Nicole from Houston

Feel free to email me at cullywiseman at yahoo dot com and I will email you back.

Back in Galveston

I am back in my beloved and simultaneously despised Galveston. The rest of the Morcocco, Spain, Portugal trip was amazing. Craig was a great travel partner and we saw and did a lot.

So its the end of my time in Africa for a while, but the work lingers on. My abstract was accepted to the 2006 International AIDS Conference in Toronto, Canada. I really wasnt expecting it to be accepted and thus planned my entire 4th year assuming that I would not attend. But of course, it was, and I had to make some major changes.

The first few months look a little like this:

Period 1: Move in, study for Step 2
Period 2: Actually study for Step 2, attend 2 wedding and the AIDS conference
Period 3: Emergency Medicine rotation at Denver Health
Sept 15, 16, 17: ACL Music Festival!!!
Period 4: Something easy...
Period 5:Trauma Surgery at UTMB

I should point out that period 1 and 2 are actually going to be pretty hectic. I have to move in, work at St. Vincent's arrange a complicated web of flights, trains, buses and car rentals to get me around between Toronto, Boston, and then back to Denver in time to start my rotation. Throw in the writing of a personal statement and running a clinic for the uninsured with 4 other medical students and you'd start to wonder how I would even have time to study for Step 2. In fact, I dont.

So now my question becomes: what happens to this blog. I am not in South Africa anymore and thus writing a blog called Sanbona doesnt make much sense. At the same time, I really want to keep posting ideas, thoughts, plans, even if no one reads it.

So I'll either keep writing here, or I'll start a whole separate blog to document my life as a 4th year medical student. We'll see.

Regardless, its actually nice to be back. Was sad to see my old medical school class graduate on June 3rd, but my new class is awesome and has been very welcoming so far.

Will be in touch!

Morocco

So I have obviously been a way for a while. Sorry for that. I am currently traveling in Morocco with friend and Fogarty fellow Craig Connard. We met up in Marrakech and have been making our way north little by little.

 

Marrakech was an ancient city with a large and lively square. Here you can find street performers, story tellers, snake charmers, dancing monkeys, and traveling bands. The square, called Djenna El-Fna, is an overwhelming maze of interesting colorful people that seems to copme alive with sound and energy each day around dusk. There are also endless souqs or shops where you can buy everything from fresh safron to a fine Arabian carpet. Despite having asked several times, most vendors did not know of any magic carpets. I have yet to ask about genies, but have secretly rubbed several lamps in the hope of coming across one with three wishes to spare.

 

If you can think of any other Arabian myths and sterotypes that I can make into bad jokes, please let me know. I have already used the °rock the Kasbah° joke far too many times. I really need some new material here.

 

Next was Essouria (pronounced ess-way-uh), on the Atlantic coast. This was a very relaxed beach and fishing town with a wide stretch of coastline that was ideal for frisbee, soccer, and getting sunburned. We spent 3 days here dining on fresh grilled fish and cheap beers. Because of a lucky bet with our hotel owner on the outcome of the Barcelona Arsenal soccer game, we essentially stayed in our nice apartment for free.

 

We then met some of Craig's friends in the capital, Rabat. I wasnt expecting much, but this city was really amazing. We stayed at a friends house right on the ocean. The whole neighborhood was painted white and bright blue. It had a very mediteranean feel to it. We wandered through ancient Roman ruins, shopped for gifts, smoked the hooka with our new friends, (which, mom and dad, is very harmless tobacco...) and saw a great musician from Mali play in a 700 year old garden.

 

We have now made it to Fes, one of the oldest and largest imperial cities in Morocco. Inside the ancient city walls are over 9,000 twisting alleys, paths, and streets. We just arrived today, and havent yet been able to get completely lost yet. But if you dont get an email from me for a while, this may be why.

 

We will next head to Tangier where will then cross the straight of Gibralter into Spain. We plan on a few nights in Seville and a few more in Lisbon before heading home. This should put me in Texas around May 31st.

