Medical conditions - renal failure

[babscat]

We shall be submitting our application under the Parent Category in September and are doing all we possibly can to avoid the need to provide further information once we are eventually allocated a case officer.
I am 70, OH 76, so medicals are a quite a concern.
To our dismay, OH recently discovered that his medical records show stage 2 renal failure, which is an appendix 10 condition - an automatic refusal for PR!!
According to his Dr this is not a problem as it is well controlled by medication and is a common condition in men of his age.
I realise we can apply for a medical waiver, but it seems a comparatively trivial and well condition. He is fit and active in every way (plays 18 holes of golf 3 times a week and painted the outside of our house this summer!)

It would be great if anyone can offer any hope or advice!

[phpalix]

That's a tough one.

Note: I have no experience with this in anyway but I see it this way:

Their purposes from requiring STRICT medical tests are:
1- protecting people living in NZ from diseases that could be brought with the immigrants.
2- trying to avoid treating someone on the country account.

As your OH condition won't endanger other people, then you are clear with number 1.

As for number 2, how about offering to buy a health insurance package? or trying to communicate to them that you wont need their money for your medication.

From what I can conclude from their manual, your chances are slim, but even trying is better than just letting go something you want.

best of luck.

[babscat]

Thanks for replying, phpalix. Needless to say your reply wasn't quite what I had hoped for!!

The term Chronic, according to our doctor simply aplies to a condition that is not curable, and doesn't mean you cannot live a normal life if it is controlled by medication. My post should have read "a well managed condition" I unfortunately omitted the important word! There can't be many people of this age who are in perfect health, though I know there are no concessions in the medical for oldies.

The term "renal failure" sounds frightening but the doctor assures him it is very common in older people and nothing to worry about. (The controlling medication is inexpensive.) On the other hand, its part of a doctor's job to be reassuring, nor does the appendix doesn't give any exceptions!

We discussed our NZ application with the doctor and he and he saw no reason why there should be any problem. We shall just have to keep our fingers crossed.

Any more thoughts/comments very welcome!

[JandM]

Sympathies. All of us hoping to go the parent route will have concerns about the medicals, I'm sure. I can well understand you were hoping not to have to be involved with the MAs, but it's happened.

I'm afraid it's no use you or your doctor trying to argue against the rules being what they are - that way lie frustration and wasted energy. The only difference anyone could make at the MA stage would be if a doctor could say, 'No, he hasn't got renal failure, it's something else.' Almost certainly your CO will tell you at an early stage of considering your case that you need to apply for a medical waiver. Then you can supply evidence of the low level of medical support and small amount of medication needed, and also the advantage to your children of having you nearby, and their contribution to NZ.

[phpalix]

babscat, Pleas don't get me wrong, I just tried to explain my understanding of what they wanted to achieve with the medical tests. I believe that the CO is a person who's job is making sure that the specifications are met. Your doctor might be right with not seeing a reason for not approving the application. but at the same time, the immigration guys will always refer to the specification given to them.

As JandM suggested, you will need your medical waiver to convince them.
I am not sure if I saw that on this forum or somewhere else, but the MA is mainly about the probability of a person needing expensive medical treatment in specific time interval, so he would be thinking about the chance your OH needing more complicated medications, when and how expensive. so maybe its a good idea to try explaining to them how the medication needed is not expensive.

Also as stage two is early, you could try to explain to them (consulting your doctor) about the probability of going into more advanced stages (I would mention time needed with the chances).

I believe their main concern will be the need for dialysis, so maybe you could use that as an argument your doctor should be able to provide you with some information you could use to write better statements built on scientific opinion.

Once again, I really wish it goes well.

[babscat]

Thanks for replies phpalix and JandM!

phpalix - no problem! I understand only too well what you mean. It's myself I'm trying to convince! Best laid plans, etc!

I shan't have any problem finding reasons for a medical waiver so all is not quite lost yet!

[JandM]

phpalix, I think you would perhaps better understand the situation about NZ immigration medicals if you were to look at this link. http://www.immigration.govt.nz/opsmanual/i10008.htm See A4, F4.1.c, and Appendix 10.

I know you mean kindly, but what you're saying without knowing these rules isn't to the purpose. It isn't any use anyone trying to change the system or disputing the rules NZ immigration have in place - everyone has to work within the framework that is already there.

Babscat, all the best. (((())))

[KatieBen]

A few thoughts -

1) GFR (measure of kidney function) declines every year after around 60 so a figure that might suggest chronic kidney disease stage 2 (CKD2) in a 30 year old may be normal in a 76 year old.

