Ask the Doctor: Hepatitis C Test; Medications and Supplements
Q: I recently saw an advertisement in the paper that said all baby boomers should get a Hepatitis C screening. I’m a 68-year-old male and I feel fine. Do I really need this test?
A: Hepatitis C is a serious liver disease caused by the hepatitis C virus (HCV). Many people that carry this virus feel fine for years so they don’t even know they have it. The danger is two-fold: HCV can still be damaging your liver even though you don’t have symptoms, and you could unknowingly be spreading the virus to other people. Hepatitis C is the most common chronic viral infection found in the blood and is spread through contact with blood. For some people, the virus may only be a short-term (acute) infection, lasting about six months. Chronic hepatitis C results when the body can’t fight off the infection. It’s estimated that about 75 to 85 percent of people with acute hepatitis will develop chronic hepatitis C. Without medical treatment, chronic hepatitis C can eventually cause liver cancer or liver failure. An estimated 2.7 to 3.9 million people in the United States have chronic hepatitis C, and the majority of them are baby boomers. Early diagnosis and treatment can prevent liver damage.
The only way to know if you have it is with a blood test. Medicare Part B covers a one-time screening test if it’s ordered by your primary care doctor or health-care practitioner. You don’t pay for this test if your doctor accepts Medicare assignment, meaning that he or she agrees to accept the cost that Medicare has approved as full payment. That doesn’t include any fees for cost sharing, if any. Given the vast number of screening tests offered to patients, it can be difficult to know which is right for you. Talking with your doctor is, of course, best. Also know that the U.S. Preventive Services Task Force (USPSTF), an independent panel of non-federal experts, makes recommendations about clinical preventive services, such as screenings, counseling, and preventive medications. Their recommendations are based on a rigorous, systematic review of peer-reviewed evidence. The USPSTF does recommend hepatitis C screening test for those born between 1945 and 1965 and anyone who is considered high risk, which includes past or current injection drug users and anyone who received a blood transfusion or solid organ transplant prior to 1992.
Q: My wife takes several supplements along with her daily medications. She insists they’re natural and therefore safe to take. Can these supplements be harmful?
A: Supplements can adversely interact with medications. Because they’re not FDA regulated, they may not contain what they claim. And worse, they may contain substances that can cause harm. Dietary supplements include vitamins, minerals, herbs, and enzymes. When purchasing supplements, look for the third-party verified mark from NSF or USP. Both organizations test and certify products. Unintended consequences of interactions include delayed, decreased, or enhanced absorption of a medication. For example, the herb St John’s wort (Hypericum perforatum) is an inducer of liver enzymes, which means it can reduce the concentration of medications in the blood. It can reduce the level of medications such as the cholesterol-lowering drug lovastatin (Mevacor, Altocor), and the erectile dysfunction drug sildenafil (Viagra). Vitamin E taken with a blood-thinning medication such as warfarin (Coumadin) can foster anti-clotting activity and increase bleeding risk. Ginseng, a stimulant, can also interfere with warfarin and can enhance the bleeding effects of aspirin and nonsteroidal anti-inflammatory drugs, such as ibuprofen and naproxen. According to a study, the CDC found that nearly a third of study participants taking medications also took supplements. Many people do so to help ensure they’re getting the nutrients they need. But supplements shouldn’t be a substitute for a healthy diet. While your wife may indeed be health-minded in her choice of supplements, it’s crucial that she discuss what she’s taking to make sure it’s compatible with her medications.
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