Positive TB Diagnosis after Sputum Exam in India

[9000miles 46]

Hey everybody,

 

My wife got the dreaded call from the medical exam center (one of the ones in North India) 3 weeks after her Sputum exam submissions to come back to their office for consultation after a sputum test came back with results. Of course, the only results that can come within 3 weeks are a positive one. Opening this thread to share experience since all the TB content on this site so heavily leans toward the Philippines, where a large amount of people getting these tests done are positive to start.

 

We didn't expect TB but my wife has had various medical issues over the past year (coughing, back pain) which we've tried diligently to resolve but were never once suggested to take a test for TB. We were able to get wife's conditions to a manageable place with medicines and physical therapy and planned to get to USA to visit a doctor and knock these out for good. But the medical center found out for us, and we visited to discuss with the doctor. I have to add, the doctors and nurses were very nice and spent a lot of time answering our questions. And they made it clear to us... we just need to finish the treatment and go enjoy our new life after. 

 

The treatment process is brutal - 6 months of daily medicines taken in front of doctor. Because the TB cases in India are less common, there aren't alternative locations other than the medical exam centers to complete the treatment. The embassy and CDC seem somewhat actively involved in these treatments from what I understand the doctor did mention asking permission from the embassy about one of the questions we had. I felt much more like my wife was being treated by Americans than the lousy medical experiences we've had in the past.

 

We start the medicines soon, along with all the other testing and consultations that come along with it.

 

If anybody *in india* has experience about TB treatment in Indian panel physician offices, please share your experience! I think from what the doctor told us, the medical centers catch about 2 cases a month. 

 

*People in the Philippines, please don't use this tread as there are dozens if not hundreds of Philippines posts about sputum testing and TB treatment*

 

Wish us luck!

[JeanneAdil 6,191]

this is a "hard pill to swallow"  as i know your wait is already long

be consoled in the fact there is a treatment now for TB as so many in the past have perished 

and know that the final outcome will be in favor of your visa/ you have many here that will add you to our prayers

 

[9000miles 46]

12 hours ago, JeanneAdil said:

this is a "hard pill to swallow"  as i know your wait is already long

be consoled in the fact there is a treatment now for TB as so many in the past have perished 

and know that the final outcome will be in favor of your visa/ you have many here that will add you to our prayers

 

Thanks so much for your prayers We're happy we caught it now before it got worse and can overcome it without having to deal with worse symptoms. The medical center seems like they're gonna take good care of us throughout the process and I'm happy to know the best practices from the CDC are being used for my wife's care.

Edited November 8, 2020 by 9000miles

[9000miles 46]

Update: We're a week into treatment and wife is handling it well.

 

We were told by medical center that interview was automatically cancelled. I am able to correlate that we are not required to attend our interview with others who have done sputum testing and the embassy has responded to their emails.

 

I'm trying to figure out if our case file is waiting safely at the embassy during our treatment. We can't go to the interview regardless since the treatment for TB requires my wife to be in the doctors office so much. Other places on the internet say that NVC expires cases after a year of no responses. I've seen that 221gs have a year to respond to the embassies requests. Where do we fit into this? I'm pretty nervous about whether or our case file is safe at the embassy during our treatment since they haven't initiated any communication with us. Having a very difficult time getting in contact with any American staffers there as well, which I presume is due to covid staffing shortages. Trying every channel I can to get an answer. Will share back here when I can determine what the official status of a case file undergoing treatment for class A TB is.

 

Otherwise, I'll post back once we hit our 2-month mark because that's the next X-Ray and we'll know whether the treatment is working as expected (or we're looking at something drug resistant, which while extremely unlikely, is a risk we're aware of).

Edited November 18, 2020 by 9000miles

[9000miles 46]

One more thing, I'm aware of the class A TB waiver. We're probably not going to bother. Here's what I've found in researching those

 

1) Very slow to get a response

2) Unlikely to be approved unless there's some proof that US care is superior to what can be provided in beneficiaries home country

3) I am staying in India with my wife for her treatment and couldn't find a doctor to take the case regardless

4) I've heard anecdotally you need to attend interview and get 221G for medical to use the waiver anyways and we aren't able to attend interview.

