July 3, 2024 • 61 mins
Diabetic Autonomic Neuropathy affects up to 50% of long-term diabetics yet remains largely undiagnosed and misunderstood. Bethanie Spangenberg explains how this condition impacts the body's involuntary functions including heart rate, digestion, temperature regulation, and bladder control.
• Autonomic neuropathy differs from peripheral neuropathy by affecting involuntary body functions rather than intentional movements
• 7% of Type 2 diabetics already have autonomic neuropathy at diagnosis, with numbers increasing to 50% after 15 years
• Cardiovascular symptoms include resting heart rates above 100, orthostatic hypotension, and decreased exercise tolerance
• Gastrointestinal effects include delayed stomach emptying, difficulty swallowing, and disrupted bowel function
• Heart rate variability under 40-45 on smartwatches can indicate developing autonomic dysfunction
• "Silent" heart attacks can occur when nerve damage prevents pain signals from reaching the brain
• VA claims for autonomic neuropathy must focus on individual symptoms like gastroparesis or orthostatic hypotension
• Exercise, despite being difficult, helps improve autonomic function by forcing neural pathways to activate
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Episode Transcript
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Ad (00:00):
Blog Talk Radio.
J Basser (00:04):
It's time for the Exposed Vet Radio Show.
The Exposed Vet Radio Show, wediscuss issues affecting today's
veteran.
Now here's your host, john andRay.
Welcome, ladies and gentlemen,to the Exposed Vet Radio Show.
Today's the third day of July2024.
It's going to be an interestingshow.
(00:25):
Today's the third day of July2024.
We'll get an interesting show.
We got Bethany Spangenberg fromValley Corvette she's on and we
got Mr Ray Cobb, our trusteeco-host, who, by the way, last
week went to the VA's version ofHarold's House of Pain and
couldn't talk too much.
He got a few words in, but Ithink he was kind of
snaggletooth a little bit Todayhe's doing a whole lot too much.
Ray Cobb (00:46):
He got a few words in, but I think he was kind of
snaggletooth a little bit.
I had no teeth, they just tookthem all out, man.
J Basser (00:52):
Well, I told you you could have come up here.
I could have done it withparaplyers and a ball-peen
hammer.
You've been all right.
Ray Cobb (00:57):
I'll tell you what it would not have hurt anymore.
I can guarantee you that.
J Basser (01:02):
I don't know what you mean, buddy.
I don't know exactly what youmean, but today Beth is going to
discuss a condition that's nearand dear to me and some other
folks.
It can be a bad side effect ofdiabetes.
It's called diabetic orautonomic neuropathy.
I know it's kind of hard tounderstand and digest, but I
(01:27):
think she can explain it to us.
Bethany, how are you doing?
Bethanie Spangenberg (01:30):
I'm doing well, thank you.
I'm excited for tonight's topic.
I know that you've been pokingme about talking about it for a
little bit, so I'm glad thatwe're able to knock it out
tonight.
J Basser (01:42):
That's good.
That's good.
It's good.
I know a lot of vets areaffected by this.
A lot of them don't even knowwhat it is.
Bethanie Spangenberg (01:53):
Yeah, and I know you know we'll talk a
little bit tonight aboutdifferent symptoms and things
that your provider should belooking for, but from even the
clinical side of things, it'snot a topic that's readily
discussed.
It's something that normally wecall a diagnosis of exclusion.
So basically, if you'reconcerned with it or if we're
(02:14):
concerned with it, we put youthrough all these different
tests, and if none of thoseother tests show that you have a
condition or a differentcondition, then we say, oh okay,
well, it must be diabeticautonomic neuropathy.
And so when we look at it fromthe clinical side of things,
it's usually the bottom on ourlist of concern and so a lot of
(02:36):
times it goes without diagnosisor a misdiagnosis, and the
statistics are actually prettysignificant for those with
diabetes.
In the presence of diabeticautonomic neuropathy, now I will
say I prefer to say the wholediabetic autonomic neuropathy,
but in a lot of the medicalliterature they call it DAN.
(03:00):
So if we talk about DAN today,dan is diabetic autonomic
neuropathy.
So hopefully there's noconfusion about having somebody
else I don't know you pullthings up your sleeve.
There might be other people onthis phone call that I don't
know about.
Ray Cobb (03:24):
There may be.
We may have lost him.
Bethanie Spangenberg (03:28):
Exactly.
Ad (03:29):
So we're going to talk to Dan that's not here, yeah.
Ray Cobb (03:34):
Dan, that's what I'm thinking.
I have a question for you thatthis has to do with if I
understood correctly what littleI read about it this week.
If I understood correctly whatlittle I read about it this week
, does this have to do with thenerves control over certain
muscles or certain reaction thatnormally the body or the brain
(03:57):
doesn't?
That does it automatically.
Yeah, such as heart rate orthings like that.
Bethanie Spangenberg (04:03):
So I'm just going to use that as an
opportunity to just dive rightin and talk about what it is and
what it isn't.
But I think, before we get toofar into what it is, I really
want to explain the nervoussystem a little bit and try to
make it clear as mud foreverybody.
So when we look at our nervoussystem, we look at it as two
(04:26):
components.
We have a central nervoussystem, which is the brain and
the spinal cord, and theneverything that is not the brain
and the spinal cord is theperipheral nerves.
So we've got our centralnervous system and then our
peripheral nervous system andthen if we divide the peripheral
nerve system, it is dividedinto other components.
(04:51):
So one of those is somatic andthe other one is autonomic.
So when we look at somatic, it'sthe nerves that are associated
with intentional movements orvoluntary movements.
So our muscles, our muscle,control us moving our arms.
That's the somatic nervoussystem.
If we put our hands onsomething that's hot or that's
(05:14):
cold, that is the somaticnervous system, because we are
intentionally grabbing andfeeling the pressure or
adjusting to the temperaturepressure or adjusting to the
temperature.
There is part of thattemperature regulation that is
in the automatic or theautonomic system.
And so when we look at, when wehear the term diabetic
(05:37):
peripheral neuropathy that wenormally hear about, or we hear
about it more readily, that isgoing to affect the somatic
nervous system and we're nottalking about that type of
peripheral neuropathy today.
So this is something different.
That is not those muscles andskin that we're intentionally
(05:58):
controlling.
The autonomic nervous system isthose involuntary reactions or
those involuntary actions suchas your heart rate, your blood
pressure, breathing, digestion,and that's just to name a few,
because it's pretty extensive ofwhat the autonomic system does.
(06:20):
But these are things that we door that are controlled
subconsciously, and so you askedabout, did you ask about blood
pressure?
Is that what you were askingabout?
Ray Cobb (06:34):
Well, there's some of the things that well, one thing
that's similar to blood pressure.
I was wondering about AFib.
You know, when your heart goesinto irregular beat, which is
referred to as AFib, is that apart of it or is that a sign of
it?
Bethanie Spangenberg (06:54):
It can be so.
If that nerve system or thosecommunication systems don't
effectively communicate, then itcan create either a high heart
rate, it can cause disruptionwithin the regular rhythm.
Sometimes it has to do withelectrolyte imbalance.
(07:16):
So when we look at AFib wedon't think first of diabetic
autonomic neuropathy.
We think of something else,some type of blood vessel
disease or muscle disease of theheart.
But it can cause somedisruption in that heart rhythm.
Ray Cobb (07:33):
Okay.
Bethanie Spangenberg (07:36):
So autonomic nerve go ahead.
J Basser (07:39):
Dan's brother can ain't it.
Ad (07:44):
Yes yes, absolutely.
Bethanie Spangenberg (07:46):
It is abbreviated Any type of
autonomic neuropathy that isaffecting the cardiovascular
system.
They call it Can.
So we have Dan and Can and Danand a few other ones coming
through.
I do want to mention all thedifferent organ systems that are
(08:06):
controlled by the autonomicnervous system, because it's
pretty extensive and we again,these are not things that we
actively control.
These are things that our bodydoes on its own.
So the autonomic nervous systemcontrols our eyes, has some
components of the eyes, the skin, the salivary glands, the heart
, the lungs, the stomach, thepancreas, the adrenal glands,
(08:28):
the liver, the gallbladder, thebladder and the genitals.
So they have a lot of controlover things that we are not
actively thinking about.
(08:57):
About the autonomic nerve, thediabetic autonomic neuropathy
can affect both type 1 and type2 diabetes.
When type 2 diabetes isdiagnosed, it's typically
something that's been going onfor a while, and we're just now
meeting the criteria for theblood sugar level to be
diagnosed as type 2 diabetes.
So statistics show that atdiagnosis of type 2 diabetes
(09:20):
that 7% have some type ofdiabetic autonomic neuropathy,
which I found that striking.
Normally with type 1, becauseit's more of an abrupt onset of
sugar dysregulation thatautonomic neuropathy doesn't
present itself until five yearsor more after the onset of
(09:45):
diabetes.
So I found that to beinteresting, that 7% at time of
diagnosis of type 2 diabetes hassome type of diabetic autonomic
neuropathy.
J Basser (10:03):
I read that too.
Ray Cobb (10:03):
It makes sense.
Yeah, it is a diabetic type 2diabetic and if you're just
learning about this, what aresome signs or what are some
things that indicate that youneed to bring up to your doctor?
Bethanie Spangenberg (10:20):
So that's the tricky part, because
sometimes you don't have to haveany symptoms whatsoever and
they call this subclinicalfindings or things where you're
not experiencing symptoms but wecan see it somewhere in your
vital signs.
Or if we look at cardiacfunction we may be able to find
it.
So the most common types ofneuropathy affect the heart and
(10:47):
blood vessels, thegastrointestinal system, the
bladder, the skin and even somemetabolic and sleep dysfunction.
Those are your primary things.
That it can affect Noteverybody is the same.
That it can affect Noteverybody is the same.
(11:08):
There's not a group of symptomsthat one diabetic can have to
say, oh, that's diabetic.
Autonomic neuropathy Again, likeI said earlier, it's usually a
diagnosis of exclusion andthat's really because sometimes
those symptoms can be vague andthey can make a clinician
believe that it might besomething different and so they
have to rule that the morecommon probability out first
(11:34):
before they really get to theautonomic neuropathy diagnosis.
But if we like, for example, ifwe look at the cardiovascular
system, you can have a heartrate above 100 at rest and
that's a concern that theautonomic nerves aren't doing
what they're supposed to do atstabilizing that heart rate.
(11:55):
You can have decreased exerciseintolerance, meaning you go to
exercise and you start todevelop pain in your legs.
From running or even justlifting your arm to put in a
light bulb, you can developburning in your arms because the
body cannot adjust to theincreased need for oxygen so
(12:21):
those vessels don't dilate toallow increased blood flow to
those muscles and so thosemuscles are deprived of oxygen
and so it starts to trigger aburning sensation in the arm of
them or the legs.
You can have tension or lowblood pressure if you change
position.
Ray Cobb (12:40):
I think that is something, yeah, I think I've
heard that one before.
Bethanie Spangenberg (12:46):
That would be so we call that orthostatic
hypotension, and that isprobably one of the more common
diabetic autonomic neuropathyfindings that occur in diabetes.
And then you can get thingslike POTS, which is very similar
too.