 

Am doing lots and lots of gift shopping and trying to gather presents for as many as possible. Please send me any special requests and I'll try to accomodate. Sending an email or leaving a comment on the blog (which are all forwarded to me via email) has been shown to increase your chances of getting something cool by 85 percent.

 

Regardless, I hope you all are well and safe and happy. While I am having a blast here, I am really looking forward to getting home and catching up with old friends and family. Stay well and I hope to see you all soon.

My mom met Bono

I presented all my final data this Friday to the CAPRISA staff. Its been stressful week with managing 4th year of medical school plans, trying to squeeze in important weddings and conferences in between away rotations, and gettting ready to go home for good. Lots and lots to think about.

The presentation went for about 2 hours and went well, I thought. Though I was mentally exhausted by the end of it. Kylie and I decided to have an easy Friday night and rented a movie, ate some bunnies (bean curry in a carved out piece of bread, an Indian/Durnan classic), and took it easy. I started feeling sick just before bed, and had chills and a fever all night. Was not a lot of fun. I never get sick, and here I am.

I woke this morning with a nasty headache and body ache. I wanted to check my email, and it hurt to look at the screen. But I found this great email from my mom, and it made me feel a lot better:

Cully,
I got to meet Bono last night thanks to Karen and Phil! (my Aunt and Uncle) I went to a reception before he spoke to the World Affairs Council in Dallas.

I shook his hand and told him my son was doing aids research in s africa. he asked me your name and he said "I'll be thinking about cully wiseman, thank you for him." I said "thank you for all you are doing and for being here tonight." he said, "he is experiencing some hard things so thank you for cully."

He then gave a really fantastic presentation. I wish you could have been there.

mom

How cool is that? Bono knows who I am. Sure, I imagine he forgot 2 minutes later as I'm sure people say stuff like that to him all the time. Regardless, it hit me at a time when I needed a little something to make me feel better.

My head still hurts and I still feel pretty crappy, but not as bad as I did.

Tsotsi

We finally went to see Tsotsi, a recently released South African film. The movie recently won an Acadamy Award for best foreign language film. Despite that accomplishment, I was still half expecting to see a movie that was good, but not great. I was suprised and can say that Tsotsi is one of the best movies I have seen in a very long time. It combines those key elements of poignancy and entertainment. It really makes you think and consider new points of view, but also keeps you entertained throughout. It would be great for anyone to see, whether they have been to South Africa or not.

On vacation

I just got back from my first real vacation in Africa. Have taken plenty of extended weekend trips (like the last one to Cape Town), but this is my first week long trip. I met my dad in Johannesburg and we first flew to Kruger. We spent 2 nights in a SA National Parks camp and 2 nights in a private game reserve, Lukimbi Lodge. While the SANP lodge was very nice, it really paled in comparison to the private lodge. We then met Kylie back in Jo-burg and headed north to Livingstone, Zambia. There we stayed at a cool, rustic lodge and did the tourist circuit of Victoria Falls, a Zambezi River cruise, and a very cool gorge swing. Then we head all the way back to Durban so my dad could see where I lived, worked, and surfed.

While this short entry doesnt do the trip justice, I am short on time these days. After all, I leave very soon!! So I hope the following picutres at least provide a pictoral depiction of the trip.

This elephant was in "must" which apparently meant it was mating season and that he was really pissed off. He walked towards our Land Rover and made some menacing huffing noises. But we yielded to him, and this was about as close as we came to being sat on or tusked. It was pretty frightening though to be on the receiving end of such a large animal's aggresion.

Picture of me on the front of the Land Rover holding my favorite African beer, a Windhoek (pronounced vind-hook). a.k.a. the capital of Namibia.

