September 5, 2024 • 60 mins
The endocrine system functions as a complex network of glands that regulate hormones controlling everything from metabolism and growth to immunity and reproduction. Our expert breaks down how thyroid and parathyroid conditions develop, progress, and impact multiple body systems.
• DBQ Discussion
• Endocrine diseases typically occur in patterns of three, with one condition often developing 10-15 years after the previous one
• Thyroid dysfunction symptoms develop gradually—weight changes, fatigue, temperature intolerance, and mood issues often go unnoticed for years
• One abnormal TSH reading indicates thyroid dysfunction beginning, even if subsequent tests temporarily return to normal
• VA rates thyroid conditions at 30% for six months after diagnosis, then rates based on residuals affecting other body systems
• Veterans must document detailed symptom timelines and progression in their statements to support claims
• Parathyroid glands regulate calcium, affecting bone strength, heart rhythm, and nerve function
• Environmental exposures can trigger endocrine disorders in genetically susceptible individuals
• When filing claims for endocrine conditions, consider secondary connections to already service-connected conditions
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
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 another episode of the
Exposed Vet Radio Show on thisSeptember 5th 2024.
My name is John Stacey.
They call me Basher.
(00:25):
Folks probably remember Basherbetter than John Stacy.
We're going to bring you a goodshow today.
We've got a guy riding sideshuttle today from the great
state of Tennessee, mr Ray Cobb.
How are you, ray?
Ray Cobb (00:37):
I'm doing great.
It's a nice day down here, alittle cooler, sun shining,
slight breeze blowing.
It's been great.
I've been out all day.
J Basser (00:45):
It's been pancake hot here today.
I don't know, I don't know.
We've got a treat today, folks.
We've got this young lady thatcomes on.
She's on about once a month andwe make it a squall and pledge
to bring her on once a monthbecause she's nothing but a
bushel basket of information andwe went over several DBQs in
(01:05):
the past.
But today we're going to getour shoulder pads on and our
football helmets and ourmouthpieces in and we're going
to tackle the endocrine system.
Dbq Bethany how are you doing?
Bethanie Spangenberg (01:19):
I'm doing well.
I'm doing well.
I'm excited for tonight's show.
This will actually mark off ourendocrinology section of the
DBQ, so finish strong on thatsection and keep moving on.
Talked about you know the rain.
(01:42):
A couple shows we did thissummer.
Somehow I was recording or wewere doing the show during a
rainstorm and I had talked aboutlike how we really weren't
getting rain and just a coupledays ago they actually declared
a natural disaster for ourcounty because of how bad the
drought has been in Ohio.
(02:03):
So I just thought about that asa follow up to all my
complaining about the rain, orme cheering for the rain, I
guess.
J Basser (02:12):
There's an Indian website out there you can
actually learn how to do thatrain dance and maybe it'll help
it rain you know I've talkedabout that quite a bit.
Bethanie Spangenberg (02:21):
So I, um, I have a family member that's
lived, grew up in Southern Ohioand then moved out to California
.
He married a California ladyand came back and that
California lady she was born andraised in LA and she decided to
build a garden this year.
So they came back to SouthernOhio, built a garden and I guess
(02:44):
she went outside and startedwatering the garden and her
husband started yelling at herlike hey, you're not supposed to
water the garden.
And I'm like no, no, no, no, no, it's okay, you can water your
garden.
Like, I understand there's adifference between what you do
in california and here, but wedon't have any rain.
You need to water your garden.
You'll get nothing.
I I just found it comical thatI guess you don't know how to do
(03:08):
a garden.
J Basser (03:09):
I had a friend in San Diego that lived in a big house
in Rosecrans.
We talked every once in a while.
He ate him on grass, it'salways as dry and how fair as it
can be.
He had his asphalt company comein and they asphalted his whole
yard and he painted it green.
Bethanie Spangenberg (03:28):
Oh my gosh .
Ray Cobb (03:31):
Well, my son used to work for a company and he was
the manager of it.
And what they did?
They sold AstroTurf.
And they would go in and take aguy's yard up and put some rock
and things down and cover itwith astroturf.
Never had to mow the yard again.
Bethanie Spangenberg (03:53):
Man well, how do you grow your garden?
I guess, To put it in a raisedbed, a window box, exactly.
J Basser (03:59):
No we just leave you a little place out for that.
It's good to take that dirt outevery once in a while and put
some good topsoil in there andthe best topsoil you can get.
If you know anybody that's gota farm, ask them if you can
borrow some dirt out of theirbarn.
That would be all you need.
Ray Cobb (04:14):
Oh yeah.
J Basser (04:17):
That corn would be over your head.
