Immunosuppression: Dangerous??

[Bergamasque]

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Hello,

I recently applied to some labs in my school and was rejected from one on-the-spot because I briefly mentioned that I am on Immunosuppressants following a question about my interests (it escalated rather quickly), and was essentially told to reconsider being "pre-med" . I currently volunteer in an emergency room, and all of the labs I was interested in work with pathogens. The problem is that I really really love Immunology, if I could read it for hours, I would (and would totally love to be in an Immunology lab). I also really want to get accepted into Medical School. My health issues don't pose too much of a challenge on my academics, but when I'm sick, I am out for a week or two. At the same time, during my shifts in the ER I can't help but get this foreboding feeling throughout all my shifts, as if I'm coming down with something myself. I don't think I've gotten sick from being in the ER as of yet though, but my condition makes me very susceptible to some really nasty stuff. I would just really like to know if immunosuppressed doctors exist, and if so should I be honest about my condition when applying to these labs or positions? As of now, the hospital I volunteer for isn't aware but I can expect that if they were I'd be out for my own safety and the safety of the patients.

edit: ethical dilemma with wanting to work in healthcare but posing an issue by increasing chance of disease transmission to other patients. If I disclose this information to the coordinator, (or admissions), I can fully expect my volunteer gig to be terminated, if I don't im being dishonest and potentially harming everyone in the ER, including myself. Likewise, PI's studying pathogens need to work very hard to get their license to handle these pathogens. Allowing an immunosuppressed undergrad might pose a violation, if I keep my condition a secret it may be considered selfish, if not, detrimental to myself.

best.

 

[getdown]

Hello,

I recently applied to some labs in my school and was rejected from one on-the-spot because I briefly mentioned that I am on Immunosuppressants following a question about my interests (it escalated rather quickly), and was essentially told to reconsider being "pre-med" . I currently volunteer in an emergency room, and all of the labs I was interested in work with pathogens. The problem is that I really really love Immunology, if I could read it for hours, I would (and would totally love to be in an Immunology lab). I also really want to get accepted into Medical School. My health issues don't pose too much of a challenge on my academics, but when I'm sick, I am out for a week or two. At the same time, during my shifts in the ER I can't help but get this foreboding feeling throughout all my shifts, as if I'm coming down with something myself. I don't think I've gotten sick from being in the ER as of yet though, but my condition makes me very susceptible to some really nasty stuff. I would just really like to know if immunosuppressed doctors exist, and if so should I be honest about my condition when applying to these labs or positions? As of now, the hospital I volunteer for isn't aware but I can expect that if they were I'd be out for my own safety and the safety of the patients.

edit: ethical dilemma with wanting to work in healthcare but posing an issue by increasing chance of disease transmission to other patients. If I disclose this information to the coordinator, (or admissions), I can fully expect my volunteer gig to be terminated, if I don't im being dishonest and potentially harming everyone in the ER, including myself. Likewise, PI's studying pathogens need to work very hard to get their license to handle these pathogens. Allowing an immunosuppressed undergrad might pose a violation, if I keep my condition a secret it may be considered selfish, if not, detrimental to myself.

best.

Well, the danger isn't that you're affecting anyone else, it's that YOU could die. You said it yourself, you're immunocompromised and thus susceptible to some nasty bacteria. This why the labs studying the DEADLY pathogens (because that's what's killing people) would outright reject you so YOU don't end up contracting the pathogen, getting sick and then spreading it to the world. So, here's the deal:
1. being immunosuppressed doesn't disqualify you from medical school and being a physician. You likely shouldn't be in a field that deals with contagious diseases like ID but other fields should still be open to you. Maybe consider heme-onc or rheumatology. Those fields deal with the immune system and don't necessarily have highly contagious patients. You should always disclose your condition at least to the admin so they can make certain arrangements because it's for YOUR OWN SAFETY. No one wants the med student to just drop dead one day.
2. I understand immunology is your interest but working pathogens is NOT the way to go in your case. I'm sure there are other immunology labs working on non-pathogen related studies.
3. There are other volunteer gigs available that won't be dangerous to you. It doesn't have to always be in the ED. You can volunteer in nursing homes, homeless shelters, etc

Best of luck man.

 

[curbsideconsult]

This is a toughie, but I think pretty much every aspect of medicine is going to be dangerous for you. Even heme-onc and rheum. Patients come to see you because they're sick and most aren't going to cancel a rheum appt, or any other doc appt, because they have a cold or the flu. In fact, they'd be more inclined to keep that appt. How are you going to do your rotations in med school if you're going to be out for a week or two at a time? I'm pretty sure all rotations are 4wks or less. I understand this is probably an ADA vs. school/employment kind of thing, but can you do everything that's required of a med student/doctor even with reasonable accommodations? Not sure what you do now in the ED, but unless you're currently a nurse, you'll be way more hands on and susceptible to just about everything as a med student. If you want to go a little extreme, you might want to check with an education or employment lawyer about your situation.

 

[siliso]

There’s a wide variety in types and levels of immunosuppression. Probably the most profound being just after allogeneic bone marrow transplant. Physicians I’ve known/known of who had BMT and survived it have returned to practice after 1-2 years nonclinical work to avoid exposures.