Does this picture make you want to sing "cha-ma, cha-ma, cha-ma, cha-ma, cha-ma cha-meleon." It does for me.
The amazing view from Taita Falcon Lodge. We ate breakfast and dinner from the deck that looked over the Batoka Gorge. I was convinced I could throw a rock over the edge to the river. Despite multiple attmeps, I never really even came close. Now my shoulder hurts.

Incredible Victoria Falls. We visited just after the rainy season at the peak of the flow over the falls. The spray from the falls was quite intense. It was a beautiful, sunny day, yet it felt like a full on hurricane in dark stormy weather. Pretty amazing.

The intrepid traveling trio about 30 meters upstream from the falls. Notice the massive spray behind us.

My Dad and I, shortly after we convinced him to try the gorge swing in Zambia. We were actually quite proud of him for giving it a try. While I obviously managed to shave in the time between the previous 2 pictures, I am, infact, wearing the same smelly shirt.

Me making the jump off the gorge swing. Was a little scary the first time, but pretty fun once the swing caught you.

Can you believe there was a 30 foot scorpion outside our room in Zambia? This was one of the many intimidating bugs we had to contend with at our rustic lodge.

And finally, back to civilization in Durban. Kylie set up an amazing dinner for us at a nearby Thai restauraunt. We invited all our friends and had dinner for 12. The food, the company and the atmosphere were all amazing. It was probably one of my favorite nights in Durban. Note Nupe at the far end of the table. He's been back in SA for a few short weeks and we were happy to have him around.

The other side of Florida Road

So, you might recall my entry about our beloved Florida Road. I had described it as a fun, safe oasis in Durban where you can stroll from bar to restauraunt and forget that you are in one of the most dangerous cities in Africa.

That is unless you were strolling tonight and encountered the knife fight that happened no less than 20 feet from our restaurant. I present it here in a somewhat lighthearted manner, but a the time, it was anything but.

We first noticed a gathering of police cars around one of the cross streets that we use to get to Florida Road from our house. We were a little worried because while we always considered Florida road to be safe, the cross street (really more of an alley) is dark and a little scary. So we wanted to know if anything had unsafe happened on our somewhat hidden shortcut.

We saw police and a medic hovering around a particular corner outside a restaurant. They seemed concerned and were talking on their radios and walking around briskly. Their actions seemed rapid and purposeful. Then we noticed they were carefully stepping over a body that was laying on the sidewalk. We were shocked to see a black man on his back with his limbs sprawled out awkwardly around him. After a careful look, it was clear that he was not breathing.

Not know what else to do, we just stood there and stared. I couldnt believe what I was seeing. It was hard to believe that a man was lying dead on the sidewalk where we so frequently walked. We asked some people what had happened, and they said that two car guards had gotten into a fight and one was stabbed in the heart.

A car guard is a very common job in South Africa. They stand and wait in your parking lot while you are away, ostensibly to prevent crime and theft. You typically give them a few Rands when you return. They range from very official car guards with uniforms who are often employed by a shopping mall, to the unsavory, often drunk ones that you only give money to because you are afraid they might attack you if you dont.

Apparently, two of them had gotten into an altercation over who deserved the 3 Rand tip (about 50 cents) and one was stabbed as a result. There was no blood on the sidewalk and I imagined the man was stabbed in the heart, causing it to stop pumping instaneously. It occured literally a few steps from a popular Italian sidewalk cafe. It was tragic and surreal to see the lifeless body on the pavement next to a crowded restaurant full of white diners. Unbelievably, most of them continued to eat, not paying too much attention to the commotion.

So this was our first real brush with crime and violence in Durban so far, and I am hoping it is our last (yes, I just knocked on some wood). While it likely doesnt happen very often on this side of town, I unfortunately think its not too uncommon of an occurence in Durban. It still seems like an unreal scenario and one I likely wont forget.

I just looked over my old post about Florida Road (see link above) and it seems quite ironic that I had been so recently touting it as a safe, fun, hip place to spend an evening. Kind of makes me feel trite and superficial after what I saw tonight. Unfortunately violent crime has become a real part of South Africa, whether it occurs in the townships or on Florida Road.

