[Mrs Pony]

We've heard back from our CO about my medicals... They want a letter from my Rheumatologist now. The email went like this...


''Please have the applicant produce a report/opinion from a Rheumatologist

Applicant seems to have Systemic lupus erythematosus. Please confirm. How did the disease present and how is it currently manifest. What are the potential long term complications and how frequently do these occur.

What monitoring is required re: specialist inputs, bloods, imaging etc.
Is there the likely future need for immunosuppressant drugs such as Cyclophosphamide or TNF inhibitors.
From reported series, what is the 5 and 10 year mortality rate'' Now I'm worried that they aren't going to approve me for PR ... and if I can't get PR can OH get it since he's the Primary?! My Lupus isn't bad at all to be honest. I'm very luck! I only went to the dr about every 4 months and he took me off one medication before we left the US. Now I'm only on Voltaren (50mg, once a day) which you can get over the counter here (maybe not my dosage)!

I have an appointment with a GP tomorrow and I'll see if they can refer me to a Rheumatologist here... I have copies of my medicals with me, both my GP and Rheumatologist from the US... I'll also see about staying up late or waking up early to get a hold of my dr is the US to see about getting that letter from him.

I just feel like crying right now! NOTHING has gone smoothly for us!

[BodaciousBean]

Hey Ponies,

Sorry for your hiccups on the way. :( I am sure it is not as bad as it may seem, NZIS probably needs some extra clarification that everything is A-okay. Hang in there guys, you are almost there! :nice1

[mgf]

It gets frustrating I know. Hang in there....

[Kanga]

I just feel like crying right now! NOTHING has gone smoothly for us!

Try really, really hard not to take it personally. It's more than likely a box ticking exercise and you will get there, just don't let it grind you down completely in the process. VISA applications are agonising beaurocracy because you have such an emotional investment in them, so it can be so incredibly draining ((((Mrs Pony))))

[dusk]

... these things happen, I guess you will feel more pressured as you are trying to do all the application stuff whilst also trying to survive in NZ whilst job hunting and trying to survive on your savings.

As for your question, your OH could potentially get PR if you removed yourself from the application should it turn out that you were refused on medical grounds, as long as he then had enough points and there were no other issues with his application and he completed any other requirements that NZIS may require (such as an interview if he doesn't have employment offer from an employer ont he accredited list/on the LTSSL) but this would mean you would have to submit another application for yourself of some kind, so would not really help in the long run and it's a long way from certain that it's going to come to that anyway, so try not to fret about it unless it happens :)

The best thing you can do is gather all the information about your medical condition that NZIS have asked for and hope that the MA agrees that it's not serious or too costly to support.

I might add for anyone else reading this considering coming over during or before submitting your PR/work visas requiring full medicals, it is important that if you have a serious/ongoing medical condition you get all the information and reports you can before you set off, so that you have a decent history of the condition and can prove (where necessary) that it is under control and you have a decent prognosis for ongoing care for the forseable future - or should that not be the case you at least have all the information possible at hand.

The additional stress and costs associated with medical referrals on your application are the last thing you need if you are already trying to cope with all the challenges life in a new country will be throwing at you.

[BkyMonster]

If you remove yourself from the application, assuming enough points and otherwise for the application to continue, keep in mind that you will not be eligible for a medical waiver if you were eligible to be included in the original application. Best to fight it through for the eventual chance of medical waiver if everything else goes badly (I have spent our entire process planning for what-if-things-go-wrong and boy has it helped because they sure did). I just (today) found out that I am now done with a 7 month MA hassle (...and now they can go back to looking for other things wrong with the application. Cynical, me? Never.) Be prepared to pay out the nose for private specialists.

[Mrs Pony]

humm... No I don't think he would have enough points on his own... unless he got a job offer and well you all know how that's going... I just want to feel settled already and I'm not going to feel totally settled until we get PR... must...have... patience...! :)

[CJ22]

The MA is simply looking for an opinion at this point. If the opinion given is 'not a major problem' then the MA is likely to go with that opinion. It's not neccesarily the case that chronic conditions are refused. Diabetics are regularly passed, despite it being a fatal condition without constant and permanent monitoring and treatment. Diabetes is passed on the basis that the sufferer can continue to be a productive member of society with that treatment. If Mrs. P can get an opinion that says the same thing then there's likely to be no problem in the end.

Yes it will add a delay to the process, but at least they are unlikely to refuse the application while the investigation is ongoing. Many people have over-stayed for long periods (with NZIS approval) while medical issues are resolved. Bear in mind you are in NZ, so the delay may be less. Most of the delay associated with the MA is the 1 month round-trip for the slightest communication between NZIS London (or wherever) and the MA.

Finally, the opinion may not be massively costly. It depends how much lab work would be required to provide it. If you can provide a rheumatologist with a detailed history, he may produce an opinion without having to do much investigating himself, who knows.