 

[tonyburgos 1]

Maybe need to exams more expecific, so I sugest https://nearbyall.com/delhi/medical/type/x_ray_centre/ for her treatment 

[9000miles 46]

1 minute ago, tonyburgos said:

Maybe need to exams more expecific, so I sugest https://nearbyall.com/delhi/medical/type/x_ray_centre/ for her treatment 

According to US immigration law, if somebody is diagnosed with TB in their immigration medical exam, they must receive treatment at the immigration medical center. If they choose to decline the immigration medical center's treatment, the immigration medical center will inform the embassy that the candidate is not proceeding. I believe they inform the countries local health authorities as well, which probably results in contact tracing and the associated stigma. If a candidate gets treatment at another center, the immigration medical center will not provide a medical report for them for at least 1 year after the candidate completes treatment at that other location. USA can't trust unaudited medical centers to provide adequate treatment for TB which comes back with a vengeance and likely drug resistance if not treated properly. If the candidate doesn't proceed with TB treatment, they're just going to suffer with it as long as they do. My wife didn't have any signature symptoms, but TB, like covid, can come in reduced intensity symptom format.

 

If you're reading this and you or your family member got the TB diagnosis, accept the immigration medical centers treatment. Move closer to the office if you have to. The treatment cost is provided with your medical exam, and the delay to your case will only be about 8 months. I've heard TB treatment in USA can cost around $20,000 pre-insurance which would be a killer expense to have so soon after moving. My wife is doing her treatment at medical exam center so we can move to USA as soon as we can given the circumstance. The care she is receiving is excellent compared to the care we normally receive in the region (even at brand-name hospitals), and we are already seeing some positive changes in her because of the treatment.

 

 

[9000miles 46]

Treatment Update

 

My wife’s treatment crossed the halfway mark a few weeks ago. I said I’d post after 2 months but since the result of the 2nd sputum test result is pretty significant as far as whether or not the treatment is working, I’m posting this after 5 weeks of a negative (no) result on her second sputum submission (the reasons for this are better explained in CDC and WHO technical treatment instructions). The hardest part of TB treatment is the first two months - lots of medicines (6-7 big pills a day) and your body getting used to side effects (for the first few weeks, you’ll be very itchy). After the first two months were completed, we went for her second X-Ray. I asked the doctor to show me the old and new X-Rays thinking the difference between them would be pretty subtle. Much to my surprise, the X-Ray result before her treatment and after was night and day - the original one was very cloudy around the middle right side and the new one was much more clear. To visually see how much the disease impacted my wife’s lungs was a pretty powerful experience which made me again thankful we’re getting her treated now. Of course, TB does leave scarring in lungs and a totally clear X-Ray is not going to show so quickly after the lungs begin the process of healing.

 

The back pain I mentioned for my wife had become a very mild concern after 2 months and it’s pretty easy to look back and say that the biggest TB symptom she had was unresolvable lower back pain. She’s walking totally normal now. Since the pain’s been there a while, I anticipate it’ll take her some time to get her full strength there but I’m somewhat relieved knowing my wife can hike or ride a bike with me when this whole treatment is completed. If anybody has a stubborn back pain that nothing seems to treat, accompanied by occasional coughing, just pay for the TB test! There’s definitely a correlation that isn’t widely published enough.

 

We have less than 3 months left remaining in her treatment, on a milder 2-pill a day regimen. Since the first part is about killing the disease and the second part is about preventing it from coming back, I don’t anticipate any significant changes in that time. Our monthly visits with the doctor are now quick and easy. He’s a very nice guy and I’m happy he’s managing treatment.

