Test­ing for hemochro­mato­sis not needed for ev­ery­one

Cape Breton Post - - ADVICE - Keith Roach Dr. Roach re­grets he is un­able to an­swer in­di­vid­ual let­ters, but will in­cor­po­rate them in the col­umn when­ever pos­si­ble. Read­ers may email ques­tions to ToYourGood­Health@med.cor­nell.edu or re­quest news­let­ters at 628 Vir­ginia Dr., Or­lando, FL 328

DEAR DR. ROACH: I am 64 years old and was di­ag­nosed with hered­i­tary hemochro­mato­sis sev­eral years ago, fol­low­ing an en­hanced an­nual phys­i­cal exam that my com­pany pro­vides. My con­di­tion is now suc­cess­fully man­aged through reg­u­lar phle­botomies, or blood-let­ting. I con­sider my­self very lucky, as I understand that many peo­ple with hemochro­mato­sis are ei­ther mis­di­ag­nosed or di­ag­nosed too late, and as a re­sult end up de­vel­op­ing se­ri­ous and some­times fa­tal diseases, in­clud­ing liver cir­rho­sis, heart dis­ease, diabetes, var­i­ous types of can­cer or arthri­tis. I also understand that hemochro­mato­sis is a rel­a­tively com­mon ge­netic dis­or­der, es­pe­cially among those of North­ern Euro­pean de­scent, and that a sim­ple blood test for fer­ritin and trans­fer­rin sat­u­ra­tion gen­er­ally can lead to early de­tec­tion of the con­di­tion (as it did in my case). Should there not be more wide­spread screen­ing for hemochro­mato­sis among atrisk pop­u­la­tions, given that it is rel­a­tively com­mon, eas­ily treated and can lead to so much un­nec­es­sary suf­fer­ing or even death if it goes un­di­ag­nosed? — S.M.

AN­SWER: Hered­i­tary, or pri­mary, hemochro­mato­sis pre­vents the body from reg­u­lat­ing ab­sorp­tion of iron. Nor­mally, the body ab­sorbs all the iron it can when body stores are low and very lit­tle when body stores are ad­e­quate, but in hered­i­tary hemochro­mato­sis, the body ab­sorbs max­i­mally all the time, lead­ing to iron over­load. This may af­fect mul­ti­ple or­gans, in­clud­ing liver, heart, bone mar­row and joints.

The pol­i­cy­mak­ers who de­cide whether to rec­om­mend pop­u­la­tion-level screen­ing have rec­om­mended against screen­ing for hered­i­tary hemochro­mato­sis, based on the rar­ity of peo­ple who will de­velop symp­toms of hemochro­mato­sis. Even among peo­ple with the gene for hemochro­mato­sis, de­vel­op­ment of overt dis­ease is only in a sub­set of those with the high­est-risk gene mu­ta­tion.

How­ever, this rec­om­men­da­tion does NOT ap­ply to fam­ily mem­bers of peo­ple with hered­i­tary hemochro­mato­sis, who should be screened. Also, clin­i­cians should know to look for hemochro­mato­sis in peo­ple with vague symp­toms, such as fatigue, joint pain or skin-color dark­en­ing. The con­di­tion may be looked for by ei­ther ge­netic test­ing, or by trans­fer­rin sat­u­ra­tion, which is the iron level in the blood di­vided by the “to­tal iron bind­ing ca­pac­ity.” Fer­ritin lev­els are high only in iron over­load, which most of­ten hap­pens ear­lier in men than in women.

DEAR DR. ROACH: Few things are more sat­is­fy­ing on a cold win­ter night than a nice warm bed with an elec­tric blan­ket. I am con­cerned about the elec­tro­mag­netic waves emit­ted from the wiring in the blan­ket. Should I be wor­ried? — D.A.

AN­SWER: This is a con­tro­ver­sial area, but I think the best an­swer prob­a­bly is that you do not have to be wor­ried. It is true that elec­tric blan­kets, like all elec­tri­cal de­vices that run a cur­rent, gen­er­ate mag­netic and elec­tri­cal fields, and that th­ese fields can pen­e­trate body tis­sues. How­ever, the ma­jor­ity of re­search in the area finds no in­crease in risk of dis­ease, es­pe­cially can­cer, from ex­po­sure to th­ese low-level elec­tro­mag­netic fields.

I have seen burns from elec­tric blan­kets that have be­come worn, and older elec­tric blan­kets lack au­to­matic turn-offs and other safety fea­tures of newer blan­kets. I would rec­om­mend re­plac­ing an old elec­tric blan­ket. Also, I don’t rec­om­mend any kind of heat­ing de­vice for peo­ple with dam­age to nerves, es­pe­cially di­a­betic neu­ropa­thy.

Peo­ple who re­main con­cerned about the harm of EMFs can ei­ther use the blan­ket to warm up the bed and then turn it off, or buy a low­volt­age elec­tric blan­ket, which pro­duces much-lower-strength EMFs.

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