Medical dilemma - please help!

[luckymom 0]

Hello,

Luckymom's husband here. Luckymom, my Filipino US temporary resident alien wife, is currently in the Philippines to be with her 13 and 18 year old sons, both of whom I have petitioned to join my wife and I here in the USA.

She left for the Philippines on March 8 and accompanied her 2 boys to their medical examination at St. Luke's Medical Center in Manila a week ago. Both boys are scheduled for their interviews next Monday, March 23rd, but we have run into a snag. The 18 year old was never skin tested for TB, but instead was given a chest x-ray (which he passed). The 13 year old, on the other hand, was given a TB skin test (which he failed), and then was sent for a chest x-ray. The x-ray came back as abnormal, though they don't know if it is TB or not - nothing conclusive. As a result, he has been ordered to have BOTH a sputum SMEAR test and a sputum CULTURE test. The smear test only take a few days, but the culture test requires him to remain in the Philippines for an additional 2 months, which means his interview must also be rescheduled. They also said that if the culture is positive, then he would be required to remain in the Philippines for 6 months while he is being treated.

I have done some research on the net on these tests as well as talking to a doctor at our government sponsored TB clinic here in the US, and from everything I have discovered, the procedures being followed at St. Luke's are incorrect and do not follow typical protocol. From what I have learned, they SHOULD be ordering ONLY a smear test at this point. If he is smear negative, then he should be allowed to travel, as he is not contagious and is not a health threat. If he is smear positive, then he should begin medication to attack all 4 of the possible bacterial variations and have a culture test administered at that point in order to isolate the bacteria and adjust the medication to best combat it. They also said that after about 6 to 8 weeks of treatment, he should become smear negative, and as they already said, he should be allowed to travel to the US.

My questions:

1. Is St. Luke's policy typical of the new medical protocol as of July 2008?

2. Is the official NVC policy on this available for me to read somewhere?

3. Is there a phone number I can call where I can talk to to someone with the authority to do something about this?

4. Do you have any other ideas on anything else I can do here in the US to stop this injustice?

I feel so incredibly helpless right now. My wife and 2 stepsons are in the Philippines and I can't seem to do anything about the situation. If the boy tests smear positive, then obviously they are making the right decision in keeping him there, as that means he is contagious and a health risk. But the TB professionals have assured me here in the US that there is no reason for him not to travel if he is smear negative, and under normal conditions it should only take 6 to 8 weeks for him to become smear negative (if he is now smear positive), not 6 months. What are these people doing????

Thanks,

Bob

P.S. - Moderators, if this is in the wrong forum, please move the thread to the correct forum.

[luckymom 0]

Anyone? Have I posted this in the wrong place?

[MaxOnline 0]

I don't think they'll be allowed in till they're totally cured... whether they're Smear Negative or Smear Positive, the embassy won't grant them visa unless they're clean

Edited March 18, 2009 by MaxOnline

[liraC 2]

Hello,

Luckymom's husband here. Luckymom, my Filipino US temporary resident alien wife, is currently in the Philippines to be with her 13 and 18 year old sons, both of whom I have petitioned to join my wife and I here in the USA.

She left for the Philippines on March 8 and accompanied her 2 boys to their medical examination at St. Luke's Medical Center in Manila a week ago. Both boys are scheduled for their interviews next Monday, March 23rd, but we have run into a snag. The 18 year old was never skin tested for TB, but instead was given a chest x-ray (which he passed). The 13 year old, on the other hand, was given a TB skin test (which he failed), and then was sent for a chest x-ray. The x-ray came back as abnormal, though they don't know if it is TB or not - nothing conclusive. As a result, he has been ordered to have BOTH a sputum SMEAR test and a sputum CULTURE test. The smear test only take a few days, but the culture test requires him to remain in the Philippines for an additional 2 months, which means his interview must also be rescheduled. They also said that if the culture is positive, then he would be required to remain in the Philippines for 6 months while he is being treated.

I have done some research on the net on these tests as well as talking to a doctor at our government sponsored TB clinic here in the US, and from everything I have discovered, the procedures being followed at St. Luke's are incorrect and do not follow typical protocol. From what I have learned, they SHOULD be ordering ONLY a smear test at this point. If he is smear negative, then he should be allowed to travel, as he is not contagious and is not a health threat. If he is smear positive, then he should begin medication to attack all 4 of the possible bacterial variations and have a culture test administered at that point in order to isolate the bacteria and adjust the medication to best combat it. They also said that after about 6 to 8 weeks of treatment, he should become smear negative, and as they already said, he should be allowed to travel to the US.