Bethanie Spangenberg (04:21):
Yeah, it's actually interesting to see
because you know we drive aroundhere to the different
cornfields and they're justreally struggling and we haven't
seen anything like this forseveral years.
I don't know.
But I just had to follow up onthat because the last two shows.
I think it was a majorthunderstorm and you could hear
it in the background of theradio.
(04:41):
And I'm like of all the timesto rain, it has to be at 7 pm
Eastern time on the firstThursday of the month.
Ray Cobb (04:51):
You can't rain any other time I heard it too.
J Basser (04:55):
I heard it too.
I think you were sitting in thecar waiting for somebody to
come out of a tractor orsomething, but anyhow, I thought
you had that cassette goingwith golf books that kept
raining.
Ray Cobb (05:04):
I didn't know, oh shoot.
Bethanie Spangenberg (05:09):
But today we're going to talk about the
endocrine system and it's a bigone, but the VA has it really
tied down to, I'm going to say,two sections, and it's the
thyroid and the parathyroid, andthat's really what we're going
to hit home today.
J Basser (05:24):
Yeah, okay, we love this.
I've got thyroid issues.
You can go right ahead.
You know what I mean.
Bethanie Spangenberg (05:30):
Well, I want to introduce the endocrine
system first, because you know,we talk about the cardiovascular
system, which is the heart andthe blood vessels.
We talk about, you know, theurinary system or other systems
in the body, and the endocrinesystem isn't as clear in its
name as some of the other ones,but the endocrine system is a
(05:50):
lot of different organs andglands that regulate hormones
and signals for body function.
So if I start at the top andwe're looking at the brain or
the head, we have thehypothalamus, the pituitary
gland and the pineal gland andall of that sits in the center
(06:11):
of the brain and that controlsand helps to regulate hormones
such as sleep cycles ortemperature regulation, hunger,
behavior, and it's also part ofthe feedback system.
So if we're not making orgetting enough thyroid hormone
in the system, the pituitarygland will send out function as
(06:33):
far as signals go.
Then if we drop down into theneck, the neck contains your
thyroid and your parasyroidglands and in the center of the
(06:56):
chest right where they wouldjust above, where they would
start doing chest compression.
So right in the center, justabove the bottom part of the
sternum, is called the thymus.
A lot of people don't hearabout the thymus.
It has to do with more ofimmune regulation and sending
(07:17):
out, like battle the battle, thecells that fight off the battle
.
Excuse me, they're the battling.
How do I want to word this?
If there is a virus, the thymuswill trigger the immune system
to release cells to fight thatvirus.
(07:38):
So they're the battle cells iswhat I'm trying to say.
The battle cells is what I'mtrying to say.
And then, if we drop down intothe abdomen, we have the
pancreas, which we've beaten uppretty well when we talk about
diabetes.
But the pancreas also releasesdigestive hormones or digestive
(08:02):
enzymes.
And then at the top of ourkidneys sits the adrenal glands.
And then, if we drop lower intothe genital region, we have the
ovaries and testicles.
So all of those systemscommunicate to regulate hormones
and regulate our immunity.
They also help with growth ofour youth.
(08:22):
So when we're young, growth ofour youth.
So when we're young, or if wehave broken bones or if we get
injuries, it helps to repair andalso helps with reproduction.
So there's a lot that goes onwithin the endocrine system and
they all work together, they allcommunicate together as I said
previously about the thyroidhormone and the pituitary gland
(08:44):
but they all regulate our bodysystem or our systems to work
together.
We say, and the research hasshown that endocrinopathies, or
diseases of the endocrine system, occur in threes.
So typically what we see in theclinic is if an individual
(09:14):
develops diabetes, about 10 to15 years later we'll see them
develop some other type ofendocrine disease, such as hypo
or hyperthyroidism, and then weadd another 10 to 15 years and
then they start to developanother endocrine disease.
And so, when we talk about itin the terms of service
(09:38):
connection, if you have anendocrine disease and you go on
to develop another one, if youhave an endocrine disease and
you go on to develop another one, you need to consider filing as
a secondary because of how theendocrine system functions
together.
J Basser (09:57):
Does that make sense?
Yeah, it makes sense.
It's kind of you know, put themin the same bag.
I think you need to know beforeyou even do it, or they're
going to deny it.
It's what they do.
Bethanie Spangenberg (10:06):
I would agree a thousand percent,
because that is what we see, andI get surprised by that,
because the research is thereand it is very clear that these
endocrine diseases are notstandalone diseases because of
how they communicate, becausethey are a regulatory system.
(10:28):
So if you have one part of thesystem that's malfunctioning,
something else in the body hasto make up for it, or they're
going to change or modify theirfunction to accommodate to that
original dysfunction.
And so we see it clinically.
The research is there.
