Tb treatments (INH) during medical school

[shannn]

Hey everyone,

 

So, long story short, my past 2 Tb tests (taken 8 years apart) have been positive and my doc has recommended I undergo 6 months of INH. My chest X-rays are clear though (and have been for the past 8 years). I went overseas as an infant (so I took a BCG vaccine, and yes, I have the scar to show for it)

 

Should I undergo the 6 months of medication? I am hesitant to do so because of the side effects, but if I choose not to undergo INH, will it affect me in any way? (i.e. during medical school shadowing or during my clerkship?)

 

Anyone know anyone who has gone through INH? What were their experiences?

 

Thanks

 

[BigM]

This is probably an issue that is serious enough that you need to discuss it with administration at your school.

[mystery_chick]

Hey everyone,

 

So, long story short, my past 2 Tb tests (taken 8 years apart) have been positive and my doc has recommended I undergo 6 months of INH. My chest X-rays are clear though (and have been for the past 8 years). I went overseas as an infant (so I took a BCG vaccine, and yes, I have the scar to show for it)

 

Should I undergo the 6 months of medication? I am hesitant to do so because of the side effects, but if I choose not to undergo INH, will it affect me in any way? (i.e. during medical school shadowing or during my clerkship?)

 

Anyone know anyone who has gone through INH? What were their experiences?

 

Thanks

 

 

I'm in the same boat and debating about the same issues. I have also had the BCG vaccine and had a positive 2nd step and a clean chest x-ray. I actually went to talk to a nurse at the local health unit and was about to start the INH before she told me you cannot drink at all while you're on INH (which in itself was not a big issue but it definitely made me do a double take). Despite the fact that she told me multiple times that the INH is "very safe" from what I've gathered it can be pretty harsh on your liver and so you're suppose to get your liver enzymes checked regularly while you're on it (sounds safe no? ). You're not legally obligated to take the INH unless you have active TB (in which case you wouldn't be treated with just INH anyways). Taking 9 month (the full treatment) of the drug apparently only kills 90% of the TB although apparently taking it for 6 month is considered a completed treatment. So from a personal health stand point I'm not feeling very confident in how much 6 month of 2 pills a day will help me. And as long as your chest X ray stays clean you're not contagious

 

Anyways, still debating. If I do end up going on it, it won't be until after O week

[shannn]

This is probably an issue that is serious enough that you need to discuss it with administration at your school.

 

I'm going to talk to them in September, see what they say about my placements

 

I'm in the same boat and debating about the same issues. I have also had the BCG vaccine and had a positive 2nd step and a clean chest x-ray. I actually went to talk to a nurse at the local health unit and was about to start the INH before she told me you cannot drink at all while you're on INH (which in itself was not a big issue but it definitely made me do a double take). Despite the fact that she told me multiple times that the INH is "very safe" from what I've gathered it can be pretty harsh on your liver and so you're suppose to get your liver enzymes checked regularly while you're on it (sounds safe no? ). You're not legally obligated to take the INH unless you have active TB (in which case you wouldn't be treated with just INH anyways). Taking 9 month (the full treatment) of the drug apparently only kills 90% of the TB although apparently taking it for 6 month is considered a completed treatment. So from a personal health stand point I'm not feeling very confident in how much 6 month of 2 pills a day will help me. And as long as your chest X ray stays clean you're not contagious

 

Anyways, still debating. If I do end up going on it, it won't be until after O week

 

Gahh, I feel the exact same way as you.

I really don't want to go through the treatments...I guess I'll have to continue asking around.

 

Let me know what you decide on (and why), I'll make sure to do the same

 

It's so weird though, my friend who had a BCG vaccine no longer gets positive Tb test results.

[mini]

Hey! Quite the dilemma....

 

I had the BCG vaccine as well (born overseas), and I test positive.... Because I worked in a hospital during my undergrad, they referred me to the TB clinic, where the doc also recommended that I undergo 9 months of treatment, "just in case". My X-rays were and have always been negative.

 

Anyways, to make a long story short... I did the treatment, because I knew that it might be required later on (for med school, work, etc).