10,000th day in Cape Town

Today is my 10,000th day. Having calculated it a few months ago (at timeanddate.com) I knew that it landed on April 1st. Kind of ironic, but true. 10,000 days is 27 years, 4 months, and 18 days. Perhaps yours has passed you by, or maybe its just around the corner, but its worth noting either way.

I am currently in Cape Town, over on the west coast of South Africa. Its truly one of the most beautiful cities on the planet. Set on a long peninsula with a 3,000 foot mountain range in the middle. Its a very progressive, exciting, cosmopolitan city that still has close ties to nature, the ocean, and the environment. You come here to visit, and immediately start thinking of how you might be able to find your future job here some day.

We spent the morning driving down the cape peninsula, stopping at some beautiful beaches along the way. We drove up a windey steep road to Chapman's peak with stunning views of the sea and mountains to the right. Then we stopped off to see the penguins at Boulder's beach in Simon's Town.

After lunch and an ice cream cone, we are now heading to the Cape Town International Jazz Festival. Hoping the rest of the day will be as fun as the first half. What a great way to spend my 10,000th day.

Three Years of War

March 19th marked the Iraq war's 3rd anniversary. I remember well March 19th 2003 when the war actually started. I was a first year medical student struggling through my neuroscience block, but keeping an eye on the news via the internet.

I remembered being appalled by Bush's insistence that we must invade Iraq. I remember him pleading to the UN for permission to once again invade the country. The UN sent their investigators to look for weapons and found none because their were none. They voted not to allow the US to invade. But we invaded anyway. I was shocked and saddened that our country would subvert the UN's doctrine. It made the statement that we are the exception, that the rest of the world must abide by the UN's rules and regulations, but we do not have to.

I thought for sure time would prove me wrong. I thought that we would find the chemical weapons plant making awful gases and missiles loaded with anthrax. I wanted the US to find them. But they didnt. We found Saddam, but never saw any of his missile silos or nuclear weapons. Its bad enough to ignore the UN and insist that we are right. That we turned out to be wrong in the end, is shameful.

And here we are. Three years and over 33,000 civilian deaths later. What have we accomplished? I wont say nothing, because some good has come from our invasion. We took a madman out of power. We freed a country from tyranny, sort of. They had elections. All those things are good, I am not discounting that. However, there is still widespread poverty, crime, and violence in Iraq, and progress has been very slow, to say the least.

But my real concern is with how the world and history will view our actions and our priorities. We have set the precedent that its ok to ignore the UN when you have a really strong hunch about a country's intentions. Unfortunately, we have also set the precedent that its ok when that hunch is dead wrong.

More importantly, it says to the world that the US will invade who we want, when we want, primarily because we can. It says we will ignore events like the genocide that occurred in Rwanda and that which is occurring in Sudan today. We will spend 250 billion dollars, will sacrifice over 2,000 of our young troops to defend our interests. We will only donate a fraction of our war expenditure to the worst plague the world has ever known.

$250 billion dollars would fund worldwide AIDS treatment for 24 years. I worry not only about the US, but about the entire human race when I realize how much we spend on killing compared to that which we spend on helping.

So you may not agree with my statistics or my logic, and that is fine. Either way, I hope Americans take a critical look at what is going on in our world and what the United States role has been in it. We have been at war for three years now. Its time for us to think about that, and decide if its something we support, or perhaps something we now see as a mistake. Let those thoughts and decisions influence your politics, your vote, or even your words and actions. I obviously only present my views here. On this anniversary, I hope you are able to take a close look at our world, and a deep look into yourself, and develop your own.