Yet we're looking at all thesenegative nexus opinions, and
(10:52):
that's where the disconnectbetween clinical medicine and
doing VA disability does notline up, like why are we
changing our clinical thoughtprocess because we're doing a
DBQ or we're writing a nexusopinion when clinically it is
very clear what happens andtranspires in the body?
So I think that's why it'simportant to talk about the
(11:14):
endocrine system and talk aboutthese, because diabetes is so
prominent and then thyroid tofollow.
So, but you're right, I think alot of times you have to go in
with a nexus.
J Basser (11:30):
It's sad, but you do.
You got to realize all thesepeople that are doing the
adjudication of these claims.
They're not medicalprofessionals.
They don't have a license topractice medicine, plus they're
not attorneys either.
They don't have a license topractice medicine, plus they're
not attorneys either.
You know they don't have alicense to practice law.
Bethanie Spangenberg (11:45):
We'll get that quick, you know.
And then, when we look at theDBQs that are available for the
endocrinology system, theendocrine system.
The VA has three DBQs.
The two primary DBQs are thediabetes mellitus, which we've
discussed, and then the onewe're going to talk about mainly
(12:06):
tonight is the thyroid andparathyroid.
The third one is everythingelse that has to do with the
endocrine system and it's oftenthe very rare diseases that,
honestly, I've probably onlyseen two or three of these
diseases in 15 years.
Am I 15 years now?
(12:27):
Where am I at 2009.
So, yeah, 15 years of practice.
I've only seen two or three ofCushing's syndrome or Addison's
disease, and those are diseasesaffecting the adrenal glands, or
diabetes insipidus, which is adifferent kind of diabetes where
the kidneys make you urinate alot, or even some of the hyper
(12:51):
or hypopituitary dysfunctions.
(13:11):
We don't see a lot of those.
Those are when you go to thespecialist or the
endocrinologist, or in thebigger cities they're going to
see some of those diseases.
So if you have one of thosediseases.
You really should be relying onyour medical evidence from your
specialist to prove ordemonstrate the symptoms and the
(13:32):
residuals of that condition.
I would not rely on a VAcompensation attention examiner.
I would try to get yourspecialist to write the evidence
there to write the evidencethere, but we're not talking Go
ahead?
J Basser (13:46):
Is that pituitary issue itself?
Is that where the people thathave that issue that they never
stop growing and they want to beabout eight foot tall before
they die?
Bethanie Spangenberg (13:55):
Yeah.
J Basser (13:55):
So, pituitary.
Bethanie Spangenberg (13:57):
Yes, they call it giantism?
Or they?
Have different names for it.
But, yes, that's where thegrowth hormone, the pituitary,
doesn't regulate the growthhormone appropriately and it can
go both ways you can havereally little people and you
have really tall people.
But it also has severalhormones, so not only the growth
(14:21):
hormone but the thyroidstimulating hormone, the
prolactin, and there's severalmore.
The pituitary dysfunction istypically recognized in use
because of some of thedysfunctions that we see or the
abnormalities in their growthcycles that we see, the
(14:45):
abnormalities in their growthcycles that we see, but those
are the ones that are rare andthat again compensation and
pension examiner should reallynot be.
They're not experienced enough.
Even I'm not experienced enoughand that really that evidence
needs to lay a anendocrinologist or a specialist
(15:06):
for those particular ones.
So that's.
We're not even going to attemptthose because that trying to
spit out some of that content, Iwould lose absolutely everybody
so today our focus is thyroidand parathyroid.
J Basser (15:24):
Good, you know, most people have had thyroid issues
over the last time, you know,but I'm taking that medicine
levothyroxine for hypothyroidism?
Ray Cobb (15:44):
Yes, is that?
The one I take every morning,when I get up a little bitty
pink one On your stomach with afull glass of water.
J Basser (15:52):
Yep, yep, that's going to be your thought.
Bethanie Spangenberg (15:55):
That's it.
J Basser (15:56):
Yep, I've been taking that for several years.
Ray Cobb (16:02):
Well, and it's actually Go ahead yeah.
Bethanie Spangenberg (16:08):
There's actually a delay when people are
diagnosed with the endocrineconditions because a lot of
times the diseases will.
There's not like an instantmoment or there's not like a
sudden symptom that you feelwhen you start to develop an
endocrine disease.
It's something that happensover time and you start to
(16:28):
develop symptoms and you startto go, oh, that's not normal,
but I can cope.
And then a year or two can goby and symptoms persist and
you're coping just fine, butthen it gets worse and then a
couple of years go by and thenyou're like okay, I can't, I
can't cope anymore.
So a lot of your endocrinediseases they'll pop up with
(16:51):
symptoms over a long period, andso in order to capture the
exact moment when things wentwrong is very difficult, and so
people will experience symptomsfor several years before they
ever get a diagnosis of anendocrine disease.
