Hello George,
I have a concern. I was diagnosed back in October/03 with Hep C. I can't really see it as a problem if I decide to rejoin Uechi; I probably had the virus for the last 25 years and am now into Chinese Medicine, that seems to be helping; hopefully, I won't have to get into Interferon treatment. I'm now waiting on a liver biopsy, yet my enzyme count is within the normal range.
The only way it can be spread is through blood to blood contact, and I can't see a problem there, unless I force myself on someone to be a blood brother. Other than that, I guess I would just have to try to avoid any solid "shots" to the liver when doing any kind of sparring. I feel I would have to have the moral responsibility to inform my instructors as well as fellow students. I
guess my biggest fear would be ignorance and discrimination; as a result, being treated differently within the Do-Jo. This has been keeping me back from rejoining a Ueich-Ryu club. What do you think?
Serious issue...
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gmattson
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Serious issue...
I received this email last week. I suggested that the student discuss his condition with the instructor he wanted to work with. I learned today that the teacher refused to allow the student to join his dojo. Any comments/suggestions from our readers?
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Bill Glasheen
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This is very unfortunate...
For a long time, medicine wasn't aware of the existence of Hepatitis C. Consequently it existed in the blood supply for a number of years and spread to a good number of people through routine transfusions associated with standard medical procedures.
The disease is very serious, but it is difficult to get without tranfusion or other direct means. Now that it can be identified, it can be contained somewhat. The truth is that we all should treat bodily fluids as potential poisons in the dojo, and not worry so much about any one student. If someone starts bleeding, they must stop and the blood must be cleaned up.
Do I understand the instructor who wants to keep the Hep-C-positive student out of his dojo? Well...it's his/her prerogative. Here in Virginia, a court backed up an instructor's desire to keep an HIV-positive student out of his dojo. It cost the school owner a legal fortune but...he won and the HIV+ student is out. Is there a place for such a student in any dojo? Probably. Does a person have a moral obligation to inform an instructor of his/her status before joining? That's a good question, and one you should ask your doctor. Let's just say that I have the greatest respect for this individual's desire to be open. I think he did the right thing.
There is always plan B. One could find a dojo where one could do forms and exercises alone, and not put others at risk through contact work that could lead to cuts and blood spilling. One could also join a general gym and do weight lifting and general aerobic work.
- Bill
For a long time, medicine wasn't aware of the existence of Hepatitis C. Consequently it existed in the blood supply for a number of years and spread to a good number of people through routine transfusions associated with standard medical procedures.
The disease is very serious, but it is difficult to get without tranfusion or other direct means. Now that it can be identified, it can be contained somewhat. The truth is that we all should treat bodily fluids as potential poisons in the dojo, and not worry so much about any one student. If someone starts bleeding, they must stop and the blood must be cleaned up.
Do I understand the instructor who wants to keep the Hep-C-positive student out of his dojo? Well...it's his/her prerogative. Here in Virginia, a court backed up an instructor's desire to keep an HIV-positive student out of his dojo. It cost the school owner a legal fortune but...he won and the HIV+ student is out. Is there a place for such a student in any dojo? Probably. Does a person have a moral obligation to inform an instructor of his/her status before joining? That's a good question, and one you should ask your doctor. Let's just say that I have the greatest respect for this individual's desire to be open. I think he did the right thing.
There is always plan B. One could find a dojo where one could do forms and exercises alone, and not put others at risk through contact work that could lead to cuts and blood spilling. One could also join a general gym and do weight lifting and general aerobic work.
- Bill
I realize there is a remote possibility of "blood spill" ; maybe in full contact sparring, but come on, in Bunkai, and pre-arranged Kumite!?!?!? Especially where padded sparring boots and gloves for hands and feet are now available. If we're going to be this discriminating, lets screen for Hep C, and watch the current worlwide Uechi membership Drop! You'd be surprised! As Gichin Funakoshi once said; "Karate is not only for the young and strong - it's for everybody."
Running the risk of catching Hep C is no different than a freak accident of a broken neck or back from day to day activity within the dojo.
Running the risk of catching Hep C is no different than a freak accident of a broken neck or back from day to day activity within the dojo.
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Bill Glasheen
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Absolutely. All it takes is one student who hasn't trimmed his/her nails. I think I've personally spilled blood twice in the past few months. Once was from some work with a student with long nails (shame on her...). The other was from a collision of my shin with another student's knee. I don't seem to bruise so much any more, but the scraping contact drew blood.I realize there is a remote possibility of "blood spill" ; maybe in full contact sparring, but come on, in Bunkai, and pre-arranged Kumite!?!?!?
