Just found out I have chronic Hep B. What's next?

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hi12345

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I got accepted into MD school and will matriculate next year, however I just found out I got chronic Hep B. My viral load is very low <20IU/ml. I will have to disclose this within my vaccination record. I have tried to do some research into this and there is some stigma around this issue so I want to find as much information about this as possible to prepare myself.

My questions are:

1. Does this mean my medical career is over? Have anyone experienced the same things and what it feels like during clinical experience? Does that mean that I will not get to do surgical rotation or will be restricted in certain rotations?
2. I know I will not get to do invasive specialties that involve invasive surgical procedure such as Cardiothoracic, trauma, oral, and OB/GYN. How about anesthesia or intensivist? or Neurosurg? How about other procedure such as intubation, lines, scopes?

This new is very devastated for me because I worked so hard for this. I am very thankful for any feedbacks.

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I cannot speak for Hep B specifically, but I have tuberculosis and so far it has not been a problem although if/when I become active again I will be more contagious than you. Also there are also doctors with HIV, so I assume Hep B (which is less scary) doesn't kill a medical career. I think most people are never going to know about your status. I doubt it will restrict you terribly much but it is hard to know. I wouldn't really care if my doctor had Hep B provided they were not offering up a blood transfusion to me.

Trust me, the TB diagnosis literally a few days before I started medical school was pretty devastating to me as well. I was on meds until just a few weeks ago.
 
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I think you may be barred from entering a surgical specialty but no your medical career is not over
 
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I cannot speak for Hep B specifically, but I have tuberculosis and so far it has not been a problem although if/when I become active again I will be more contagious than you. Also there are also doctors with HIV, so I assume Hep B (which is less scary) doesn't kill a medical career. I think most people are never going to know about your status. I doubt it will restrict you terribly much but it is hard to know. I wouldn't really care if my doctor had Hep B provided they were not offering up a blood transfusion to me.

Trust me, the TB diagnosis literally a few days before I started medical school was pretty devastating to me as well. I was on meds until just a few weeks ago.

Thank you very much for sharing. I hope you did not have to delay starting medical school.
 
Thank you very much for sharing. I hope you did not have to delay starting medical school.

No, but I wish it did. This semester sucked and I am going to have to take a LOA for medical reasons to come back next fall.
 
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I think you may be barred from entering a surgical specialty but no your medical career is not over
Mind citing your sources if you are going to make such dramatic conclusions?
 
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No, but I wish it did. This semester sucked and I am going to have to take a LOA for medical reasons to come back next fall.

May I ask why you have to take LOA? I thought with TB, all you have to do is to take medication for few weeks then you will not be contagious anymore? The only reason I am asking is because I had an abnormal X-ray and was referred to TB clinics...but my CT scan was negative. The pulm recommended me to start taking med just for prevention.

Nope, not true (even if he were Hep C or HIV +).

May I ask why you think it is not true? I read the CDC recommendation and according to my research, the residency program guideline is only stricter which means any invasive surgical residency is really not an option for me. And even during rotation such as surgery, I will be limited.
 
I cannot speak for Hep B specifically, but I have tuberculosis and so far it has not been a problem although if/when I become active again I will be more contagious than you. Also there are also doctors with HIV, so I assume Hep B (which is less scary) doesn't kill a medical career. I think most people are never going to know about your status. I doubt it will restrict you terribly much but it is hard to know. I wouldn't really care if my doctor had Hep B provided they were not offering up a blood transfusion to me.

Trust me, the TB diagnosis literally a few days before I started medical school was pretty devastating to me as well. I was on meds until just a few weeks ago.

How did this even happen?

Did you have to notify them about it?
 
May I ask why you have to take LOA? I thought with TB, all you have to do is to take medication for few months (as many as 9 for latent TB) then you will not be contagious anymore? The only reason I am asking is because I had an abnormal X-ray and was referred to TB clinics...but my CT scan was negative. The pulm recommended me to start taking med just for prevention.

Fixed that for ya. That stuff can have some nasty side effects, too.
 
May I ask why you have to take LOA? I thought with TB, all you have to do is to take medication for few weeks then you will not be contagious anymore? The only reason I am asking is because I had an abnormal X-ray and was referred to TB clinics...but my CT scan was negative. The pulm recommended me to start taking med just for prevention.

Medications are a minimum of 4 months and that is because at that moment I was not contagious. If I had active TB, I would be on meds for a year or two. I had a bad reaction to the med initially.

Then with the fact that I was sexually assaulted, robbed multiple times (house once, car several times), had all my med school notes destroyed, am on my 5th computer and 3rd printer since July, I ended up with PTSD and became very very jumpy. My neurologist put me on a medication which caused me to have severe memory loss. He then switched meds and I ended up with seizures. Then two of my family members died two weeks ago and I keep going into and out of the ER. I apparently need a vacation which multiple doctors have suggested by this point. Apparently if I don't take a LOA to relax, my medical career will be over before it begins.

How does this even happen?