If your condition is mild, then this is more likely just the MA justifying his expensive retainer than a genuine attempt to block the application.

[Mrs Pony]

I'm going to a NZ GP tomorrow so I'll see what happens then... I have a copy of all my medical records (GP and rheumatologist from the US)

I'll also see about calling my rheumatologist in the US and see about having him write me a letter. Maybe with the medical records that I have I won't need it though...

It gives me a bit more hope knowing that diabetics don't have a problem getting in!

[BkyMonster]

Finally, the opinion may not be massively costly. It depends how much lab work would be required to provide it.

Having had to do one specialist report that required no lab work at all and cost me over 1kNZD (and could have cost 1.5k), it's more the expense of having to deal with specialists who are private network rather than the subsidized network (which I was not eligible for not having a 2+ year permit). Another private specialist I had to deal with was also expensive IMO. When I had to deal with the public hospital I had a very reasonable bill IMO for the services provided.

I'd agree that the MA just wants more info and the best thing to do is just give them everything (and more, very thorough is best IMO) that they ask for.

[sophiedb]

Best wishes *hug*

[M-Squared]

Fingers crossed for you guys (((hugs)))

[Mrs Pony]

So I found this on here... http://www.immigration.govt.nz/opsmanual/index.htm


Appendix 10 - Medical conditions deemed to impose significant costs and/or demands on New Zealand's health and/or education services



HIV infection
Hepatitis B surface antigen positive, with abnormal liver function
Hepatitis C, RNA positive, with abnormal liver function
Malignancies of solid organs and haematopoietic tissue, including past history of, or currently under treatmentExceptions are:

treated minor skin malignancies (not melanoma)
malignancies where the interval since treatment is such that the probability of cure is > 90%, e.g.: early stage (I & IIA) breast cancer at 5 years; low risk prostate cancer at 5 years; early stage (Dukes A & B1) colorectal cancer at 5 years; childhood leukaemia at 5 years


Solid organ transplants, excluding corneal grafts more than 6 months old
Chronic renal failure or progressive renal disorders
Diseases or disorders such as osteoarthritis with a high probability of arthroplasty in the next four years
Central Nervous System disease, including motor neurone disease, complex partial seizures, poorly controlled epilepsy, prion disease, Alzheimer's and other dementia, and including paraplegia and quadriplegia
Cardiac disease including ischaemic heart disease, cardiomyopathy or valve disease requiring surgical and/or other procedural intervention
Chronic obstructive respiratory disease with limited exercise tolerance and requiring oxygen
Genetic or congenital disorders: muscular dystrophies, cystic fibrosis, thalassaemia major, sickle cell anaemia if more than one sickle crisis in 4 years, severe haemophilia, and severe primary immunodeficiencies
Severe autoimmune disease, currently being treated with immuno-suppressants other than prednisone
In a person up to the age of 21 years, a severe (71-90 decibels) hearing loss or profound bilateral sensori-neural hearing loss
In a person up to the age of 21 years, a severe vision impairment with visual acuity of 6/36 or beyond after best possible correction, or a loss restricting the field of vision to 15-20 degrees
In a person up to the age of 21 years, a severe physical disability, where they are unable to stand and walk without support, and cannot independently dress, eat, hold a cup, or maintain their stability when sitting.

So... I think I should be ok... because I'm not on Prednisone nor is the meds that I'm on now an immuno-suppressant... just an anti-inflammatory! Now to call the US dr to see about getting a letter! They better be open... I'm tired!! (8am there is midnight here!)

[M-Squared]

So I found this on here... http://www.immigration.govt.nz/opsmanual/index.htm

So... I think I should be ok... because I'm not on Prednisone nor is the meds that I'm on now an immuno-suppressant... just an anti-inflammatory! Now to call the US dr to see about getting a letter! They better be open... I'm tired!! (8am there is midnight here!)

Excellent! :nice1 It's a pain in the arse calling around the world isn't it? I rely on www.timeanddate.com/worldclock to figure out *when* it is I'm calling. :)

[Kalla]

i'm sure you'll be fine. Best of luck.

It's frustrating isn't it!! You think you're there and them WHAM - another hurdle.

Fingers crossed for you guys.

[willow]

Hi Renee

I thought you would end up having to do this because of your lupus. i had to see a rheumatologist when we were having the run around from the MA's and that was for a condition I have never had anyway!!

My advice to you would be to get the consultant to answer precisely the questions asked, addressing each one in turn. I printed off the email from the MA and took it with me and left the consultant with a copy and clear instructions to answer each question. I had earlier had a problem because my GP had done a report, but hadn't said I was sat in front of her! the MA sent back an email saying that the gp had not indicated she had actually seen me (so frustrating). I would be very clear and specific about the whole report, but particularly get them to write clearly some thing like "I examined Mrs Pony in my clinic today". Honestly, it is worth the hassle of such specifics as you want to hit a wall when you get a reply from the MA which is so picky.