 

The pills were annoying to take, but I didn't experience any major side effects. I did have to go in every month to do blood tests and to talk to several nurses and doctors, but it was just a routine.

 

I would recommend that you do it if you feel like it will make your personal worries go away...but I think I will still be asked for the chest X-rays anyway at every job, meaning I will have to go through the same thing, whether or not I took the meds. No employer/school has ever FORCED me to get them.

 

I hope this helps in your decision! If you have any questions, just pm me. Good luck!

[shannn]

Hey! Quite the dilemma....

 

I had the BCG vaccine as well (born overseas), and I test positive.... Because I worked in a hospital during my undergrad, they referred me to the TB clinic, where the doc also recommended that I undergo 9 months of treatment, "just in case". My X-rays were and have always been negative.

 

Anyways, to make a long story short... I did the treatment, because I knew that it might be required later on (for med school, work, etc).

 

The pills were annoying to take, but I didn't experience any major side effects. I did have to go in every month to do blood tests and to talk to several nurses and doctors, but it was just a routine.

 

I would recommend that you do it if you feel like it will make your personal worries go away...but I think I will still be asked for the chest X-rays anyway at every job, meaning I will have to go through the same thing, whether or not I took the meds. No employer/school has ever FORCED me to get them.

 

I hope this helps in your decision! If you have any questions, just pm me. Good luck!

 

Cool, thanks, that's good to hear.

 

I'll PM you in the not-too-distant future about the INH treatments.

 

Thanks again!

[aKGDH]

Hmm I dunno about everyone else, but there is no way I'd ever consider taking any medication without clear cause, particularly if it is a hassle or has side-effects. I think it's important to remember that recommendations are exactly that -- recommendations. It is advisable for doctors to be aware of public health and safety, so it's in their best interest to recommend a patient testing positive for TB to get INH, when perhaps the best course of action is not in line with the advice of the doctor.

 

I've also tested positive for TB twice now with 2 clean chest X-rays. If anyone suggests that I take INH I will say 'no.'

[Madz25]

Hey everyone,

 

So, long story short, my past 2 Tb tests (taken 8 years apart) have been positive and my doc has recommended I undergo 6 months of INH. My chest X-rays are clear though (and have been for the past 8 years). I went overseas as an infant (so I took a BCG vaccine, and yes, I have the scar to show for it)

 

Should I undergo the 6 months of medication? I am hesitant to do so because of the side effects, but if I choose not to undergo INH, will it affect me in any way? (i.e. during medical school shadowing or during my clerkship?)

 

Anyone know anyone who has gone through INH? What were their experiences?

 

Thanks

 

 

Hey

 

Same here. I test positive. I was born overseas and got the BCG vaccine. I have the scar to show for it. Chest X-rays have always been clean. I was also told to do the prophylactic course of antibiotics. I declined. Im not going to kill my liver because I test positive on a test due to a vaccine.

 

I'm now a resident and have had no problems. As long as you have a clean chest x-ray. I never came across a situation where I was required to do the course of antibiotics.

 

DO NOT stress over this. It's not a big deal. You'll never have to get a TB test again. Just get a yearly CXR and you're good.

 

Hope this helps.

[estairella]

About the TB skin test and INH treatment

 

1) Just because you had the BCG vaccine doesn't mean you'll test positive

 

2) Just because you test positive doesn't mean you have latent TB

 

3) Just because you have latent TB doesn't mean you'll get a reactivation - cumulative 10% (5% in the first year and 5% in the rest of your life). Since you tested positive 8 years ago, that has already reduced your risk down to 5%.. but depending on how long you live, that might be more like 4% LOL.

 

4) A 6 or 9-month course of INH will clear latent TB if you have it, but will NOT protect you from re-infection.

 

5) Not only that, but if you are later re-infected, you can no longer go through the INH protocol (you'll have to go through a much more rigorous drug regimen)

 

-----------------------------

 

1) As long as your chest x-rays are clear, you are NOT required at any hospital or university to undergo treatment (Unlike vaccinations, INH is HUGELY hepatotoxic - that would be, um, quite unethical!)