So rather than the bloodpressure changing or
(13:08):
malfunctioning, I guess inposition, the heart rate in POTS
does not adjust appropriatelywith position change.
And so to diagnose thosecardiovascular autonomic
neuropathies there's specialtesting to do, and Ray what kind
of testing have you had?
Ray Cobb (13:30):
Well, good point.
I'm not for sure what alltesting I've had.
I haven't had any recently, butback in 2011, when I had my
open heart surgery, they ran alltype of tests there and then,
when they were checking my legsfor neuropathy in my hands and
(13:51):
arms, I had all type ofelectrical type where they, you
know, use the little shock andsee how fast you react to the
and at what level theelectricity causes your muscles
to relax.
But I think that's the onlytest that I can relate to that
I've had, and that's why I waswondering is there some that I
(14:13):
should be asking the doctors tolook at or just kind of let it
go by?
When you were talking about theheart and the standing up and
the blood pressure, all of mineseem to be fairly regulated as
long as I take my medication,and medication might be what.
(14:34):
Does that help regulate it ornot?
Bethanie Spangenberg (14:37):
Well, John , I think that's your cue.
J Basser (14:44):
Great To answer the question on that.
They regulate a lot of thesearrhythmias and things like that
with pretty high-powered betablockers.
I've been taking one for years.
We just increased it here lastyear.
The issue that you know it'skind of hard to find but if you
(15:07):
start having issues like Bethanysaid, it's kind of a you know
you have to check the boxes onit to get a diagnosis.
You know you need more than oneissue and I can tell you, for
example, when you, if you takethis medication I've been taking
for years, every time you go tosee a heart doctor you have to
get an EKG.
That's kind of I guess aclinical standard for like solo.
(15:28):
All right, bethany, yes.
And so you start looking at EKGresults and you start seeing
crazy things like, for examplesince 2017, I've had probably 20
to 30 EKGs and 16 or 17 of themhave this thing called poor R
wave progression, which is theR-axis on your EKG as always low
(15:48):
and it's below the threshold of30, so it's like a minus 15 or
minus 13 or minus 12.
That's a giveaway.
Another issue is, if you havearrhythmias, you've got HVAB,
you have other arrhythmias andthings like that.
That could be a part of it too.
(16:10):
The big issue is blood pressure.
If your blood pressure say, forexample, I'm sorry, it's like
hypertension, okay, on Monday,my blood pressure will be 175
over 132.
On Tuesday, it'll be 160 over99.
(16:31):
On Wednesday, it'll be 90 over70.
There's no control there.
It's either or you hardly eversee a regular blood pressure
reading.
Then, when you stand up andyour blood pressure drops, say
30 points or more, andespecially if your blood
pressure is near normal or low,that's when, especially, blood
pressure is near normal, low,that's when you're going to have
your syncope.
So you're going to open status,going to wipe you out, happens
(16:52):
to me a whole lot.
Bethanie Spangenberg (16:54):
So, and you, you're able to talk about
this because you've walked thatpath and you've had these tests
done and they've done the thetilt table test for you, and
that's where they check yourblood pressures at different
positions.
J Basser (17:08):
I don't know years ago .
I had it a couple weeks agowhen a kid sort of worked up and
the cardiologist said that Icould not do the tilt table test
.
It's too dangerous.
Bethanie Spangenberg (17:22):
So when we look at the cardiovascular side
of things, if we're concernedwith an autonomic involvement,
we definitely look at the EKG.
We do some tilt testing, theexercise intolerance.
That's hard to diagnose.
It's really based off ofclinical symptoms and you rule
out like a large nerve fiberneuropathy or a somatic nerve
(17:45):
disease, like we talked aboutearlier, and so they can do an
EMG in your legs, you know, andyour nerves in your legs, and
they'll tell you.
J Basser (17:55):
You know that your big nerves are basically okay,
there's a little issue butusually they can find the small
fiber, neuropathy, which isactually another giveaway, and
things like that.
Bethanie Spangenberg (18:09):
So one thing that I found valuable when
I was reviewing this materialfor tonight is they were talking
about heart rate variability,and I knew that heart rate
variability is a sign of cardiachealth, but I never realized
how it plays out in autonomicneuropathy.
So I know.
John, you talked about gettinga smartwatch.
(18:31):
Do you have one?
Do you wear one, Ray?
Do you wear a smartwatch?
J Basser (18:35):
I've been wearing one for years.
Ray Cobb (18:37):
No, I try to get him to.
J Basser (18:39):
I've tried to get him to.
Ray's, I mean he's, he's one ofthe time X boys.
Well, you know it's.
Ray Cobb (18:50):
in listening to this I've been beginning to think
that, um, I am not anywhere nearas severe or have as much of
any of this, because my heartrate is pretty regulated, of
course, with medication.
My blood pressure when I takemy medication is fine.
(19:14):
I have normal readings all daylong.
If I come off of it for a dayor two, yeah, then the readings
get out of whack, but on a dailybasis, as long as I take my
medication, I mean, I'm going tobe somewhere around the 120,
over 63 or 19, over, you know,61.
Bethanie Spangenberg (19:41):
We've covered a little bit of the
cardiovascular system, but we'vegot one, two, three, four, at
least five more systems to touchbase on.
So okay keep an open mind youmight have to start asking your
provider questions.
J Basser (19:54):
Well, she wants to be made quick and that would be
good.
Get a smartwatch.
Bethanie Spangenberg (20:05):
So, if you look at the data on your heart
rate variability, you can have asubclinical sign in that heart
rate variability that says maybeI am experiencing some diabetic
autonomic neuropathy and sowhen you look at the heart rate
variability, for a healthy adultyou should sit somewhere
(20:28):
between 40 and 45.
If it gets lower, it can golower with age, but if it gets
much lower then it's going to beabnormal and then you should be
asking your provider questions.
Ranges can go from 19 to 75 onthe heart rate variability.
(20:49):
Your higher numbers are goingto be your professional athletes
, your endurance runners.
They're going to have adifferent heart rate variability
.
So for a healthy adult, you'regoing to sit somewhere between
40 and 45.
Anything lower and you've beendiabetic.
You need to start askingquestions about what does it
mean?
And is there something else weshould be looking for as it
(21:12):
relates to autonomic neuropathy?
Okay, so I thought that wasinteresting.
I never really put the twotogether as how I could use my
smartwatch, the heart ratevariability and looking for
subclinical signs of diabeticautonomic neuropathy.
And if you're new to listening,I'm also a diabetic and I have
(21:33):
been for 25 years and based onthese statistics, it shows that
some studies have shown, up to50% of diabetics have some type
of autonomic neuropathy after 15years.
So the chances just go up everyyear that you have this disease
(21:54):
.
So it's kind of a strikingnumber, say that again.
J Basser (22:04):
Pay attention to your high heart rate.
Notifications at rest.
Bethanie Spangenberg (22:09):
Yes.
So other than the heart and theblood vessels, the autonomic
neuropathy can affect yourgastrointestinal system.
It can cause troubles withmotility in the esophagus.
It can cause dysphagia ordifficulty swallowing.
It can mimic reflux disease.
It can cause slowing of thebowels to where your bowels
(22:33):
don't empty like you'reconstipated.
It can actually cause diarrhealike you're constipated.
It can actually cause diarrheaand it can cause loss of
sphincter control where you havefecal incontinence and there's
no other nerve damage, not hadany back issues.
So those are different thingsthat can occur with
(22:55):
gastrointestinal autonomicneuropathy, intestinal autonomic
neuropathy.
The other thing to consider isthere's a big push or a lot of
news out there about likeOzempic and Wagovi and a lot of
diabetes medications or weightloss medications, and one thing
I think it's important tounderstand is if you're on those
(23:16):
medications for either weightloss or for diabetes, you need
to understand that thatmedication is designed to slow
stomach motility.
So with those medications youcan have nausea because your
food isn't digesting as quickly.
You can have what they callearly satiety or you can't eat
(23:39):
as much as you used to.
You get fuller quicker.
You can have constipationbecause your bowels aren't
moving the same.
So some people or somediabetics who experience the
gastroparesis or the decreasedmotility of the GI system, they
do have weight loss and that isthe purpose of that medication.
(24:02):
So if you're like, oh, I'm onOzempic and I have these same
symptoms, it's probably theOzempic mimicking the slowing of
the motility than it isgastroparesis.
J Basser (24:13):
So, just keep that in mind.
I'm assuming you had it beforeyou started taking Ozempic.
Ray Cobb (24:18):
Yeah, yeah, right, I mean, mine came on since I've
been taking Ozipic and as far asweight loss, I have gone from
320 pounds down to, right now,about 247 last week.
(24:38):
Whoa buddy Good deal, that'sgood.
J Basser (24:42):
It's a good deal, that's good, that's really good.
But also, I mean in defense ofall the veterans out here even
if you are taking your servicefor your diabetes and it's
causing you to have that, andstill if it's causing this due
to a service-needed medication,you know all better still aren't
every sniff of medication is.
Bethanie Spangenberg (25:01):
You know, I'll bet they're still on it and
you know of all thecomplications related to
autonomic dysfunction.
Gastroparesis is in the ratingschedule, so the only.
There's no DBQ for autonomicneuropathy.
There's no diagnostic code inthe rating schedule for
(25:21):
autonomic neuropathy.
You have to break it down towhat system it affects.
And gastroparesis is in therating schedule.
And they even put thatorthostatic hypotension in.
I've seen it under peripheralvestibular disorders, which is
an ear condition.
Yeah, right.
(25:44):
When it's really an autonomicthing.
So it's interesting how theyhave to kind of work with their
rating schedule to fit thesymptoms.
J Basser (25:56):
You look at the vascular system too, it's, you
know, it's basically the same.
I mean, you know, because itcauses vascular issues too, as
well as feet issues.
So you know, I mean it's a bigfor it, that stuff, there's a
lot of stuff involved with it.
So, but the VA doesn't havethat.
The right-hand side is not,what do you call it?
It doesn't cover enough.
You know, it doesn't diseases.
So they just had a loop andit's similar to it.
Bethanie Spangenberg (26:19):
Right, yeah, and before we leave too
far from that medication, theozempic Wagovi there's several
of them out there the long-termeffects we really don't know.
So some people who have stoppedthe medication have continued
to experience some of thatgastric motility slowing and
(26:43):
there is some concern.
You know what it does forlong-term effects because we
haven't seen you know, we don'thave the 10-year study on these
medications yet so just keepthat in mind as you take that
medication or if you stop thatmedication.
Just keep that in mind as well.
If we move on to thegenitourinary section, some of
(27:10):
the autonomic dysfunction can beerectile dysfunction, female
sexual dysfunction.
You can have urinaryincontinence or urinary
frequency and then you lose thedistress signals.
So when your bladder getsdistended and tells you, oh hey,
there's pressure here and youneed to go to the bathroom, the
(27:33):
autonomic neuropathy can blockthat signal to where the nerves
aren't functioning correctly andyou don't know that your
bladder is full, and it canresult in the urinary
incontinence.
Some of the skin changes thatcan occur you can have dry skin,
(27:57):
you can have swelling and thisis outside of what we talked
about about the peripheralvascular diseases.
This is different.
You can have swelling in theskin itself.