I think you should be ok, but be prepared for a bit of reports and more reports.

good luck

Willow:)

[Mrs Pony]

So I stayed up until 3 last night... to call the US... and they emailed me back and said...since all i have is joint pain and not a disease he can't really write a letter....

Sooooooooooooooo.......... I don't have lupus!? I'm so lost! My last DR said I did... and now I'm getting I just have joint pain.... ugh.... my head hurts...

I'm bringing ALL my medical charts to the GP to see what they say...

[dusk]

Mrs Pony, looks like the best thing you can do is forward the list of questions you have quoted in your post from the CO/MA to your rheumatologist in the US and get them to write a report on you answering those specific questions (and this is probably the cheapest option even if they charge for a report will likely be cheaper than going to see a new specialist here in NZ)

Do make sure you definitely get the questions answered by the correct specialist, otherwise the MA is likely to ask for another report which does so (here speaks the voice of experience) - if you have medical history which contains any summaries of your condition you can include these too, as it will help back up your case.

[JandM]

My last DR said I didSo who in the US were you getting this 'joint pain' thing from yesterday? Why not talk to the doctor who gave you the lupus diagnosis? As Dusk says, it's very important to give them a connected trail of information.

[Mrs Pony]

I sent my US rheumatologist the email that we got from our CO... but I probably wont hear anything until tomorrow on that...

I had 2 rheumatologist in the US... the first one I went to told me it was Lupus... and the 2nd one (most recent) seems to think its just joint pain/arthritis...

Just got back from the NZ GP ($59 for a consult ouch!) and he said that Lupus is hard to diagnose so he thinks that the rheumatologist doesn't want to say that it IS Lupus because it might not be... If that's the case then I guess the rheumatologist just needs to put that in letter form...

[victoria24]

sounds positive, itll all work out renee

[willow]

Hi Renee

After our experience with medicals and having to submit more and more evidence, which took time and money, my advice to you would be to go straight to a consultant rheumatologist/immunologist in Wellington. get him to examine you, do blood tests for lupus (look on the internet so you know exactly what needs to be taken) and get him to do a report for the MA. From our experience the MA wants to know about the situation now, not a few months ago when you saw someone. We thought reports from consultations last year would suffice, but that just made the MA want up to date info, all of which delayed the process. I would bite the bullet and just go to the top (eg a rheumatologist or even better an immunologist as they specialise in lupus). as soon as we did that our medicals were cleared within days.

be ahead of the game to save yourself the stress, time and ultimately money as i bet will end up having to see a consultant anyway.

[CJ22]

Willow's right.

[Jakarta]

Geez, you are having a rough ride with this process, what with this and your proof of relationship status.

Good luck to you and I hope you get it sorted.

[Mrs Pony]

Our deadline is June 11th! Which seems too close!

Well things are difficult now because we're here in NZ and well the time difference is a killer! We stayed up to 3 am the other night to get a hold of our bank and dr! And the Bank issue...ugh... I don't even want to get into that! My dr in the US emailed me back saying that I don't have lupus based off seeing him from 2006-2009... so I asked him to write that in a letter and send it to me by the 22nd of May... again it's hard because I won't get a response until I'm sleeping!

[JandM]

I'm sure I have seen, in other people's posts on here, the fact that if you give NZIS as much as you have, e.g. copies of your emails asking for information, replies so far, etc., they have the capacity to grant a time extension, as long as they can see that you've been doing your best to meet their requests. So don't panic, and don't leave it till the very last minute to tell them, if you can see there will be a problem getting in in time.

However - this last doctor you spoke to is saying you don't have lupus, but you declared lupus on your forms with the medical, based on the older diagnosis, isn't that right? Well, everything Willow just said is even more relevant, then. With this contradiction in your case, the MA is definitely going to want to have an up-to-date report. You'd save time by not waiting to be told, but arranging to go and be examined straight away.

[Mrs Pony]

So I got the letter from the US Rheumatoidologist... sent that in to NZIS... and now our CO is confused because I put that i have Lupus on the Medicals and now the DR is saying that I don't have it...

Tried to clarify that my first DR said i have it ... and I was 18 (2000) so it stuck... and my latest DR said that I didn't (recently).. he never mentioned Lupus to me since I stated going to him in 2006.

Hopefully our CO will be ok with that... but I have a feeling that I'm going to have to go to a DR here to clear everything up :( Which is MORE waiting... Hopefully everything is done by March 2010 because that's when our WHV's expire!

[Silverwing86]

Hopefully our CO will be ok with that...

