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WHO:

Dr. Gish is a Hepatologist specializing in all forms of liver disease, liver cancer and liver transplant. Dr. Gish has partnered with TeleMed2U to provide telemedicine consultative services for patients with liver disease.

WHAT:

TeleMed2U is a telemedicine-based multi-specialty clinical practice increasing access to specialist providers providing, “healthcare anywhere and everywhere.” The telemedicine consultation will be conducted through our HIPAA and HITECH compliant platform. Connectivity testing will be done in advance to ensure you can connect via our telemedicine platform. Following the consultation, a clinical note will be provided including a summary of your liver consultation with Dr. Gish and his consultative recommendations.

COST:

Payment will be processed through an online secure transaction portal. The fees for consultative services are:

Initial 60 minute consultation per patient: $500.00
Follow Up 30 minute consultation per patient: $300.00

NEXT STEPS:

If you’d like to continue, please click Next to complete the form and we will contact you to schedule connectivity testing. During the test you will have the opportunity to determine the method of providing medical records, discuss appointment availability as well as discuss any additional questions that you have. If you are a healthcare facility interested in services, please complete the form and we can discuss the options that are right for you and your patients.

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You should be aware of the general risks of transmitting information over the Internet, which may not use encryption. You should therefore not share any personal medical information that you would wish to be held confidential in a physician/patient or similar clinical relationship.

The information contained on this website is not intended, should not substitute for, or be used instead of, a clinical or therapeutic relationship with a health care professional who is fully familiar with the specifics of your case. The information on this site may assist you in your personal, general research but none of it constitutes the practice of medicine or any other health care profession.

Nothing in this site is intended as a recommendation or endorsement of any specific tests, products, procedures, healthcare provider, opinions, or other information that may be mentioned in this site. Any reliance on any information provided by the website personnel, others appearing on the site at the invitation of the website and/or other visitors to the site is solely at the user's risk.

E-mail correspondence with Dr. Robert G. Gish Consultants, LLC or any of its employees, or agents, does not create a physician/patient relationship between us or cause Dr. Gish to create or retain any medical records about you, monitor your care, or communicate with your own health care provider.

Always seek the advice of your physician or other qualified health care provider with any questions you have regarding your medical care. If you suspect that you may have a medical condition, or are seeking medical advice or treatment, we recommend that you consult a qualified health professional as soon as possible.

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HBV Vaccine FAQs

Aug 2, 2023

HBV Vaccine FAQs

I have a patient who is positive for anti-HBc (hepatitis B core antibody) but negative for all other hepatitis B serologic markers. Should he receive hepatitis B vaccine?
If the positive anti-HBc is believed to be a true positive, the individual would not require vaccination since they have already (presumably) had HBV infection. Isolated positive anti-HBc could indicate low-level chronic infection.

Can you get hepatitis B testing after the vaccine?
It is best to wait at least three weeks before getting a hepatitis B test. If you are testing and vaccinating on the same day it is best to test then vaccinate.

What is an appropriate titer level for full protection? How long does that full protection last?
10IU/mL a Lifetime!

What if the vaccine is interrupted- do I need to restart the series?
For all ages, when the HepB schedule is interrupted, the vaccine series does not need to be restarted. If the Heplisav-B series is interrupted, the second (final) dose should be given as soon as possible. For Engerix-B, Recombivax HB, and PreHevbrio, if the series is interrupted after the first dose, the second dose should be administered as soon as possible, and the second and third doses should be separated by at least 8 weeks. If only the third dose has been delayed, it should be administered as soon as possible.

Can you use two different types of vaccines - the two-dose and three-dose and what does that schedule look like?
Data are limited on the safety and immunogenicity effects when Heplisav-B or PreHevbrio are interchanged with HepB products from other manufacturers. When feasible, the same manufacturer’s vaccines should be used to complete the series. However, vaccination should not be deferred when the manufacturer of the previously administered vaccine is unknown or when the vaccine from the same manufacturer is unavailable.

The 2-dose, 4-week HepB series for adults only applies when both doses in the series consist of Heplisav-B. Series consisting of a combination of 1 dose of Heplisav-B and a vaccine from a different manufacturer should consist of 3 total vaccine doses and should adhere to the 3-dose schedule minimum intervals of 4 weeks between dose 1 and 2, 8 weeks between dose 2 and 3, and 16 weeks between dose 1 and 3. Doses administered at less than the minimum interval should be repeated. However, a series containing 2 doses of Heplisav-B administered at least 4 weeks apart is valid, even if the patient received a single earlier dose from another manufacturer.

I’m a nurse who received the HepB series more than 10 years ago and had a positive follow-up titer (at least 10 mIU/mL). At present, my titer is negative (less than 10 mIU/ mL). What should I do now?
Do nothing. Data show that vaccine-induced anti- HBs levels might decline over time; however, immune memory (anamnestic anti-HBs response) remains intact following immunization. People with anti-HBs concentrations that decline to less than 10 mIU/mL are still protected against HBV infection.

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