Kathryn Knowles  00:05

Hi everybody. We are on season nine, Episode 14, and today I’ve met with me. How Matt, how you doing? Yay.

 

Matt Rann  00:12

Very well. Thank you very much indeed. Having said that, I’m going to not comment about holidays, but I will, in fact, I will comment about holidays I’m not a Tenerife in about four weeks, and I’ll leave you with that, but it’s that feels very, very good, because I can absolutely sure you look out the window, it seems to have rained for 48 hours, non stop. We’ve

 

Kathryn Knowles  00:29

not had it that long here. It’s not flooded.

 

Matt Rann  00:32

I have to say, all you, but, but, yeah, so So Tenerife here, we can

 

Kathryn Knowles  00:37

absolutely we’ve had loads of flooding here, loads of streets and everything. It’s roads being cast off and everything quite intense. No

 

Matt Rann  00:46

no not being that bad. But hey, ho, what can I say? Look, look brilliant.

 

Kathryn Knowles  00:51

So you keeping well? I am keeping well. Thank you. I am having just be honestly, obviously open and truthful with everybody as always. You know, I’m having a moment where I’m finding mental health is being tested a little bit at the moment, got quite a lot of pressure on in terms of both my parents aren’t well and and has been quite significant support for them over the last six months, and there’s just been some extra stresses put in recently. So I’m just having a bit of time of it, but I’m using my techniques, and I’m reaching out for support, where, where I need them. So I’m, I’m good to go, and glad to be able to do the podcast. Still, great.

 

Matt Rann  01:27

Okay, we’ll look after yourself when you will do Thank you. So today,

 

Kathryn Knowles  01:31

everybody, we’re talking about hepatitis and what can be available when you apply for protection assurance. This is the practical protection podcast you

 

Kathryn Knowles  01:46

so I’ll start off with my little summary before we let Matt Lewis explain anything to us. So we do have when it comes to hepatitis, we’ve got hepatitis A, B, C, D and E. There’s also alcoholic hepatitis and autoimmune hepatitis. Now I’m not sure if it’s the same for all of them, so Matt, I’m sure you’ll correct me to go along. But essentially, hepatitis is some form of inflammation of the liver which is making it or it can make it not work exactly as we want it to be. It also it can be something some of them that people can recover from, depending upon the type. But there are some people who are living with the condition and it is chronic. So in terms of chronic hepatitis C, and that is about 70,000 people in the UK are living with that chronic hepatitis B, it’s about 180,000 people that are living with that, and it’s chronic. And from from my research, I could see from the Hepatitis B and C, which are the ones that we are asked about on the Protection Insurance Application. They tend to be if there’s been some kind of blood infection, or some kind of blood that has the hepatitis as well. Hepatitis infection in it has unfortunately passed to somebody else. Some of the other ones, like hepatitis A, which we hear of that’s more to do with food and drink that’s unfortunately, being contaminated and usually by poo. And there isn’t that many cases really. The closest one I got was about 2021, it’s in about 106 cases. Interestingly, that I found out hepatitis D, you must have Hepatitis B to be able to develop hepatitis B. So I’m sure, Matt, you’ll be able to explain that to us. And Hepatitis E is one that does happen quite a bit. It’s approximately 20 million cases worldwide, and that is from things like raw and undercooked meat and shellfish. So Matt, can you take us into what hepatitis is doing, how it affects the body and and obviously, give us that knowledge in terms of the the B and C, as to why that would be that tends to pop up specifically on the in show as questions. Yeah, absolutely.

 

Matt Rann  03:50

Thank you for that.

 

Matt Rann  03:52

I thought I just as I always do, take a take a little bit of a side move, if you like, just spend a couple of minutes if, if that indeed on on the liver, you, quite rightly said, you have yet another itis, which is inflammation. And he quite rightly said, it is liver. Here, the organ that we are specifically talking about, and facts about the liver. Just to give everybody a heads up on how important it is for us. Is it? Here’s the pub question. It is the largest solid organ in the body, the liver. I didn’t know that, so, yeah, kind of pub quiz question? There you go. You’ve now got the answer. Now it’s incredibly important monitors, monitors everything that goes through the body so it removes toxins from the blood supply. It maintains healthy blood sugar levels.