Problem is, the CO has no authority to be okay with it or not. They can only send what information you provide on to the MA and they are the ones that have to come to a conclusion on whether or not you would "pose significant costs and/or demands on New Zealand's health and/or education services" (as per Appendix 10).

As someone who has gone through the whole MA rigamarole as well, I agree with Willow. Get a current report from a relevant specialist (it being a specialist is crucial, GP's do not carry any weight whatsoever with INZ !) which is as unambiguous as possible. If the specialist can unequivocally state that you were misdiagnosed and there is no issue to speak of, all the better.

It is a very difficult and stressful time to go through (and I know, it took us over a year :uhoh, but we did get through successfully !), but don't give up ! If nothing else, it shows you have stamina and determination, and won't give up easily when things get tough, right :D ?

The very best of luck to you. Have been following your story for a while now and can't wait to read the message that you can finally settle because everything has been sorted :nice1 ! Will be keeping fingers and toes crossed for you...

Cheers,
Silver

[JandM]

Silver is absolutely right, it isn't up to the CO to decide on this - they have to send medical matters to be assessed by an MA. All your CO is trying to do is to understand what your health situation truly is. You have told them why you put 'lupus' on the form, although you now think that was wrong, but quite honestly, your reason for doing it doesn't matter.

Just like when you posted before, the MA is going to look at the form, which says one thing, and the doctor's letter saying the other thing, and ask, 'Okay, which one is true?' The only way s/he can be sure is to have you looked at by a specialist, now. Like Willow said three weeks ago -


From our experience the MA wants to know about the situation now, not a few months ago when you saw someone. We thought reports from consultations last year would suffice, but that just made the MA want up to date info, all of which delayed the process. I would bite the bullet and just go to the top (eg a rheumatologist or even better an immunologist as they specialise in lupus). as soon as we did that our medicals were cleared within days.

be ahead of the game to save yourself the stress, time and ultimately money as i bet will end up having to see a consultant anyway.

[Mrs Pony]

Well the medicals were filled out by my Primary (GP) ... the letter that I just got from the DR was my Specialist...

Our CO is the one that emailed us... and that's who i wrote back to... so who ever looks at it I hope it's ok...

[JandM]

Yes, but the CO and the MA don't know how to choose who is telling the truth, between the two doctors in the past saying different from one another.

They'll want a new, top, specialist to look at you, now, and say what s/he finds. That's why people are suggesting that YOU ask to be referred to an immunologist in NZ, because that would save time if you don't wait to be told to do it.

[Mrs Pony]

Got an email from our CO saying that he's sent everything to the MA... So I'm guessing that our Relationship issue is cleared up... So hopefully it will be a week or so until we know what the MA says... I've already made an appt with a GP to see about getting a referral for a Rheumatoidologist because with our luck I'll need to see a DR here...

PLEASE keep us in your prayers & thoughts... and send some good luck our way... OH is still looking for work (he's the Primary) and has an interview next week with an AV company that seems promising! But he's getting down since he hasn't had any bites and is applying for jobs everyday.

Next week is the last week I'll have my trainer there (taking maternity leave) so I'm getting a bit nervous about that... but i think i'll be ok... the only thing is that she's the only one that does this job so I don't really have anyone to ask about anything other than her! eek!

Other than all that .... everything is super!

[victoria24]

:nice1

[Sheldon]

Hang in there!

[M-Squared]

Sweet as! :nice1

[Kalla]

Hang in there. Sounds like things are moving along for you guys (although slowly!) - you'll get there in the end!

[Mrs Pony]

I sure hope so... OH is getting depressed because he can't find work and he's applied for everything! and still can't even get an interview... There is one job he applied for with some film company but it doesn't close until July 16th... so it's just more waiting... Which seems to be our life story!

[NJ2NZ]

Hang in there, Mrs. Pony! We're dealing with an MA request for opinions of two specialists and my GP. Doesn't appear MA has any clear idea of what s/he is looking for. But we'll play along (fortunately judging by the numbers cited, its relatively cheaper to speak to a specialist here - with insurance) and see what the next email will bring. It didn't begin very auspiciously. Sending an email requesting the status of the application, we learnt from the CO that she sent out docs to us by DHL ten days earlier - obviously we hadn't received them. A frantic search eventually located the package with the management office of the condo where we live. But that's ten precious days lost on a 30-day deadline! we're hoping to make it nevertheless. The big question is whether the MA will be convinced by the opinions the docs are sure to give - nothing seriously wrong and no reason for concern. Well, what can we do but to wait and hope for the best!

Again, hang in there - if your US doctor didn't see any reason for keeping you on medication I doubt if the MA can find anything to reject the application.

[Mrs Pony]

Yea I mean the only meds I'm on is Voltaren which is sold over the counter here in NZ and I've been doing just fine... even with this crazy winter weather! And it's not like I'm going to die if i don't take it! So I really don't see how I would be considered a "burden"...