 

Embassy Updates

 

About 6 weeks into my wife’s treatment, we got a text message from US Travel Docs saying her passport was ready for pickup. I highly expected that this letter was her visa denial letter, which we haven’t formally received. You technically need this letter to apply for a waiver (but again, you’re not gonna get approved for a waiver). A formal rejection letter was not something I was super excited to give my wife, but I was surprised to find a more personal letter just stating that my because my wife has a Class A medical condition, she’ll need to complete treatment in India, then we can reschedule her interview. The letter also strongly recommended we just take the treatment provided by medical center since treatment waivers are hardly granted (noticing a theme? USA doesn't want people applying for these). I had been going through a lot of stress getting a clear answer if our case was safe at the embassy during treatment from many parties, but this one letter from the embassy cleared my doubts and was good encouragement that starting our treatment immediately before was the correct form of action. Thank you Mumbai for providing us this.

 

If you are diagnosed with TB in medical exam, don’t fret, the embassy will get you this letter via mail or visa pickup center, but give them several weeks to dispatch it out to you.

 

Embassy Class B Processing Updates

 

I found a few people who’s interviews were impacted by culture tests and trying to get new interview dates afterwards. There’s nothing published online about what happens next (which is a shame because I've found quite a few people being flagged for the additional testing), nor do the customer support agents on the phone or email have answers. So here’s the pattern I see:

 

• The medical center will call you informing you that final results are complete. They might call you to the location for more vaccinations or X-Rays. They’re gonna do this on their time, and not yours. You need to be proactive and followup with them often to make sure there’s no further delays. Keep track of the day after your culture results are completed (at my medical center, they issue a final negative report exactly 8 weeks after the final submission) and try to visit and make sure they get your entire medical report finalized. Try to get an E-Medical receipt in case you schedule an interview before the embassy gets the update into your file.
• Because there was potential or real TB involved in your case, the medical center has extra US paperwork to fill for your case. They will not get it to the embassy overnight. From the others I’ve been in touch with, think closer to one week.
• When the embassy receives your new medical report, US travel docs sends an email informing you to use the “Class B” reschedule category on US Travel Docs website. Again, this email could take 1-2 weeks after the medical center sends your final report. Don’t delay scheduling an interview.
• Appointments are sporadically available (remember I’m writing this during covid and reduced embassy staffing). You probably need to be on top of the scheduler 2 times a day to get an appointment. Remember you have 3 months of medical clearance from date of final culture result (so you’ve already 1-2 weeks the medical center spent preparing and sending report). You also might get a 221g for something else, so you really need to make an effort to get the first appointment you can after embassy receives your result
• After this point, your case is somewhat more “normal”
• You’re gonna need to do more sputum submissions when you arrive to USA. The doctors in USA are under no obligation to trust you’re free of TB because the foreign clinic said so. Your clearance for the medical report was for travel purposes. Local health department will follow up about this. Make sure your phone number and address are updated in DS-260. Not following up on this on arrival could have legal consequences (taking this from my study of the waiver rules, but not certain). In the very unlikely chance you get a positive culture result in the USA based test, you can be treated at your local clinic there and don’t need to return to your home country.

 

I hope this helps! And if I’m wrong about any of this, please correct me so that I can edit this post. I’m trying to provide resources that I didn’t get when we first got my wife’s diagnosis. Again, this is all for India. If you’re in the Philippines, there’s a different system and your experience will be totally different.

 

I’ll try to provide one more update the end of our treatment to explain how the treatment is wrapped up and we become a more “regular” Class B medical case. Additionally, I’ll try to post an update after we complete our move to USA since there’s a lot of internal paperwork associated with cases that underwent TB Treatment.