You can also have heatintolerance and sometimes in the
patients that I've had, this isone of the first symptoms that
they have and it really comesdown to hey, I was outside on a
(28:21):
hot day and I just couldn'ttolerate the heat and I got
really nauseous and I got sick.
And here their body is notsweating, so they don't have the
temperature regulation becausetheir body is not sweating to
lower the skin temperature.
And there's actually a test wecall it a sweat test to see how
(28:43):
much you sweat and they can lookat the conduction of the sweat
to see what is occurring in yoursweat glands.
Ray Cobb (28:54):
Okay question on that line.
You're talking something I havenoticed recently.
For example, outside today Iwas not sweaty, although as soon
as the sun hits I do have a lotof dry skin, and Pam made the
comment this morning she needsto start putting more lotion on.
(29:16):
Putting more lotion on and withthe dry skin.
I was outside today when thesun hit my skin.
It felt like a thousand littleneedles hitting me.
Is that an?
Bethanie Spangenberg (29:34):
indication that I need to have it looked
at, or a question.
I would be more concerned withthe dry skin rather than the
sensation that you're getting.
I've not other than gettingsunburned, which you're going to
be susceptible to.
I'm not sure.
To me that doesn't correlatewith some type of skin nerve
(29:57):
disease.
Ray Cobb (29:58):
Okay, nerve disease.
Bethanie Spangenberg (30:01):
A couple other things that we can see or
appreciate in patients withdiabetic autonomic neuropathy is
that they lose their pupillaryreflex with light.
And some patients will say youknow, I really struggle at
nighttime with driving becauseit hurts my eyes when I see the
(30:25):
bright lights.
So what happens is you're atnight and your pupils are big
and then when you get light fromother cars, your pupils are
supposed to constrict to controlthat light function, to control
that light function, and withautonomic neuropathy your pupils
can lose the ability toconstrict and relax to adjust to
(30:45):
light accommodation.
And so some people withdiabetes experience that and
then they go see the eye doctorand they also because glaucoma
and cataracts can mimic similarsymptoms and they're at higher
risk because they're diabetic.
So if you have any type of eyesymptoms related to driving,
(31:07):
whether it's painful or a glare,you should talk to your
symptoms or your concerns withyour eye doctor and they can do
some testing for complicationsof diabetes, as it relates to
the eye, I've heard to tell youthat you know they've actually
told me to quit driving.
Ray Cobb (31:27):
I mean, you know I actually one person said it was
laser, too much laser in one eye.
The other said it was an eyestroke and the other said it was
just abnormal blood cellsaround my retina that ruptured,
but sufficiently legally.
(31:49):
In my left eye I'm blind.
I'm actually 20 over 2,000 inthe left eye and the right eye
is still 20, 25.
But you're hit head on when yousaid driving at night, which I
don't do.
But even if I'm riding and thecar lights are coming at me, it
(32:13):
actually hurts my eyes.
You know pain, so I can relateto that.
And another thing I brought upanother topic what if I'm
outside and then come into adarker room and it takes a while
for me for my eyes to adjust soI can even see in what I'm
(32:34):
going to call normal light in aroom?
Would that be also anindication?
Bethanie Spangenberg (32:39):
That can be a sign or a symptom of
pupillary dysfunction.
That's a good example.
If we look at a differentmetabolic autonomic neuropathy
(33:06):
and some of you out therelistening it's probably one of
the most common up there withorthostatic hypotension, but
it's hypoglycemia, unawareness.
So if you've ever experienced alow blood sugar, you get shaky,
you get sweaty, your heart rateincreases, kind of get confused
(33:27):
or your thoughts are slow.
And if you have autonomicneuropathy, you start to not
feel those symptoms.
You don't have the heart rateincrease, you're not getting
sweaty, you're not experiencingthat autonomic, normal,
(33:49):
autonomic response to a lowblood sugar, and so that is a
common symptom, I guess, symptomof autonomic neuropathy.
They even make dogs out therethat are able to tell from the
sweat on your skin whether yourblood sugar is low.
You put off a scent, you putoff a certain like sweat or I
(34:15):
don't know the term to use, butthe dogs are able to sense that
you have low blood sugar butthat's how common it is.
Yes, thank you so they have dogsout there that are trained to
sense a low blood sugar, andthose with long-standing
diabetes may experience thehypoglycemia unawareness or low
(34:40):
blood sugar unawareness, andthey can actually qualify to get
one of these dogs as acompanion dog because it's
life-saving for them.
J Basser (34:50):
That should be a situation like this.
It should be a prereq for theVA for aid and attendance.
Ray Cobb (35:01):
I would think it would be yeah.
J Basser (35:04):
Yeah well, you must not be in my world buddy.
Ray Cobb (35:09):
Yeah, Understand that one yeah.
J Basser (35:14):
You know what I mean.
I've had a cat save my lifebefore.
Bethanie Spangenberg (35:22):
Related to diabetes or something different
?
J Basser (35:30):
Yes, I had a little over a few years ago.
I dropped pretty high anddidn't catch it and my test of
my sugar.
I was down in the 30s, headingtoward the 20s and the cat saw
me and got up there and nextthing you know, she's licking me
all over the head and face andwoke me up.
Bethanie Spangenberg (35:42):
Oh my gosh .
J Basser (35:47):
She sure did.
It's bad stuff, people, reallybad stuff.
Bethanie Spangenberg (36:00):
So the last couple things that I want
to mention, as it relates tothings like systems.
They have.
This in the other category isdiabetic.
Autonomic neuropathy cancontribute to sleep apnea
because of the decreasedrespiratory signal or the
(36:27):
restriction in the breathing.
You're supposed to adjust yourbreathing throughout the night,
related to your sleep cycles,related to your heart rate.
They're trying to regulate youracid levels in your blood
system and your body does thatthrough breathing, so you can
see some increased carbondioxide retention.
(36:48):
On lab levels or even during asleep study, you can see some
changes.
Sometimes the brain doesn't tellyour body to breathe also, and
that can contribute, and it'sspecifically diabetes.
So diabetes over time canaffect the brain to where it
doesn't tell the brain tobreathe, and those are, you know
(37:13):
, complications of long-standingdiabetes.
The last one is anxiety anddepression, and it can
contribute to those.
Because you don't have the,your emotional response is
suppressed.
So when we get excited, ourheart rate normally increases
and we're sad, our heart doesdifferent things.
(37:35):
Well, if you're running at ahundred heart rate all day,
you're going to feel moreanxious.
So it can contribute to thoseconditions indirectly.
Specific testing as it relatesto each body system.
(38:00):
Now, there's not a lot that wecan do.
When it comes to thehypoglycemia unawareness, Again
that's a symptom.
We can't do a test to say youknow, this test result shows
that you have autonomicneuropathy, For those types of
things.
it's purely based off of yoursymptoms and the history that
(38:22):
you're telling your provider.
When it comes to thegastrointestinal motility
slowing, there is imaging thatthey can do.
They can do a gastric emptyingor a barium swallow.
When they do the barium swallow, you drink it and then they
(38:46):
take images of you at certaintime intervals and they can show
how fast the material is movingthrough your system.
When it comes to some of thoseurinary symptoms, the urinary
incontinence they can scan yourbladder to look and see how much
urine is being retained, ifyou're completely emptying your
(39:07):
bladder or not, and then theycan also do some CT imaging to
kind of look and see how quicklydye is moving through your body
.
There's no one test that.
If you're concerned with havingdiabetic autonomic neuropathy,
there's no one test that allowsa clinician to put their finger
on it.
It's typically something thatyou present the symptoms to your
(39:33):
provider.
Your provider has to be awareof what symptoms and kind of
group them together or kind ofseparate them out.
They have to be able to havethe clinical skills to make
autonomic neuropathy in theirdifferential diagnosis or
concern for it, and then theyput you through all kinds of
(39:55):
testing.
So it's a diagnosis ofexclusion.
Usually it takes a while tocapture the diagnosis.
It's not something that'stypically done on a first or
second visit.
Maybe it's three or four visitswith special testing and even a
specialist or cardiologist toget involved.
So if someone is listening andthey're concerned with it, just
(40:19):
know that it is a process andit's not a quick answer for you.
Ray Cobb (40:25):
Is there any treatment for it?
Bethanie Spangenberg (40:28):
That's a great question.
So there is no medication.
There isn't anything specificto treat diabetic autonomic
neuropathy.
What happens is the treatmentfrom the clinical side is
optimizing your blood sugars andtreating or trying to prevent
(40:55):
complications, so to get yourblood pressure under control, so
that you don't develop a strokefrom your elevated blood
pressures.
When you decide to go.
You know your blood pressuresdecide to be what did you say,
john?
170 over 132 or something?
J Basser (41:15):
like that.
Bethanie Spangenberg (41:20):
So we try to give you medications so that
you don't have a stroke.
We give you aspirin to try toprevent any type of stroke or
cardiac ischemia that may arise.
We try to give medications toprotect your kidneys because
those high and low bloodpressures really put your
kidneys to work and that cancause some damage.
(41:42):
Try to get your cholesterolunder control.
If you get your cholesterollowered and in control, you're
less likely to have a stroke,less likely to have a blood clot
.
You're less likely to have aheart attack.
Heart attack stroke and bloodclots, heart attack, heart
(42:03):
attack, stroke and blood clots,and so there is some literature
out there that says thatexercise can help to improve
autonomic neuropathy.
The exercise forces your body totrigger some autonomic function
.
So if you think about whathappens when you exercise, your
heart rate goes up, your bloodpressure has to adjust, which
(42:24):
also involves your kidneystalking to your heart, the blood
flow increases to thoseautonomic nerves in the body and
it also helps to force ortrigger the production of your
sweat glands.
And so that exercise has beenshown to, or some studies have
(42:48):
shown that it helps to reducethe severity, not necessarily
treat it, not necessarily makeit go away, but it does improve
some of the symptoms.
So does that answer yourquestion?
J Basser (43:05):
Yeah, it's great.
Let's get up and hobble aroundthe block you want to.
Bethanie Spangenberg (43:14):
So I will say that I have struggled with
the exercise intolerance forabout the last 10 years.
When I had my daughter about 10years ago, I almost died with
her and that triggered a lot ofstress on my body, and shortly
(43:38):
after that I noticed that evenwalking up the stairs and
running around the track wasdifficult for me.
I was an athlete prior to havingmy daughter.
I ran track, I went to stateand track, I went to a Division
II school for cheerleading.
I went to a Division II schoolfor cheerleading and we stunted
(44:00):
and tumbled and all this crazystuff.
But after I had her, I was notcapable of tolerating any
exercise and I really struggledto get that back.
And so, for me personally, Istarted to take supplements to
try to help.
I started.
(44:21):
I had some panic attacks withthat as well, because you don't
have again your heart rate'sgoing 100 miles an hour and you
just you can't relax.
J Basser (44:32):
And so it's been.
Bethanie Spangenberg (44:33):
It's taken me a while, but I've got back
to you know, to where I can runmore comfortably.
I can't run consistently forlong periods of time because I
start to get that pain andburning in my legs.
I've had my blood vesselstested so I know it's not a
matter of peripheral arterialdisease, but my body's not
(44:58):
responding to the exercise.