 

Matt Rann  04:48

It regulates blood clotting. And I’ve seen one article which says it performs hundreds of other vital functions. Didn’t go into those hundreds, but we really haven’t got time to go into. Those hundreds either. But hopefully that just gives you a very high level picture of how important the actual liver is within the body and the well being of the body, particularly as it removes toxins from the blood supply. You can immediately think of alcohol being one of the toxins. Okay, we’ve already said that hepatitis A general term to describe inflammation of the liver. And the causes of hepatitis are viral infections. As you’ve already said, these are viral infections. There are five different types, A, B, C, D and E, as you said, chemicals in the atmosphere can also cause hepatitis. Thinking about the body delivers important role with removing toxins. Drugs can cause hepatitis. So we’re not just talking the so called recreational drugs, yeah, we’re also talking of prescription drugs, okay, which can include the one that keeps on coming up all the time is paracetamol. So hence why doctors or chemists don’t allow you to binge on paracetamol, because it can damage the liver. As I’m sure most of our listeners will know liver damage can be caused by drinking alcohol. And we’ve also got the one that you mentioned, the immune system, where it’s the immune system that attacks the liver, known as autoimmune hepatitis. Now autoimmune it just happens that I had a case the other day and it, I have to say, I’m pretty sure it only impacts women. Okay, I think, or majorly, you know, you put up in your high nine 90% only impacts women. I can’t really give you a heads up on that, but it is, having said that it is pretty rare, but bizarrely, knowing that I was going to talk to you about hepatitis today, there you go. The case hit my desk with a lady who had auto immune symptoms of it. Well, some a lot of the time there are no symptoms at all. And I think Kathryn, you mentioned, was it 106 cases of hep a yes, in 2021

 

Kathryn Knowles  07:24

sorry, in 2021 that was that I got. I couldn’t find any more recent unfortunately. Okay,

 

Matt Rann  07:31

I think I mean, to be perfectly honest with you, HEPA is. It comes and goes pretty quickly. I’ll go into HEPA a little bit later on, but it could well be that you feel off a bit of our kind of I’ll go into the other symptoms of hep artist in a minute, and you never bother going to your doctor. So it might be one of the reasons why there are so few cases also, I suppose, hygiene, yeah, certainly a lot better in this country. We’ve all been abroad whereby they said, don’t, don’t drink the water, or don’t drink, I know, remember going to Egypt. Yeah, lucky. You know Egypt too. Lucky you because it’s a great I loved it.

 

Kathryn Knowles  08:18

I loved it until the the unescapable moment that the stomach started

 

Matt Rann  08:25

to go, Yeah, I must admit I had that. It didn’t. Theresa didn’t. That’s my wife, by the way, guys, listeners, she didn’t at all. And she’s usually the one who comes down with that, those types of symptoms, but she didn’t. I did, but it didn’t take one moment away of how wonderful that holiday was, floating down the Alan, visiting all of the monuments. It was great either way. Sorry, what I was saying was they say Don’t, don’t take any vegetables or lettuce and things like that. Don’t eat it because of the water that it is bathed in, yeah, anyway, okay, symptoms, so we’ve already know, sorry, we all probably have heard of jaundice and that kind of yellow discoloration of the skins, and also the whites of the eyes can turn yellow. Yeah. Also symptoms, being poor appetite, vomiting, tiredness, abdominal pain and diarrhea. So those are generically symptoms of hepatitis. Across all the range of hepatitis is that you can get hepatitis, nevermind not going to try and be clever. Okay, so diagnosis, and this is where I wanted to go into a little bit of detail around what ifas intermediaries may come across when talking to their clients. Yes, it’s a little bit technical, but I will, I think it’s. Explainable without without too much brain ache. I think time will tell on that. But diagnosis generally is by physical examination, and I have to say that. I suppose that goes with a lot of diseases, but what the doctor will be looking at here is enlargement of the liver. And I know when I was an underwriting my reassurance days, the chief medical officers that we had, and we had a lot of them, used to say, you know, you’ll be lucky if an examiner could actually feel a palpable liver. You know, one out of 20 cases where a liver is actually enlarged, it’s very difficult to find on purely by by feeling the abdomen. Bloods are absolutely essential for diagnosis of hepatitis, and therefore you get your your liver enzymes, which, if you’ve ever seen blood test results, you will see them crop upon that and by definition, you the the bloods themselves can detect each of the five viruses we’ve talked about with the letters A, B, C, D and E, yeah. So those blood tests themselves. If I take Hepatitis B as that’s one that we do come across the most in terms of the reports from the doctor, etc. And in fact, hepatitis B and C are actually asked for automatically by some insurers, yeah, automatic requirement and very high sums, assured. I can’t think actually the UK should, or I’ve seen it, but certainly your your international companies certainly do so with the again, you’re looking at antibodies and antigens. Just a very quick GCSE here. An antigen is any substance, toxin or other foreign substance that can cause the immune system provide to produce antibodies. An antibody is a protein produced by your immune system to attack or fight off antigens. Probably antigen, I don’t know, is as well known as an antibody, but you can see that both of those are important in context of actually diagnosing current hepatitis or past hepatitis. Now I know having seen many, many Hepatitis B test results over the over the years that there are, there are three tests, really, the common ones, which talk about hepatitis B, surface antigen. Is there something Kathryn that you come across yourself? I don’t mean with you in your personal health. I mean in terms of your medical No, the I don’t think

