Transcript of Ask the Doctor (part 2) We've generated a transcript of the conversation between Neil McClements (HUK CEO) and Dr Susan Hancock (FRCGP), suitable for screen readers and other assistive technologies. Please note that this was auto-generated and some typos may be present. Enjoy! Neil McClements: [00:00:01] So thank you everyone for joining us for part two of ask the doctor. Um, I'm here with Dr. Susan Hancock, who's one of Haemochromatosis UKs clinical advisors and is a GP and a fellow of the Royal college of GP. So hello Susan. Thanks for joining us again. Dr Susan Hancock: [00:00:18] Hello. Good morning. And I hope you're all keeping well and these difficult times. Good morning. Great. Neil McClements: [00:00:25] Well, we've had some more questions through for members, um, in relation to coronavirus and hemochromatosis. So without further ado, let's see if we can take the first one. So, um, this is coming from Lorna in Perth. Lauren is saying I need a month. We've been a section at the moment. I've not had one for two months due to the department being too busy. They called today with an appointment at the end of June. Is this going to be detrimental to my liver? Dr Susan Hancock: [00:00:51] Oh, hi, Lonna. Please don't worry too much. Um, during the course of all these questions today, I've taken, uh, some. [00:01:00] Advice from some of our other advisors who are both doctors and one in research and one actually consultant for hemochromatosis. So I can categorically say that there is no worry about having six months off any section you will not likely to damage any of your organs. Mmm. If you think, let's get this in proportion, if ferritin is normally going to be controlled at about 60, um, that's the recommendations. It's got to go above a thousand and be at that level for quite a long period of time. For that to be any worry about your liver, so don't worry, everything will be fine. Neil McClements: [00:01:39] Fantastic. Okay, great. Hopefully that gives you some encouragement there. Lorna, let's move on, uh, to our next question, which is coming from. David in Boston. Um, David says of just rich maintenance, but my Venice sections had been canceled for six months due to covert 19. Uh, my GPS suggested a met results [00:02:00] to help reduce our and absorption. Whilst I cannot do in a section. Do these tablets work and are there any risks associated with them? Dr Susan Hancock: [00:02:09] Okay. A good question. Diverse. Um, and I, I've, I've gone to a couple of things to say about this. Um, there's no definite clinical evidence yet. Um, but there is anecdotal evidence in some cases that a map result helps, particularly with spacing out the time between Venice section. Um, appointments when they're needed. Okay. It makes sense because it's to do with, uh, the acid levels in your stomach and that is related to iron absorption. If your GP is recommending it or suggesting it, I would think you have no contraindications to taking it. Of which there are very few. It's a relatively easy a tablet to take, particularly if you're only going to be taking it over a short period of time. [00:03:00] But what I cannot say is as any real strong, concrete clinical evidence at this moment in time to support that, but no harm and giving it a go, I would suggest, however, that you have a little look at the dietary recommendations on the haemochromatosis websites and combine it with a little bit of dot. She manipulation. Safely and see if that will help as well. Neil McClements: [00:03:24] Right. Thank you, Susan. And that's a, that dark tree information is available on our website at on overload to all.uk. Uh, if you have a look, uh, um, uh, just such poor diet and you'll find it, it'll pop up quite readily. So thank you. That's great. Uh, we've got another question has come in from Deborah. Deborah is a care worker. Um, so thank you, Debra, for everything that you're doing, um, to keep us all safe at this time. Uh, NHS. coronavirus site mentions having a condition that makes you more likely to catch infections under the high risk list. [00:04:00] Yes. Please advise if hemochromatosis falls under this risk factor. So w where do we stand, Susan, on hemochromatosis being, um. Risky. Dr Susan Hancock: [00:04:10] Well, let me say to Deborah, thank you very much for all your work. Deborah. Everybody in the country should be applauding you and we'll do this evening at eight o'clock hopefully that this hemochromatosis is not a condition that makes you much more likely to catch infections. That is character, categorically the case, unless you have a problem. Having damaged any of your and organs, your your liver, particularly your heart, or it's given you diabetes, you did damage to your pancreas. If you have any of those conditions, and you may be in a higher risk category, but not just the hemochromatosis, but really please from all of us, be very careful distancing, hand-washing. I'm sure you're doing all of that very careful and keep yourself