I'm not getting the dilationwithin the muscle structure to
feed the oxygen in my muscles.
But for me personally, intrying to recover.
It has taken me a long time andit's a matter of running for 30
seconds and walking and thenrunning.
You know it's taken a while torecover from that, but it has
(45:21):
improved for me.
So I know that, john and Ray, Iknow it's not on your agenda to
start running, but thatmovement, even walking, starting
somewhere, can kind of help tobuild that tolerance.
J Basser (45:38):
Ray and I are both athletes At a much younger age.
Of course, football playersPlayed baseball, even shot up
for the Reds.
Even tied up for the red cord.
(46:05):
That's been a few years ago,but this issue is kind of
dangerous, you know.
I mean you know, you don't know, you've got it, you know, and
it goes to the heart and thecardiac involvement.
Bethanie Spangenberg (46:26):
I mean, I see reports all the time.
I guess sudden death and thingslike that can occur too, you
know yeah, I didn't want to gothat morbid, but it can happen.
That's the silent cardiacdistress signal, that
malfunction.
So I talked a little bit aboutthe distress signal of the
bladder, but that's the samewith the abdomen.
If you get abdominal distensionwhether, let's say, you have an
(46:49):
appendix rupture and yourabdomen distends, you don't
necessarily feel that pain fromthe abdominal distension.
Same with the heart.
You don't necessarily feel thedistress signal that the body is
putting out.
Hey, with the heart, you don'tnecessarily feel the distress
signal that the body is puttingout.
Hey, you know, the heart's notgetting enough oxygen and so the
distress signal is an autonomicsignal.
(47:10):
And so some people who havediabetic autonomic neuropathy
find themselves having a heartattack and never having any
symptoms find themselves havinga heart attack and never having
any symptoms.
J Basser (47:22):
That's one.
Another symptom is the silentheart attack, because you don't
feel the heart attack.
That's another symptom of it.
I'll tell you how they foundmine.
They found mine on my legs andthey started looking and started
(47:44):
putting stuff together andstarted talking about heart rate
and done tests for heart rate,things like that.
Over time.
This Apple Watch I didn't knowtoo much about the health app.
You know, when I first got towatch I started out with a 6 and
we changed over and of coursemy brainiac son helped me
finally get it set up here abouta year and a half ago and you
watch the symptoms and and it'spretty sharp, but you start
(48:06):
looking at 350 to 360 heart ratenotifications at rest in a
year's time or something along.
That was kind of the one thatkind.
That was the kind of the onethat kind of let the cat out of
the bag.
Bethanie Spangenberg (48:23):
So so I've actually seen those smart
watches.
I had a relative that was goingin and out of AFib and that
watch is what saved his life,because it signaled an abnormal
rhythm and he was kind ofpanicking because it went off a
few times like in the same dayand so he was able to call his
(48:46):
family doctor.
Family doctor got him in, endedup seeing a cardiologist and
here he had 35% heart function.
He was in heart failure and heended up having to have a valve
replacement.
His valve replacement or hisvalve malfunction was causing
heart failure which led to thearrhythmia, and it's all because
(49:07):
of that watch.
He had no symptoms.
So that watch was a lifesaver.
J Basser (49:13):
It is.
I wish they would work it outwith the company that did the uh
oh, two, seven meters and bringthat back to the watch.
I'd be like you know, that'sthe thing, you know what I'm
doing.
So he's got the apps.
Not that it's kind of hard toyou know, it's pretty good,
functional to keep it charged up, right, you need to get you one
(49:35):
of these.
I'm serious, we didn't we.
Bethanie Spangenberg (49:46):
I don't know if you guys can hear this
rain.
Ray Cobb (49:49):
Yeah, how loud this rain is.
Bethanie Spangenberg (49:50):
I'm trying to it's raining and you know
what I praise the Lord.
I've needed rain for my gardenfor two weeks, and this is the
first rain, and so I'm excited.
But what timing, oh my goodness.
No-transcript.
J Basser (50:35):
Talk to my outside VA doctor a lot about it, because
he's the first one to catch it,you know, and the VA finally
catches on, you know it's kindof like a day late and dollar
short situation.
Bethanie Spangenberg (50:44):
We haven't seen that before, though, have
we?
J Basser (50:47):
Too much.
But I don't know.
We've got to figure this thingout.
I mean, it's you know, I fileclaims for the statics and they
keep denying it.
Last time they sent me down,they sent it to California for a
terror thing due terrifyingexposure to asbestos and
radiation.
I'm still scratching my head onthat one.
So we'll see.
(51:08):
I'm just going to get somethingput together so we can show
them what it's all about.
Bethanie Spangenberg (51:15):
But you know, so far nobody's listening.
John, how long have you beendiabetic?
J Basser (51:23):
I was diagnosed with diabetes, started insulin in
2006.
I was pre-diabetic for severalyears before then.
I was on metformin and thenstarted the shot in 2006, so
it's been almost 18 years ago.
So even what we just talkedabout, tonight.
Bethanie Spangenberg (51:41):
So it's been almost what 18 years ago,
20 years.
So, even what we just talkedabout tonight.
The statistics are against you.
You know you should be sittingat 50-plus percentage at risk of
having, you know, a peripheralor an autonomic neuropathy, and
so I'm surprised that you'vestruggled this far, you know to
get that that orthostatichypertension service connected.
J Basser (52:05):
Well, they're just, uh , I think they made a mind
they're not going to do it.
You know I did the same thingwith Bill Sheeker.
What he did is put me inhypertension years ago.
He's like you know, we know yougot it and we know what it's
from, because he's alreadyserviced for, uh, I guess it's
COPD, and I said you can't dothat.
You know, I said we're notgoing to do that.
Well, he, finally, they finallydid it.
You know, after the right.
(52:26):
You know he spent a lot ofmoney to, you know, the attorney
and stuff, but you know itdidn't do much good?
no, it didn't.
Bethanie Spangenberg (52:40):
Well, what's interesting about it too
is if they're rating theorthostatic hypotension under
the vestibular conditions, it'sa 10% rating.
So they're fighting you over a10% rating for orthostatic
hypotension.
J Basser (52:46):
Keep switching up and they don't want to rate it,
period, you know.
So it's kind of crazy, but Idon't know, I'm probably going
to have to, at least one day,get an IMO Somebody knows what
they're talking about becausethese folks don't know nothing
much about it at all.
I mean, I can understand that,you know, because it's not you
know you don't hear people talkabout this every day and you
(53:07):
know, and so.
But you look through the pasthistory and the rest of the
stuff, you know we've talkedabout it before, bethany, I
think.
Maybe you know I need to getsomething done with this because
I'm just getting fed up.
But with that and the diabeticlows and the falls, I mean I'm
serious.
I mean I broke my S5 vertebrae.
You know, with the S5, s4, Ibroke one of them.
(53:31):
I fell in the concrete and hitpretty hard and I had to go
through a bunch of tests andx-rays and I hurt my arms, I
hurt my shoulder twice, and soyou know, you stand up and for
about two minutes you walk upsomewhere and the next thing,
you know, you get real dizzy.
(53:52):
And the next thing you knowyou're on the ground and you
know you wake up pretty muchshortly afterward, but still you
know you're on the ground.
Bethanie Spangenberg (54:04):
Well, if you got this, guys sell your
slab house and buy somethingwith a padded floor Bubble wrap
works too.
J Basser (54:11):
I think I know it does .
But you know, and they're likewell, this and then how to plan
some clothes.
Ad (54:15):
They're like well, why?
J Basser (54:15):
don't you call 911 and go to the hospital?
I?
Ad (54:19):
don't have to I said.
J Basser (54:20):
there's a new study I went on today in a class that
there's a major percentage ofvets and people by itself are
avoiding going to the hospitalnow.
And guess why?
They're not going to thehospital With hypoglycemia
Because of the dexcoms, becausethe dexroms catch it.
Bethanie Spangenberg (54:42):
Absolutely you know, I was actually
earlier today I was talkingabout the rating schedule for
diabetes.
You know, part of the ratingschedule talks about weekly
visits to a diabetic careprovider and it's like I don't
ever have to go weekly anymorebecause my insulin pump data
goes straight to myendocrinologist.
(55:03):
My blood sugar data goesstraight to my endocrinologist
and if there is a flag on mychart because something's
abnormal, she calls me.
J Basser (55:14):
There you go, there you go.
Look, I'd like to see anendocrinologist.
I haven't seen one yet.
Bethanie Spangenberg (55:24):
They actually they are hard to get to
.
I will tell you that our localVA, their pump therapy is done
by a clinical pharmacologist andnot necessarily an
endocrinologist, and notnecessarily an endocrinologist.
J Basser (55:42):
For PharmD?
Yes, For PharmD, right?
Okay, they're smart.
You know I've been, that's whoI go visit.
I mean, I do biowiches visitsbecause of hypoglycemia and I've
been doing this for a long time.
We started back in Novemberdoing it because, you know, I
mean I always been dropping butsince I decided to keep an eye
on it.
no matter what I do, it stilldrops.
(56:04):
So it dropped this morning.
It was in the 50s, but it's.
You know what I mean.
I hope we lost right, or not,did we?
I'm going to double check thescreen here, but do you think
(56:30):
they have any treatment forstuff?
Have you done any independentmedical opinions on this stuff,
Becky?
Bethanie Spangenberg (56:39):
We have.
Normally it's the gastroparesisor the orthostatic hypotension
that we get asked to do opinionson.
I will say that some of theurinary incontinence is more
readily recognized.
The pupillary dysfunction,that's not my wheelhouse.
I'll never see that.
(57:00):
That's going to be, you know,ophthalmology or an eye
specialist, the hypoglycemiaunawareness if you know a
patient has that, I'm sendingthem to an endocrinologist.
You know there's not much onthe clinical side that I can do
other than getting them acontinuous glucose monitor and
(57:21):
some glucagon.
Any orthostatic hypotensionconcerns or tachycardia concerns
always go to cardiology and wehaven't done a lot of opinions
on the cardiac stuff.
J Basser (58:03):
All right, I see Ray's back in there.
I can barely hear you guys.
Ray Cobb (58:09):
I don't know what's going on with my phone?
J Basser (58:12):
Probably the weather.
Betsy, could you give us yourcontact information before we
shut it down and Valor for Vetand plug in for them.
Bethanie Spangenberg (58:21):
Valorfor Vet.
You can plug in for themValorforVetcom.
Valor V-A-L-O-R, the number 4Vet V-E-Tcom.
There's a lot of helpfulinformation that you can
research and look at and then,if you have any questions, you
give us a call.
888-448-1011, 888-448, 448-888-448-1011.
J Basser (58:43):
Well, listen, guys, that's all the time we have for
tonight.
Bethany, thank you for comingon, we'll do this again.
Stay tuned.
Next week, guys.
We've got a major show comingup.
We've got Alex Graham and PeterD'Ancelli out of California.
We'll discuss the latestlawsuit, or the Supreme Court
(59:05):
ruling that turned over theChevron deal that Reagan put in,
and that's going to be a bigdeal.
Have you heard about that one,bethany?
Bethanie Spangenberg (59:14):
I have, but I'm not sure how exactly
that impacts VA stuff, so I'llbe definitely listening next
week.
