& “damage control” namely, what to do now.

Also, a theory on what occurred.

Concerns:

1. Caregiver has latent TB, and should receive treatment.
2. Caregiver may have active TB (was positive on a Quantiferon TB test in January 2025, but negative on a MTB-RIF test in January 2025). Caregiver was sent to IOM after a medical review for a US immigrant visa. A lesion on the upper left lobe of lung was detected on an x-ray, anemia on blood tests, and BNH doctor may have concluded other things from the clinical exam.
3. Raymond was very healthy in February of 2023, swimming 1 hr a day, walking on beach , dressing and showering himself. After pneumonia in March + April 2023, Raymond was too weak to walk, swim, or dress himself. The extremely rapid decline may have been due to TB-weakened system (lungs +) in addition to the pneumonia. Or perhaps the pneumonia was not pneumonia but TB?
4. State of fibrosis of Raymond. Note CT’s from 2021, 2023, 2024, 2025 (rwhcrc.com which has DICOMs for download) tiny.cc/rwhcrc
5. Raymond and Andy had Quantiferon TB tests in January 2025 and they were negawtive, but perhaps they picked up another form of TB from caregiver?

Timeline:

January 2021 - Caregiver (filipina, from rural Mindanao, The Philippines) begins to lose weight from 55kg to 40kg over 6 months and has not been able to gain wait since.

February 2021 - Caregiver complains of lower pelvic pain.

July 2022 - Caregiver details what may have been chest pain due to pleural effusion.

July 2022 - Caregiver gets a chest x-ray at Bangkok Hospital Samui where Reticulonodular opacities granulomatous disease was suggested. [link]

July 2022 - Raymond gets Covid, has mild & few symptoms and does the 7 day Paxlovid series in the first 3 days and recovers fine.

March 2023 - Raymond is diagnosed with pneumonia (accurate?) was given Tazocin for 7 days, sent home, get a rebound of pneumonia and is medevac’d to Bumrungrad. Spends 30 days at Bumrungrad (9 days IV antibiotic; 21 days rehab, and abdomen + cardiac studies)

June 2023 - Caregiver continues to occasionally get sharp chest pains (possibly due to pleural effusion like the ones detailed in July of 2022.

September 2023 - September 2024 - Raymond has a very slow recovery, and has about 1/2 the strength he had prior to March 2023.

September 2023-September 2024 - Raymond spends 90 minutes a day with light exercise which includes 40 minutes pool walking, 30 minutes recumbent bicycling, 20 minutes a day light stretching + strengthening (weights + tension straps).