Updated 2007 TB Clincal Medical Instruction

[daktc 0]

Hello everyone,

I was wondering if you can help us out with something here requiring TB medical exam. My fiance is set for a consular interview on May 12, 2008. We completed the necessary DS forms, including completing the DS-156 form online last Friday, April 18. Regarding the question asking if he's ever had communicable disease, etc., we checked no since he's never been diagnosed with any communicable disease. In the middle of gathering paperworks for the St. Luke medical exam (that he's planning to take next week) he decided to do a complete routine check-up on April 22. His chest x-ray showed some scarring indicative of past TB. In fact, the doctor said this was likely an old TB that is not active or contageous. He has never been diagnosed with TB by a doctor, but he did remember going to the health center a long time ago for free medicine regarding prolonged cough and flu-like symptom. After chasing old medical records in one health center to another, he finally found his complete medical history of TB pulmonary from start to finish. The current health center doctor signed a certificate stating that my fiance was diagnosed last May 2000 of pulmonary TB and was cured of it in Nov. 2000 after taking prescribed medecine. However, my fiance was not diagnosed by a doctor (only a health center nurse) who failed to tell him that what he had was pulmonary TB.

My question is two-fold: What will happen to him during the St. Luke's interview? Pursuant to the new 2007 TB Clinical Instruction, will he be most likely placed in the category of TB Class B-1, in which the U.S. embassy needs to be alerted, and with a clearnce of 3 months? Secondly, we are very concerned with the answer we gave to the DS-156 question asking if my fiance has had a communicable disease (active TB being one of it), and what if the consul accuses us of misrepresentation (lying about this)? We honestly did not know he had TB in the past since the health center worker who diagnosed him was not a doctor (a nurse) and failed to tell him his complete illness. Also, he has had several medical exams after being cured from TB (rigorous merchant marine training, athletic qualification--he's a basketball player) and not one of them had alerted him to this fact.

Please help us if you have any advice!

Thank you!

[yankee 0]

I would suggest during the SLMC medical, don't check on the questions regarding the TB, if they found out something on the chest, they will ask your fiancee to go back again for another test to make sure if won't cause any problem to your petition. There will a session that your fiancee will be interviewed by a Medical Specialist so that's the time for him to explain that matter. He can go to St. Lukes for Medical now, they don't mind the date of Medical, the earlier the better.

It sounds goofy but somebody told me to drink Sterilized Milk ( Bear Brand) few days chest x-ray. maybe he can do the same thing. nothing will loose anyway..

[fitzee21 0]

It sounds goofy but somebody told me to drink Sterilized Milk ( Bear Brand) few days chest x-ray. maybe he can do the same thing. nothing will loose anyway..

The doctors told my fiancee not to drink any milk. She was doing the same, but they told her not to drink it. However, that was after they found a "suspicious abnormality" with her chest x-ray, so maybe they didn't want her to drink milk prior to the sputum test. I'm not sure.

[warwick8 0]

I think it's just all right to check no in your DS156 form because your fiance was not aware of his "illness" and was not diagnosed by a doctor at that time but by a health center nurse. Since he completed the 6 month treatment for pulmonary TB and his xray showed scarring, it is safe to assume that your fiance is indeed non-infectious. However, St. Luke's will still do their standard chest xray and there's a high probability that the "scarring" will show in his xray, so be prepared that your fiance might have to do the sputum test. But also keep in mind that "reading" an xray is subjective and it depends on the radiologist. What might be a "spot" to one might just be a "speck" to another.

Regarding milk, i haven't read any scientific basis on that. There's no harm in trying at least you'll be getting your daily dose of calcium

[daktc 0]

I think it's just all right to check no in your DS156 form because your fiance was not aware of his "illness" and was not diagnosed by a doctor at that time but by a health center nurse. Since he completed the 6 month treatment for pulmonary TB and his xray showed scarring, it is safe to assume that your fiance is indeed non-infectious. However, St. Luke's will still do their standard chest xray and there's a high probability that the "scarring" will show in his xray, so be prepared that your fiance might have to do the sputum test. But also keep in mind that "reading" an xray is subjective and it depends on the radiologist. What might be a "spot" to one might just be a "speck" to another.

Regarding milk, i haven't read any scientific basis on that. There's no harm in trying at least you'll be getting your daily dose of calcium

Maraming salamat for your advice, input, and encouragement! We hope everything will go smoothly as planned. As for mlik, you're right, it does a body good, and he drinks it daily (probably part of the reason he's so tall) He hasn't been told by the doctor not to stop drinking it or etc.

Wishing everyone else good luck!

[웃 910]

Hi everyone. I was just wondering what are the chances of having TB if something shows up on the xray?