Okay, well, that will beshutting down.
J Basser (59:20):
So I'll be definitely listening next week.
Okay, well, that will beshutting down.
We'll see you guys next week,and this is John, on behalf of
Bethany Spangenberg and Mr RayCobb.
We will be signing off.
For now, you have beenlistening to the Exposed that
Podcast.
Any opinions expressed on theshow are the opinions of the
guest speakers and notnecessarily the opinions of
(59:40):
Exposed that, exposed Thatcom orBlog Talk Radio.
Tune in next week for anotherepisode of the Exposed that
podcast.
Thanks for listening.
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Blog Talk Radio.
J Basser (00:04):
It's time for the Exposed Vet Radio Show.
The Exposed Vet Radio Show, wediscuss issues affecting today's
veteran.
Now here's your host, john andRay.
Welcome, ladies and gentlemen,to the Exposed Vet Radio Show.
Today's the third day of July2024.
It's going to be an interestingshow.
(00:25):
Today's the third day of July2024.
We'll get an interesting show.
We got Bethany Spangenberg fromValley Corvette she's on and we
got Mr Ray Cobb, our trusteeco-host, who, by the way, last
week went to the VA's version ofHarold's House of Pain and
couldn't talk too much.
He got a few words in, but Ithink he was kind of
snaggletooth a little bit Todayhe's doing a whole lot too much.
Ray Cobb (00:46):
He got a few words in, but I think he was kind of
snaggletooth a little bit.
I had no teeth, they just tookthem all out, man.
J Basser (00:52):
Well, I told you you could have come up here.
I could have done it withparaplyers and a ball-peen
hammer.
You've been all right.
Ray Cobb (00:57):
I'll tell you what it would not have hurt anymore.
I can guarantee you that.
J Basser (01:02):
I don't know what you mean, buddy.
I don't know exactly what youmean, but today Beth is going to
discuss a condition that's nearand dear to me and some other
folks.
It can be a bad side effect ofdiabetes.
It's called diabetic orautonomic neuropathy.
I know it's kind of hard tounderstand and digest, but I
(01:27):
think she can explain it to us.
Bethany, how are you doing?
Bethanie Spangenberg (01:30):
I'm doing well, thank you.
I'm excited for tonight's topic.
I know that you've been pokingme about talking about it for a
little bit, so I'm glad thatwe're able to knock it out
tonight.
J Basser (01:42):
That's good.
That's good.
It's good.
I know a lot of vets areaffected by this.
A lot of them don't even knowwhat it is.
Bethanie Spangenberg (01:53):
Yeah, and I know you know we'll talk a
little bit tonight aboutdifferent symptoms and things
that your provider should belooking for, but from even the
clinical side of things, it'snot a topic that's readily
discussed.
It's something that normally wecall a diagnosis of exclusion.
So basically, if you'reconcerned with it or if we're
(02:14):
concerned with it, we put youthrough all these different
tests, and if none of thoseother tests show that you have a
condition or a differentcondition, then we say, oh okay,
well, it must be diabeticautonomic neuropathy.
And so when we look at it fromthe clinical side of things,
it's usually the bottom on ourlist of concern and so a lot of
(02:36):
times it goes without diagnosisor a misdiagnosis, and the
statistics are actually prettysignificant for those with
diabetes.
In the presence of diabeticautonomic neuropathy, now I will
say I prefer to say the wholediabetic autonomic neuropathy,
but in a lot of the medicalliterature they call it DAN.
(03:00):
So if we talk about DAN today,dan is diabetic autonomic
neuropathy.
So hopefully there's noconfusion about having somebody
else I don't know you pullthings up your sleeve.
There might be other people onthis phone call that I don't
know about.
Ray Cobb (03:24):
There may be.
We may have lost him.
Bethanie Spangenberg (03:28):
Exactly.
Ad (03:29):
So we're going to talk to Dan that's not here, yeah.
Ray Cobb (03:34):
Dan, that's what I'm thinking.
I have a question for you thatthis has to do with if I
understood correctly what littleI read about it this week.
If I understood correctly whatlittle I read about it this week
, does this have to do with thenerves control over certain
muscles or certain reaction thatnormally the body or the brain
(03:57):
doesn't?
That does it automatically.
Yeah, such as heart rate orthings like that.
Bethanie Spangenberg (04:03):
So I'm just going to use that as an
opportunity to just dive rightin and talk about what it is and
what it isn't.
But I think, before we get toofar into what it is, I really
want to explain the nervoussystem a little bit and try to
make it clear as mud foreverybody.
So when we look at our nervoussystem, we look at it as two
(04:26):
components.
We have a central nervoussystem, which is the brain and
the spinal cord, and theneverything that is not the brain
and the spinal cord is theperipheral nerves.
So we've got our centralnervous system and then our
peripheral nervous system andthen if we divide the peripheral
nerve system, it is dividedinto other components.
(04:51):
So one of those is somatic andthe other one is autonomic.
So when we look at somatic, it'sthe nerves that are associated
with intentional movements orvoluntary movements.
So our muscles, our muscle,control us moving our arms.
That's the somatic nervoussystem.
If we put our hands onsomething that's hot or that's
(05:14):
cold, that is the somaticnervous system, because we are
intentionally grabbing andfeeling the pressure or
adjusting to the temperaturepressure or adjusting to the
temperature.
There is part of thattemperature regulation that is
in the automatic or theautonomic system.
And so when we look at, when wehear the term diabetic
(05:37):
peripheral neuropathy that wenormally hear about, or we hear
about it more readily, that isgoing to affect the somatic
nervous system and we're nottalking about that type of
peripheral neuropathy today.
So this is something different.
That is not those muscles andskin that we're intentionally
(05:58):
controlling.
The autonomic nervous system isthose involuntary reactions or
those involuntary actions suchas your heart rate, your blood
pressure, breathing, digestion,and that's just to name a few,
because it's pretty extensive ofwhat the autonomic system does.
(06:20):
But these are things that we door that are controlled
subconsciously, and so you askedabout, did you ask about blood
pressure?
Is that what you were askingabout?
Ray Cobb (06:34):
Well, there's some of the things that well, one thing
that's similar to blood pressure.
I was wondering about AFib.
You know, when your heart goesinto irregular beat, which is
referred to as AFib, is that apart of it or is that a sign of
it?
Bethanie Spangenberg (06:54):
It can be so.
If that nerve system or thosecommunication systems don't
effectively communicate, then itcan create either a high heart
rate, it can cause disruptionwithin the regular rhythm.
Sometimes it has to do withelectrolyte imbalance.
(07:16):
So when we look at AFib wedon't think first of diabetic
autonomic neuropathy.
We think of something else,some type of blood vessel
disease or muscle disease of theheart.
But it can cause somedisruption in that heart rhythm.
Ray Cobb (07:33):
Okay.
Bethanie Spangenberg (07:36):
So autonomic nerve go ahead.
J Basser (07:39):
Dan's brother can ain't it.
Ad (07:44):
Yes yes, absolutely.
Bethanie Spangenberg (07:46):
It is abbreviated Any type of
autonomic neuropathy that isaffecting the cardiovascular
system.
They call it Can.
So we have Dan and Can and Danand a few other ones coming
through.
I do want to mention all thedifferent organ systems that are
(08:06):
controlled by the autonomicnervous system, because it's
pretty extensive and we again,these are not things that we
actively control.
These are things that our bodydoes on its own.
So the autonomic nervous systemcontrols our eyes, has some
components of the eyes, the skin, the salivary glands, the heart
, the lungs, the stomach, thepancreas, the adrenal glands,
(08:28):
the liver, the gallbladder, thebladder and the genitals.
So they have a lot of controlover things that we are not
actively thinking about.
(08:57):
About the autonomic nerve, thediabetic autonomic neuropathy
can affect both type 1 and type2 diabetes.
When type 2 diabetes isdiagnosed, it's typically
something that's been going onfor a while, and we're just now
meeting the criteria for theblood sugar level to be
diagnosed as type 2 diabetes.
So statistics show that atdiagnosis of type 2 diabetes
(09:20):
that 7% have some type ofdiabetic autonomic neuropathy,
which I found that striking.
Normally with type 1, becauseit's more of an abrupt onset of
sugar dysregulation thatautonomic neuropathy doesn't
present itself until five yearsor more after the onset of
(09:45):
diabetes.
So I found that to beinteresting, that 7% at time of
diagnosis of type 2 diabetes hassome type of diabetic autonomic
neuropathy.
J Basser (10:03):
I read that too.
Ray Cobb (10:03):
It makes sense.
Yeah, it is a diabetic type 2diabetic and if you're just
learning about this, what aresome signs or what are some
things that indicate that youneed to bring up to your doctor?
Bethanie Spangenberg (10:20):
So that's the tricky part, because
sometimes you don't have to haveany symptoms whatsoever and
they call this subclinicalfindings or things where you're
not experiencing symptoms but wecan see it somewhere in your
vital signs.
Or if we look at cardiacfunction we may be able to find
it.
So the most common types ofneuropathy affect the heart and
(10:47):
blood vessels, thegastrointestinal system, the
bladder, the skin and even somemetabolic and sleep dysfunction.
Those are your primary things.
That it can affect Noteverybody is the same.
That it can affect Noteverybody is the same.
(11:08):
There's not a group of symptomsthat one diabetic can have to
say, oh, that's diabetic.
Autonomic neuropathy Again, likeI said earlier, it's usually a
diagnosis of exclusion andthat's really because sometimes
those symptoms can be vague andthey can make a clinician
believe that it might besomething different and so they
have to rule that the morecommon probability out first
(11:34):
before they really get to theautonomic neuropathy diagnosis.
But if we like, for example, ifwe look at the cardiovascular
system, you can have a heartrate above 100 at rest and
that's a concern that theautonomic nerves aren't doing
what they're supposed to do atstabilizing that heart rate.
(11:55):
You can have decreased exerciseintolerance, meaning you go to
exercise and you start todevelop pain in your legs.
From running or even justlifting your arm to put in a
light bulb, you can developburning in your arms because the
body cannot adjust to theincreased need for oxygen so
(12:21):
those vessels don't dilate toallow increased blood flow to
those muscles and so thosemuscles are deprived of oxygen
and so it starts to trigger aburning sensation in the arm of
them or the legs.
You can have tension or lowblood pressure if you change
position.
Ray Cobb (12:40):
I think that is something, yeah, I think I've
heard that one before.
Bethanie Spangenberg (12:46):
That would be so we call that orthostatic
hypotension, and that isprobably one of the more common
diabetic autonomic neuropathyfindings that occur in diabetes.
And then you can get thingslike POTS, which is very similar
too.
So rather than the bloodpressure changing or
(13:08):
malfunctioning, I guess inposition, the heart rate in POTS
does not adjust appropriatelywith position change.
And so to diagnose thosecardiovascular autonomic
neuropathies there's specialtesting to do, and Ray what kind
of testing have you had?
Ray Cobb (13:30):
Well, good point.
I'm not for sure what alltesting I've had.
I haven't had any recently, butback in 2011, when I had my
open heart surgery, they ran alltype of tests there and then,
when they were checking my legsfor neuropathy in my hands and
(13:51):
arms, I had all type ofelectrical type where they, you
know, use the little shock andsee how fast you react to the
and at what level theelectricity causes your muscles
to relax.