How did I get TB? Hell if I know to be honest. I have suspicions but I always had negative PPDs, the T Spot said "Hi you've been exposed" and I went to get a chest x-ray and it was like "Hey! You have TB! Congrats!" Ironically, the results were showing that I would have likely had it some years before. I was pulling false negatives on the PPD tests for years apparently. I could have gotten it when shadowing. Or volunteering. Or when I was homeless. Or when I was working with migrant workers. Maybe even got it when I was a child in Florida. I want my whole family checked but no one wants to get checked just in case.
 
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How did I get TB? Hell if I know to be honest. I have suspicions but I always had negative PPDs, the T Spot said "Hi you've been exposed" and I went to get a chest x-ray and it was like "Hey! You have TB! Congrats!" Ironically, the results were showing that I would have likely had it some years before. I was pulling false negatives on the PPD tests for years apparently. I could have gotten it when shadowing. Or volunteering. Or when I was homeless. Or when I was working with migrant workers. Maybe even got it when I was a child in Florida.

Damn. I should probably get tested too I guess.

I want my whole family checked but no one wants to get checked just in case.

In case....what, they have TB and then have to deal with it? I mean....given how contagious it is, imo that'd be doing a huge public service. Granted idk if that would screw over their professional careers or not
 
May I ask why you think it is not true? I read the CDC recommendation and according to my research, the residency program guideline is only stricter which means any invasive surgical residency is really not an option for me. And even during rotation such as surgery, I will be limited.

Because as a surgeon, I've never seen or heard of a residency program or hospital restricting surgical privileges due to someone having HBV/HCV/HIV. All health care providers should be treated and treat patients as if they are positive.

Residency programs may choose their own "program guidelines" but in light of the current CDC and ACS recommendations, it would appear that restricting residency to those who are HBV negative would run the risk of a lawsuit, even if the latter is not a protected class.
 
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Fixed that for ya. That stuff can have some nasty side effects, too.

You have no idea. Rifampin 600 mg for 4 months. All my body fluids (including my tears) were bright red. I looked like a vampire. And that was the least upsetting effect.

Damn. I should probably get tested too I guess.

In case....what, they have TB and then have to deal with it? I mean....given how contagious it is, imo that'd be doing a huge public service. Granted idk if that would screw over their professional careers or not

It's my family, they believe if they don't know about something, it goes away on it's own.

Go for the T Spot and not the PPD. More expensive but more accurate.
 
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You have no idea. Rifampin 600 mg for 4 months. All my body fluids (including my tears) were bright red. I looked like a vampire. And that was the least upsetting effect.



It's my family, they believe if they don't know about something, it goes away on it's own.

Go for the T Spot and not the PPD. More expensive but more accurate.

I mean I do them yearly but maybe one more wouldn't be so bad. Occmed would probably give em to me for free.
 
In case....what, they have TB and then have to deal with it? I mean....given how contagious it is, imo that'd be doing a huge public service. Granted idk if that would screw over their professional careers or not

When people feel healthy they don't want to learn that they actually have a problem. When people feel sick they want their feelings to be validated with a diagnosis. Just kind of how people work.
 
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You have no idea. Rifampin 600 mg for 4 months. All my body fluids (including my tears) were bright red. I looked like a vampire. And that was the least upsetting effect.

I hope I never convert. I have been around patients who were later discovered to have active TB (without wearing a respirator), but thankfully, my PPDs are still negative. I don't want to take those meds...
 
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Medications are a minimum of 4 months and that is because at that moment I was not contagious. If I had active TB, I would be on meds for a year or two. I had a bad reaction to the med initially.

Then with the fact that I was sexually assaulted, robbed multiple times (house once, car several times), had all my med school notes destroyed, am on my 5th computer and 3rd printer since July, I ended up with PTSD and became very very jumpy. My neurologist put me on a medication which caused me to have severe memory loss. He then switched meds and I ended up with seizures. Then two of my family members died two weeks ago and I keep going into and out of the ER. I apparently need a vacation which multiple doctors have suggested by this point. Apparently if I don't take a LOA to relax, my medical career will be over before it begins.



How did I get TB? Hell if I know to be honest. I have suspicions but I always had negative PPDs, the T Spot said "Hi you've been exposed" and I went to get a chest x-ray and it was like "Hey! You have TB! Congrats!" Ironically, the results were showing that I would have likely had it some years before. I was pulling false negatives on the PPD tests for years apparently. I could have gotten it when shadowing. Or volunteering. Or when I was homeless. Or when I was working with migrant workers. Maybe even got it when I was a child in Florida. I want my whole family checked but no one wants to get checked just in case.

Aw, I am so so sorry for your losses what you had to go through. It must be a very tough time....on top of medical school.
 
I hope I never convert. I have been around patients who were later discovered to have active TB (without wearing a respirator), but thankfully, my PPDs are still negative. I don't want to take those meds...

So were mine though... T Spot is how we found out. I have no idea how I ended up with TB. I've never knowingly been around a patient with it.

Aw, I am so so sorry for your losses what you had to go through. It must be a very tough time....on top of medical school.

Thanks. I literally have a two page single spaced list of all the things that have gone wrong. A facilitator said I had the perfect storm with medical school.
 