My fiancee and I are waiting another 8 weeks for her results. Are there any obvious symptoms because she doesn't have a cough or flu symptoms or anything of that nature.

[warwick8 0]

Hi! If it shows in her xray she has TB, more likely than not she does have it. TB, especially in crowded countries (third world countries), are prevalent and most patients are asymptomatic. Sometimes, they will have night sweats, weight loss, anorexia, gets tired easily, shortness of breath and fever.

Daktc, good luck! keep us posted

[fitzee21 0]

Hi! If it shows in her xray she has TB, more likely than not she does have it. TB, especially in crowded countries (third world countries), are prevalent and most patients are asymptomatic. Sometimes, they will have night sweats, weight loss, anorexia, gets tired easily, shortness of breath and fever.

Daktc, good luck! keep us posted

Well, most likely, she has it, but most likely, it is not active. If they find it is not active, she will be cleared.

Hi everyone. I was just wondering what are the chances of having TB if something shows up on the xray?

My fiancee and I are waiting another 8 weeks for her results. Are there any obvious symptoms because she doesn't have a cough or flu symptoms or anything of that nature.

Roughly 220 of 100,000 people in the PI have it actively. So, you could estimate that her chances of having active TB are roughly 0.22%. I think she'll be just fine.

[웃 910]

Hi! If it shows in her xray she has TB, more likely than not she does have it. TB, especially in crowded countries (third world countries), are prevalent and most patients are asymptomatic. Sometimes, they will have night sweats, weight loss, anorexia, gets tired easily, shortness of breath and fever.

Daktc, good luck! keep us posted

She doesn't have these symptoms. Definitely not anorexia/weight loss! Definitely not fever or night sweats or shortness of breath. Maybe you could say she gets tired easily but most people do.

Roughly 220 of 100,000 people in the PI have it actively. So, you could estimate that her chances of having active TB are roughly 0.22%. I think she'll be just fine.

So if she has TB but it is inactive, then she is cleared to come to the US? But does she need to take medicine? What exactly does "inactive" TB mean?

[James and Rachel 0]

So if she has TB but it is inactive, then she is cleared to come to the US? But does she need to take medicine? What exactly does "inactive" TB mean?

She would still have to be treated with inactive TB before she is cleared to come to US.

In inactive (latent) TB, TB bacteria are alive but inactive in the body. The body builds walls around these bacteria, the way a scab forms over a cut. TB bacteria can stay alive inside these walls for years.

A person with inactive TB can develop active TB if they do not receive treatment (the lifetime risk is 1 in 10).

People with inactive TB:

* Have no symptoms

* Do not feel sick

* Cannot spread TB to others

* Have a positive (reactive) skin test

* Can develop active TB

In active TB (TB disease), TB bacteria become active and multiply. Active TB is very serious, causing permanent damage and even death. A person with active TB can spread TB to others.

People with active TB may:

* Have a bad cough longer than 3 weeks

* Have pain in the chest

* Cough up blood and sputum

* Feel weak or tired

* Lose appetite and weight

* Have chills, fever or sweat at night

[웃 910]

She would still have to be treated with inactive TB before she is cleared to come to US.

So in other words, after waiting the 10 weeks for the results, she will have to wait even more time to be treated, whether she has inactive or active TB? I thought that if she had inactive TB, she would get immediate clearance and be treated in the US??????

Edited April 29, 2008 by thegreatgate

[James and Rachel 0]

She would still have to be treated with inactive TB before she is cleared to come to US.

So in other words, after waiting the 10 weeks for the results, she will have to wait even more time to be treated, whether she has inactive or active TB? I thought that if she had inactive TB, she would get immediate clearance and be treated in the US??????

My wife showed a spot on her xray. They had her do a sputum test. Waited 6 weeks for results which came back positive for inactive TB. She started treatment the next day. so for us, 6 months of treatment (even if inactive). Now just 3 months left. She just had her second round of sputum culture that came back negative this time. but, still more waiting. Probably not a good idea to fly in an airplane with any kind of TB. (many people in a confined place is just too risky). This is just our experience.

James

[shakira08 0]

She would still have to be treated with inactive TB before she is cleared to come to US.

So in other words, after waiting the 10 weeks for the results, she will have to wait even more time to be treated, whether she has inactive or active TB? I thought that if she had inactive TB, she would get immediate clearance and be treated in the US??????

My wife showed a spot on her xray. They had her do a sputum test. Waited 6 weeks for results which came back positive for inactive TB. She started treatment the next day. so for us, 6 months of treatment (even if inactive). Now just 3 months left. She just had her second round of sputum culture that came back negative this time. but, still more waiting. Probably not a good idea to fly in an airplane with any kind of TB. (many people in a confined place is just too risky). This is just our experience.