[Gar9 5]

On 2/17/2021 at 3:59 PM, 9000miles said:

Treatment Update

 

My wife’s treatment crossed the halfway mark a few weeks ago. I said I’d post after 2 months but since the result of the 2nd sputum test result is pretty significant as far as whether or not the treatment is working, I’m posting this after 5 weeks of a negative (no) result on her second sputum submission (the reasons for this are better explained in CDC and WHO technical treatment instructions). The hardest part of TB treatment is the first two months - lots of medicines (6-7 big pills a day) and your body getting used to side effects (for the first few weeks, you’ll be very itchy). After the first two months were completed, we went for her second X-Ray. I asked the doctor to show me the old and new X-Rays thinking the difference between them would be pretty subtle. Much to my surprise, the X-Ray result before her treatment and after was night and day - the original one was very cloudy around the middle right side and the new one was much more clear. To visually see how much the disease impacted my wife’s lungs was a pretty powerful experience which made me again thankful we’re getting her treated now. Of course, TB does leave scarring in lungs and a totally clear X-Ray is not going to show so quickly after the lungs begin the process of healing.

 

The back pain I mentioned for my wife had become a very mild concern after 2 months and it’s pretty easy to look back and say that the biggest TB symptom she had was unresolvable lower back pain. She’s walking totally normal now. Since the pain’s been there a while, I anticipate it’ll take her some time to get her full strength there but I’m somewhat relieved knowing my wife can hike or ride a bike with me when this whole treatment is completed. If anybody has a stubborn back pain that nothing seems to treat, accompanied by occasional coughing, just pay for the TB test! There’s definitely a correlation that isn’t widely published enough.

 

We have less than 3 months left remaining in her treatment, on a milder 2-pill a day regimen. Since the first part is about killing the disease and the second part is about preventing it from coming back, I don’t anticipate any significant changes in that time. Our monthly visits with the doctor are now quick and easy. He’s a very nice guy and I’m happy he’s managing treatment.

 

Embassy Updates

 

About 6 weeks into my wife’s treatment, we got a text message from US Travel Docs saying her passport was ready for pickup. I highly expected that this letter was her visa denial letter, which we haven’t formally received. You technically need this letter to apply for a waiver (but again, you’re not gonna get approved for a waiver). A formal rejection letter was not something I was super excited to give my wife, but I was surprised to find a more personal letter just stating that my because my wife has a Class A medical condition, she’ll need to complete treatment in India, then we can reschedule her interview. The letter also strongly recommended we just take the treatment provided by medical center since treatment waivers are hardly granted (noticing a theme? USA doesn't want people applying for these). I had been going through a lot of stress getting a clear answer if our case was safe at the embassy during treatment from many parties, but this one letter from the embassy cleared my doubts and was good encouragement that starting our treatment immediately before was the correct form of action. Thank you Mumbai for providing us this.

 

If you are diagnosed with TB in medical exam, don’t fret, the embassy will get you this letter via mail or visa pickup center, but give them several weeks to dispatch it out to you.

 

Embassy Class B Processing Updates

 

I found a few people who’s interviews were impacted by culture tests and trying to get new interview dates afterwards. There’s nothing published online about what happens next (which is a shame because I've found quite a few people being flagged for the additional testing), nor do the customer support agents on the phone or email have answers. So here’s the pattern I see:

 

• The medical center will call you informing you that final results are complete. They might call you to the location for more vaccinations or X-Rays. They’re gonna do this on their time, and not yours. You need to be proactive and followup with them often to make sure there’s no further delays. Keep track of the day after your culture results are completed (at my medical center, they issue a final negative report exactly 8 weeks after the final submission) and try to visit and make sure they get your entire medical report finalized. Try to get an E-Medical receipt in case you schedule an interview before the embassy gets the update into your file.
• Because there was potential or real TB involved in your case, the medical center has extra US paperwork to fill for your case. They will not get it to the embassy overnight. From the others I’ve been in touch with, think closer to one week.
• When the embassy receives your new medical report, US travel docs sends an email informing you to use the “Class B” reschedule category on US Travel Docs website. Again, this email could take 1-2 weeks after the medical center sends your final report. Don’t delay scheduling an interview.
• Appointments are sporadically available (remember I’m writing this during covid and reduced embassy staffing). You probably need to be on top of the scheduler 2 times a day to get an appointment. Remember you have 3 months of medical clearance from date of final culture result (so you’ve already 1-2 weeks the medical center spent preparing and sending report). You also might get a 221g for something else, so you really need to make an effort to get the first appointment you can after embassy receives your result
• After this point, your case is somewhat more “normal”
• You’re gonna need to do more sputum submissions when you arrive to USA. The doctors in USA are under no obligation to trust you’re free of TB because the foreign clinic said so. Your clearance for the medical report was for travel purposes. Local health department will follow up about this. Make sure your phone number and address are updated in DS-260. Not following up on this on arrival could have legal consequences (taking this from my study of the waiver rules, but not certain). In the very unlikely chance you get a positive culture result in the USA based test, you can be treated at your local clinic there and don’t need to return to your home country.