 

Kathryn Knowles  13:01

it is something that I’ve necessarily picked up on with writing and things like that, from what I would be like discussing with underwriters, with but, uh, but maybe Alan might have done, but

 

Matt Rann  13:11

not me, okay? Or maybe I’m going a little bit too technical. I thought it was interesting of interest. Yeah, absolutely. So Hepatitis B surface antigen that test actually detects current infection. Okay, Hepatitis B core antibody shows whether you have been ever infected. Okay, so the hepatitis surface antigen negative, but you can be core antibody positive, showing that you’ve had a past infection, and importantly, the Hepatitis B surface antibody. So we talked about core antibodies, surface antigen, core antibody, then surface antibody shows that you’re protected against the Hepatitis B virus, and that will usually show up when you’ve been vaccinated. So if you had a hepatitis test tomorrow, it’s more than likely, on the basis that you haven’t had hepatitis, I haven’t had hepatitis. Let’s talk about me, rather than you. I know that I come up as hepatitis surface antibody positive. Do

 

Kathryn Knowles  14:20

you know what we have come across this? Maybe the three kids? No, no. It was with a client. Ah, okay, with a client who was a medical professional, and it’s they were having medical stuff and things like that. And it came up positive with hepatitis. And we had to go through the whole thing of then saying to them, you know, obviously, what sort of like having a debate with the insurer and going, Look, they are a medical professional. They have to have this, you know, this vaccine done, and things like that. And luckily, the insurer did listen. So yes, I have come across it a bit. Yes, we’ve got it overlooked. So they went, Okay. We understand and and we’ve got it all sorted. Good.

 

Matt Rann  15:02

I’m very glad about that, because I’ll talk about we have seen this a bit whoever that insurer was in a minute. But anyway, so I just thought I’d use those Hepatitis B there as as an example of those, the tests which can show whether you’ve got current infection, you’ve had past infection, or indeed, you are protected. I can only think that I don’t know the answer to this question. I should have looked it up afterwards. But whether a vaccination just causes service antibody, I don’t know. I suppose the core antibody as well. I don’t think it does. I don’t think it does. Okay, so complications of some of the hepatitis is that we’re talking about, and you’re absolutely right. Kathryn, in the very beginning, as you know well, know that it’s B and C of those five types of hepatitis that the insurers concern themselves with, but really the compete complications of those two in particular is scarring of the liver. And everybody will, I’m sure everybody will have heard of Tom cirrhosis, and that’s actually what it means. It’s generally the scarring is severe and it’s non reversible, to actually get the diagnosis of cirrhosis, or the term cirrhosis, it can cause liver failure and it can cause liver cancer. There’s some very high profile footballers in particular, who have had been treated with replacement livers of alcoholic liver disease. So liver failure, replacement livers there, and liver cancer itself. Okay? So very quickly, through those viral infections, five viruses, A, B, C, D and E had a I’m not repeating too much what we’ve already said, I think we’re gonna add a little bit more. It’s usually a food born illness. This is hepatitis, a it’s spread through contaminated water and unwashed food. It’s of the hepatitis is, it is the least likely to damage the liver. It’s usually very mild and completely resolved within six months. Okay? Hepatitis B is spread by exposure with contacted contaminated Bloods, particularly needles, syringes and bodily fluids, semen and vaginal fluids come from mother to baby two. Okay. It can be a chronic disorder, and in some cases, main lead to long term liver damage, including cirrhosis and cancer after many years of carrying the virus. So hepatitis B, again, is a serious disease, and hepatitis B and C, the best cases, in terms of longevity is, are those cases that were being hep C’s been caught early, and the virus itself hasn’t had time to damage the liver too much, if at all, in fact, if the very, very early cases. But as I’ve said, cirrhosis itself is permanent. It’s severe. Scarring causes liver fibrosis, and like a few other of the medical conditions that we talked about over the past year or so, the scar tissue itself will prevent the liver from working properly, therefore doing all of those jobs that we spoke about at the very beginning. Yeah, Hepatitis C is only through infected blood or mother to baby during childbirth as much as B, but it could also, it also can cause liver cancer and cirrhosis in the long term. Okay, apparently, to throw in a wonderfully, wonderful stat, and it’s wonderful on being very sarcastic in by saying that, in terms of hepatitis B and hepatitis C can occur together, by the way, you’re saying early doors with Hepatitis B hepatitis D, not always, though, like hep B and hep D, hep B and C, and around 80% of the world’s liver cancer cases are caused by a joint Hepatitis B and C combination. So you see if it has hepatitis B and C, then the underwriters will be very interested to know the detail of the case hepatitis D, again, it’s not one that we particularly concern ourselves about, unless the liver has been damaged, which it can be. But it’s solely found in people infected with hepatitis B, which you said, and hepatitis C doesn’t tend to be found in. Europe that much. But to be fair, with immigration and people traveling so much from the areas where it’s predominantly found, such as Africa, Asia and South America, then I would imagine it will be on the on the increase itself. Yeah,