 

2) Depending on where you're placed, you will either have to get a yearly chest x-ray or not. One chest CT has about 1000x the radiation of 1 chest X-ray... so even if you had to do that for the rest of your life (let's say 100 chest x-rays)... you're subjecting yourself to the equivalent of 1/10 of a single CT.

 

--------------------------------

 

1) You can't drink alcohol on INH. You'll be missing out. lol

 

--------------------------------

 

So anyways, I had the BCG vaccine as a child. I used to test negative. Then within 1 year I went from negative to positive - clear sign of infection. Chest x-rays clear. So, I decided not to take it.

 

To me it just doesn't make sense - as a healthcare worker, chances are I'll be exposed to a lot of bugs, TB included. Taking the INH and then getting re-infected would feel like a slap in the face. At least right now, I know I already got it crawling under my skin!

[Typical Premed]

I had a positive skin test for TB when I was in Grade 12 despite never having a BCG vaccine. It was recommended that I do the 9 month INH treatment and I ended up going through with the treatment. I never experienced any side-effects although it was a mild inconvencience not being able to drink any alcohol for a 9 month span which included prom and frosh week, lol. When I apply for any hospital positions and when I started med school, I was just required to tell them that I had undergone the treatment and that my CXR's have always been negative. However, INH does have some major side effects such as hepatotoxicity and peripheral neuropathy (I had to take B12 along with INH to counteract this). Therefore, it really is up to you to weigh the risks and benefits and make a decision that is right for you.

[spiderpig]

This is a very interesting thread for me, since I also tested positive for TB, with a negative chest x-ray. I'm 99.9% sure I had BCG vaccine when I was a child.

 

About the TB skin test and INH treatment

5) Not only that, but if you are later re-infected, you can no longer go through the INH protocol (you'll have to go through a much more rigorous drug regimen)

 

Thanks for the info estairella. #5 right there is enough reason for me to decline the drug treatment if I'm asked to do so in the future.

 

Hey

 

Same here. I test positive. I was born overseas and got the BCG vaccine. I have the scar to show for it. Chest X-rays have always been clean. I was also told to do the prophylactic course of antibiotics. I declined. Im not going to kill my liver because I test positive on a test due to a vaccine.

 

I'm now a resident and have had no problems. As long as you have a clean chest x-ray. I never came across a situation where I was required to do the course of antibiotics.

 

DO NOT stress over this. It's not a big deal. You'll never have to get a TB test again. Just get a yearly CXR and you're good.

 

Hope this helps.

 

Hi Madz,

 

Since you're done the whole med school process are are now in residency, can I ask how many times you've needed to get the chest x-ray so far? And how often you need to keep getting it.

 

(I know everyone is saying the amount of radiation is nothing to be worried about, but I'm nevertheless uncomfortable about it, especially if my positive skin test is a result of BCG and not a latent infection.)

[mystery_chick]

To me it just doesn't make sense - as a healthcare worker, chances are I'll be exposed to a lot of bugs, TB included. Taking the INH and then getting re-infected would feel like a slap in the face. At least right now, I know I already got it crawling under my skin!

 

That's the other thing for me too... I'll be in and out of hospitals frequently for the next 6-10 years at LEAST and even though TB is not that common in N America, you can still be exposed so that just put 9 month of effort to waste. No thanks.

[shannn]

Thanks for all the input everyone

 

I think I will forgo treatment and continue to get chest X-rays

 

My family doctor is really pushing for the INH, but, I am not really comfortable going through the treatment plan

[Madz25]

Hi Madz,

 

Since you're done the whole med school process are are now in residency, can I ask how many times you've needed to get the chest x-ray so far? And how often you need to keep getting it.

 

(I know everyone is saying the amount of radiation is nothing to be worried about, but I'm nevertheless uncomfortable about it, especially if my positive skin test is a result of BCG and not a latent infection.)

 

I get the CXR once/year. It really is no big deal. Think about the patients admitted to hospital that require daily CXRs! I've heard (someone correct me if I'm wrong) that you're exposed to more radiation on a flight from Vancouver to Toronto than in one CXR.

