Unfortunately, only one treatment for iron overload

Dear Dr. Gott: My mother is 81 years old. She has a problem with producing too much iron in her blood. The only treatment that we are aware of is to have blood drawn off when the count gets too high. What causes this? Is it hereditary? What can we do to keep the count low? Please let me know whether there is a relationship to the environment or food. Also, when the count starts to get high, her head starts to itch and she feels totally worn out. Can you help us?
My mother is on warfarin for blood clots in her legs (twice), calcium plus D, Actonel once a month, methotrexate for arthritis, folic acid and PreserVision for degeneration of her eyes.

Dear Reader: Your mother is likely suffering from a condition known as hemochromatosis. It is the most common form of iron-overload disease. There are several forms, including primary/hereditary, secondary, juvenile and neonatal.
Primary or hereditary hemochromatosis is generally caused by a defect of the gene HFE, which regulates the amount of iron absorbed from food. There are two mutations, C282Y and H63D. Those with one copy of the defect C282Y become carriers who don’t develop hemochromatosis but may have higher-than-normal iron levels throughout life. Those with two copies can develop the condition.
Secondary is caused by anemia, alcoholism and other disorders. Juvenile and neonatal hemochromatosis are caused by a mutation of the gene hemojuvelin.
Treatment, as you know, is phlebotomy (blood drawing). If started before the condition progresses, it may prevent symptoms; otherwise, it typically improves but doesn’t eliminate symptoms. Arthritis caused by iron overload will not benefit from treatment. There is no other treatment available.

Dear Dr. Gott: Your webpage was last updated Dec. 28, 2009. Any chance that you will bring it up-to-date? I read your column in my local newspaper.

Dear Reader: The website (AskDrGottMD.com) is updated six days a week. Tuesday through Sunday, a new column appears online. The date that you are seeing (at the bottom right corner), is the date that the webpage layout was last updated. Just below the title of the columns, there appears a date. This is the date that the column was posted to the website (or when it appeared in print in the case of the classic columns), and you will find that it is current.

Dear Dr. Gott: With flu season just around the corner, I wonder what the recommendation is this year for getting a shot. With three young children to care for, I cannot afford to be sick, but I really hate to subject my body to unnecessary shots if I don’t need them.

Dear Reader: It’s rather fortuitous that your inquiry reached me today — the same time I received a statement from the Department of Health and Human Services on this very subject.
As might be expected, everyone six months or older is urged to receive the vaccine when it becomes available. This year’s will include the 2009 H1N1 strain as part of the regular seasonal vaccine. While there were concerns last year regarding H1N1, we are assured that seasonal flu shots have an excellent safety record.
People in high-risk categories are strongly urged to be immunized. This includes people diagnosed with chronic conditions, diabetes, asthma, pregnant women and those working in the health care profession.
Continue to wash your hands on a regular basis, avoid surrounding yourself with ill people who are coughing and sneezing, keep commonly touched or used items clean, eat healthful meals, get adequate sleep and exercise regularly. This last statement is meant for the general public, since I’m sure with three young children you rarely get a good night’s sleep, are lucky to catch leftovers for dinner and likely get adequate exercise simply picking up after them. Perhaps, for this very reason, parents are urged to get the vaccine.
To stay up to date, visit www.flu.gov for the latest information available.

Dear Dr. Gott: I am a 50-ish African-American woman with a problem most think I am lucky to have. I can’t stop losing weight. My cholesterol is on the high side, so I can’t eat most high-calorie foods because they also contain a lot of fat. I am also a vegetarian, don’t like sweets very much, and work out at a gym daily. I don’t want to put on much weight. My normal weight is around 100 pounds, and I’m mentally comfortable with that.
My doctors have looked at the obvious: They have checked my thyroid and for any digestive disorders. I love food and eat a lot of pasta with veggies sauteed in olive oil. I also love cheese but don’t want to raise my cholesterol levels higher. Other than the weight loss, I’m in excellent shape.
Can you give me any suggestions?

Dear Reader: There are a number of common causes for weight loss, but you don’t appear to fit the norm. They include malnutrition, depression, chronic diarrhea, drug use, cancer, excessive alcohol consumption, eating disorders and loss of appetite. One thing that might be an issue is a dental problem or mouth ulcers. Should you have ill-fitting dentures or canker sores, this might be addressed. If you faint or feel lightheaded, sweat excessively, have increased thirst, palpitations, have hair loss are on laxatives or diuretics, these issues, too, might be considered. They may lead to an underlying cause that your physician has not addressed.
You might consider speaking with your doctor regarding a nutritional assessment and making sure that you have had complete laboratory analysis. A vegetarian diet is commonly a healthful one and far better than consuming fast foods on a regular basis. You might choose to speak with a dietician at your local hospital for some fine-tuning that will allow your weight to stabilize.
You apparently are burning more calories than you are consuming. A way around this is to supplement your meals with snacks throughout the day. Granola bars, fruit and raw vegetables would be good choices. I don’t know what your breakfast consists of, but you might consider making your own cereal with a variety of nuts, cranberries, honey and raisins. Top it with skim milk, and have a glass of orange juice and tea or black coffee.
There are countless ways of incorporating good foods into your diet without packing on the pounds, but it may take a little preparation on your part to make this happen.

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