Shepherd's Keep

Since we've been back in South Africa in 2006, Kylie has been working as a nurse at an orphanage here in Durban. Its called Shepherd's Keep and is located on the other side of Durban in an area called the Bluff. Shepherd's Keep is a privately owned and funded orphanage for abandoned infants. Most are less than 6 months old. Many were found in parks, wrapped in plastic bags, in public bathrooms, all discarded like unwanted property. As a result, many of them have anoxic brain injury and/or cerebral palsy. Some will hopefully grow up to be healthy happy adults, others will have permanent dysfunction and fail to fully develop normally.

We visited Shepherd's Keep a few weeks ago and took some of the pictures below.
This is a picture of Kylie and Sibusiso. He is 7 months old and has been at the orphanage since birth. He is a very healthy baby and has hit all his developmental milestones on que. Currently he has no foster parents.
Zuma is 14 months old. He was brought to Shepherd's Keep when his mother was sent to prison. The orphanage had been doing the paperwork for Zuma's grandmother to adopt him. The mother will likely be able to stay with them once she is out of prison. Luckily, Shepherd's Keep was around for him during the interim period.

This is Princess (the baby) with Happiness (the caretaker). There are about 6 caretakers looking after 16 babies at any given time. None are actual nurses (Kylie was the first) but all are certified caretakers. They get paid about $5 a day to work at Shepherd's Keep. Keep in mind "a day" usually starts at 6 am and ends at 7 pm. Kylie thinks they could all use a raise.

If you'd like to make a donation to Shepherd's Keep, please click here. You can rest assured that your donation will be going to a good cause. Might even help the caretaker's earn a fair wage.

Match Day

Yesterday was match day for medical students throughout the country. On this fateful day, every 4th year medical student recieves notifcation of where they "matched" for residency. After having spent much of their 4th year applying and interviewing at various residencies, med students finally discover which residency has decided to accept them as a new doctor and a new employee. Its a very important and very nervous day for most everyone. These agreements are binding and once the student has matched, they must work at their assigned location. Many students feel that match day is the culmination of all they have worked for as a medical student.

At UTMB, all the students gather in an auditorium. All the envelopes indicating the student's residency are tossed randomly into a jar. One by one, each student is called out to collect their envelope. When they do, they put a $1 bill into another jar. The last student to be called gets the money. The second to last gets the pity of the class.

I lived through the match vicariously as had I opted to stay in America, I would have likely been a part of it all. I emailed all my friends to find out where they had ranked. I wanted to be as much a part of it all as I could, despite the vast distance between Galveston and Durban.

So this morning I found the match list on the UTMB website and read it carefully. For some reason, I was nervous. I knew so many fates had just been decided, and I wondered who was going to be disapointed, who would be elated.

All in all, the results looked promising. Most all of my friends got their 1st or 2nd choice. Many people matched in competitive fields like plastic surgery, orthopedics, and (ughh) dermatology. Others matched at competitive places like Duke, UC San Diego, and the Mayo Clinic. It was great to read about the sucess of my former classmates, and I am truly proud of all of them.

I googled "match day" and came across this article in the New York Times about match day at Cornell. I imagine their match day was quite different than UTMB's, what with the hotsy totsy champaigne and fruit and cheese brunch.

AIDS Article

Found this article on news24.com about South Africa's AIDS crisis. Here are some important points if you dont feel like reading it all. Many I already knew, some were new to me:

-With over 5 million infected, South Africa has more HIV positive citizens than any other country on the planet

-Currently, about 500,000 people in South Africa urgently need antiretroviral therapy. I assume this means that 500,000 have CD4 counts below 200.

-The government and/or private agencies are treating around 200,000 leaving a deficit of 300,000 that will go without therapy and likely die from AIDS related illness as a result.

-50,000 children need ARV's, but only 10,000 are receiving it. (Personally, I would be suprised if 10,000 children in South Africa are on ARV's as I have encountered only one in my entire time here)

-One of the interviewees also argues that AIDS therapy should start at a CD4 of 350, not 200. I tend to disagree with this. In my study, those with CD4 counts in the 100's do just fine on ARV's. They respond well, they have good viralsupression, and low mortality. On the other hand, those who wait until their CD4 count is below 50 have a significantly increased risk of death and treatment failure (this is essentially what my paper is about).