 

Kathryn Knowles  20:22

one, isn’t it? It can be, yeah, under cooked foods, and I’m absolutely fanatical about food and so paranoid about it not being cooked properly. I get really, really some chicken or something, and I think it looks slightly pink or something, I just like, immediately stop and get on to come and inspect food, and make sure it’s okay.

 

Matt Rann  20:43

God bless you. See Alan, we could maybe in the past life, he was one of those poor people that had to taste the food of the king before the king took it. So make sure they wasn’t poisoned. So unfortunately, some of these people were were died of poisoning, not the king, but he’s a witch. Have you ever heard, by the way, it’s just complete diversion. The Have you ever heard of a royal whip? Boy

 

Kathryn Knowles  21:10

whip? I was going to say, I’m I’m going to guess that it’s maybe come up on Qi at some point. I do like Qi, but I can’t, off the top of my head, think with that the person that the person that they used to make eat the food just going up to, it’s going for the context of what

 

Matt Rann  21:24

we’ve been saying, similar, similar. This is a person, because if, if the king sorry, if a prince or can’t believe it happened to a princess, but if a prince was naughty, say, with his tutor or something like that, then he would be, he would be sent to not sentence, but be told he would be getting a whipping, right?

 

Kathryn Knowles  21:42

Literally, about a whip. It

 

Matt Rann  21:45

is okay. Happened was rather like the king with his person who tasted, tasted the food, the prince would have a whip boy. So rather than him being whipped, the boy would be whipped because you couldn’t whip

 

Kathryn Knowles  22:02

a royal Okay,

 

Matt Rann  22:06

and there was a whip boy. That’s

 

Kathryn Knowles  22:10

why I’m gonna say that. I’m sorry such I’m thinking. I’m not sure how we’ve got from hepatitis to whipping.

 

Matt Rann  22:17

Well, there you go. Nuggets that come through on it all, something completely silly, but there we go. Okay, so in terms of immunos, immunization or treatment, hepatitis A, again, certainly, I’ve had hep a and hep B vaccinations before traveling abroad, particularly, I’m in Egypt. Would be absolute classic. I’ve been to the Far East, into Africa. So so generally with hep a immunization, so you have two weeks before traveling abroad, and gives you protection for 12 months. If you get a B booster, Hep a jab, it lasts for 25 years. Hep B. Now this was really interesting when I wanted to return to bear in mind your insurance comment. My daughter, who I spoke to earlier this morning, confirmed this. I can’t really remember with my children, but hep B vaccinations given, given to all new babies, unless, I suppose the parents said no from during the first 24 hours of their birth, and two or three doses during, you know, whilst they were toddlers. I suppose

 

Kathryn Knowles  23:33

it’s, I will go while we’re talking, I’m going to go into my NHS app, and I’ll be okay.