2) you say your husband was only recently aware - did the medical pick it up? Mild renal impairment is very common in people with high blood pressure (with or without treatment) and if this is the case it may not be an appendix 10 condition (ie progressive).

3) an appendix 10 condition isn't an automatic bar to PR (or we wouldn't be here) - but it does make it a bumpier ride to get there!

What the MA is lookng for is cost of continuing treatment (less than $25k over a reasonable life expectancy), likelihood of progression to CKD 5 (end stage, requiring transplant or dialysis), cost of ongoing follow up / investigations.

Limited resources dictate stringent rules unfortunately. I tried to suggest that we agree to have private medical insurance when our application hit a similar hurdle but we were told that once they grant PR it is an automatic entitlement to public healthcare, such provisions cannot be enforced.

Probably no bad thing, I doubt any company would take us on without excluding pre existing conditions - and if they did we probably couldn't afford the premiums!

Best of luck with your application.

[bjtk1972]

I'm sorry to hear that, it must have come as a shock. I can't offer any advice regarding renal failure affecting your application but as a renal transplant patient, I can give you some information about kidney issues.
I hope not to come across as being pessimistic but it's best to talk about these things frankly. Unfortunately, whichever way you look at it, chronic renal failure will result at some point, in the patient requiring a transplant or going onto dyalisis. Obviously, depending on the patient's age and the rate of decline, other 'natural causes' may well come into play before this. Much in the same way that prostate cancer in older men is not usually a cause of death, as it can be a slow growing cancer and the body 'wears out' naturally before the cancer is responsible for a person's death. I'm sure that at the sprightly age of 70 (my parents recently turned 70) you're thinking 'but 70's not that old!' so take heart take heart knowing that you could live another twenty years before your renal impairment began to affect your day to day life and dyalisis became a necessity.
As with medical monitoring, I imagine Immigration would be interested in your routine creatinine levels as well as your Creatinine Clearance. Obviously, if you've been unaware of any problems there won't be any history of blood tests but you can ask the GP for an FBC blood test, which will show these figures. Creatinine is a waste product, normally processed by the kidney's and pee'd away. As the kidney's function lessens, this waste product is not removed from the blood and stays in the body. At low and mid levels, it's not particuarly damaging in itself but as it is a toxin, it is dangerous in higher levels - by which I mean around 800 (normal Creatinine is around 50-90 in women and 90-150 in men), at which point a person would feel very unwell and particuarly lethargic. As a point of reference, my Creatinine was 222 at first measure and gradually increased over time until it was around 800 two years later, after which I had a transplant. HOWEVER. my condition was a specific Chronic GFSS, which causes the kidneys to decline rapidly, while age releted renal decline is normally much less aggressive. I think most patient's concern comes from the word 'Failure' - Perhaps the NHS should look at changing it to 'Declining Function' or something!
What I do think might affect Immigration's decision is that you have no data from monitoring. Regular blood tests over a period of time (12-24 months perhaps) is the only reliable way to build up a picture of what the kidney's are actually doing and what speed the decline is. Also, a biopsy can give a snapshot of damage to the kidney, highlighting any particular areas for investigation. This process can seem scary and daunting but if your Doctor isn't referring you for one, then he won't be that concerned about your renal function.
Also bear in mind that once off the NHS register for more than 3 months, you are no longer intitled to NHS care whilst in the UK (with the exception of Emergency care). This catches a lot of poeple out who retire to Europe and return for treatment. And continuing to pay NI does not exempt you from this! I'm not sure if it's differnt for, er, maturer people but worth looking into.
When we emmigrate to Welly in six weeks, it'll be a big step for me to sign off the NHS after 12years of care and support. And even though medical care in NZ is of a high standard and similar to the UK, it's a big decision as a patient. It's worth pointing out though that if your return to the UK to live after living abroad, you will be reinstated within the NHS system and entitled to free care.
Anyway, I wish you well in your health and your application, please ask me any other questions you may have
BK

[KatieBen]

I hope not to come across as being pessimistic but it's best to talk about these things frankly. Unfortunately, whichever way you look at it, chronic renal failure will result at some point, in the patient requiring a transplant or going onto dyalisis.

This depends very much on the cause of the renal failure. Not every cause is progressive and even then, some cases can be managed medically such that they never progress to end stage renal failure. So it's not that any way you look at it you'll end up on a transplant list or dialysis though I expect your own experiences have coloured things a little.

Good control of blood pressure, cholesterol, weight, lowering salt intake, not smoking, avoiding painkillers like ibuprofen - all will help.

Babscat, I would wait and see what your GP suggests (or renal physician if your OH is referred to one) before worrying too much.