Writing about contracting Hepatitis B in a secondary

[HeppyBee]

One of my secondaries has a prompt that asks you to describe a difficult experience.

I wanted to write about when I found out I had contracted Hepatitis B when I was younger-it was weird because it was around high school-middle school and no one had any idea how I had gotten it because I wasn't sexually active. The best guesses were brief blood/blood contact from playing sports.

Would talking about contracting hepatitis B be a good idea?

I know carrying hepatitis B carries a certain stigma-similar to HIV, I even made a new account because I'd rather not be linked to it. This stigma makes me pretty apprehensive about writing about it. However, this was definitely a difficult time for me and I really had to come to terms about what my condition was.

LizzyM if you read this, I'm especially curious as to how you believe an adcom would take this.

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[HeppyBee]

Bump

 

[BLACKMD]

I'd address the stigma head on and go for it. It's a great story.

 

[911 Turbo]

No I'd avoid writing about it

 

[talinnlove]

I don't see why not. Personal struggle with disease can be highly relevant to your inspiration to pursue medicine. You weren't engaging in any risky behaviors when you contracted HBV, so I don't see any possible way that this could be interpreted as a character flaw or detriment to your application. I'm just a pre-med kid here and have never served on an adcom, but I feel like talking about how you dealt with a disease that carries social stigma, as you mentioned, has the potential to be very moving.

Dr. Rosalind Kaplan of Temple School of Medicine has hepatitis C and has written several pieces that might help you figure out how to contextualize your experience, or maybe just give a little inspiration. This is one of them: http://www.brandeis.edu/magazine/2011/fall/turning-points.html

 

[Arbor Vitae]

Can you work in a hospital if you have Hep B?

 

[Spitphire]

I can only see OP as being a troll, only because of your name and post amount
if not, i'm not sure if I would write about it or not.

 

[HeppyBee]

Thanks for all the kind responses.

Let me just go ahead and post with my main account so everyone knows [insertnamehere] has hep B.

I can only see OP as being a troll, only because of your name and post amount
if not, i'm not sure if I would write about it or not.

 

[Spitphire]

Thanks for all the kind responses.

Let me just go ahead and post with my main account so everyone knows [insertnamehere] has hep B.

Didn't mean to come off as rude, i apologize. But if you plan on writing about it, what happens when it comes up in an interview? If you can't make it known on the internet anonymously then how will you be able to talk about it to another person?

 

[HeppyBee]

Didn't mean to come off as rude, i apologize. But if you plan on writing about it, what happens when it comes up in an interview? If you can't make it known on the internet anonymously then how will you be able to talk about it to another person?

I've talked to people about it before and I just made it known anonymously by making a new account. I didn't want to post it on my main account because that threatens my anonymity and and privacy much more than using a new account. You could easily trace my account to me.

 

[Spitphire]

I've talked to people about it before and I just made it known anonymously by making a new account. I didn't want to post it on my main account because that threatens my anonymity and and privacy much more than using a new account. You could easily trace my account to me.

Understandable i guess. Though I would have chose another name. Good luck! sorry if i offended you.

 

[Oranges123]

One of my secondaries has a prompt that asks you to describe a difficult experience.

I wanted to write about when I found out I had contracted Hepatitis B when I was younger-it was weird because it was around high school-middle school and no one had any idea how I had gotten it because I wasn't sexually active. The best guesses were brief blood/blood contact from playing sports.

Would talking about contracting hepatitis B be a good idea?

I know carrying hepatitis B carries a certain stigma-similar to HIV, I even made a new account because I'd rather not be linked to it. This stigma makes me pretty apprehensive about writing about it. However, this was definitely a difficult time for me and I really had to come to terms about what my condition was.

LizzyM if you read this, I'm especially curious as to how you believe an adcom would take this.

OP, my dad passed away from chronic hepatitis B related liver cancer so this issue is really close to my heart.

I am praying that you are getting antiviral treatment and that you are protecting yourself AND others. Remember BBS (blood, birth, and sex) is how HBV is spread (like don't share razors). Remember HBV and liver cancer are known as "silent killers". They often don't display symptoms until later in life (aka when you have a family).

