People with disABILITIES

EnterpriseWorks For People with disABILITIES, in partnership with the Ohio Rehabilitation Services Commission, assists people with disabilities to start a business or to help strengthen an existing business. We help prospective entrepreneurs decide if self-employment is the right career decision and help build the business step by step through a combination of classroom participation and individualized technical assistance. If already self-employed, EnterpriseWorks will guide individuals as they strengthen or expand their business.

The Ohio Rehabilitation Services Commission (RSC) might be able to assist you. To find out, visit their web site or call them at 1-800-282-4536 Voice/TTY, toll-free in Ohio.

• Have a disABILITY?
• Reside in Ohio?
• Interested in self-employment?

If you have an open case with the Ohio Rehabilitation Services Commission, notify your counselor of your interest in self-employment. Your counselor will make the necessary arrangements and schedule an appointment with the EnterpriseWorks Coordinator in your area.

If you have questions about this program, click here or call 1-800-867-2997.

July 2009 is
National Hemochromatosis
Awareness Month

Hemochromatosis (HHC) is a leading cause of iron overload disease. People with HHC absorb extra amounts of iron from the daily diet. The human body cannot rid itself of extra iron. Over time, these excesses build up in major organs such as the heart, liver, pancreas, joints and pituitary. If the extra iron is not removed, these organs can become diseased. Untreated hemochromatosis can be fatal.

Iron is an essential nutrient found in many foods. Iron carries oxygen (in hemoglobin) to all parts of the body. Normally, humans absorb about 8-10% of the iron in foods that they eat. People with HHC can absorb four times that amount. Individuals with hemochromatosis absorb too much iron from the diet. Iron cannot be excreted therefore the metal can reach toxic levels in tissues of major organs such as the liver, heart, pituitary, thyroid, pancreas, and synovium (joints). These overburdened organs cease to function properly and eventually become diseased.

Therefore, undiagnosed and untreated HHC increases the risk for diseases and conditions such as diabetes mellitus, irregular heart beat or heart attack, arthritis (osteoarthritis, osteoporosis), cirrhosis of the liver or liver cancer, depression, impotence, infertility, hypothyroidism, hypogonadism, and some cancers. Mismanaged iron in the brain is seen in those patients with neurodegenerative diseases: Alzheimer's, early onset Parkinson's, epilepsy, multiple sclerosis, and Huntington's disease.

SIGNS & SYMPTOMS…
Chronic fatigue and joint pain are the most common complaint of people with hemochromatosis. Other common symptoms include, lack of energy, abdominal pain, loss of sex drive, and heart flutters or irregular heart beat. Symptoms usually begin in men in their late 20’s to early 30’s. In women, symptoms usually start about 10-15 years after they stop having a period. If hemochromatosis is not found early and treated, iron may accumulate in body tissues causing disease such as:

- arthritis (osteoarthrithis, osteoporosis) knuckles, ankles and hips
- liver disease, including an enlarged liver, cirrhosis, cancer, and liver failure diabetes
- heart problems ( irregular heartbeat, heart attack or heart failure)
- impotence
- infertility
- loss of period or early menopause
- abnormal skin color, ashen gray-green or reddish-bronze
- hypothyroidism (which can cause depression)

Hemochromatosis can be overlooked by a doctor who is concentrating on treatment of diseases that are present in the patient. Many doctors still believe what they learned in medical school, that hemochromatosis is rare and only happens in older men. When hemochromatosis is discovered early and treated before organ damage can occur, a person can live a normal, healthy life.

GENETICS…
Genetic tests can confirm a diagnosis and can help identify family members who are at risk for hemochromatosis.

Type I hemochromatosis, which occurs in adults, is caused by defects in the HFE gene. HFE has many purposes, but one important role is that it helps to control the amount of iron that is absorbed from food. There are several known defects in the HFE gene, but two defects are most often found in people with hemochromatosis. These two defects are called C282Y and H63D.

Everyone has two copies of HFE, one from Mom and one from Dad. A person can have two normal copies, one normal and one changed (mutated or mutation) copy; two copies of the same mutation; or two different mutated copies.

When a person has one mutated copy, he or she is called a carrier or heterozygote. When a person has two of the same mutated copies, he or she is called a homozygote. When a person has two different, but mutated, copies, he or she is called a compound heterozygote. Genetics can be very difficult to understand at first. What is most important is that you know which gene combination causes the greatest known risk of loading iron.

DIAGNOSIS…
A person can ask his or her doctor to check body iron levels with the following tests: Serum iron -- (SI) This test is best conducted after fasting for at least three hours. Also, iron or vitamin C supplements should be discontinued at least three days before taking the test. Do not discontinue other medication unless your doctor tells you to. Total iron binding capacity (TIBC) -- This test tells how well the body binds iron. Serum iron divided by TIBC x 100% gives you important information about the transferrin-iron saturation percentage (TS%). TS% is usually 25-35%; in some people with iron overload, the TS% is very high. There are other types of iron overload where the TS% is normal. Serum ferritin (SF) -- This measures the amount of iron stored in the body.

Normal levels of serum ferritin are different for men, women and children. If a person has high body iron, the TS% is elevated and the serum ferritin is elevated. There are exceptions to these test results; see other types of hemochromatosis.

In the past, liver biopsy was widely used to diagnose hemochromatosis. Today, liver biopsy is not necessary to diagnose the inherited form of HHC. DNA tests are available to determine if a person has genetic hemochromatosis.

TREATMENT…
It is very important to get iron levels down to normal. Therapeutic blood removal or phlebotomy is used to accomplish this. Therapeutic phlebotomy (TP) is the same as regular blood donation but TP requires a doctor’s order (prescription). Regular blood donation can be done every 8 weeks. A person with severe iron overload may need to give blood as much as 8 times in a single month! The goal is to bring blood ferritin levels to a normal range of 25 to 75ng/ml. Depending on the amount of iron overload at diagnosis, reaching normal levels can take many phlebotomies. Serum ferritin drops about 30ng/mL with each full unit (500cc) of blood removed. Once iron levels reach normal, a person can begin maintenance therapy, which involves giving a pint of blood every 2 to 4 months for life. Some people may need to give blood more often depending on what they eat and how quickly their body absorbs iron. The TS% and serum ferritin tests can be done periodically to help determine how often blood should be removed.

When hemochromatosis is diagnosed early and treated before organs are damaged a person can live a normal life expectancy. For people who have disease at the time of diagnosis, life expectancy may be shortened depending upon the disease. For example: if a person gets diagnosed and treated before serum ferritin is above 1,000ng/ml the risk of cirrhosis or liver cancer is less than 1%.

DIET…
Red meat contains the most easily absorbable form of iron. People with hemochromatosis should limit the amount of red meat they eat. They should also limit the amount of alcohol they drink and how much supplemental vitamin C they take. Alcohol and vitamin C can increase the absorption of iron. Supplemental vitamin C should be limited to 200 milligrams. Many fresh fruits and vegetables contain vitamin C. These foods should not be eliminated from the diet because they also contain antioxidants, fiber and other important nutrients.