My point? Blood will get spilled in a contact activity, and martial arts (even point sparring and prearranged kumite work) is a contact activity. We must treat ANY blood with great care. Am I suggesting that this person therefore should not be in a karate dojo? Not necessarily. But I do believe that he should first talk with his doctor - for MANY reasons.
Nevertheless I share your feelings, KGD, and thank you so much for speaking from the heart. I don't have the hard statistics in front of me, but you're not far off when you characterize the risk to others as negligible.
- Bill
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Bill Glasheen
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Here's a good website that can help folks understand more about the disease.
All About Hepatitis C
On the website is a FAQ section. I thought I'd share these Q&A's.
Again with all blood, you must assume the worst and practice "standard precautions."
- Bill
All About Hepatitis C
On the website is a FAQ section. I thought I'd share these Q&A's.
Serious stuff... Note the use of the term "sterilize" even when talking about common kitchen utensils exposed to HCV blood. The virus can live on dry surfaces for some time.Q: How can I avoid spreading hepatitis C to my family?
A: Hepatitis C is spread by exposure to HCV-infected blood. To avoid spreading hepatitis C, you should minimize these types of exposures. Don't share any instrument that can carry blood on it, such as toothbrushes, nail clippers, razors, etc. If you have any cuts or open wounds, treat them immediately and cover them with the appropriate type of bandage. If you get cut with any household instrument such as a knife or can opener, treat the cut and sterilize the instrument (by boiling it in water) before using it again.
...
Q: Should I tell my dentist that I have hepatitis C?
A: It is important to tell your dentist and other health professionals that you have hepatitis C. Your dentist needs to take precautions since oral surgery and even routine dental procedures can involve exposure to blood and therefore has the potential to spread hepatitis C. Similarly, if you are having blood drawn for any purpose, inform the phlebotomist (the person who draws your blood) that you have hepatitis C so that he or she can take the necessary precautions to avoid needlestick injuries.
Again with all blood, you must assume the worst and practice "standard precautions."
- Bill
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Dana Sheets
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Physician I know recently told me that the conversion rate for a Hep C+ needle stick was 3%. That's direct fluid to fluid contact. Course I need to go find backup for that number. In any case, people need to be as informed as possible so they can make informed decisions.
Dana
Dana
Did you show compassion today?
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Stryke
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Dana Sheets
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http://www.medicine.mcgill.ca/ugme/infectioncontrol.htm
The conversion rates for HBV HCV and HIV are low on the page. Hep C shows up at 3%.
Dana
The conversion rates for HBV HCV and HIV are low on the page. Hep C shows up at 3%.
Dana
Did you show compassion today?
My uncle passed away from Hep C about a year and a half ago. I think that the Interferon Treatment is what killed him! It was definately as bad as watching my Dad die of cancer and beign sick from the cemotherapy.
I also have another aunt, her ex-husband my and my uncles first wife all have Hep C. This disease is going to kill two uncles and two aunts , at least before it is done!
However, the doctor's in Pitt. told us that it would be very difficult to "catch" Hep C. through normal interactions. When you talk about blood contact you need a good amount of contact!
My heart goes out to the student! The guy just wants to train. I f he was at my school I would train w/him. I would also spar w/him no problem! However, I could see wear others would be nervious abiout training w/him.
I think that a couple of precuatuions could really minimize the opportunities for it to spread. ie Wearing a headgear while sparring that has the bars or shield to protect the face of the student against broken or bloody nose! This is always the way I hace seen the most blood spilled in class or tournament.
Also, doing a quick finger and toe nail check on the class beforehand, which the students should already be doing individualy. And I would have him wear a Tae Kwon Do chest protector to help and shots to the body for his own helath.
I also have another aunt, her ex-husband my and my uncles first wife all have Hep C. This disease is going to kill two uncles and two aunts , at least before it is done!
However, the doctor's in Pitt. told us that it would be very difficult to "catch" Hep C. through normal interactions. When you talk about blood contact you need a good amount of contact!
My heart goes out to the student! The guy just wants to train. I f he was at my school I would train w/him. I would also spar w/him no problem! However, I could see wear others would be nervious abiout training w/him.
I think that a couple of precuatuions could really minimize the opportunities for it to spread. ie Wearing a headgear while sparring that has the bars or shield to protect the face of the student against broken or bloody nose! This is always the way I hace seen the most blood spilled in class or tournament.
Also, doing a quick finger and toe nail check on the class beforehand, which the students should already be doing individualy. And I would have him wear a Tae Kwon Do chest protector to help and shots to the body for his own helath.