My questions:

1. Is St. Luke's policy typical of the new medical protocol as of July 2008?

2. Is the official NVC policy on this available for me to read somewhere?

3. Is there a phone number I can call where I can talk to to someone with the authority to do something about this?

4. Do you have any other ideas on anything else I can do here in the US to stop this injustice?

I feel so incredibly helpless right now. My wife and 2 stepsons are in the Philippines and I can't seem to do anything about the situation. If the boy tests smear positive, then obviously they are making the right decision in keeping him there, as that means he is contagious and a health risk. But the TB professionals have assured me here in the US that there is no reason for him not to travel if he is smear negative, and under normal conditions it should only take 6 to 8 weeks for him to become smear negative (if he is now smear positive), not 6 months. What are these people doing????

Thanks,

Bob

P.S. - Moderators, if this is in the wrong forum, please move the thread to the correct forum.

Am so sorry to hear that your step son will undergo sputum test,am on the same boat and waiting is really sucks..My smear test turn out negative but am here,still waiting for the culture result as of january 29,2009...

[luckymom 0]

I don't think they'll be allowed in till they're totally cured... whether they're Smear Negative or Smear Positive, the embassy won't grant them visa unless they're clean

Yes, I think you are correct, but this is just plain WRONG to stop them from traveling if they are smear negative. My brother-in-law went to the Philippines last May to pick up his 2 children and they tested positive as well. They were allowed to travel and simply ordered to be treated for TB once they arrived in the US. It seems as if the NVC policy has changed...but for the worse. The way they had it before was the right way to handle things.

Am so sorry to hear that your step son will undergo sputum test,am on the same boat and waiting is really sucks..My smear test turn out negative but am here,still waiting for the culture result as of january 29,2009...

Thanks for your thoughts, and I am so sorry to hear that you are going through the same thing. It is so frustrating! I suppose that it will actually be a lot longer than 2 months, as the interview will need to be rescheduled, and then a new flight booked...all for no reason (if the smear is negative, that is).

According to what I have read since my original post here, the proper protocol is to start administering 4 different medications right away while waiting for the culture test. The assumption is that the culture will not only come out positive, but will identify the particular bacteria that is present in the body. After about 2 weeks of medication, the patient is usually no longer contagious (assuming a positive smear test), and SHOULD be cleared for travel. It seems that St. Luke's, or the NVC, whoever is responsible for this terrible policy, is going too far with their precautionary measures.

BTW, did they start you on the 4 medications yet?

[liraC 2]

I don't think they'll be allowed in till they're totally cured... whether they're Smear Negative or Smear Positive, the embassy won't grant them visa unless they're clean

Yes, I think you are correct, but this is just plain WRONG to stop them from traveling if they are smear negative. My brother-in-law went to the Philippines last May to pick up his 2 children and they tested positive as well. They were allowed to travel and simply ordered to be treated for TB once they arrived in the US. It seems as if the NVC policy has changed...but for the worse. The way they had it before was the right way to handle things.

Am so sorry to hear that your step son will undergo sputum test,am on the same boat and waiting is really sucks..My smear test turn out negative but am here,still waiting for the culture result as of january 29,2009...

Thanks for your thoughts, and I am so sorry to hear that you are going through the same thing. It is so frustrating! I suppose that it will actually be a lot longer than 2 months, as the interview will need to be rescheduled, and then a new flight booked...all for no reason (if the smear is negative, that is).

According to what I have read since my original post here, the proper protocol is to start administering 4 different medications right away while waiting for the culture test. The assumption is that the culture will not only come out positive, but will identify the particular bacteria that is present in the body. After about 2 weeks of medication, the patient is usually no longer contagious (assuming a positive smear test), and SHOULD be cleared for travel. It seems that St. Luke's, or the NVC, whoever is responsible for this terrible policy, is going too far with their precautionary measures.

BTW, did they start you on the 4 medications yet?