 

Matt Rann  23:38

I’ll go on so it says, I mean, so, so you have one within 24 hours of birth, and then two shortly after that, and then after that, three, you’re you’re immunized, and you’re protected from hepatitis B for at least 20 years, probably for life, okay, but hep B vaccinations are also given. So they’re happening at birth. Now it’ll be given to all people in high risk occupation, a lot of people who will travel abroad, is my understanding. But it also includes people with poor immune function, such as people with HIV AIDS, and those babies are born premature as well hepatitis and by the way, Hepatitis B may just come across the initials H, B V, sometimes when you’re talking to people hepatitis C, H, C, V. Now with hepatitis C, there is no effective vaccine, okay, it’s apparently genetically too complicated, too complicated for medicine at this moment in time. So the last 10 or 15 years to be able to come on an active, an effective vaccine for hep C. But the very, very good news is it can be treated with a 90 treated with a 90% success rate. So Hep C can be treated and with with things called da Direct. Acting antiviral drugs and that can stop, help enormously, stop the progression of the disease. As saying early doors was that early detection before liver damage or other complications such as cancer, liver failure, etc, come into play. So Hep C, well, I must admit, when I started in my underwriting career, which is a very long time ago, as everybody knows, Hep C, you wouldn’t touch a case with hep C, but now, what I mean by touch a case? Sorry, we wouldn’t be able to provide terms for a case, but now certainly can.

 

Kathryn Knowles  25:40

Yeah, I’ve just had a look. I’ve had a thing. So what’s interesting is that on my obviously, there’s a long time between me and my children in terms of their things so, but on both all of ours, it says Hepatitis B vaccination due, and it’s literally right after a born and like in the next few weeks after having boosters. But it doesn’t say on anything that has been given. Oh, so, so that’s interesting, because obviously my youngest was born in 2017 so maybe it’s something new that they’re doing more for newborns. I’m

 

Matt Rann  26:13

just trying. Well, yes, I mean, you’re when I checked with my daughter, I mean her, her little boy, is only two, yeah, who serves well before, well, the only thing I would say is, you know, I know a lot of my vaccinations weren’t even recorded on the GP, yeah, because we travel abroad quite a bit, we’re lucky enough to do that, they couldn’t actually tell quite what I’ve been vaccinated. You know, got yellow fever and all types of strange things you get. You can get vaccinated. They didn’t actually know, but I would imagine, do you still have again? You have to forgive me, I’m going back a very long time with our two but they don’t. The little ones have kind of their own little medical record, which they keep with them, or the parents keep holding Yeah,

 

Speaker 1  26:59

the little red books, yeah, go everywhere, absolutely. Maybe in there they might

 

Kathryn Knowles  27:04

say it Alan. Have a look. So usually put on the they usually stick the actual label into the thing, so you’ve got, like, exact, the exact batch and everything like that, yeah. But now have a look. And if not, I’ll, unfortunately for the children, I’ll probably book them in to get it done, because I did it with my older two. When I had my youngest, he has an extra vaccine compared to those two. It was an extra meningitis one. How come he’s got that? And then they’re like, Oh, well, now it’s an advice where I was like, Well, if that’s the thing, then the other two are going to get it. So I put them in place. I

 

Matt Rann  27:37

say, oh dear. And it’s, you know, I’m a vaccine nut. LuckI, my wife is as well. So I

 

Kathryn Knowles  27:43

would anything and everything. I would rather have it than not have it. You know, in a sense, I’d rather have done everything possible to prevent it, yeah, but obviously, then I also know people who are very different to me, and we know people, so obviously, we’ve got all the things going around at the moment about the flu vaccine for kids at this time of year at the schools. And I always do it, because I just think, Well, why not? You know, do a bit of extra protection. But I know one of my friends who’s similar age to myself, absolutely won’t do it. And it’s, it’s such an individual thing, isn’t it? It is

 