But I think that's the onlytest that I can relate to that
I've had, and that's why I waswondering is there some that I
(14:13):
should be asking the doctors tolook at or just kind of let it
go by?
When you were talking about theheart and the standing up and
the blood pressure, all of mineseem to be fairly regulated as
long as I take my medication,and medication might be what.
(14:34):
Does that help regulate it ornot?
Bethanie Spangenberg (14:37):
Well, John , I think that's your cue.
J Basser (14:44):
Great To answer the question on that.
They regulate a lot of thesearrhythmias and things like that
with pretty high-powered betablockers.
I've been taking one for years.
We just increased it here lastyear.
The issue that you know it'skind of hard to find but if you
(15:07):
start having issues like Bethanysaid, it's kind of a you know
you have to check the boxes onit to get a diagnosis.
You know you need more than oneissue and I can tell you, for
example, when you, if you takethis medication I've been taking
for years, every time you go tosee a heart doctor you have to
get an EKG.
That's kind of I guess aclinical standard for like solo.
(15:28):
All right, bethany, yes.
And so you start looking at EKGresults and you start seeing
crazy things like, for examplesince 2017, I've had probably 20
to 30 EKGs and 16 or 17 of themhave this thing called poor R
wave progression, which is theR-axis on your EKG as always low
(15:48):
and it's below the threshold of30, so it's like a minus 15 or
minus 13 or minus 12.
That's a giveaway.
Another issue is, if you havearrhythmias, you've got HVAB,
you have other arrhythmias andthings like that.
That could be a part of it too.
(16:10):
The big issue is blood pressure.
If your blood pressure say, forexample, I'm sorry, it's like
hypertension, okay, on Monday,my blood pressure will be 175
over 132.
On Tuesday, it'll be 160 over99.
(16:31):
On Wednesday, it'll be 90 over70.
There's no control there.
It's either or you hardly eversee a regular blood pressure
reading.
Then, when you stand up andyour blood pressure drops, say
30 points or more, andespecially if your blood
pressure is near normal or low,that's when, especially, blood
pressure is near normal, low,that's when you're going to have
your syncope.
So you're going to open status,going to wipe you out, happens
(16:52):
to me a whole lot.
Bethanie Spangenberg (16:54):
So, and you, you're able to talk about
this because you've walked thatpath and you've had these tests
done and they've done the thetilt table test for you, and
that's where they check yourblood pressures at different
positions.
J Basser (17:08):
I don't know years ago .
I had it a couple weeks agowhen a kid sort of worked up and
the cardiologist said that Icould not do the tilt table test
.
It's too dangerous.
Bethanie Spangenberg (17:22):
So when we look at the cardiovascular side
of things, if we're concernedwith an autonomic involvement,
we definitely look at the EKG.
We do some tilt testing, theexercise intolerance.
That's hard to diagnose.
It's really based off ofclinical symptoms and you rule
out like a large nerve fiberneuropathy or a somatic nerve
(17:45):
disease, like we talked aboutearlier, and so they can do an
EMG in your legs, you know, andyour nerves in your legs, and
they'll tell you.
J Basser (17:55):
You know that your big nerves are basically okay,
there's a little issue butusually they can find the small
fiber, neuropathy, which isactually another giveaway, and
things like that.
Bethanie Spangenberg (18:09):
So one thing that I found valuable when
I was reviewing this materialfor tonight is they were talking
about heart rate variability,and I knew that heart rate
variability is a sign of cardiachealth, but I never realized
how it plays out in autonomicneuropathy.
So I know.
John, you talked about gettinga smartwatch.
(18:31):
Do you have one?
Do you wear one, Ray?
Do you wear a smartwatch?
J Basser (18:35):
I've been wearing one for years.
Ray Cobb (18:37):
No, I try to get him to.
J Basser (18:39):
I've tried to get him to.
Ray's, I mean he's, he's one ofthe time X boys.
Well, you know it's.
Ray Cobb (18:50):
in listening to this I've been beginning to think
that, um, I am not anywhere nearas severe or have as much of
any of this, because my heartrate is pretty regulated, of
course, with medication.
My blood pressure when I takemy medication is fine.
(19:14):
I have normal readings all daylong.
If I come off of it for a dayor two, yeah, then the readings
get out of whack, but on a dailybasis, as long as I take my
medication, I mean, I'm going tobe somewhere around the 120,
over 63 or 19, over, you know,61.
Bethanie Spangenberg (19:41):
We've covered a little bit of the
cardiovascular system, but we'vegot one, two, three, four, at
least five more systems to touchbase on.
So okay keep an open mind youmight have to start asking your
provider questions.
J Basser (19:54):
Well, she wants to be made quick and that would be
good.
Get a smartwatch.
Bethanie Spangenberg (20:05):
So, if you look at the data on your heart
rate variability, you can have asubclinical sign in that heart
rate variability that says maybeI am experiencing some diabetic
autonomic neuropathy and sowhen you look at the heart rate
variability, for a healthy adultyou should sit somewhere
(20:28):
between 40 and 45.
If it gets lower, it can golower with age, but if it gets
much lower then it's going to beabnormal and then you should be
asking your provider questions.
Ranges can go from 19 to 75 onthe heart rate variability.
(20:49):
Your higher numbers are goingto be your professional athletes
, your endurance runners.
They're going to have adifferent heart rate variability
.
So for a healthy adult, you'regoing to sit somewhere between
40 and 45.
Anything lower and you've beendiabetic.
You need to start askingquestions about what does it
mean?
And is there something else weshould be looking for as it
(21:12):
relates to autonomic neuropathy?
Okay, so I thought that wasinteresting.
I never really put the twotogether as how I could use my
smartwatch, the heart ratevariability and looking for
subclinical signs of diabeticautonomic neuropathy.
And if you're new to listening,I'm also a diabetic and I have
(21:33):
been for 25 years and based onthese statistics, it shows that
some studies have shown, up to50% of diabetics have some type
of autonomic neuropathy after 15years.
So the chances just go up everyyear that you have this disease
(21:54):
.
So it's kind of a strikingnumber, say that again.
J Basser (22:04):
Pay attention to your high heart rate.
Notifications at rest.
Bethanie Spangenberg (22:09):
Yes.
So other than the heart and theblood vessels, the autonomic
neuropathy can affect yourgastrointestinal system.
It can cause troubles withmotility in the esophagus.
It can cause dysphagia ordifficulty swallowing.
It can mimic reflux disease.
It can cause slowing of thebowels to where your bowels
(22:33):
don't empty like you'reconstipated.
It can actually cause diarrhealike you're constipated.
It can actually cause diarrheaand it can cause loss of
sphincter control where you havefecal incontinence and there's
no other nerve damage, not hadany back issues.
So those are different thingsthat can occur with
(22:55):
gastrointestinal autonomicneuropathy, intestinal autonomic
neuropathy.
The other thing to consider isthere's a big push or a lot of
news out there about likeOzempic and Wagovi and a lot of
diabetes medications or weightloss medications, and one thing
I think it's important tounderstand is if you're on those
(23:16):
medications for either weightloss or for diabetes, you need
to understand that thatmedication is designed to slow
stomach motility.
So with those medications youcan have nausea because your
food isn't digesting as quickly.
You can have what they callearly satiety or you can't eat
(23:39):
as much as you used to.
You get fuller quicker.
You can have constipationbecause your bowels aren't
moving the same.
So some people or somediabetics who experience the
gastroparesis or the decreasedmotility of the GI system, they
do have weight loss and that isthe purpose of that medication.
(24:02):
So if you're like, oh, I'm onOzempic and I have these same
symptoms, it's probably theOzempic mimicking the slowing of
the motility than it isgastroparesis.
J Basser (24:13):
So, just keep that in mind.
I'm assuming you had it beforeyou started taking Ozempic.
Ray Cobb (24:18):
Yeah, yeah, right, I mean, mine came on since I've
been taking Ozipic and as far asweight loss, I have gone from
320 pounds down to, right now,about 247 last week.
(24:38):
Whoa buddy Good deal, that'sgood.
J Basser (24:42):
It's a good deal, that's good, that's really good.
But also, I mean in defense ofall the veterans out here even
if you are taking your servicefor your diabetes and it's
causing you to have that, andstill if it's causing this due
to a service-needed medication,you know all better still aren't
every sniff of medication is.
Bethanie Spangenberg (25:01):
You know, I'll bet they're still on it and
you know of all thecomplications related to
autonomic dysfunction.
Gastroparesis is in the ratingschedule, so the only.
There's no DBQ for autonomicneuropathy.
There's no diagnostic code inthe rating schedule for
(25:21):
autonomic neuropathy.
You have to break it down towhat system it affects.
And gastroparesis is in therating schedule.
And they even put thatorthostatic hypotension in.
I've seen it under peripheralvestibular disorders, which is
an ear condition.
Yeah, right.
(25:44):
When it's really an autonomicthing.
So it's interesting how theyhave to kind of work with their
rating schedule to fit thesymptoms.
J Basser (25:56):
You look at the vascular system too, it's, you
know, it's basically the same.
I mean, you know, because itcauses vascular issues too, as
well as feet issues.
So you know, I mean it's a bigfor it, that stuff, there's a
lot of stuff involved with it.
So, but the VA doesn't havethat.
The right-hand side is not,what do you call it?
It doesn't cover enough.
You know, it doesn't diseases.
So they just had a loop andit's similar to it.
Bethanie Spangenberg (26:19):
Right, yeah, and before we leave too
far from that medication, theozempic Wagovi there's several
of them out there the long-termeffects we really don't know.
So some people who have stoppedthe medication have continued
to experience some of thatgastric motility slowing and
(26:43):
there is some concern.
You know what it does forlong-term effects because we
haven't seen you know, we don'thave the 10-year study on these
medications yet so just keepthat in mind as you take that
medication or if you stop thatmedication.
Just keep that in mind as well.
If we move on to thegenitourinary section, some of
(27:10):
the autonomic dysfunction can beerectile dysfunction, female
sexual dysfunction.
You can have urinaryincontinence or urinary
frequency and then you lose thedistress signals.
So when your bladder getsdistended and tells you, oh hey,
there's pressure here and youneed to go to the bathroom, the
(27:33):
autonomic neuropathy can blockthat signal to where the nerves
aren't functioning correctly andyou don't know that your
bladder is full, and it canresult in the urinary
incontinence.
Some of the skin changes thatcan occur you can have dry skin,
(27:57):
you can have swelling and thisis outside of what we talked
about about the peripheralvascular diseases.
This is different.
You can have swelling in theskin itself.
You can also have heatintolerance and sometimes in the
patients that I've had, this isone of the first symptoms that
they have and it really comesdown to hey, I was outside on a
(28:21):
hot day and I just couldn'ttolerate the heat and I got
really nauseous and I got sick.
And here their body is notsweating, so they don't have the
temperature regulation becausetheir body is not sweating to
lower the skin temperature.
And there's actually a test wecall it a sweat test to see how
(28:43):
much you sweat and they can lookat the conduction of the sweat
to see what is occurring in yoursweat glands.
Ray Cobb (28:54):
Okay question on that line.