Assuming for the negative result of my sputum culture..If the smear test is positive will start for the medication and if turn out negative have to wait 2 mos for the result of sputum culture,and if the result tuns out postive then start for the medication..There are some member here in VJ who undergone sputum test and smear test turns out negative but the culture test turn out positive,..

[vsmtghdy 2]

First of all, I'm sorry to hear about the case of one of your step son.

Panel Physicians conducting medical/physical examination and Civil Surgeons (in the US) follows the Technical instructions for Tuberculosis. Under this Instructions are the following:

1. A TST (Tuberculin skin test) must be performed on all applicants 2 years of age or older, regardless of pregnancy or previous immunization with BCG vaccine. There are two exceptions:

• Applicants who have written documentation of a previous TST reaction of 5 mm or greater of induration (with the signature of a health-care provider) need not be retested. In such a case, the applicant will need a chest radiograph to evaluate for TB disease. A verbal history of a positive TST reaction from the applicant is not acceptable.

• Applicants who report a severe reaction with blistering secondary to previous tuberculin skin testing need not be retested. In such a case, the applicant will need a chest radiograph to evaluate for TB disease.

2. Applicants for Whom a Chest Radiograph Is Required=> A chest radiograph is required for all applicants who:

• Have a TST reaction of 5 mm or greater of induration.

• Are immunosuppressed, regardless of the TST result, including those who are: (a) HIV infected (B) Receiving the equivalent of 15 mg/day or more of prednisone for at least one month © Have a history of organ transplantation.

• Have signs or symptoms of active TB disease, regardless of the TST result.

3. An applicant with an abnormal chest radiograph(s) suggestive of active TB must provide three sputum specimens on separate days within a 7-day time frame. The collection of the three sputa must be supervised. All three sputum specimens must be examined for the presence of acid-fast bacilli (AFB) AND cultured for M. tuberculosis.

They don't usually start patients on multi-drug anti-TB regimen (quadruple or triple regimens) because they have to make sure which medicine the patient is still susceptible, this is to prevent the incidence of multi-drug resistant type of TB (MDR-TB). One reason why there's rising incidence of MDR-TB is because doctors give medicines even if the patient don't need that medicine (yet) and when that patient will have an active TB, the medicines will not be useful since patient is already resistant to that medicine. And there are those patients that take the medicine and when they feel fine, they will stop the meds and this will make this organisms resistant to this medicines. There are those that are smear negative (sputum AFB negative) and will turn out positive with the culture and these are those that may have to be treated. There are those that are smear negative and culture negative.

Panel Physicians and Civil Surgeons will have to Classify Applicants with Evidence of TB, since there are those that will be cleared but will need further evaluation upon arrival in the US. Applicants should be medically cleared before USEM can grant them their visa.

[luckymom 0]

The protocol you just outlined is not the same as what I have read or what I was told by the TB Clinic here in Rhode Island, but it sounds EXACTLY like the protocol that is being followed at St. Luke's. Where did you get this information, or are you a doctor?

3. An applicant with an abnormal chest radiograph(s) suggestive of active TB must provide three sputum specimens on separate days within a 7-day time frame. The collection of the three sputa must be supervised. All three sputum specimens must be examined for the presence of acid-fast bacilli (AFB) AND cultured for M. tuberculosis.

This is where my stepson is right now. They took a sputum sample yesterday, today, and he has to go back for another tomorrow. I guess there is zero chance of them allowing him to travel in any less than 2 months, right?

And if he is smear negative but culture positive, then that means he will need 6 months of treatment before they clear him medically, and the 6 months will start AFTER the 2 months of waiting for the culture test. Do I have this right?

Basically, what is the WORST case scenario?

[luckymom 0]

Basically, what is the WORST case scenario?

Ok, I'll answer my own question, as it seems to have happened. The 13 year old had 3 sputum smears - the first 2 were negative, but the third was positive, so St. Luke's will not allow him to travel and wants him to start 6 months of medication immediately. That's not the bad part. The bad part is that they DEMAND that he visit the hospital ONCE A DAY FOR 6 MONTHS to receive his medication even though it is taken orally. Since the apartment where the boys live is in Cabanatuan City, some 4 hours drive EACH way, this is an impossible demand. There is no leniency here....either follow their protocol or have the visa denied. And just to make things a little worse, they want to test the 18 year old all over again even though he came out negative in ALL of the tests.