Matt Rann  28:10

very much. So, yeah, absolutely. And it’s everyone to their own. And, you know, obviously the kids can have it when, when they’re old enough to decide for themselves as well. Absolutely, you know, it’s certainly a view which is to be broad. It’s just different from I suppose, but that’s fine, absolutely fine. So in terms of the different types of hepatitis, we’ve kind of gone through those. As I say, there are more than just obviously, the viral the five viral hepatitis is you’ve got the chemicals, drugs, alcohol linked, and the autoimmune hepatitis as well. But at the end of the day, we’ve already talked about hepatitis A, D and E, but suddenly, alcohol, drugs, chemicals can lead to can lead to the same end game, which is cirrhotic liver, which will eventually fail and you need a liver transplant or And sadly, somebody will get liver cancer, yeah, so they, if you like, from an underwriting perspective, it’s generation around the the type of hepatitis that somebody has been diagnosed with, the when, and nearly always is going to be sorry, like, remember why that was The when is important with all medical disorders, but with this one, you’ll want to see very much if the type of hepatitis that the person has suffered from has actually caused any liver damage date, and we talked about those tests and so. Absolutely there’s probably, I would say there is certainly another one that I see time and time again, and that’s the ultrasound scan of the liver. Yeah, the one of the the other tests that can be used, at least historically. I haven’t seen it so much recently. It’s actually a needle biopsy of the liver. Okay? I always remember talking to our doctors, our CMOS, back in the day, that really a negative needle biopsy doesn’t really mean vast amounts, because you’re taking a tiny little bit of skin tissue, sorry, I should say from the liver in from the biggest organ in the body. Yeah, and you can easily miss a, a some, some damaged tissue. So liver biopsies, not that useful, but your the scan, the ultrasound scan itself is very useful, but also the blood test result, particularly the liver function test to see how damaged the deliver action is, and your underwriters will really base the core of the decision will be around whether the damage, if indeed there is any, to the Liver itself, and how the liver is coping your underwriters see time and time again. Or I think they do make it this way. I certainly do alcoholic hepatitis, where somebody is drinking and some of those liver functions, gamma GT being the one that underwriters tend to swear by at the moment, as and other ones as well AST and alt, but it’s gamma, GT, can. Can is pretty sensitive to alcohol abuse, and it’s so fortunately or unfortunately. It’s fortunate that some people can drink heavily and their liver can cope with it with absolutely no problem at all. Others of the same sex as well. I might add, it’s not just this man woman thing. Tend they can have, I suppose, what’s untechnical Tom for sensitive liver and the Gemma GT can go shooting up with an amount of alcohol that others livers can cope with absolutely no problem at all. So little bit dependent. But of course, if it goes shooting up, even with a sensitive liver, it means that your liver is is working harder than it should do, and therefore the consequences of that eventually, if you continue to drink, then you know, you will, you will get that scarring. There is also something else that’s is doing their owns more recently, and that’s called Nash. Have you ever heard of that? Kathryn, okay, well, that’s, that’s non alcoholic, sciatic, hepatitis, okay? And it’s often linked with fatty liver.

 

Kathryn Knowles  32:56

Ah, yes, of course. That’s where

 

Matt Rann  32:58

probably fatty liver maybe is something that’s more common these days. Certainly, doctors are paying much more attention to it than they used to. But and can be rateable in its own right, even with even if the liver itself is functioning okay in terms of the blood results, the fact that the sciatic bit is fat, basically the fat, the fatty the fact that the liver itself has been infiltrated by veins, if we can call it that the fat, will cause it to struggle after a time. And usually people with fatty livers Nash are told to reduce their alcohol, particularly, which is the modern way, of course, of leaving two or three days before having any alcohol. So don’t drink on consecutive days. In other words, let your liver recovery between and as we all know, the the recommended alcohol is from from the NHS these days is a maximum of 14 units, men and women. And also, with that, those gaps between during the week, whether that’s remarkably low or not, I don’t know. I know it causes an awful lot of debate, even amongst doctors, whether that is too low, on the other hand, you’ll get doctors saying you shouldn’t drink at all. Yes, even with a normal, you know, generally fit person, they should not drink. You’ll get that from doctors as well. So it does seem a divergence in thinking there. But anyway, that’s, you know, alcoholic hepatitis is one that, even if it’s early days with hepatitis, is one that underwriters in particular, will come across a lot. And with the moving medicine, NHS medicine certainly to try and make, to try and catch disease early, or even before it starts. Then. There’s a lot of testing going around. There’s a lot of attention going around on alcohol consumption as well. Yeah, we’ll see a lot of it. Is that okay? Is there anything that flies out of that? Little over, say, little that overview on on hepatitis, no. Concentrate on the liver, how it’s functioning, and cirrhosis, failure, cancer,

 