safe. Neil McClements: [00:04:59] Great. [00:05:00] Fantastic. Thank you very much. As Susan, and actually we've got another question here actually from Andy, um, who similarly is working on the front line. Um, so st can you please confirm that G H patients with liver fibrosis due to the condition are in the high risk category? Should I be self isolating for 12 weeks? I'm part of the research team at the hospital currently running covert 19 research. What should I do? Oh, Sandy. Dr Susan Hancock: [00:05:28] This is quite a difficult question and, and I understand your concern. Um, the, the first part of the question is yes, liver fibrosis will put you in a, a higher risk category than if you didn't have it. Um, if you want to check that out, um, you can have a look on the recommendations online. Um, . I'm not sure exactly from this question what you're doing with the research team running [00:06:00] covert 19 research. If that situation puts you at a higher risk than anybody else in the population of catching this, then I think you should seriously consider maybe asking if you can do it remotely or or something from home rather than exposing yourself. If it doesn't, then I guess it's you're the same as anybody else with the fibrosis. Yes. You need to, and I think the government say, um, stringently follow social distancing measures. So it's, it's a bit of a risk assessment. Mmm. On the hall or on the part of caution, if I were you, um, in this situation, better to be safe than, sorry. I hope that helps. Neil McClements: [00:06:51] That's fantastic. Thank you, Susan. I mean, this is a, I think, very common type. A query that we're receiving on our helplines at the moment is people [00:07:00] just trying to work out for their own specific circumstances. What the right thing to do is. Yeah. It's not always an easy decision, but for most of us, we should be staying at home. Uh, so as to not, uh, encourage the spread of the virus. Um, so thank you, Andy, for what you're doing on that research program. Uh, it sounds very interesting and obviously we are very much in a bet, uh, to you for being involved in this kind of work in present time. So thank you again. Um, we've had another, uh. Query come in, and this is coming from Wayne in London. I think this is quite, Mmm, quite representative. Actually. We've had a lot of people this week. Um, for those of you who are watching, this will catch up. It's actually Thursday, the 2nd of April, 2020 and we've had quite a few people who've received letters like this. So, uh, Wayne says, I've received the letter identifying me as someone at risk of severe illness. Should I catch the coronavirus. Is this a standard precautionary measure? Because I have hemochromatosis. Dr Susan Hancock: [00:07:57] no is the short answer to that. And we [00:08:00] mentioned this last week in the webinar that people at very high risk will be getting notification. I thought it was probably going to be by text message, but it turned out to be letter M. so a very small number of people who have, uh, an immune problem, uh, we'll be getting this hemochromatosis per se without any other. Illnesses, either appetite into it or separate from it would not put you in this high risk group. So there must be some other reason why your GP feels that you, um, are in the high risk group. If you want to go onto, um, the government UK guidance, it will give you a list of conditions that are in each of the groups they precautionary group and the high risk group. So I hope that helps you, Wayne. great. Neil McClements: [00:08:48] And for anyone watching this, if you go to the hemochromatosis UK website, have a look at that coronavirus advice page. Um, we have actually provided links, see some of these resources. So if you're not [00:09:00] sure how to find that things on the gov UK website, don't panic. Uh, come to our website, have a look at the coronavirus page, and we have all of the information that's relevant to. Uh, people with hemochromatosis actually listed in there, along with a load of other resources. So for anyone who's homeschooling, we've got loads of homeschool resources. Um, and I know there's a lot of people who are really struggling with that at the moment. So, um, do, do check out the website. Okay. We've got a slightly different question now. Um, this is from Jenny and Exeter. Uh, Jenny says I'm in my seventies. Uh, we have a water leak at home. Is it okay to have a plum around to put it right. Dr Susan Hancock: [00:09:39] Oh, good morning, Jenny. Um, yes, you, you're right to ask it because obviously you're over 70, which puts you in the slightly high higher risk group, um, of having a problem. If you catch. Coronavirus. Um, I guess this really depends on how severe your water leakers. Um, if it's something that is important and it's going [00:10:00] to wreck your house and need you to shut the water down, yes, you should have a plumber in. Um, but I do think you might, I'm hoping you can find a plumber. Um, I, I do