For those who might be facing a similar situation, here is a link to the new Technical Instructions for Tuberculosis:

http://www.cdc.gov/ncidod/dq/pdf/ti_tb_8_9_2007.pdf

Now I really don't know what we are going to do...

[William33 110]

Moved to the PI forum, at the request of the OP.

[luckymom 0]

Just a word of advice for people in the Philippines... Since TB seems to be very common there, I recommend that you get checked for it as early in the immigration process as possible in order to reduce or eliminate delays later in the process. This way, if you have TB, you can get it cured while your papers are being processed. St. Luke's is VERY thorough in their examinations and the use of any "tricks" to try to fool them will only result in longer delays, as any lab or x-ray result that is inconclusive will mean that further testing (and time) is necessary. The only reason I bring this up is because I have read of people passing around "homebrew methods" as to ways in which to fool the testing procedure, and those methods simply will not work.

As far as our case is concerned, it has been nothing but horrible ever since my wife has returned to the Philippines - First the failing of the medical exam by the 13 year old (and now he has to be treated on a daily basis AT ST. LUKE'S FACILITY - no home treatment allowed), and then the interview of the older boy at the US Embassy was a nightmare. The interviewer tried accusing my wife and I of having a fraudulent marriage and did not want to allow me to continue with the petitions of my stepsons. I am ashamed to say how disappointed I am in a person like this representing the USA, as he was totally wrong and out of line with his accusations. After conferring with others for about 20 minutes, he came back and said that he had "misjudged" the situation, but he never admitted his mistake nor did he apologize for his rude, insulting behavior.

Right now I just want to get my wife and older stepson back here to USA as soon as possible to get some rest and regroup. Then once we are sure that the younger boy is fully cured of TB and is declared fit to travel, I will send my wife back to pick him up. I only wish that it were possible for me to go there, as I would really like to meet that interviewer face to face, but unfortunately I run my own small business here and it is impossible for me to leave for more than a few days at a time.

[Dakine 26]

Just a word of advice for people in the Philippines... Since TB seems to be very common there, I recommend that you get checked for it as early in the immigration process as possible in order to reduce or eliminate delays later in the process. This way, if you have TB, you can get it cured while your papers are being processed. St. Luke's is VERY thorough in their examinations and the use of any "tricks" to try to fool them will only result in longer delays, as any lab or x-ray result that is inconclusive will mean that further testing (and time) is necessary. The only reason I bring this up is because I have read of people passing around "homebrew methods" as to ways in which to fool the testing procedure, and those methods simply will not work.

As far as our case is concerned, it has been nothing but horrible ever since my wife has returned to the Philippines - First the failing of the medical exam by the 13 year old (and now he has to be treated on a daily basis AT ST. LUKE'S FACILITY - no home treatment allowed), and then the interview of the older boy at the US Embassy was a nightmare. The interviewer tried accusing my wife and I of having a fraudulent marriage and did not want to allow me to continue with the petitions of my stepsons. I am ashamed to say how disappointed I am in a person like this representing the USA, as he was totally wrong and out of line with his accusations. After conferring with others for about 20 minutes, he came back and said that he had "misjudged" the situation, but he never admitted his mistake nor did he apologize for his rude, insulting behavior.

Right now I just want to get my wife and older stepson back here to USA as soon as possible to get some rest and regroup. Then once we are sure that the younger boy is fully cured of TB and is declared fit to travel, I will send my wife back to pick him up. I only wish that it were possible for me to go there, as I would really like to meet that interviewer face to face, but unfortunately I run my own small business here and it is impossible for me to leave for more than a few days at a time.

" I only wish that it were possible for me to go there, as I would really like to meet that interviewer face to face,"

Sorry vent all you want but COs are GOD. In the long run everthing will work out for the positive. Just give thanks "somewhere" that TB is curable.

PS ! ihad my wife and anak tested for TB 6 months before their approximate SLEC medical. Anak had PC but was cured way before their medical. I've posted NUMEROUS times for peeps to have a premedical. I guess most ignore it say it won't happen to them!

Edited March 25, 2009 by Haole

[ryandgracey 2]

Well, sputum culture for TB remains to be the gold standard in diagnosing TB, and not a sputum smear.