Are you getting treatment with a PCP or infectious disease specialist?
On an excellent guide to HBV treatment, there is nothing better than the Asian Liver Center at Stanford University's physician guide: http://liver.stanford.edu/media/publications/Handbook/2013Handbook.pdf

Because you have HBV, you will have to take special precautions, such as double gloving and less exposure to invasive procedures. You will also need to receive career counseling etc. You should be on antiviral medication NOW, if you aren't already.

Remember, your HBV needs to be disclosed one way or the other at medical school, during residency, during fellowship, and as an attending. Starting treatment as soon as possible lowers your infectivity and decreases your probability of getting liver cirrhosis or cancer.

CDC has published guidelines on the management of healthcare workers with bloodborne chronic disease: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6103a1.htm

PSA😍😍😍
Remember that there is a difference between ACUTE and CHRONIC HBV infection. An ACUTE infection is one in which your body's immune system completely clears the virus and develops antibodies, most notably antibody to hepatitis B surface antigen. A CHRONIC infection is one in which your body's immune system is unable to completely clear the virus and HBV resides dormant in your liver cells.

CHRONIC HBV infection can ONLY be confirmed with a POSITIVE HEPATITIS B SURFACE ANTIGEN TEST (HBsAg).

 

[Oranges123]

But to answer the question at hand, do not talk about your HBV status unless that was an experience that was instrumental in you choosing to enter medicine.

 

[chronicidal]

If you mention you have hep B prior to being admitted, you're opening yourself up to the possibility of discrimination that you will never find out about. That is, somebody might decide to reject you because you have hep B. You will have no recourse if this situation occurs because the reasoning behind admissions decisions are often not recorded.

The relevant stigma is not so much about sexual behavior or drug use or being Asian. It's not about how you got it. It's about your infectiousness. It's about how likely it is you might give it to someone else during med school, an issue that is fraught with misconceptions even among well-meaning physicians.

In recent years, a number of students with hepatitis B have had their admissions revoked when their school found out they had hep B. The Dept of Justice sued on behalf of these students. The schools settled (see advisory letter below). Such discrimination is a violation of the Americans with Disabilities Act, as medical students with hepatitis B should be able to complete the curriculum without posing a threat to others. Based on the latest evidence, chronic hep B is not in itself sufficient to exclude someone from the practice or study of medicine (see CDC article below). That said, most schools have not articulated up-to-date policies regarding admissions or management of students with hepatitis B, meaning your experience may vary.

Know that because you have hep B, you will probably be tested during med school to make sure that your viral load is low. If it's high, you may be prevented from partaking in certain activities where the risk of exposure to the patient is higher (e.g. first assisting on a open abdominal surgery), at least until treatment reduces your viral load. During med school, you may also be advised to enter a specialty that does not involve invasive procedures. The specifics of these policies (what's considered a high load, how often you should get tested, what is an invasive procedure, how involved your participation has to be and whether it can affect your grade, etc.) will vary, so after you get accepted, do your homework before you choose a school (ask about the policies).

All of this is a hassle, not only for you, but for the school as well. They're trying to protect themselves from a medicolegal perspective. In their zeal to avoid lawsuits, however, institutions can go too far and unfairly treat applicants/students who have hep B. Don't put yourself in a position where you're vulnerable to this possibility.

Read the federal government's advisory letter to med schools about the issue here: http://1.usa.gov/18Vi7OS

Read the CDC's recommendations on the management of students with hep B here: http://1.usa.gov/143YfVa

Some other commentary I found: http://bit.ly/Qowm48, http://bit.ly/16L9Qan, http://bit.ly/15zoVge

Feel free to message me with more questions. I can put you in touch with advocates who are very knowledgeable about the situation of prospective medical students who have hep B.

 

[Arbor Vitae]

It will have to be disclosed before even starting med school too. I just had to get reimmunized against Hep B before they will even let me start. Do not mention it anywhere before being accepted. You will have to mention it before matriculating because they will require you to be immunized and since you already have it, the cat will be out of the bag.