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@familyaerospace .....

tumblr_inline_mr4giu494K1qz4rgp.gif
 
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I just wish I had been able to say goodbye to my grandmother personally. Cousin I didn't really care about, but my grandmother yea. Heaven help everyone when the other grandmother dies.
 
Poor FAS's cousin :(

Those darn grandmas. Always hogging the love.

I have a lot of first, second, and third cousins. Actually this one was a first cousin, once removed, I think. Most of them look down on me and they never acknowledge me except to tell me I am wasting my life and that I should be working in a deli like them so I am less hurt. I know I am a horrible person, but ignore me or insult me and I will remember it forever.

For both grandmas, I am the only grandchild so you can see how that likely plays out. I am sad I didn't get to say goodbye, but part of it was my Dad was being a jerk so I didn't go back to see her. I had hoped she was not going to die before I had the next opportunity to see her again.... nope. :-(
 
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If you read the CDC guideline that is what they say.

No it isn't. Chronic HBV is easily treated. You will have no difficulty keeping an undetectable viral load if you are a remotely compliant patient. These sort of committees exist at every hospital and yours will be the easiest case. You do, however, have the honor of being a question on the GI boards every single year (usually its a dental student for some reason but close enough).
 
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Because as a surgeon, I've never seen or heard of a residency program or hospital restricting surgical privileges due to someone having HBV/HCV/HIV. All health care providers should be treated and treat patients as if they are positive.

Residency programs may choose their own "program guidelines" but in light of the current CDC and ACS recommendations, it would appear that restricting residency to those who are HBV negative would run the risk of a lawsuit, even if the latter is not a protected class.

Reading CDC recommendations really made me feel like surgical specialty is not a choice anymore...which makes sense...if the head of residency program has a choice, why would they want someone with Hep B versus without...just because of the risk of liability. They even recommend a doctor disclose their Hep B status to patients and I can see how patients will freak out knowing whether their doctor has Hep B or even HIV.

No it isn't. Chronic HBV is easily treated. You will have no difficulty keeping an undetectable viral load if you are a remotely compliant patient. These sort of committees exist at every hospital and yours will be the easiest case. You do, however, have the honor of being a question on the GI boards every single year (usually its a dental student for some reason but close enough).

What do you mean when you mention "being a question on the GI board every single year?
 
Dental Student, chronic HBV, low level viremia. What to do.

Look, I'm trying to stay on the not give medical advice side of things but you have to trust me, this is not an issue.
 
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I think you should be safe to go especially with your viral load level.
 
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Reading CDC recommendations really made me feel like surgical specialty is not a choice anymore...which makes sense...if the head of residency program has a choice, why would they want someone with Hep B versus without...just because of the risk of liability. They even recommend a doctor disclose their Hep B status to patients and I can see how patients will freak out knowing whether their doctor has Hep B or even HIV.

Are you reading the updated CDC guidelines?

The 2012 updated recommendations reaffirm the 1991 CDC recommendation that HBV infection alone should not disqualify infected persons from the practice or study of surgery, dentistry, medicine, or allied health fields.

The previous recommendations have been updated to include the following changes: no prenotification of patients of a health-care provider's or student's HBV status; use of HBV DNA serum levels rather than hepatitis B e-antigen status to monitor infectivity; and, for those health-care professionals requiring oversight, specific suggestions for composition of expert review panels and threshold value of serum HBV DNA considered "safe" for practice (<1,000 IU/ml). These recommendations also explicitly address the issue of medical and dental students who are discovered to have chronic HBV infection. For most chronically HBV-infected providers and students who conform to current standards for infection control, HBV infection status alone does not require any curtailing of their practices or supervised learning experiences.

You might find this interesting:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3724342/
 
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Dental Student, chronic HBV, low level viremia. What to do.

Look, I'm trying to stay on the not give medical advice side of things but you have to trust me, this is not an issue.

I will still follow up with a hepatologist for medical management. I just want to know the barrier I will experience as a medical student or picking out a specialty. Thank you for your response:)
Are you reading the updated CDC guidelines?

The 2012 updated recommendations reaffirm the 1991 CDC recommendation that HBV infection alone should not disqualify infected persons from the practice or study of surgery, dentistry, medicine, or allied health fields.

The previous recommendations have been updated to include the following changes: no prenotification of patients of a health-care provider's or student's HBV status; use of HBV DNA serum levels rather than hepatitis B e-antigen status to monitor infectivity; and, for those health-care professionals requiring oversight, specific suggestions for composition of expert review panels and threshold value of serum HBV DNA considered "safe" for practice (<1,000 IU/ml). These recommendations also explicitly address the issue of medical and dental students who are discovered to have chronic HBV infection. For most chronically HBV-infected providers and students who conform to current standards for infection control, HBV infection status alone does not require any curtailing of their practices or supervised learning experiences.

You might find this interesting:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3724342/

Hmmm....I may have read an older version and some other articles that talk about the limitation in invasive surgical specialty in Hep B positive health care provider. Thank you very much for pointing this out to me. This really helped.
 
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