James

Hello! i would like to add on this thread. I came from Philippines, and during my time i was classified by SLEC as "inactive class B-2" they checked on me in the pulmonary section at SLEC, but still they approved my medical becoz i have no symptoms, but still informing me to have another check-up upon arrival in USA. And to add also, in my visa, they noted there that i am class b-2. So after few weeks in US, we received right away mail from CDC (control disease center) that i need to coordinate with our local health clinic in our area in our state of which i do so (If u wont do it, they will report you to the authority, and it will affect your status here in US). They will give you random check-up like PPD Test, X-ray, and sputum test...if u came out all negative still with all the result NO TREATMENT, but if ur PPD Test came out POSITIVE they wil treat you only INH Meds for 6mos...but if ur sputum test came out positive for TB, you will be treated for 9mos. and they will isolate you for 2-weeks, and u can't easily travel without the knowledge of the health clinic becoz its not allowed and u are taking the meds everyday.

But better to stay healthy rather than taking a risk and suffer for the disease. Now i am done with all the treatment,but i wont deny that its like they are torturing you with all the meds they give you everyday so u will be cleared from the disease. God bless....

Edited April 29, 2008 by shakira08

[stuck_in_manila 0]

hi!

just wondering how the medical exam of your fiance went? hope it was okay:)

[daktc 0]

hi!

just wondering how the medical exam of your fiance went? hope it was okay:)

Hi, Ed and Sue. Thank you so much for your concern. Yes, my fiance had his exam at St. Luke's last Wed, April 30. Everything went along smoothly and he passed all exams, or so it seemed, since they never told him otherwise. They told him to come back Friday, May 2, since May 1 was a national holiday. He was surprised since only then was he told that they need to do 3 sputum exams since they found scars on his x-ray. Shouldn't this be something that they tell him on the first day of exam? Anyway, they told him to come back this Wed., Thurs, and Friday for the sputum exam. They also told him that even if these are negative, he will have to do a culture exam that takes another 8 weeks for the result to come out. This is really quite frustrating for us since it used to be that "scars" on x-rays were considered Class B-2 and got medical clearance until about August 2007 when the U.S. Center for Disease Control (CDC) came up with stricter TB guidelines.

Shakira, if I may ask, when did you arrive in the US? Reason I'm asking is because I want to see how strict immigration really is even for those with inactive TBs after the new CDC regulations went into effect.

As for us, I will speak to the attending physician after my fiance's first sputum exam on Wed. I have gathered the questions below, and I hope that these might be of some help for thos undergoing the same troubling process. I'm quite concerned and hope that St. Luke's will not abuse its discretion and medical expertise and offer "extra treatments" that go above and beyond the limitations of the new CDC guidelines.

When talking to St. Luke's physician ask:

a. What's the next step? After three negative sputum exam, why wait for culture when Class B-2 used to get medical clearance? What to expect after culture? How long until results are in? Why does it take this long for results to come in?

b. Since this is not active TB, new CDC guideline states for treatment either in the home country or after arriving in the U.S. What are the chances of my fiance getting treatment after arriving in the US? What are the benefits of getting treated at home? What would the hassle be in getting treatment in the US? Will there be a lot of hassle at the port of entry (POE)?

c. How will they let USEM know about the change of interview? Since my fiance will not show up for his interview on May 12, will we have to call in the toll-free number and let them know that St. Luke's will be rescheduling interview?

d. The K-1 approval will expire on June 28, 2008. How can we be assured that USEM will auto-extend this K-1 petition so we won't get any hassle at the POE?

e. What are the costs for treatment and how long will it take?

f. My fiance lives in Cebu, so it will take time to secure plane ticket for next medical appointment at St. Luke's. When will you let him know about the next scheduled appointment, and how much time from that notice will he have for the actual appointment?

Same goes for the interview date itself. I am now planning to come home to make sure everything goes smoothly. Upon medical clearance, will you please give us a reasonable amount of time for me to purchase my tickets?

g. How will this medical finding impact our interview and his chance of immigrating to the U.S. at a reasonable time?

h. Is there anything else we can do on our end to make sure this process will move along smoothly?

Other than this, I am comforted by a very nice prayer one VJ'er posted not too long ago:

DON'T RUN AHEAD OF GOD

LET HIM DIRECT YOUR STEPS

HE HAS PLANS AND HE HAS TIME

GOD'S CLOCK IS NEVER TOO EARLY

AND HE IS NEVER TOO LATE

IT ALWAYS STRIKES ON TIME.

I hope you all are well, and please let us know if you've successfully gone through this experience!

Thank you, and God bless!