 

[HeppyBee]

Oranges123 and chronicidal, thank you so much for this advice. Last I was aware, I cleared my acute infection. I only follow up ~once a year which is less than I know I should, but I have lackluster insurance. I do make sure to take care that I don't spread it to others even though I have cleared my infection. I knew I had to disclose my condition at one point or another, but I didn't consider the possibility of discrimination that I will never know about. I thought talking about it on my own terms would be nice, but I realize now that prior to admission is neither the time nor forum.

 

[chronicidal]

Oranges123 and chronicidal, thank you so much for this advice. Last I was aware, I cleared my acute infection. I only follow up ~once a year which is less than I know I should, but I have lackluster insurance. I do make sure to take care that I don't spread it to others even though I have cleared my infection. I knew I had to disclose my condition at one point or another, but I didn't consider the possibility of discrimination that I will never know about. I thought talking about it on my own terms would be nice, but I realize now that prior to admission is neither the time nor forum.

Oh. If you cleared it, then you cleared it. To clarify, that means you are anti-HBs(+), HBsAg(-), anti-HBc(+), with no detectable HBV DNA. Talk about it all you want.

The situation would be totally different if you were a chronic carrier. To clarify, this means HBsAg(+), anti-HBs(-), and anti-HBc(+), with or without detectable HBV DNA.

 

[Koalafied]

One of my secondaries has a prompt that asks you to describe a difficult experience.

I wanted to write about when I found out I had contracted Hepatitis B when I was younger-it was weird because it was around high school-middle school and no one had any idea how I had gotten it because I wasn't sexually active. The best guesses were brief blood/blood contact from playing sports.

Would talking about contracting hepatitis B be a good idea?

I know carrying hepatitis B carries a certain stigma-similar to HIV, I even made a new account because I'd rather not be linked to it. This stigma makes me pretty apprehensive about writing about it. However, this was definitely a difficult time for me and I really had to come to terms about what my condition was.

LizzyM if you read this, I'm especially curious as to how you believe an adcom would take this.

Just tell them you were crammed in a boat back in the late 70's.

 

[ritatud]

I'd address the stigma head on and go for it. It's a great story.

 

[Oranges123]

Oh. If you cleared it, then you cleared it. To clarify, that means you are anti-HBs(+), HBsAg(-), anti-HBc(+), with no detectable HBV DNA. Talk about it all you want.

The situation would be totally different if you were a chronic carrier. To clarify, this means HBsAg(+), anti-HBs(-), and anti-HBc(+), with or without detectable HBV DNA.

I would go to your PCP and ask for the HBsAg test. If it is positive you have chronic HBv infection. If it is negative, you don't.

I would also ask for the hepatitis b surface antigen antibody test to confirm if you have immunity. OP are you from the states? The HBV vaccine is almost universally given as an infant.

anti HBc is superfluous; just confirms whether you had an acute infection in the past.

 

[Oranges123]

so in summary,

hbsag +
anti-hbs - means chronic hbv infection; recommend hep a vaccine and start antiviral treatment asap; also measure hbv dna levels

hbsag -
anti hbs - means unprotected; need 3 series hbv vaccination

hbsag -
anti hbs + means immune; dont need to do anything! u dont have to see a doctor if u r immune; hbv vaccine provides 99% immunity

 

[Oranges123]

a lot of medical schools have antiquated understandings of hbv infection. dont disclose it on ur application but feel confident that the cdc, the justice dept, and thousands of scientists and physicians have ur back if ur selected school wants to revoke ur admission

 

[anonapotamous]

I just found out while getting my blood tests to start medical school, I am:

HepB surface AG reactive
Hep B Core Ab reactive and
Hep B surface Ab titer NONreactive

My school says I must have a positive Hep B surface antibody titer. Obviously I don't.

Can they prevent me from matriculating and rescind my acceptance? I have chronic Hep B.

Does the Hep B surface antigen have to be below a certain level?

I'm getting medical help now, and am hoping for the best.

 

[chronicidal]

Can they prevent me from matriculating and rescind my acceptance? I have chronic Hep B.

Does the Hep B surface antigen have to be below a certain level?

1) Unequivocally no. This is a violation of the Americans with Disabilities Act. Read the above linked advisory letter from the Dept of Justice/HHS/Education to medical schools.
2) A school could require HBV DNA levels below a certain level for you to participate in invasive procedures.