Anyway, I am glad that the independent news is constantly talking about AIDS, even if many are tired of hearing about it (even myself at times). I think the SA government has fallen short and its up to the media to continue to make people aware that AIDS in South Africa is a pandemic of historic proportion.

Negative

My PPD test is NEGATIVE. Zero millimeters of induration. I dont know how in the world I managed to avoid tuberculosis while I was here. I've been around dozens of patients with active, hacking, TB cough. Heck, I did most of my research at a TB clinic! Regardless, I am negative. That's my story for now and I am sticking to it!

AIDS disability grant

I came across an interesting patient yesteday at Vulindlela. She was a mother of 4 and had been on antiretrovirals for a little over a year. She had a less than expected CD4 count response to the ARV's, but good viral supression. Essentially this meant that the AIDS medicine she was taking was keeping the virus from replicating, but her immune system was not coming back to life the way it should be. She was there with her youngest daughter of 2 who was also HIV positive, though not on any antiretroviral medicine. The mother still had some disability in the form of excessive faituge, skin problems, anemia and weight loss. After we discussed all the medical details, I began asking her how she supported her family and children.

Her husband had died a few years ago and she was simply too ill to work. Her children were too young to have jobs, and instead needed to be in school and looked after constantly. How is a single mother of 4 who is sick with AIDS supposed to find a job in rural South Africa? Under most circumstances, such a situation would be devastating to a small family. However, the South African government has instituted an AIDS disability grant for HIV positive patients that are too ill to work. Thus, this patient had an income of about $180 per month. Raising a family of 4 on what amounts to about a $2,000 per year income is certainly not easy, but it is much better than nothing. I realized that this small struggling family would have been lost without this grant. I was actaully quite proud of South Africa for deciding to support their disabled HIV positive population.

There is a small problem I forsee with the issuing of an AIDS grant. Only those with clinically defined AIDS are eligible for the grant. Thus, the patient's CD4 count must be below 200. Once the patient starts on ARV's and the CD4 count becomes above 200, they are no longer eligible and are expected to go find work.

This obviously presents a conflict of interest between taking your antiretrovirals and recieving your monthly grant. Indeed, I have told patients about the "good news" that their CD4 count has risen to 250 or 300, only to see them break down into tears because they know they will no longer be eligible for their AIDS grant. I have also heard of patients refusing to take their ARV's regularly to prevent their CD4 count from getting too high. Such behavior can have devastating effects on the patient, and on the course of the epidemic as it may foster viral resistance to the medications.

I dont really know the solution to this probelm. The SA government obviously needs to prioritize who recieves finacnial support, but by designing such a strict cutoff, you may also cause some major problems for an individual, and may worsen the epidemic itself. Regardless, I was happy that this patient had some financial support. I think its the humane and right thing to do if your government has the means to do so. For this family, it may have meant the difference in subsistence and starvation.

Honesty and email

Kylie and I had been planning for weeks that one of her friends from college would come out to South Africa and visit us. I'll graciously refer to her as Ms. X from now on so as to protect her identity. Kylie and Ms. X had plans to drive from Durban and Cape Town and do some scuba diving along the way. I was going to come a long for some of the trip. Flights were bought, rooms reserved, and Kylie even spent two weekends taking a diving course just so she could dive with her friend. We were all excited to see Kylie's old friend and show her a good time in South Africa.

The plan was that Ms. X was to going to visit her boyfriend in Florida just before her trip to South Africa. She emailed us from Florida saying she was about to head back home to pack and leave for her long flight to Durban. However, the morning that Ms. X was to leave, we got a very flustered email from her saying that she had lost her passport and could not make the trip. She seemed very apologetic and upset by the whole thing. Naturally, Kylie was too. We had been planning for weeks on her arrival, and this changed everything considerably. We scrambled to salvage what we could of the reservations, but ended up losing some money as a result.

