Enlarged Spleen and low platelet count

[samster]

Hi

Hope somebody can help with some advise. My parent's PR application has been processing for >1 year and now the MA has come back and said that as my fathers spleen is enlarged and low platelet count (not sure how much) they need us to send details from a suitably qualified medical professional regarding those diagnosis. But for now they recon he has/or may have a chronic condition Cirrohis? which will cost >$25000

My father has gone to his GP and GP has requested to see the diagnostic details that was forward to immigration last year. I sent a letter to CO but not heard back.
Spoke to a friend who is a Dr; he said that enlarged spleen and low platet count go hand in hand. My dad is 75 and healthy. I have been going through forums and found that if the first medical officer declined saying some reason then it's unlikely to change.

My father's condition does not fall under the list of appendix 10 conditions.

Has anybody got any experience around ultrasound results similar to this? specially enlarged spleen? what other tests need to be done? do we get the GP to do tests and send results? or will we need to wait until MA requests tests? or do we just send a letter from GP saying what his thoughts are?

Thanks
Sam

[JandM]

Hello and welcome.

Sorry to hear your father has run into a problem.

From what you say here, the MA has already asked for what they want - "they need us to send details from a suitably qualified medical professional regarding those diagnosis." Was it the doctor at the medical for NZ immigration who FIRST mentioned these conditions to your father, or another? (It sounds as if his GP wasn't aware of it, so I guess, the former.)

The MA hasn't declined your father's case yet - they've asked for further clarification. In your shoes, I wouldn't wait for the CO to send anything back. You don't have time to hang about on this - if there is no reaction from you, the system is likely to assume you are accepting this worst-case guess from the MA. Unless the letter from NZIS actually mentioned a specialist, the first thing is to ask the GP to look him over and test for these conditions again. Regardless of what the readings were at the time of the medical, he can then give his opinion on what he finds, e.g. this is a perfectly healthy person and any previous readings must just have been a glitch, or this slightly low reading is due to x and I'm treating it with y and expect it to be cleared up in two weeks, and (it is to be hoped) this is definitely not due to cirrhosis. It is important for MA purposes that at each stage, the doctor gives an opinion on what the condition is NOW, gives details of any treatment being given, and the prognosis in the short and long term. If the GP doesn't feel competent to give such opinions, then your father needs to ask to be referred to a specialist. Note that the MA may insist on hearing from a specialist in any case, even several times, to be satisfied that this is not a long term condition with expensive treatment.

All the best.

[samster]

My father went to see a specialist after the first medical was done as requested by the initial visa officer. He has told my father that he doesn't have a serious condition to be worried about; just eat healthy and he'll be fine. But I am not sure what he wrote in his report as it was sent off to immigration directly.
As he is the person who examined my father and as he is an approved NZIS specialist I think his opinion will carry weight. That's why I asked for what his comments were. He is a highly qualified gastroenterologist.
As I have emailed the CO wouldn't that count as response from our end at this point of time?
His GP says that It's quite difficult to answer concerns without knowing what these were based on.
CO has given us a deadline(within a month) to send additional medical opinions.

Thanks
sam

[JandM]

I see what you mean. However, you can't rely on everything that happens with MAs and COs seeming logical - a lot of people on the forum have found that the only way to get to the other end of the process is to jump through hoops as set.

You say they've asked for additional medical opinions, and with what's at stake, can you risk their not agreeing that the first specialist's report is enough?

I'm not surprised to hear about the month deadline, and this isn't long to fit in a consultation and for the paperwork to be done.

(If you want to know detail of what the first specialist said, could your father not ask for a copy of what he sent to immigration? - he'd have the right, as he's the patient, I would think.)

[samster]

Yes my fathers has asked for a copy of what he sent to immigration. Yes I think he should have the right as a patient. It doesn't say anywhere that they will not give info.

I guess even the month's deadline; if we give a logical reason to say we need some more weeks they will agree. Has somebody got any experience with a CO not agreeing to that?

[KatieBen]

First up - hello

With regard to your father's medical - the problem is that there are many causes for an enlarged spleen, some of which may be on appendix 10 but many of which aren't. The low platelet count is almost certainly related to the enlarged spleen.

What the MA needs to have confirmed is the underlying diagnosis causing this - by itself, an enlarged spleen isn't a diagnosis, it's a clinical finding. Your father needs to have this fully investigated (which may involve more blood tests, or imaging of his abdomen like an ultrasound or CT scan) to determine why his spleen is enlarged.

Once he has a formal diagnosis, the specialist can determine what sort of treatment - if any - is needed. Some people may need their spleen removed surgically, some people may need medication, some people don't need any treatment at all. With this information, the MA can assess what sort of cost your father will impose on the NZ health system to decide whether he meets an acceptable standard of health.

I would imagine this would certainly take longer than a month to organise within the NHS (you don't state where your father is but many people here are from the UK so apologies if this assumption is incorrect).

The CO has no reason not to agree to an extension to allow the relevant investigations to be performed that I can see. Our application was also delayed with medical issues and the CO agreed to extensions of the deadlines each time they were requested.

What your father needs to do is see his GP and take with him a copy of the medical and the MA letter. His GP should be able to arrange any further investigations of his splenomegaly if needed in the first instance and then refer on to a hospital specialist if this is necessary. The original specialist that you say your father saw who said there was nothing serious to worry about should also be able to give you a copy of what he sent to immigration.

Unfortunately the MA needs to have in black and white a diagnosis, likely prognosis and outcome together with any future treatments which may be required so they can put a figure on it. That figure has to be sub $25000 and they seem to assume worst case (i.e. most expensive) if they don't have clear cut information to go on. Even with a letter saying "nothing serious" they will still want to know the exact diagnosis - again, it all comes down to money.

Good luck with it all, I hope your father's application ultimately goes through OK!

[sophiedb]

What KatieBen said

I didn't get any joy from the MA until I asked my oncologist to answer every single point in that letter, in bullet point format. That did seem to do the trick!