think you need to make sure that when the plumber comes that you buy all the social distancing regulations that are recommended. Um, you need to keep two meters apart. You need to wash down, you need to wash your hands. He needs to wash his hands, that sort of thing. And I'm sure any plumber who's at the moment lined up to do emergency work will already have that in hand. Um, but yes, by all means, Jenny, if it's serious enough to give you trouble, get the plumber in. Neil McClements: [00:10:41] Great. Hopefully that helps Jenny. Um, our next question has come from the isle of man Tracy. Uh, since I work as a hospital social worker and visits. Over 65 year old patients daily. My manager is anxious for me. Clarify if I'm at high risk due to G H so the decision [00:11:00] can be made about my vulnerability on the ward. I'm currently not in maintenance, but getting very close to it. I have no other health issues. So Susan, um, what should Tracy B be doing. Dr Susan Hancock: [00:11:11] Good morning, Tracy. I'm watching the isle of man quite closely as we're planning a holiday there later on this year, so I hope you're a, I think you're all locked down. Um, the, the hemochromatosis providing you have no, no other health issues, which you've mentioned at the end, no damage from it. She would not put you with any further risk, any higher risk of coming into hospital. However, I am questioning whether. Anybody who isn't absolutely necessary should be doing face to face visits with over 65 year old patients in a hospital situation who themselves must have be or have been on well, and even at 65, they still have a higher risk of, of, uh, uh, virus giving complications than say a [00:12:00] 25 year old. It is age related. So my suggestion to you would be to ask your manager four safety of the patients. Mmm. And under the regulations that are set out by the government, could you actually do this remotely? Is there any way that you could work and talk to the patients via an iPad or something like that and therefore you're not putting them at risk and you're not mixing unnecessarily. Mmm, I hope that's of some help. And that was a discussion that I had with our advisors as well. So that's what they thought, um, uh, ultimately would be the answer. So I hope that's helpful, Tracy. okay, Neil McClements: [00:12:45] that's great. And I think it's really encouraging, uh, Tracy, that your manager is actually proactively taking steps to try and understand the situation. Um, so it sounds like you've got a great team around you, so thank you for what you're doing in the hospital. [00:13:00] And, uh, hope you stay well. Okay, let's move on. Uh, our next question has come in from Andrew in stoke on Trent. Um, no, I actually don't know what this is. I have an F three fibrosis grazing of my liver. I'm at greater risk of Corona virus, so, okay. Susan, for those of us who don't know a lot about livers, um, what is an F three fibrosis. Dr Susan Hancock: [00:13:21] Yeah. It's just a grading of the level of fibrosis that has happened. The damage that's happened, any sort of fibrosis in the liver implies a reduction of, of, of ability to work. Um, so the answer to that, Andrew, is yes, you are at a greater risk. If you catch Corona virus, not at a greater risk of anybody else of catching it. So you have to do this severe or, or very serious, um, social distancing, um, and hand-washing. But the government are constantly talking about you need to be very vigilant because you don't really want to [00:14:00] catch this. Um, if necessary, sort of keep away from, from, uh, you know, family and friends if you can. I know that's, um, that's quite a tall order. Um, but as I said before, better to be on the safe side. Mmm. Does that, I hope that helps. Probably not what you wanted to hear. Neil McClements: [00:14:21] Well, I learned something new today, Susan, so thank you for that. So an F three fibrosis is a type of, uh, fibrosis. Okay, great. Mmm. Moving on. Um, and an Aberdeen, um, I have genetic hemochromatosis. Can bitumen C help improve my immune system to fight the coronavirus? A little bit of questions about this. So, vitamin C. Dr Susan Hancock: [00:14:44] thank you for this question because I've noticed there's been a lot of social media stuff popping up about vitamin C. okay. And I had a think about this, uh, at some depth this morning, the fisherman see story with viral infections has been rumbling on for about as long as I [00:15:00] have been a doctor. Um, which generally means that there's no actual definite answer. Um, and everybody sits on the fence. Um, I looked through a Cochrane database, um, which is a special sort of the research where they pulled together a lot of information from different areas and it came down as being not proven to be of any. Yes, I am a wet that trying it in, in China intravenously, but the results won't be out till September. So I think the stand on this is, there's no evidence that vitamin C. Extra vitamin C we'll help. However, if