asthma drug albuterol, for $10 for a 90-day supply. It also expanded the number of women's medications it offers for $9, adding drugs to treat osteoporosis, breast cancer and hormone deficiency. It is selling alendronate, the generic version of the osteoporosis drug Fosamax, for $9 for a 30-day supply or $24 for a 90-day supply.

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