Dear Dr. Roach: My 50-year-old, active son-in-law became very fatigued a year and half ago. He initially was diagnosed with low testosterone and given further testing. Finally, six months from the onset of his symptoms, he was diagnosed with hemochromatosis, with iron levels in the 600s. Consequently, one and a half pints of blood have been withdrawn weekly for about two months. Levels are now in the 500s. His organs all have been tested for damage, but only two benign tumours have been found in his kidneys. But the fatigue has continued. Is there anything else he should be doing?
M.F.
Hemochromatosis is a disease of iron metabolism. In hereditary hemochromatosis, the body absorbs as much iron as it can, even if it doesn鈥檛 need it, and the iron builds up in various tissues in the body. The organ systems most commonly affected are bone marrow, heart and liver; however, many other organs will be affected if the disease is not treated. Low testosterone is common in hemochromatosis, and it might have been a clue in such a young man.
Men tend to be affected at a younger age than women, as women are protected to a certain extent by menstruation, but young women certainly can have asymptomatic or even symptomatic disease.
Fatigue in hemochromatosis can have several causes, but the most worrisome is iron overload in the heart, which can cause heart failure. He probably should have an echocardiogram if his doctors have not already done one. Fatigue is common and does not need to be heart-related. In my experience, fatigue often gets better with treatment of the iron overload, which can take a year or more to successfully return to normal.
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Dr. Roach Writes: In February, a writer asked why there is a stigma against hearing aids, and why some people do not want to wear them. I received many letters noting the cost of the units, which for many is prohibitive.
My answer, that glasses are not necessarily a sign of growing old but hearing aids almost always are, wasn鈥檛 to explain why people don鈥檛 get hearing aids, but rather why I think some people don鈥檛 want to get them or even to wear the ones they have. However, the cost issue may be the real reason for many or even most people.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Email questions to [email protected]