I have never met Ms. X, but knowing what I know about females, I suspected she was lying. No one loses their passport 6 hours before a flight. I figured she decided to stay in Florida and simply didnt want to confess that she had ditched us for her boyfriend. Luckily, knowing what I know about computers, I thought I could prove it.

What Ms. X didnt realize is that every email has kind of "envelope" on the outside called a header. The header tells you a lot about where the email is going, and where it has been. Instead of physical addresses, the internet uses IP addresses. These IP addresses can easily be looked up and the actual, physical location that the email was written can be discerened.

So, with Kylie's permission, I looked at the header of Ms. X's email. It was supposedly written from her home in Washington DC amidst the confusion of her lost passport. However, when I looked up the IP address, this is what came up:

IP Address	Country (Short)	Country (Full)	Flag	Region	City	ISP	Map
216.106.180.10	US	UNITED STATES		FLORIDA	FT. LAUDERDALE	STS TELECOM

We can thus assume that she never left and had made up the whole story about her losing her passport as a cover.

Because Kylie is the sweetest, kindest person on the planet, she wouldnt confront her friend about it. She really wasnt even all that mad, though I think her feelings were hurt. She just played along with the story and said that these things happen. I thought she should have confronted her, but Kylie resisted the temptation. That is why she is such a great friend and good person.

I think this story teaches us somthing that we have always known: be honest! Sure, it would have sucked to email Kylie and explain that you have decided not to come to South Africa and stay with your boyfriend in Florida. But it would have been much better than lying about it, and getting caught. So if anything good can come out of Ms. X's bad decisions and my internet snooping, maybe its the realization that in most cases, the truth is a hell of a lot better than a lie, especially when it comes to your friends.

Also know that your emails can be traced with a minimal amount of effort. In fact, here are two sites that will teach you how to do it: This site shows you how to find the IP address of the sender. This site allows you to look up the IP address and will give you a print out like the one above.

So be good and honest to one another and hopefully you will never need to even use these sites.

Cully's PPD Placement

I just had a PPD skin test done to check for a latent tuberculosis infection. For med students, you already know what this is. For the rest, please allow me to explain.

Almost 1/3 of the world's population (2 billion people) are currently "infected" with TB. Now, this doesnt mean that they are sick. The vast majority of these 2 billion have what is known as latent tuberculosis. This means that theoretically, someewhere in there body there are TB bacteria that may someday wake up and actually cause the disease. This should not be confused with actual pulmonary tuberculosis, which innvolves night sweats, weight loss, coughing, and is highly contagious. Latent TB is not contagious. However, there is a 10% lifetime chance that those with latent TB will someday develop pulmonary TB. The chance is 10% each year for those with HIV.

To check for latent TB, a small amount of inactive TB is placed under the skin in the form of purified protien derivative (PPD). If your body reacts to the antigen, it is presumed that you are latently infected. You then need a chest X-ray to rule out active disease that may be contagious. Now, here is the awful part. Those who have a positive PPD will have to take a drug called isoniazid (or INH) for 9 months. INH is a toxic drug and is hard on your liver. People often develop tingling and burning in their toes and fingers while on INH. But worst of all YOU CAN NOT DRINK ALCOHOL WHILE TAKING INH! I know, isnt it terrible! Thats like being pregnant!!

In order to be allowed to rotate at USC this fall, I have to have a recent PPD placed. Mine was just injected under my left arm, and I am now PRAYING that it will not react. Please send all your positive energy, prayers, health chakras, etc to my left arm. Not only do I not want to have any TB bugs hiding out in my body, I really dont want to take INH for 9 months.

I'll know in 48-72 hours if its positive or not. Stay tuned to find out the exciting sequel to "Cully's PPD placement." Hopefully, it will be as boring and uneventful as it sounds.