Doc's outlook optimistic

She's confident medical team will come up with cure

Bill Scanlon, Rocky Mountain News

Published June 1, 2007 at midnight

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Andrew Harley Speaker is in good spirits and healthy, but concerned about the trouble he caused on two continents, said the Denver doctor who cared for him Thursday.

Speaker, confined to a small room at National Jewish Research and Medical Center, has extensively drug-resistant tuberculosis, but is "smear negative," meaning he isn't coughing out any TB germs, said Dr. Gwen Huitt, director of the day unit for adult infectious diseases.

"He is doing extremely well," said Huitt, who expects to start the patient on a new round of medications today. "He has a sense of relief that he is finally at the facility he wanted to get to, and on the road to better health."

Speaker reached National Jewish in east Denver early Thursday by motorcade after arriving from Georgia on a private plane, hospital President Michael Salem said.

The man has no symptoms of the disease. It was discovered after an X-ray for a rib injury revealed a suspicious mass on one lung, Huitt said.

Speaker may have had what is known as XDR TB for years in a latent form, but for some reason it became active enough recently that it showed up in blood work, Huitt said.

She reiterated what other experts around the country have said: It's unlikely, but not impossible, that he infected fellow passengers during long flights from Atlanta to Europe and back again.

Tests show that Speaker's wife, who has been around him more than anyone else, hasn't been infected.

The chances of Speaker infecting anyone in Denver are practically nil - both because he's not currently infectious and because he has been extremely cooperative, Huitt said.

"He absolutely expressed concern about putting others at risk," said Huitt, who described Speaker as a "nice guy." "He's emotional about what went on."

Huitt said she is "very optimistic" that the National Jewish team will find drugs to treat Speaker's particular strain of TB.

"He's very healthy," she said. "He is used to jogging every day."

A backup plan would be an operation by University of Colorado surgeons to remove the infectious part of the lung.

The man's day-to-day life during the weeks or months he spends at National Jewish "will be pretty boring," Huitt said.

He won't be allowed out of his room until doctors perform tests to confirm he remains "smear negative," and then only with a mask, like other TB patients.

Speaker's wife will be able to visit him, but won't spend the night in his room.

Once he starts his medications, he will be watched carefully. Some of the drugs are extremely difficult to take, with side effects such as nausea, rash, lack of balance and toxicity to the liver or kidneys.

Speaker's care could cost between $250,000 to $350,000.

The air ambulance flight and other costs of transporting him from Atlanta to Denver totaled another $12,000, said a spokeswoman for Kaiser Permanente, Speaker's health insurer, which paid the bill.

What's planned in TB treatment

TB patient Andrew Harley Speaker spent his first day at Denver's National Jewish Medical and Research Center undergoing medical tests and reviewing his health history with doctors. His care included:

• A basic physical exam.

• A review of his health history and social contacts to help doctors try to pinpoint how he was infected.

• An interview to determine where he's traveled.

• Blood tests, in part to determine if his liver and kidneys can withstand powerful, potentially toxic antibiotic treatment.

• Giving a sample of lung mucus that doctors will test to determine the strain of TB he has and how drug-resistant it is.

• Undergoing lung X-rays and a computerized tomography - or CAT scan.

What's next:

Speaker will start treatment with about five powerful antibiotics. The drugs will be pretested to determine their effectiveness at fighting his drug-resistant strain of TB.

If the antibiotics aren't completely successful, he likely will undergo surgery to remove part of his lung, which will help the antibiotics fight the remaining TB germs.

He is expected to stay at National Jewish for from a few weeks to a few months.Source: National Jewish Medical And Research Center

scanlon@RockyMountainNews.com or 303-442-8729

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