 

You NEED to get the CXR. Even if you're school is OK with you getting it only once, when you apply for electives med schools will want a recent one done within 1 year of your proposed elective dates. When I started residency (i.e. less than a month ago lol), the hospital also wanted a recent CXR. Luckily, I got one before I moved and didnt have to go through the hassle while trying to adjust to a new city and to residency!

[estairella]

I've heard (someone correct me if I'm wrong) that you're exposed to more radiation on a flight from Vancouver to Toronto than in one CXR.

 

That's not surprising, since:

To explain it in simple terms, we can compare the radiation exposure from one chest x-ray as equivalent to the amount of radiation exposure one experiences from our natural surroundings in 10 days.

Source

[rskhan29@hotmail.com]

I also had the BCG shot and tested positive for the first skin test. My chest X-ray came back negative, and I believe that was good enough for UWO.

The doctor that requested the X-ray said that I should probably go on INH anyways, but the doctor who actually gave me my result didn't seem to think it was necessary.

 

The strange thing is that just last year I tested negative for the skin test. I don't know what could have caused the change.

[UTPEOPLE]

I also had the BCG shot and tested positive for the first skin test. My chest X-ray came back negative, and I believe that was good enough for UWO.

The doctor that requested the X-ray said that I should probably go on INH anyways, but the doctor who actually gave me my result didn't seem to think it was necessary.

 

The strange thing is that just last year I tested negative for the skin test. I don't know what could have caused the change.

 

OMG!!!! why didnt you tell them that you already had the skin test? you only test negative for the skin test once in your life... the second time, your body has antibodies already (from the first time) and will mount a greater immune response (the inflammation of which you are measuring for the skin test).

 

The INH shouldnt be too bad though, cause as long as you have a strong liver... you should be fine... Although if you do take INH... no drinking vitamin Alcohol for a year

[astrogirl]

OMG!!!! why didnt you tell them that you already had the skin test? you only test negative for the skin test once in your life... the second time, your body has antibodies already (from the first time) and will mount a greater immune response (the inflammation of which you are measuring for the skin test).

 

I've had more than one negative skin test.

[A-Stark]

OMG!!!! why didnt you tell them that you already had the skin test? you only test negative for the skin test once in your life... the second time, your body has antibodies already (from the first time) and will mount a greater immune response (the inflammation of which you are measuring for the skin test).

 

This is completely wrong, since the immediate inflammatory response to the Mantoux test is not antibody-mediated. It's always possible to have a false positive, of course, but the PPD does not give the same effect as actual TB exposure!

[mystery_chick]

This is completely wrong, since the immediate inflammatory response to the Mantoux test is not antibody-mediated. It's always possible to have a false positive, of course, but the PPD does not give the same effect as actual TB exposure!

 

I've been told that once you test positive (even slightly +ve, as in within the 10mm guideline) the next test will be more positive, but I wasn't told exactly why since having BCG will most likely make you at least slightly +ve....

[chemgirl]

Not true. I've been testing negative q2years since 1998.

 

How does one know that they have a "strong liver"?

 

OMG!!!! why didnt you tell them that you already had the skin test? you only test negative for the skin test once in your life... the second time, your body has antibodies already (from the first time) and will mount a greater immune response (the inflammation of which you are measuring for the skin test).

 

The INH shouldnt be too bad though, cause as long as you have a strong liver... you should be fine... Although if you do take INH... no drinking vitamin Alcohol for a year

[estairella]

How does one know that they have a "strong liver"?

 

Easy... take the INH treatment. If your liver function tests remain normal throughout, you have a strong liver. If you suffer from liver failure.. probably not so strong.

[leviathan]

Correct me if I'm wrong but I don't think INH therapy can put you into fulminant hepatic failure overnight. You could consider taking it and monitoring your liver enzymes for any sign of damage. You have to make sure you take Vitamin B6 to prevent neurological changes and anemia. If things start to go south you could stop right away. OR, just get the chest x-ray annually.

[resumedocket]

This is probably an issue that is serious enough that you need to discuss it with administration at your school.

 

 

Resume Writing Services

[caseycolin]

You could consider taking it and monitoring your liver enzymes for any sign of damage. You have to make sure you take Vitamin B6 to prevent neurological changes and anemia.

 

 

 

Resume Writing Service