"Thinking is a lost art"
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benzocaine
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Bill Glasheen
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From the McGill University website...
Interesting to see McGill's policy about HBV+ and HCV+ individuals considering a career in medicine.
This definitely puts it in perspective.HBV has a sero-conversion rate of approximately 30% in unvaccinated individuals.
HCV has a sero-conversion rate of approximately 3%.
HIV has a sero-conversion rate of approximately 0.3%
Interesting to see McGill's policy about HBV+ and HCV+ individuals considering a career in medicine.
- BillStudents who are seropositive for Hepatitis B and/or C have an obligation to notify the Dean's Office upon entry into the program. ... Students will be advised not to select residency programs where patient safety would be put at risk. This will severely limit the residency programs to which the student may apply.
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Dana Sheets
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Regardless of the stats, the fear will persist, because the risk is not zero--and because the conversion rate for HCV is 100%, if you're the one that gets it.
It's true we sign up for risk when we join a dojo, and that may include the one in a million risk of death by broken neck in freak sparring accident. But that's a tangible risk. We don't want to be surprised to find out there's a similarly small but unanticipated risk of the floor caving in because it's not to code, or or getting kyusho'd unexpectedly, or of infection. Nothing will change that. People sign waivers to join martial arts clubs that mention the risk of injury. Unless they've signed that there are members with hep C they might unknowingly spar with, they shouldn't unnecessarily face this risk. If that's the minute risk they're going to face, they ought to give informed consent for that risk. I imagine many would. If no one will, then there's lots of other things to do in karate class.
There is the issue of the privacy of the HCV positive patient. People may make assumptions about their health, mistakenly assume things about their infectivity, or guess how they got it (since IV drugs, coke straws, and blood transfusions before testing was widespread were the major routes). One does have to balance these issues. I don't fault HIV+ Greg Lougainis for not asking the whole pool be bleached down when he cut his scalp doing a dive. One has to consider what the risk of infection is to others. You don't have to admit to HCV positivity before shaking hands, so why before most dojo activities? I've seen plenty of cuts and scrapes in prearranged kumite and that activity should be discussed before starting. This can be a tough issue--I for one disagree with the recommendations that HCV + people tell their dentists and phlebotomists. Why on earth? So they can "take precautions?" They should be taking precautions on everyone anyway, since so many people don't know about their infections or won't say. Hearing your patient has HCV is just going to make you more nervous about the procedure which may increase erros anyway, and if you're going to refuse to do the work, you ought to have chosen another career. All the recapping of needles, insufficient eye wear, and insufficient handwashing you can see at any medical facility any time you like is a sad reminder that universal precautions would work better if they were universal and the burden is not on the patient but the provider.
Other data:
"EPIDEMIOLOGY — The prevalence of HBV carriers varies from 0.1 percent to 2 percent in low prevalence areas (United States and Canada, Western Europe, Australia and New Zealand), to 3 to 5 percent in intermediate prevalence areas (Mediterranean countries, Japan, Central Asia, Middle East, and Latin and South America), to 10 to 20 percent in high prevalence areas (southeast Asia, China, sub-Saharan Africa) (show table 1) [1,3]."
It's worth noting that there is a cheap, safe, and effective vaccine for HBV. I for one never have to worry about infection with it again. I had the series and to work where I do, even proved I mounted a good response. There is also a prophylactic immunoglobulin treatment for HBV exposures that can prevent infection.
"EPIDEMIOLOGY — The Centers for Disease Control estimates that the number of new cases of acute hepatitis C virus (HCV) infection in the United States has fallen from approximately 230,000 per year in the 1980s to its current level of about 36,000 cases per year [1]. The decline relates primarily to reduced infections in injection drug users, a probable consequence of changes in injection practices motivated by a concern for HIV risk. The number of cases of transfusion-associated acute hepatitis C decreased significantly after 1985 and has been reduced almost to zero [2]. Thus, transfusion-associated hepatitis has had little impact on the recent change in the incidence of HCV infection (show figure 1A-1C).
The prevalence of antibody to HCV (anti-HCV) in the United States ranges from 1.4 percent (early blood donor studies) to 1.8 percent (National Health and Nutrition Examination Survey, NHANES III) [3]. Using these samples, it is estimated that there are 3.9 million persons with antibodies to HCV in the United States of whom 2.7 million are viremic [4]. Chronic hepatitis C is the most common chronic liver disease and accounts for 8,000 to 13,000 deaths each year. The majority of liver transplants performed in the United States are for chronic hepatitis C."