 

I hope this helps! And if I’m wrong about any of this, please correct me so that I can edit this post. I’m trying to provide resources that I didn’t get when we first got my wife’s diagnosis. Again, this is all for India. If you’re in the Philippines, there’s a different system and your experience will be totally different.

 

I’ll try to provide one more update the end of our treatment to explain how the treatment is wrapped up and we become a more “regular” Class B medical case. Additionally, I’ll try to post an update after we complete our move to USA since there’s a lot of internal paperwork associated with cases that underwent TB Treatment.

 

Which city in India you come from ?  In which city you are taking treatment from the Medical Center ?  Have you re-located yourself with wife only for the treatment ?  Are you a US Citizen or LPR ?  Such a long stay in India only for treatment may affect your job / Visa conditions ? 

Our sympathies go with you . Wishing Good Luck .

[9000miles 46]

18 minutes ago, Gar9 said:

 

Which city in India you come from ?  In which city you are taking treatment from the Medical Center ?  Have you re-located yourself with wife only for the treatment ?  Are you a US Citizen or LPR ?  Such a long stay in India only for treatment may affect your job / Visa conditions ? 

Our sympathies go with you . Wishing Good Luck .

Hi Gar9! Thanks for your wishes for good luck.

 

I can’t answer all those questions in detail as I prefer to remain anonymous and we are very frequently at a immigration medical center that many people from this forum pass through. 

 

I’ve been with my wife since we got married (I return to USA every few months to take care of responsibilities there) and we are IR1 now. I’m a US citizen. Our only really concern is my American domicile which can be resolved by me moving back after my wife’s treatment but before her visa is issued. 

[Gar9 5]

4 hours ago, 9000miles said:

Hi Gar9! Thanks for your wishes for good luck.

 

I can’t answer all those questions in detail as I prefer to remain anonymous and we are very frequently at a immigration medical center that many people from this forum pass through. 

 

I’ve been with my wife since we got married (I return to USA every few months to take care of responsibilities there) and we are IR1 now. I’m a US citizen. Our only really concern is my American domicile which can be resolved by me moving back after my wife’s treatment but before her visa is issued. 

Wishing you early recovery and good luck . 

 

[9000miles 46]

Finally happy to say that we’ve been allowed to end our treatment - under some conditions. My wife developed an odd side effect from the treatment - likely best described as a paradoxical reaction - and we spent the past few weeks wondering if our treatment will have to be extended. Been a nightmare to say the least. Doctor tried to consult with CDCs panel physician management team who appear to have been directed to covid duty and don’t answer their emails anymore 🤨. He consulted with some doctors locally and because my wife has met the USA treatment guidelines and is no longer contagious, we could end our medicines today and we submitted our 3 final sputum tests. We also got our 6 month chest XRay.

 

We didn’t complete our new medical yet - doctor wants to wait and see what our secondary culture test result is. CDC could also email back and recommend the doctor take a different course (unlikely I think). But if all is fine, we should be cleared for visa issuance in early July. 
 

Despite the covid situation in India, the Mumbai embassy has kept Class B appointments available! With covid cases here on the decline, we are starting to see a light at the end of the tunnel. We will wait until our sputum cultures are negative for 4 weeks before packing any bags though. We’ve been burned in this process so many times.

 

I’ll try to provide an update in a month and following that, one once we arrive in USA. I want people to see that a tuberculosis diagnosis  doesn’t totally stop you from getting a visa.