you are low in vitamin C. Then there is a lot of evidence that your immune system does not work properly, so that's the first point. So take proper replacement vitamin C, but not in high levels. The second point is that high [00:16:00] levels of vitamin C can actually affect the absorption of iron from your gut. So as a hemochromatosis patient, it's not advised at all to take high levels of vitamin C. it can completely throw your, your underlying, if you like, condition for a better word, um, your genetic predisposition completely off, and you can start to really overload quite heavily with iron from your diet. So be very careful. So the, um, so I hope that answers your question. I realize that's quite a technical answer, but basically keep the vitamin C normal, make sure you're getting fruit and vegetables, even things like , you don't need to take much to have a normal vitamin C intake. And the rec, the amounts that you take is online. It's very well documented. If you want to check. I'm sort of a half a cup of broccoli, we'll do it a [00:17:00] day. Um, you know, it's a fairly easy thing to maintain, but don't go for the high doses. Um, that's likely to do more harm. Van good. Certainly in our case with, with hemochromatosis, but probably for anybody else as well, if I'm perfectly honest. Neil McClements: [00:17:18] Right. Thank you. Susan, why don't you stand on, on between supplements generally for people with hemochromatosis? We do get quite a few people who come to us. Asking, which supplements are recommended, and we as a charity, we don't recommend any particular supplements. Um, our veterans supplements actually a good idea. Generally. Dr Susan Hancock: [00:17:37] Um, only in a situation where you don't have a normal diet. I think a normal diet should provide absolutely everything that you need. And the danger is if you start supplementing that you will overdose on a vitamin. Vitamins are not completely a nurse. They can cause harm in, in, in high doses. Um, you know, as, as the good that they, they actually produce in normal doses in the [00:18:00] body. So the key to it is keeping your diet varied. Um. Eating the right stuff, and you know, that should do everything you need for your vitamins. Um, if you seriously think you have a mineral vitamin deficiency, and probably vitamin D is the one that we struggle with in the winter. If I'm honest, I have a small exception there, then it's not, it's no harm in going in and having a chat with your doctor. Obviously not at the moment. Um, we all through the vitamin D a period of, of loneliness. It goes from about November to about February when the sunshine disappears. Um, once we pass through about February and into March and April, as long as you get out for 20 minutes a day into the air, and it doesn't have to be sunny. You will get enough vitamin D into your system, uh, and that will help your immune system. So your little walk outside and you garden around the block where your social distancing [00:19:00] is really important for your immune system as well. Um, I hope that helps. Neil McClements: [00:19:05] That's fantastic. Thank you. Uh, Susan, that's really, really important have, so I need to go for a walk after this. I need for healthy balanced diet. Okay, great. Our next question is from Liz in Lockerbie. Um, Liz says, my husband has been diagnosed with hemochromatosis and treated within the sections, but he does not have the genetic type currently tested. Uh, where's the research in identifying other genes responsible for genetic hemochromatosis? Dr Susan Hancock: [00:19:33] Um, thank you for this question. Liz and I, I did actually, um, use dr Jeremy shim and, um, uh, as a, as a resource, one of one of our help, um, help us on our advisory panel and Dr. Stuart MacDonald from, from London. Um, and we all, uh, decided that probably this wasn't a question we could answer, um, in this particular forum. And you should go back and you should talk to your healthcare provider [00:20:00] about this. It's not a common condition. Why you've got hemochromatosis and the normal genetic, uh, uh, the normal genes that we look for are not identified. That may be other issues going on and on. So the answer I'm afraid is, I can't answer that, but you need to go back and talk to your healthcare provider. Neil McClements: [00:20:20] Okay. This hopefully that sends, um, sends you off in the right direction. Uh, let's move on. Um, Henley on Thames. Chris, it says, I need to have a pint of blood taken each month to keep my ferritin levels within clinical guidelines. I understand this is more than typical and results in my having a low, often abnormally low neutrophil count. Will this compromise my immune system and should I be taking any special precautions as a result of covert 19. Dr Susan Hancock: [00:20:49] Okay. Oh, hi. Good morning, Chris. Um, it's quite a complicated question. There's neutrophils or white cells in the blood. For anybody who doesn't know, normally neutrophils are [00:21:00] concerned with bacterial infections, whereas lymphocytes are concerned with viral infections. Having also taken some advice and having a think about this, we. Mmm. I'm not happy that you know why your white cell count is going up normally low. And again, this should be something you should be asking your health care provider, your consultant, who you're under for your Venice section for your hemochromatosis. Um, because it would not be a regular sort of thing to happen. You don't mention how low it goes. Um, dr chairman mentioned that. Often the white cell count in normal patients is very slightly underneath the lab. Mmm. Uh, margins. And I've noticed that myself in general practice, and that per se, is not. A particular problem if, if it's in a person who is fit and well, and it's persistent, but abnormally low [00:22:00] implies that it's dropping lower. And I think that your health care providers should big looking for other reasons. And maybe, uh, you should be asking why. Mmm, I'm sorry Chris. I'm so, you need to go back to your consultant or, or your health care provider and say, why is this happening? And get an answer out of them. Neil McClements: [00:22:21] Right. Thank you, Susan. Um, and we have our final, a question, which is coming from Villa in Lancashire. Um, but it says I've gone from being a very fit and healthy individual, but over the past three years I've seen pick up viruses and infections very easily. I currently work at a prison, but I'm self isolating as I'm 99% sure I have the virus these days. I struggled to get over these things quickly. I'm 56 years old. Is this all because I have genetic hemochromatosis? Dr Susan Hancock: [00:22:49] Good morning, Phil. You're a net my heart. I'm in Lancashire as well. Thank you very much for you work in the prison. Um, I appreciate that. This, it must be a sort of [00:23:00] breeding ground for almost every a virus and bacteria you can think about. Yeah. Um, the answer to this is, Mmm, probably it's your. Maturing age that's causing the difficulty getting over, um, infections as quickly as you, you did when you were younger and it's not related, um, to the hemochromatosis. Mmm. So, uh, sorry about that. We can't do much about getting older, but at least, you know, it's, it's not the hemochromatosis. This is as long as you are controlling it and there's no end organ damage from, uh, previously having, Hm. Gone along with the high iron undiagnosed. So, sorry about that, Phillip. All of us, we're getting a little bit older by the minute. Neil McClements: [00:23:52] Okay. That's great. Thank you very much, Susan and Susan. Um, that was our last question. So, um, do you have any final tips or [00:24:00] advice for those of us who are, uh, keep top at home and how to maintain that good health, that physical health and mental health. Dr Susan Hancock: [00:24:07] Yeah. I think these next two weeks ago, to be crucial. Um, I think there's going to, and there already has been a significant rise in incidents. Um, people dying. Um, try not to get. Uh, two, Mmm upset by all the media stuff, which is day in, day out in your face. There are still only a small number of people who are getting seriously ill. However, I do want to say that doesn't mean that you shouldn't take everything that you're being told. Seriously, uh, maintain your social distancing. That is the key to not getting infection. And if you don't get infection, then you're not going to get seriously ill. um, social distancing the best you possibly can. Working from home, [00:25:00] asking your bosses, can you work from home? Trying to do things, uh, from a distance, if at all possible. So, yeah. Good luck everybody, and I hope you will stay fit in well until we talk again. Neil McClements: [00:25:16] That's great. Well, thank you very much, Susan. That's a really nice point to end on. And, uh, thank you again for taking the time to answer these questions, uh, for anyone who's still concerned about coronavirus and hemochromatosis, we have. Uh, some guidance pages on our website. So if you go to on overload.uk, we have lots of resources there. We try very hard to keep them up to date. Every day or every two days. And also someone needs to talk to anybody. We do have a telephone helpline, which is staffed by trained volunteers. Uh, that's available on weekdays between 12 noon and 3:00 PM. And if you don't fancy talking to anyone, but you want to ping us an email, you can do that as well. Uh, just send us an email to help [00:26:00] [email protected] Yeah. And again, our trained volunteers working very hard to respond to people's queries. On email, and you may be surprised, you might get a response within two to three hours, uh, or even quicker than that. So please, if you are concerned about any of these things, do get in touch with us. We're here to help. Um, and so it just leaves me now to say thank you again to Dr Susan Hancock, uh, for another informative session and to wish everybody well, take care, stay safe.