There is no vaccine for HCV, although acute infection can be treated: "A more recent trial that was not included in the meta-analysis involved 44 patients identified within four months of acute infection who were treated with interferon alfa monotherapy (5 MU subcutaneously daily for four weeks followed by 5 MU subcutaneously three times weekly for 20 more weeks) [4]. The majority of patients were infected with genotype 1 (61 percent). Twenty-four weeks after the end of treatment, 98 percent were HCV RNA negative, a rate of clearance that was much higher than would have been expected to occur spontaneously. Therapy was well-tolerated..."
I am unaware of any data that supports chest protectors in HCV positive people more than in HCV negative ones. Nothing about HCV makes the liver more fragile or susceptible to trauma, and if there was a significant risk of liver trauma in routine sparring, we'd have bigger problems than dealing with HCV related lacerations--namely we'd all be at risk and far more people without than with HCV would be getting hurt.
It's true we sign up for risk when we join a dojo, and that may include the one in a million risk of death by broken neck in freak sparring accident. But that's a tangible risk. We don't want to be surprised to find out there's a similarly small but unanticipated risk of the floor caving in because it's not to code, or or getting kyusho'd unexpectedly, or of infection. Nothing will change that. People sign waivers to join martial arts clubs that mention the risk of injury. Unless they've signed that there are members with hep C they might unknowingly spar with, they shouldn't unnecessarily face this risk. If that's the minute risk they're going to face, they ought to give informed consent for that risk. I imagine many would. If no one will, then there's lots of other things to do in karate class.
There is the issue of the privacy of the HCV positive patient. People may make assumptions about their health, mistakenly assume things about their infectivity, or guess how they got it (since IV drugs, coke straws, and blood transfusions before testing was widespread were the major routes). One does have to balance these issues. I don't fault HIV+ Greg Lougainis for not asking the whole pool be bleached down when he cut his scalp doing a dive. One has to consider what the risk of infection is to others. You don't have to admit to HCV positivity before shaking hands, so why before most dojo activities? I've seen plenty of cuts and scrapes in prearranged kumite and that activity should be discussed before starting. This can be a tough issue--I for one disagree with the recommendations that HCV + people tell their dentists and phlebotomists. Why on earth? So they can "take precautions?" They should be taking precautions on everyone anyway, since so many people don't know about their infections or won't say. Hearing your patient has HCV is just going to make you more nervous about the procedure which may increase erros anyway, and if you're going to refuse to do the work, you ought to have chosen another career. All the recapping of needles, insufficient eye wear, and insufficient handwashing you can see at any medical facility any time you like is a sad reminder that universal precautions would work better if they were universal and the burden is not on the patient but the provider.
Other data:
"EPIDEMIOLOGY — The prevalence of HBV carriers varies from 0.1 percent to 2 percent in low prevalence areas (United States and Canada, Western Europe, Australia and New Zealand), to 3 to 5 percent in intermediate prevalence areas (Mediterranean countries, Japan, Central Asia, Middle East, and Latin and South America), to 10 to 20 percent in high prevalence areas (southeast Asia, China, sub-Saharan Africa) (show table 1) [1,3]."
It's worth noting that there is a cheap, safe, and effective vaccine for HBV. I for one never have to worry about infection with it again. I had the series and to work where I do, even proved I mounted a good response. There is also a prophylactic immunoglobulin treatment for HBV exposures that can prevent infection.
"EPIDEMIOLOGY — The Centers for Disease Control estimates that the number of new cases of acute hepatitis C virus (HCV) infection in the United States has fallen from approximately 230,000 per year in the 1980s to its current level of about 36,000 cases per year [1]. The decline relates primarily to reduced infections in injection drug users, a probable consequence of changes in injection practices motivated by a concern for HIV risk. The number of cases of transfusion-associated acute hepatitis C decreased significantly after 1985 and has been reduced almost to zero [2]. Thus, transfusion-associated hepatitis has had little impact on the recent change in the incidence of HCV infection (show figure 1A-1C).
The prevalence of antibody to HCV (anti-HCV) in the United States ranges from 1.4 percent (early blood donor studies) to 1.8 percent (National Health and Nutrition Examination Survey, NHANES III) [3]. Using these samples, it is estimated that there are 3.9 million persons with antibodies to HCV in the United States of whom 2.7 million are viremic [4]. Chronic hepatitis C is the most common chronic liver disease and accounts for 8,000 to 13,000 deaths each year. The majority of liver transplants performed in the United States are for chronic hepatitis C."