You're talking something I havenoticed recently.
For example, outside today Iwas not sweaty, although as soon
as the sun hits I do have a lotof dry skin, and Pam made the
comment this morning she needsto start putting more lotion on.
(29:16):
Putting more lotion on and withthe dry skin.
I was outside today when thesun hit my skin.
It felt like a thousand littleneedles hitting me.
Is that an?
Bethanie Spangenberg (29:34):
indication that I need to have it looked
at, or a question.
I would be more concerned withthe dry skin rather than the
sensation that you're getting.
I've not other than gettingsunburned, which you're going to
be susceptible to.
I'm not sure.
To me that doesn't correlatewith some type of skin nerve
(29:57):
disease.
Ray Cobb (29:58):
Okay, nerve disease.
Bethanie Spangenberg (30:01):
A couple other things that we can see or
appreciate in patients withdiabetic autonomic neuropathy is
that they lose their pupillaryreflex with light.
And some patients will say youknow, I really struggle at
nighttime with driving becauseit hurts my eyes when I see the
(30:25):
bright lights.
So what happens is you're atnight and your pupils are big
and then when you get light fromother cars, your pupils are
supposed to constrict to controlthat light function, to control
that light function, and withautonomic neuropathy your pupils
can lose the ability toconstrict and relax to adjust to
(30:45):
light accommodation.
And so some people withdiabetes experience that and
then they go see the eye doctorand they also because glaucoma
and cataracts can mimic similarsymptoms and they're at higher
risk because they're diabetic.
So if you have any type of eyesymptoms related to driving,
(31:07):
whether it's painful or a glare,you should talk to your
symptoms or your concerns withyour eye doctor and they can do
some testing for complicationsof diabetes, as it relates to
the eye, I've heard to tell youthat you know they've actually
told me to quit driving.
Ray Cobb (31:27):
I mean, you know I actually one person said it was
laser, too much laser in one eye.
The other said it was an eyestroke and the other said it was
just abnormal blood cellsaround my retina that ruptured,
but sufficiently legally.
(31:49):
In my left eye I'm blind.
I'm actually 20 over 2,000 inthe left eye and the right eye
is still 20, 25.
But you're hit head on when yousaid driving at night, which I
don't do.
But even if I'm riding and thecar lights are coming at me, it
(32:13):
actually hurts my eyes.
You know pain, so I can relateto that.
And another thing I brought upanother topic what if I'm
outside and then come into adarker room and it takes a while
for me for my eyes to adjust soI can even see in what I'm
(32:34):
going to call normal light in aroom?
Would that be also anindication?
Bethanie Spangenberg (32:39):
That can be a sign or a symptom of
pupillary dysfunction.
That's a good example.
If we look at a differentmetabolic autonomic neuropathy
(33:06):
and some of you out therelistening it's probably one of
the most common up there withorthostatic hypotension, but
it's hypoglycemia, unawareness.
So if you've ever experienced alow blood sugar, you get shaky,
you get sweaty, your heart rateincreases, kind of get confused
(33:27):
or your thoughts are slow.
And if you have autonomicneuropathy, you start to not
feel those symptoms.
You don't have the heart rateincrease, you're not getting
sweaty, you're not experiencingthat autonomic, normal,
(33:49):
autonomic response to a lowblood sugar, and so that is a
common symptom, I guess, symptomof autonomic neuropathy.
They even make dogs out therethat are able to tell from the
sweat on your skin whether yourblood sugar is low.
You put off a scent, you putoff a certain like sweat or I
(34:15):
don't know the term to use, butthe dogs are able to sense that
you have low blood sugar butthat's how common it is.
Yes, thank you so they have dogsout there that are trained to
sense a low blood sugar, andthose with long-standing
diabetes may experience thehypoglycemia unawareness or low
(34:40):
blood sugar unawareness, andthey can actually qualify to get
one of these dogs as acompanion dog because it's
life-saving for them.
J Basser (34:50):
That should be a situation like this.
It should be a prereq for theVA for aid and attendance.
Ray Cobb (35:01):
I would think it would be yeah.
J Basser (35:04):
Yeah well, you must not be in my world buddy.
Ray Cobb (35:09):
Yeah, Understand that one yeah.
J Basser (35:14):
You know what I mean.
I've had a cat save my lifebefore.
Bethanie Spangenberg (35:22):
Related to diabetes or something different
?
J Basser (35:30):
Yes, I had a little over a few years ago.
I dropped pretty high anddidn't catch it and my test of
my sugar.
I was down in the 30s, headingtoward the 20s and the cat saw
me and got up there and nextthing you know, she's licking me
all over the head and face andwoke me up.
Bethanie Spangenberg (35:42):
Oh my gosh .
J Basser (35:47):
She sure did.
It's bad stuff, people, reallybad stuff.
Bethanie Spangenberg (36:00):
So the last couple things that I want
to mention, as it relates tothings like systems.
They have.
This in the other category isdiabetic.
Autonomic neuropathy cancontribute to sleep apnea
because of the decreasedrespiratory signal or the
(36:27):
restriction in the breathing.
You're supposed to adjust yourbreathing throughout the night,
related to your sleep cycles,related to your heart rate.
They're trying to regulate youracid levels in your blood
system and your body does thatthrough breathing, so you can
see some increased carbondioxide retention.
(36:48):
On lab levels or even during asleep study, you can see some
changes.
Sometimes the brain doesn't tellyour body to breathe also, and
that can contribute, and it'sspecifically diabetes.
So diabetes over time canaffect the brain to where it
doesn't tell the brain tobreathe, and those are, you know
(37:13):
, complications of long-standingdiabetes.
The last one is anxiety anddepression, and it can
contribute to those.
Because you don't have the,your emotional response is
suppressed.
So when we get excited, ourheart rate normally increases
and we're sad, our heart doesdifferent things.
(37:35):
Well, if you're running at ahundred heart rate all day,
you're going to feel moreanxious.
So it can contribute to thoseconditions indirectly.
Specific testing as it relatesto each body system.
(38:00):
Now, there's not a lot that wecan do.
When it comes to thehypoglycemia unawareness, Again
that's a symptom.
We can't do a test to say youknow, this test result shows
that you have autonomicneuropathy, For those types of
things.
it's purely based off of yoursymptoms and the history that
(38:22):
you're telling your provider.
When it comes to thegastrointestinal motility
slowing, there is imaging thatthey can do.
They can do a gastric emptyingor a barium swallow.
When they do the barium swallow, you drink it and then they
(38:46):
take images of you at certaintime intervals and they can show
how fast the material is movingthrough your system.
When it comes to some of thoseurinary symptoms, the urinary
incontinence they can scan yourbladder to look and see how much
urine is being retained, ifyou're completely emptying your
(39:07):
bladder or not, and then theycan also do some CT imaging to
kind of look and see how quicklydye is moving through your body
.
There's no one test that.
If you're concerned with havingdiabetic autonomic neuropathy,
there's no one test that allowsa clinician to put their finger
on it.
It's typically something thatyou present the symptoms to your
(39:33):
provider.
Your provider has to be awareof what symptoms and kind of
group them together or kind ofseparate them out.
They have to be able to havethe clinical skills to make
autonomic neuropathy in theirdifferential diagnosis or
concern for it, and then theyput you through all kinds of
(39:55):
testing.
So it's a diagnosis ofexclusion.
Usually it takes a while tocapture the diagnosis.
It's not something that'stypically done on a first or
second visit.
Maybe it's three or four visitswith special testing and even a
specialist or cardiologist toget involved.
So if someone is listening andthey're concerned with it, just
(40:19):
know that it is a process andit's not a quick answer for you.
Ray Cobb (40:25):
Is there any treatment for it?
Bethanie Spangenberg (40:28):
That's a great question.
So there is no medication.
There isn't anything specificto treat diabetic autonomic
neuropathy.
What happens is the treatmentfrom the clinical side is
optimizing your blood sugars andtreating or trying to prevent
(40:55):
complications, so to get yourblood pressure under control, so
that you don't develop a strokefrom your elevated blood
pressures.
When you decide to go.
You know your blood pressuresdecide to be what did you say,
john?
170 over 132 or something?
J Basser (41:15):
like that.
Bethanie Spangenberg (41:20):
So we try to give you medications so that
you don't have a stroke.
We give you aspirin to try toprevent any type of stroke or
cardiac ischemia that may arise.
We try to give medications toprotect your kidneys because
those high and low bloodpressures really put your
kidneys to work and that cancause some damage.
(41:42):
Try to get your cholesterolunder control.
If you get your cholesterollowered and in control, you're
less likely to have a stroke,less likely to have a blood clot
.
You're less likely to have aheart attack.
Heart attack stroke and bloodclots, heart attack, heart
(42:03):
attack, stroke and blood clots,and so there is some literature
out there that says thatexercise can help to improve
autonomic neuropathy.
The exercise forces your body totrigger some autonomic function
.
So if you think about whathappens when you exercise, your
heart rate goes up, your bloodpressure has to adjust, which
(42:24):
also involves your kidneystalking to your heart, the blood
flow increases to thoseautonomic nerves in the body and
it also helps to force ortrigger the production of your
sweat glands.
And so that exercise has beenshown to, or some studies have
(42:48):
shown that it helps to reducethe severity, not necessarily
treat it, not necessarily makeit go away, but it does improve
some of the symptoms.
So does that answer yourquestion?
J Basser (43:05):
Yeah, it's great.
Let's get up and hobble aroundthe block you want to.
Bethanie Spangenberg (43:14):
So I will say that I have struggled with
the exercise intolerance forabout the last 10 years.
When I had my daughter about 10years ago, I almost died with
her and that triggered a lot ofstress on my body, and shortly
(43:38):
after that I noticed that evenwalking up the stairs and
running around the track wasdifficult for me.
I was an athlete prior to havingmy daughter.
I ran track, I went to stateand track, I went to a Division
II school for cheerleading.
I went to a Division II schoolfor cheerleading and we stunted
(44:00):
and tumbled and all this crazystuff.
But after I had her, I was notcapable of tolerating any
exercise and I really struggledto get that back.
And so, for me personally, Istarted to take supplements to
try to help.
I started.
(44:21):
I had some panic attacks withthat as well, because you don't
have again your heart rate'sgoing 100 miles an hour and you
just you can't relax.
J Basser (44:32):
And so it's been.
Bethanie Spangenberg (44:33):
It's taken me a while, but I've got back
to you know, to where I can runmore comfortably.
I can't run consistently forlong periods of time because I
start to get that pain andburning in my legs.
I've had my blood vesselstested so I know it's not a
matter of peripheral arterialdisease, but my body's not
(44:58):
responding to the exercise.
I'm not getting the dilationwithin the muscle structure to
feed the oxygen in my muscles.
But for me personally, intrying to recover.
It has taken me a long time andit's a matter of running for 30
seconds and walking and thenrunning.
You know it's taken a while torecover from that, but it has
(45:21):
improved for me.
So I know that, john and Ray, Iknow it's not on your agenda to
start running, but thatmovement, even walking, starting
somewhere, can kind of help tobuild that tolerance.
J Basser (45:38):
Ray and I are both athletes At a much younger age.
Of course, football playersPlayed baseball, even shot up
for the Reds.
Even tied up for the red cord.