Kathryn Knowles  35:27

I think it’s all, all really, really useful. I mean, I think, you know, as an advisor, when I’m speaking to somebody, I’d be saying along the lines of, you know, what type of hepatitis were you diagnosed with? You know, is, you know, depending upon the type, and what they’ve said to me, you know, is it just the wants that you’ve experienced it, or has it happened multiple times when you know, sort of the symptoms that experience, sorry, the treatments and things like that. But the other thing I would ask for is the liver function test. So that was the lft, so what would be classed as sort of normal figures for, like a liver function test and that, okay, I have

 

Matt Rann  36:04

to say does, like, like all of these blood tests, it can vary between laboratories. So in other words, we’re trying to say is the lower limit or the upper limit. The upper limit being one be looking at in particular can vary, but gamma GT, you would look to be certainly below 40 to 6040. To 60 is the, I can’t remember the unit. I’m sorry, nano units

 

Kathryn Knowles  36:30

off my head either.

 

Matt Rann  36:32

I must admit, I’m lazy. I just look at the report AST and alt. I can’t muster remember, but I think you’re looking much higher between 80 and 120 Okay, as I say, you’re quite I quite often see raised gamma GTS in people, even, for, excuse me, even at 345, times the level that the upper level, up a level. But whilst that that is quite markedly increased, your AST and your alt are completely normal, yeah. So I know certainly in our NHS practice, that gamma GT is not a routine test under the liver, the broad heading of liver function, they just go for as AST and alt. Unless I suppose that they have a specific concern about alcohol consumption, they just go AST and alt, as I say, they can be completely normal. And it’s not just once. I’ve seen this. I’ve seen it quite a few times, but your gamma GT showing your drinking too much and your livers is under strain, can be very abnormal, yeah. So as I say, if you don’t have gamma GT and you’re an underwriter, and there’s, there is a question mark about alcohol criticism, then you really do need to get that kind of GT, yeah, absolutely. And on insurance exams, insurance blood tests. This is always asked for, we’re talking about. It’s not always asked for on NHS, yes,

 

Kathryn Knowles  38:15

yeah, of course. Definitely. Those exams can definitely be quite different, especially, you know, depending upon the sum short as well that’s been looked at. Certainly change the different things that are required as as we’re going further and further ahead with the underwriting. Yeah. So what would be your kind of idea? I know this is probably very different, potentially different types of hepatitis, and obviously is always in terms of the treatments and the way that it’s presenting. But what would be your thoughts in terms of expectations for life insurance, criticalness, cover and income protection? Thank

 

Matt Rann  38:48

you very much. Department you, as you’ve highlighted right at the very, very beginning of our chat, the ones for a start that you should do are red flags, if I’m calling that to under eyes, to the hep B and C and to bear the rating. So in other words, the additional premiums that people would be asked to pay very much depend on the how the liver, how far that disease, the hepatitis itself, has progressed and damaged the liver. If there is no damage at all and you are not currently Hepatitis B positive, then, sorry, Hepatitis B positive, in the context of the tester that I outlined earlier, by the way, which was the service antigen, which it shows the current infection. So if your core antibody positive and hepatitis and surface antibody positive, then and that infection is passed and it hasn’t done any damage to the liver, and you have been your liver function has. Be normal for two years, then you could well be looking at standard rates to plus 50, yeah, hepatitis B, if you are currently infectious, then I’m that is, that is a postpone, yeah, I would hate I put the underwriting terminology of decline and postpone. There’s a very gray area between the two, in my particular opinion, and but I think in terms of the clients, when you’re going to postpone, at least, there is hope that that cover can be given at some stage, which it could well be, where a decline. Kind of think, Oh no, I’m going to, you know, something horrendous is going to happen to be in the next two weeks. Next two weeks, which is not obviously the case at all. B, hep, C, again, it rather depends on the extent of the complications of the hepatitis C virus. As I’ve said, 90% of people can be cured. And if you have, if the Hepatitis C is inactive and has been inactive for a couple of years, then you’re probably looking at something between about plus 15 plus 100 Yeah, in terms of the others, HEPA, unless you have currently got symptoms, you’re going to be Standard Rates for life cover and the same really for hep hep D and E, but noting that D is always associated with hep B, which is therefore a concern in its own right for critical illness. Well, you again, I always have to carry out by saying it depends on what type of coverage you’re actually buying or recommending, whether it has things like liver failure, transplant, cancer in them. Now, cancers almost can be ever present, I think, and probably transplant as well. These days, liver failure, I’m sure, is very, very common coverage, and there you’re going to be looking at, I think, for critical illness, Hep A and E shouldn’t be a problem. Hep D is always associated with hep B, so it goes back to hep B and C. I think you’d have to be looking at a minimum period of three. To five years of the disease, having an infection having taken place, but the disease has gone. There is a cure, and also normal liver function tests before you start quoting on that, income protections, I think would probably fill in, fill in about the same, yeah. Does that help at all? No, now with your case studies, knowing you be completely wrong, but I would those, those are the areas certainly on the life insurance that people will be looking at, certainly, if I can just go back Hep C, great improvements there with the treatment of it and the fact that it can be cured in the E commerce. So whilst Hep C was non insurable in days gone past, now is it is now okay? You have to remember again. Can I just point out that some of these hepatitis is are linked to things like exposure to contaminated blood, needles, syringes? So if you’re looking at hepatitis B, you’re looking out for lifestyle potential, lifestyle issues, yeah, as well. And of course, Robin talking about is purely just hepatitis B, with no other concerns around how it was actually, how that person was impacted, I think Hep C and must be B as well, were a lot of the people who were given blood products for oh, goodness gracious. What’s the My mind’s gone completely blank. The Royal where you were bleeding up, Amy, hemophilia. There we go, hep B and Hep C. Goodness gracious, I really have been talking about whipping boys and my ancestors. And so I think hep B and Hep C were commonly found in those blood products as well. And people who sadly got those types of blood products in those days, quite a few of them actually died of liver cancer because they were infected, particularly with hepatitis C, yeah, yeah. So there we go, on that one, as well as HIV. Yeah,