There is no vaccine for HCV, although acute infection can be treated: "A more recent trial that was not included in the meta-analysis involved 44 patients identified within four months of acute infection who were treated with interferon alfa monotherapy (5 MU subcutaneously daily for four weeks followed by 5 MU subcutaneously three times weekly for 20 more weeks) [4]. The majority of patients were infected with genotype 1 (61 percent). Twenty-four weeks after the end of treatment, 98 percent were HCV RNA negative, a rate of clearance that was much higher than would have been expected to occur spontaneously. Therapy was well-tolerated..."
I am unaware of any data that supports chest protectors in HCV positive people more than in HCV negative ones. Nothing about HCV makes the liver more fragile or susceptible to trauma, and if there was a significant risk of liver trauma in routine sparring, we'd have bigger problems than dealing with HCV related lacerations--namely we'd all be at risk and far more people without than with HCV would be getting hurt.
--Ian
I'm the guy with the Hep C by the way, and yes I have a jaded past. Ironically, it was the martial arts that initially turned my life around, and smartened me up, with thanks to Sensei Loui and Sensei Clayton, along with a lot of pain,sweat, and hard work. I trained back in the eighties and early ninties without knowledge of myself being a residing place for this deadly virus. Here I am now a man of 42 to who at times feels isolated, confused and misunderstood. Perhaps I just want to feel "normal" and/recapture that nostalgia of that small Dojo on Portland St. Dartmouth where I once trained, where I first met Sensei Hopper. He took a beaten down recovering drug addict under his wing helping to show me how to persevere in the face of adversarial life situations, and with his help, taught me to believe in myself, and to overcome my deamons. Isn't that what martial arts is all about? Hell, I 'll go toe to toe with anyone, if they threaten to harm a loved one or myself, and I can hold my own if I want....always could before karate. I don't need the martial arts to be a tough guy, and that is not the reason I want to pursue martial arts. There is something much, much more sacred and profound that I want to get my finger on.
Well, I was speaking with Sensei James Woods who is an instructor and owner of Zen ShotoKai Karate Club here in Dartmouth NS where I live. His reply to my condition and request for membership, is as follows;
"Hi Kevin, since hepititis C can only be transmitted by blood to blood contact, I don't see a problem."
Where my head is at now, this would probably be a more appropriate place and style to train in anyhow. Thanks for all the input. On closing, I'll leave with some Zen sayings:
"Until I swatted a fly the flyswatter never exsisted"
Takahung Kyoshi
"On a journey, ill and my dreams, on withered fields, are wandering still."
Author Unknown
"Biting into an apple as I sit before peonies - that's how I'll die."
Shiki
Kevin
Well, I was speaking with Sensei James Woods who is an instructor and owner of Zen ShotoKai Karate Club here in Dartmouth NS where I live. His reply to my condition and request for membership, is as follows;
"Hi Kevin, since hepititis C can only be transmitted by blood to blood contact, I don't see a problem."
Where my head is at now, this would probably be a more appropriate place and style to train in anyhow. Thanks for all the input. On closing, I'll leave with some Zen sayings:
"Until I swatted a fly the flyswatter never exsisted"
Takahung Kyoshi
"On a journey, ill and my dreams, on withered fields, are wandering still."
Author Unknown
"Biting into an apple as I sit before peonies - that's how I'll die."
Shiki
Kevin
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Bill Glasheen
- Posts: 17299
- Joined: Thu Mar 11, 1999 6:01 am
- Location: Richmond, VA --- Louisville, KY
Kevin
Wow...
I cannot pretend to understand the path you came from, or the journey you now walk. Just when you think you licked a problem, it comes back to haunt you through the back door, no?
But I will say that I admire your courage and your perseverance. Loui Hopper's efforts obviously paid off in spades. And your own character is tested every day. So far so good, no?
I am so very happy you found someone to work with, and I again emphasize my deepest respect for your honesty in approaching your instructors. It sounds to me like two people with admirable personal traits found each other.
Don't be a stranger. You are always welcome here. Tell us how things go.
- Bill
Wow...
I cannot pretend to understand the path you came from, or the journey you now walk. Just when you think you licked a problem, it comes back to haunt you through the back door, no?
But I will say that I admire your courage and your perseverance. Loui Hopper's efforts obviously paid off in spades. And your own character is tested every day. So far so good, no?
I am so very happy you found someone to work with, and I again emphasize my deepest respect for your honesty in approaching your instructors. It sounds to me like two people with admirable personal traits found each other.
Don't be a stranger. You are always welcome here. Tell us how things go.
- Bill