Comparatively if you’re on azathioprine or a TNFa inhibitor or similar for some autoimmune condition, there are plenty of practicing physicians in any field who are making it just fine without huge concerns.

Solid organ transplant somewhere in the middle depending on what and how long ago. Can you be in public/crowded places safely without needing to mask up?

Labs working with supervirulent pathogens had better not be depending on anyone’s immune system to prevent the diseases!

 

[Dr.Barker&Mr.Scootches]

Hello,

I recently applied to some labs in my school and was rejected from one on-the-spot because I briefly mentioned that I am on Immunosuppressants following a question about my interests (it escalated rather quickly), and was essentially told to reconsider being "pre-med" . I currently volunteer in an emergency room, and all of the labs I was interested in work with pathogens. The problem is that I really really love Immunology, if I could read it for hours, I would (and would totally love to be in an Immunology lab). I also really want to get accepted into Medical School. My health issues don't pose too much of a challenge on my academics, but when I'm sick, I am out for a week or two. At the same time, during my shifts in the ER I can't help but get this foreboding feeling throughout all my shifts, as if I'm coming down with something myself. I don't think I've gotten sick from being in the ER as of yet though, but my condition makes me very susceptible to some really nasty stuff. I would just really like to know if immunosuppressed doctors exist, and if so should I be honest about my condition when applying to these labs or positions? As of now, the hospital I volunteer for isn't aware but I can expect that if they were I'd be out for my own safety and the safety of the patients.

edit: ethical dilemma with wanting to work in healthcare but posing an issue by increasing chance of disease transmission to other patients. If I disclose this information to the coordinator, (or admissions), I can fully expect my volunteer gig to be terminated, if I don't im being dishonest and potentially harming everyone in the ER, including myself. Likewise, PI's studying pathogens need to work very hard to get their license to handle these pathogens. Allowing an immunosuppressed undergrad might pose a violation, if I keep my condition a secret it may be considered selfish, if not, detrimental to myself.

best.

I feel like it depends on the condition you have and what your on.

I, for example, was compromised, when on 6mp. (Mercaptapurine, whatever it was called) They use it on UC and Crohns patients. I ended up with a terrible case on mono and I was incredibly sick in high school and it ****ed with everything. Biologics were different, though. I was allergic to them, but overall, I wasn't suppressed. Especially dependent on type. Entyvio only ****s with the bowel, for example.

However, it was less because of the surpression that made me almost doubt my premed path. I think many people discount how they'll react. For me, UC almost killed that dream. (Until surg anyway)

If you're that terrified of getting sick, you need to evaluate. Look into different medical areas. You can even be a doctor, but maybe not work with people that are contagious to you. If you know certain parts don't function, perhaps choose an area you can tell where youll be sick from.

However, I will stress that if you get sick that often, you should still evaluate. I've never really had the feeling I'll get sick. Other than the time that I mentioned, its rare that I got sick from anything beyond my autoimmune disease.

 

[Lannister]

What concerns me more than being immunosuppressed is that you get sick for 1-2 weeks at a time. Unfortunately, that is just not possible during medical school and residency. We get 2 sick days per rotation during M3 and M4. If you took off 1-2 weeks you would absolutely have to repeat the rotation.

 

[siliso]

You should tell potential employers if you will need some accommodation to do the job, like additional PPE. Otherwise not. Really you should ask your own physician who’s prescribing the meds what kind of restrictions you should follow to protect yourself.

A week’s illness can be accommodated in med school and residency up to a certain point after which you would need to extend your time in the program to make up for absences. Not a dealbreaker. If you are incapacitated for weeks multiple times a year the challenges would be much greater for any job or profession and I hope your condition can come under good enough control for this not to be the case.

 

[500miles]

In some ways you would be safer working in a higher bsl compared to a lower level one. If you are working with Ebola, no ones immune system will fight it very well ( although someone else may have a slightly better chance). The assumption in those labs is that if you get what your working with it's a death sentence for anyone. On the other hand, a lab that works with an opportunistic pathogen such as yeast, or maybe a virus like the flu, in a bsl 2 would have less safe guards in place and overall the attitude would be more relaxed because hey if you get a opportunistic yeast infection you would just treat it. As others have said you may want to steer further away from diseases in general though, to reduce risks as much as possible..

 

[Bergamasque]

I appreciate the responses and the PM's I've received regarding immunosuppression. I'm an organ transplant patient taking 2mg dose of Tacro, an IL-2 inhibitor. Fortunately I haven't been sick for the past year (*knocks on wood*) but when I do get sick, it's a trip to the ER nearly 100% of the time followed by a week-long period of absence. I've considered what everyone had to say and decided to continue pursuing Medical School. I've just recently got into a lab that doesn't work with infectious diseases, which is great and I will continue to santitize like crazy during my shifts. Thanks SDN!

Edit: I have considered the probability of illnesses affecting my rotations. Throughout my academic career, educators have always been understanding, especially when presented with a note from my physician. Of course Medical School & Residency is by far more cutthroat, but I suppose I'll cross that bridge when I come to it.