 

Kathryn Knowles  44:50

I think that’s, it’s important to say, as an exercise, you know, it’s the whole thing of it is hepatitis, but we might have connected conditions, so you might have alcoholic hepatitis. But. To Yes, that is hepatitis, but you’ve got the alcohol as well, and the alcohol in itself, yes, they are combined. But alcohol in its own right is its own disclosure. And then the underwriters, in a sense, will probably combine them to have a look at it and everything. But it’s, you know, if I was somebody was saying to me, they had alcoholic hepatitis, and I’d asked all my hepatitis questions, I wouldn’t just be able to leave it there. I would need to ask, from an advice point of view, I need to say some more in terms of alcohol, how much were you drinking at the at the highest point, you know, per week, in a sense, do you still drink now? You know, have you been advised to stop drinking? You know, have you had any support groups, things like that? And it’s not to say that if those answers are yes or anything like that, that the answer is an absolute no for cover, but it’s just to be clear that you know, you need to have all the information there in front of you, okay? And so we have two case studies just to round everything up. So first one is somebody in their early 30s or a non smoker, and they had autoimmune hepatitis, and had been diagnosed 14 years prior, so in the late teens, was under control with medication. There was no liver fibrosis. They had normal clotting factors as well, which was something that was the underwriters were interested in. The liver function tests were normal. The hepatitis itself had been stable for 10 years, so we’re able to get them decreasing. 420,000 pounds of life insurance over 28 years for 15 pounds per month. And then the second case to do something in the mid 40s, again, a non smoker. This was hepatitis C, and it had been diagnosed three years prior to doing the application, and it was in control with medication, and the LFTs were stable with the medication, so we were able to do income protection. And did have exclusions for claims relating to hepatitis C, as we would expect. You know, if there’s an existing condition there, we wouldn’t expect that to usually be covered for an income protection policy. So it was 2166 pounds per month, monthly benefit, 26 weeks deferred period to match their sick pay, five year maximum claim. It goes through age 70, and the premium was 40 pounds per month. So I’m really happy that we managed to get those outcomes for people. And so there we are. We’ve got to the end of the podcast. Thank you for listening, everybody and Matt, thank you for joining me next time. Sorry,

 

Matt Rann  47:11

my pleasure. Sorry to interrupt. It’s all

 

Kathryn Knowles  47:15

right next time, I’m intending on doing a bit of an overview of group critical illness cover, and then that should be us done wrapping up the group products that I can talk about. So please do visit the website, practicalhythm protection.co.uk, to see all our other episodes and to get your CPD certificate. And you can get the CPD certificate on our website. Thanks to our sponsors, the Okta members. Thank you very much, Matt, and speak to you soon.

 

47:39

Take care. Bye. You. Bye, you.