My 6-year old had a 14mm TST and was Xrayed but the results were not disclosed to me. We had our interview as scheduled but i noted a notation on her visa "TB Class A or B". I was bothered and brought this to the attention of the child's pediatrician. She was started on anti-Koch's meds for Primary Complex on the basis of the extremely positive TST which means that she had been exposed to it. She has gained weight and appetite since then which tells me that maybe she did have Primary complex. Anyway, she is now in the middle of her 3rd month of meds. Her pedia will be issuing a certification that she has been on meds since December.

[luckymom 0]

Sorry vent all you want but COs are GOD.

Just to be clear, I am not upset with the CO (what does that stand for anyway?) because of anything to do with my youngest stepson's medical problems, but rather because of the rude, unnecessary way in which he questioned my wife about our marriage and relationship. First of all, she already has her green card, meaning that we have passed all of the tests and requirements to satisfy USCIS to prove that our marriage is legitimate (because it is!). Secondly, she had our original marriage certificate with her, as well as all of the supporting documents and pictures that we brought to OUR interview when she was granted temporary resident alien status. Who is he to question what the US has ALREADY deemed to be legal and factual?

In the long run everthing will work out for the positive. Just give thanks "somewhere" that TB is curable.

PS ! ihad my wife and anak tested for TB 6 months before their approximate SLEC medical. Anak had PC but was cured way before their medical. I've posted NUMEROUS times for peeps to have a premedical. I guess most ignore it say it won't happen to them!

I was upset at first with St. Luke's policies when I first learned that my youngest boy has TB, but once I learned more about the policies and why they exist, I am no longer upset with them, as they are actually doing the right thing in order to keep TB from spreading as much as possible. Now we are all upset because of the disappointment of having to leave the younger boy in the Philippines while the rest of us are together in the US. My wife has handled this situation as well as I could possibly imagine and I am very proud of her. She has located a high security condominium to rent near St. Luke's and her 28 year old nephew is very happy to move in with him and take care of the boy until he is ready to come to the US. Based on the problems we have encountered with the US Embassy, we just want to get the older boy here (and my wife, or course) before there are any more problems. Then when the younger boy is released medically, I will send my wife back to get him. This is all costing me a fortune, but I will do whatever is necessary to bring my family together.

[happywifeymom 4]

Sorry vent all you want but COs are GOD.

Just to be clear, I am not upset with the CO (what does that stand for anyway?) because of anything to do with my youngest stepson's medical problems, but rather because of the rude, unnecessary way in which he questioned my wife about our marriage and relationship. First of all, she already has her green card, meaning that we have passed all of the tests and requirements to satisfy USCIS to prove that our marriage is legitimate (because it is!). Secondly, she had our original marriage certificate with her, as well as all of the supporting documents and pictures that we brought to OUR interview when she was granted temporary resident alien status. Who is he to question what the US has ALREADY deemed to be legal and factual?

In the long run everthing will work out for the positive. Just give thanks "somewhere" that TB is curable.

PS ! ihad my wife and anak tested for TB 6 months before their approximate SLEC medical. Anak had PC but was cured way before their medical. I've posted NUMEROUS times for peeps to have a premedical. I guess most ignore it say it won't happen to them!

I was upset at first with St. Luke's policies when I first learned that my youngest boy has TB, but once I learned more about the policies and why they exist, I am no longer upset with them, as they are actually doing the right thing in order to keep TB from spreading as much as possible. Now we are all upset because of the disappointment of having to leave the younger boy in the Philippines while the rest of us are together in the US. My wife has handled this situation as well as I could possibly imagine and I am very proud of her. She has located a high security condominium to rent near St. Luke's and her 28 year old nephew is very happy to move in with him and take care of the boy until he is ready to come to the US. Based on the problems we have encountered with the US Embassy, we just want to get the older boy here (and my wife, or course) before there are any more problems. Then when the younger boy is released medically, I will send my wife back to get him. This is all costing me a fortune, but I will do whatever is necessary to bring my family together.

So sorry for what happened. Your wife has helped me in her own way when i asked her questions about the petition of her two kids as i am exactly in the same boat. We just submitted our I 130 for my 2 kids. I am hoping they will have no problem with the medical .And i think i will have them examined first so i will know if there is something needs to be fixed before they will have their schedule.

Have a safe trip for ur wife and her son.