(46:05):
That's been a few years ago,but this issue is kind of
dangerous, you know.
I mean you know, you don't know, you've got it, you know, and
it goes to the heart and thecardiac involvement.
Bethanie Spangenberg (46:26):
I mean, I see reports all the time.
I guess sudden death and thingslike that can occur too, you
know yeah, I didn't want to gothat morbid, but it can happen.
That's the silent cardiacdistress signal, that
malfunction.
So I talked a little bit aboutthe distress signal of the
bladder, but that's the samewith the abdomen.
If you get abdominal distensionwhether, let's say, you have an
(46:49):
appendix rupture and yourabdomen distends, you don't
necessarily feel that pain fromthe abdominal distension.
Same with the heart.
You don't necessarily feel thedistress signal that the body is
putting out.
Hey, with the heart, you don'tnecessarily feel the distress
signal that the body is puttingout.
Hey, you know, the heart's notgetting enough oxygen and so the
distress signal is an autonomicsignal.
(47:10):
And so some people who havediabetic autonomic neuropathy
find themselves having a heartattack and never having any
symptoms find themselves havinga heart attack and never having
any symptoms.
J Basser (47:22):
That's one.
Another symptom is the silentheart attack, because you don't
feel the heart attack.
That's another symptom of it.
I'll tell you how they foundmine.
They found mine on my legs andthey started looking and started
(47:44):
putting stuff together andstarted talking about heart rate
and done tests for heart rate,things like that.
Over time.
This Apple Watch I didn't knowtoo much about the health app.
You know, when I first got towatch I started out with a 6 and
we changed over and of coursemy brainiac son helped me
finally get it set up here abouta year and a half ago and you
watch the symptoms and and it'spretty sharp, but you start
(48:06):
looking at 350 to 360 heart ratenotifications at rest in a
year's time or something along.
That was kind of the one thatkind.
That was the kind of the onethat kind of let the cat out of
the bag.
Bethanie Spangenberg (48:23):
So so I've actually seen those smart
watches.
I had a relative that was goingin and out of AFib and that
watch is what saved his life,because it signaled an abnormal
rhythm and he was kind ofpanicking because it went off a
few times like in the same dayand so he was able to call his
(48:46):
family doctor.
Family doctor got him in, endedup seeing a cardiologist and
here he had 35% heart function.
He was in heart failure and heended up having to have a valve
replacement.
His valve replacement or hisvalve malfunction was causing
heart failure which led to thearrhythmia, and it's all because
(49:07):
of that watch.
He had no symptoms.
So that watch was a lifesaver.
J Basser (49:13):
It is.
I wish they would work it outwith the company that did the uh
oh, two, seven meters and bringthat back to the watch.
I'd be like you know, that'sthe thing, you know what I'm
doing.
So he's got the apps.
Not that it's kind of hard toyou know, it's pretty good,
functional to keep it charged up, right, you need to get you one
(49:35):
of these.
I'm serious, we didn't we.
Bethanie Spangenberg (49:46):
I don't know if you guys can hear this
rain.
Ray Cobb (49:49):
Yeah, how loud this rain is.
Bethanie Spangenberg (49:50):
I'm trying to it's raining and you know
what I praise the Lord.
I've needed rain for my gardenfor two weeks, and this is the
first rain, and so I'm excited.
But what timing, oh my goodness.
No-transcript.
J Basser (50:35):
Talk to my outside VA doctor a lot about it, because
he's the first one to catch it,you know, and the VA finally
catches on, you know it's kindof like a day late and dollar
short situation.
Bethanie Spangenberg (50:44):
We haven't seen that before, though, have
we?
J Basser (50:47):
Too much.
But I don't know.
We've got to figure this thingout.
I mean, it's you know, I fileclaims for the statics and they
keep denying it.
Last time they sent me down,they sent it to California for a
terror thing due terrifyingexposure to asbestos and
radiation.
I'm still scratching my head onthat one.
So we'll see.
(51:08):
I'm just going to get somethingput together so we can show
them what it's all about.
Bethanie Spangenberg (51:15):
But you know, so far nobody's listening.
John, how long have you beendiabetic?
J Basser (51:23):
I was diagnosed with diabetes, started insulin in
2006.
I was pre-diabetic for severalyears before then.
I was on metformin and thenstarted the shot in 2006, so
it's been almost 18 years ago.
So even what we just talkedabout, tonight.
Bethanie Spangenberg (51:41):
So it's been almost what 18 years ago,
20 years.
So, even what we just talkedabout tonight.
The statistics are against you.
You know you should be sittingat 50-plus percentage at risk of
having, you know, a peripheralor an autonomic neuropathy, and
so I'm surprised that you'vestruggled this far, you know to
get that that orthostatichypertension service connected.
J Basser (52:05):
Well, they're just, uh , I think they made a mind
they're not going to do it.
You know I did the same thingwith Bill Sheeker.
What he did is put me inhypertension years ago.
He's like you know, we know yougot it and we know what it's
from, because he's alreadyserviced for, uh, I guess it's
COPD, and I said you can't dothat.
You know, I said we're notgoing to do that.
Well, he, finally, they finallydid it.
You know, after the right.
(52:26):
You know he spent a lot ofmoney to, you know, the attorney
and stuff, but you know itdidn't do much good?
no, it didn't.
Bethanie Spangenberg (52:40):
Well, what's interesting about it too
is if they're rating theorthostatic hypotension under
the vestibular conditions, it'sa 10% rating.
So they're fighting you over a10% rating for orthostatic
hypotension.
J Basser (52:46):
Keep switching up and they don't want to rate it,
period, you know.
So it's kind of crazy, but Idon't know, I'm probably going
to have to, at least one day,get an IMO Somebody knows what
they're talking about becausethese folks don't know nothing
much about it at all.
I mean, I can understand that,you know, because it's not you
know you don't hear people talkabout this every day and you
(53:07):
know, and so.
But you look through the pasthistory and the rest of the
stuff, you know we've talkedabout it before, bethany, I
think.
Maybe you know I need to getsomething done with this because
I'm just getting fed up.
But with that and the diabeticlows and the falls, I mean I'm
serious.
I mean I broke my S5 vertebrae.
You know, with the S5, s4, Ibroke one of them.
(53:31):
I fell in the concrete and hitpretty hard and I had to go
through a bunch of tests andx-rays and I hurt my arms, I
hurt my shoulder twice, and soyou know, you stand up and for
about two minutes you walk upsomewhere and the next thing,
you know, you get real dizzy.
(53:52):
And the next thing you knowyou're on the ground and you
know you wake up pretty muchshortly afterward, but still you
know you're on the ground.
Bethanie Spangenberg (54:04):
Well, if you got this, guys sell your
slab house and buy somethingwith a padded floor Bubble wrap
works too.
J Basser (54:11):
I think I know it does .
But you know, and they're likewell, this and then how to plan
some clothes.
Ad (54:15):
They're like well, why?
J Basser (54:15):
don't you call 911 and go to the hospital?
I?
Ad (54:19):
don't have to I said.
J Basser (54:20):
there's a new study I went on today in a class that
there's a major percentage ofvets and people by itself are
avoiding going to the hospitalnow.
And guess why?
They're not going to thehospital With hypoglycemia
Because of the dexcoms, becausethe dexroms catch it.
Bethanie Spangenberg (54:42):
Absolutely you know, I was actually
earlier today I was talkingabout the rating schedule for
diabetes.
You know, part of the ratingschedule talks about weekly
visits to a diabetic careprovider and it's like I don't
ever have to go weekly anymorebecause my insulin pump data
goes straight to myendocrinologist.
(55:03):
My blood sugar data goesstraight to my endocrinologist
and if there is a flag on mychart because something's
abnormal, she calls me.
J Basser (55:14):
There you go, there you go.
Look, I'd like to see anendocrinologist.
I haven't seen one yet.
Bethanie Spangenberg (55:24):
They actually they are hard to get to
.
I will tell you that our localVA, their pump therapy is done
by a clinical pharmacologist andnot necessarily an
endocrinologist, and notnecessarily an endocrinologist.
J Basser (55:42):
For PharmD?
Yes, For PharmD, right?
Okay, they're smart.
You know I've been, that's whoI go visit.
I mean, I do biowiches visitsbecause of hypoglycemia and I've
been doing this for a long time.
We started back in Novemberdoing it because, you know, I
mean I always been dropping butsince I decided to keep an eye
on it.
no matter what I do, it stilldrops.
(56:04):
So it dropped this morning.
It was in the 50s, but it's.
You know what I mean.
I hope we lost right, or not,did we?
I'm going to double check thescreen here, but do you think
(56:30):
they have any treatment forstuff?
Have you done any independentmedical opinions on this stuff,
Becky?
Bethanie Spangenberg (56:39):
We have.
Normally it's the gastroparesisor the orthostatic hypotension
that we get asked to do opinionson.
I will say that some of theurinary incontinence is more
readily recognized.
The pupillary dysfunction,that's not my wheelhouse.
I'll never see that.
(57:00):
That's going to be, you know,ophthalmology or an eye
specialist, the hypoglycemiaunawareness if you know a
patient has that, I'm sendingthem to an endocrinologist.
You know there's not much onthe clinical side that I can do
other than getting them acontinuous glucose monitor and
(57:21):
some glucagon.
Any orthostatic hypotensionconcerns or tachycardia concerns
always go to cardiology and wehaven't done a lot of opinions
on the cardiac stuff.
J Basser (58:03):
All right, I see Ray's back in there.
I can barely hear you guys.
Ray Cobb (58:09):
I don't know what's going on with my phone?
J Basser (58:12):
Probably the weather.
Betsy, could you give us yourcontact information before we
shut it down and Valor for Vetand plug in for them.
Bethanie Spangenberg (58:21):
Valorfor Vet.
You can plug in for themValorforVetcom.
Valor V-A-L-O-R, the number 4Vet V-E-Tcom.
There's a lot of helpfulinformation that you can
research and look at and then,if you have any questions, you
give us a call.
888-448-1011, 888-448, 448-888-448-1011.
J Basser (58:43):
Well, listen, guys, that's all the time we have for
tonight.
Bethany, thank you for comingon, we'll do this again.
Stay tuned.
Next week, guys.
We've got a major show comingup.
We've got Alex Graham and PeterD'Ancelli out of California.
We'll discuss the latestlawsuit, or the Supreme Court
(59:05):
ruling that turned over theChevron deal that Reagan put in,
and that's going to be a bigdeal.
Have you heard about that one,bethany?
Bethanie Spangenberg (59:14):
I have, but I'm not sure how exactly
that impacts VA stuff, so I'llbe definitely listening next
week.
Okay, well, that will beshutting down.
J Basser (59:20):
So I'll be definitely listening next week.
Okay, well, that will beshutting down.
We'll see you guys next week,and this is John, on behalf of
Bethany Spangenberg and Mr RayCobb.
We will be signing off.
For now, you have beenlistening to the Exposed that
Podcast.
Any opinions expressed on theshow are the opinions of the
guest speakers and notnecessarily the opinions of
(59:40):
Exposed that, exposed Thatcom orBlog Talk Radio.
Tune in next week for anotherepisode of the Exposed that
podcast.
Thanks for listening.
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