Ray Cobb (17:07):
I don't know that I had any symptoms of any of it,
but does it show up when youhave your blood work or your
urine?
J Basser (17:14):
test or anything.
Blood work.
Bethanie Spangenberg (17:17):
Yes, blood work.
And so again going back towhere these endocrine diseases
come in, threes the typicalscreening for diabetics who do
not currently have a thyroiddisease.
They are to be screened forthyroid disease once a year,
whether they have thyroid issuesor not or whether they have
(17:38):
symptoms or not, because thatcan occur very slow, very subtly
, no symptoms.
And part of the screening as aclinical standard for patients
with diabetes is to check theirthyroid gland every year, check
their thyroid hormone, makingsure everything in that area is
(18:00):
normal, that's TSH right.
Yes, that's the screening, andthen, once you get into
treatment, there's a few otherlabs that they typically do.
Now I've seen some in theclinic where, for the lack of a
(18:24):
formal term, it'll start topeter out, the thyroid will
start to kind of not likefunction correctly, and so
you'll get one abnormal TSH orthyroid stimulating hormone.
And the provider's like, oh okay, well, it's a little bit off,
this is the first time it's off,we'll repeat it again in three
months.
And then three months goes byand it's normal.
And then a year is like, okay,well, now it's normal, there's
(18:47):
no issues.
And then a year goes by andit's abnormal again.
Or you're asking about it to beretested because something's
not right.
So clinically I've seen whereyou'll get an abnormal TSH.
And then the provider's like,oh okay, well, let's repeat this
again in three months.
And I don't know why, becausethe evidence shows that once it
(19:09):
starts like you get thatdysregulation, yeah, three
months later it may be normal,but that high TSH is a signal
that something's not right.
So we can't just repeat it inthree months and then pretend it
never happens.
And I've seen that a lot.
So if you have an abnormal TSH,you really need to stay on top
of it to see, because any time aTSH is elevated is not normal
(19:32):
and so you have to monitor.
If you're a patient, you'relistening.
You're a veteran, you know thatyou've had an abnormal TSH in
the past, but it's been, youknow, a year since you've had it
tested, three months sinceyou've had it tested.
You really need to push to stayon top of it.
J Basser (19:51):
What's some of the issues?
Like I know, you can get arapid heart rate, things like
that, or slower heart rate,things like that.
A lot of people try to say,well, it could be a potassium
issue, things like that.
So there's a lot of confusionwith that.
Bethanie Spangenberg (20:06):
So if we focus only on hypothyroidism,
you think the thyroid is reallythe metabolism, your fat
breakdown, how your energy isutilized, and so if you have a
low thyroid, your metabolism isslowed, so you're not burning
(20:26):
fuel, you're not burning fatlike you should be, and the
symptoms are weight gain, slowheart rate, muscle weakness or
cramps.
You can get a puffy face, puffyeyes, joint stiffness, swelling
in the legs, depression,fatigue, constipation and
(20:49):
tolerance of cold.
In the room You're alwayssaying, oh, it's cold in here,
it's cold in here.
You're always asking for asweater, for a blanket.
You need extra blankets atnight because it's really cold,
or even brain fog.
Those are many of the symptoms.
Now, the subtle symptoms thatkind of creep in is the weight
gain, the fatigue and thedepression and cold intolerance.
(21:11):
Those are the ones that kind ofhit you first and you're like
okay, there's something going on.
J Basser (21:26):
Well, so if you've had one reading and then it went
back to normal and maybe lateron you'll have another high
rating, so basically, once youhave a high rating, it's worth
jumping all over to kind of getsomething.
Because it's one reading meansthere's something wrong, right?
Bethanie Spangenberg (21:42):
Correct One elevated reading.
It's not one of those thingswhere it's like you know well
your blood sugar, you'renon-diabetic.
You go in for labs and you'relike, oh well, your sugar is a
little high today.
Let's repeat it again in threemonths.
Well, your sugar can be highbecause you didn't fast long
enough, or you ate too muchsugar beforehand, or maybe you
(22:04):
are showing some prediabetes Forblood sugar.
Yeah, you can repeat that inthree months and see what it's
doing the thyroid.
It's not that way.
Once your thyroid stimulatinghormone is elevated, at that
point your brain is telling yourbody that you are not getting
enough.
So it is already saying there'ssomething not right here.
(22:27):
We need more thyroid hormone.
We need more thyroid hormone.
That is when it's starting togo out, it's starting to not
function normally.
And so you repeat it in threemonths and it's like, oh, is
this fine?
No, it's not fine.
You need to stay on top of it,because you've already seen that
the brain is telling the bodythere's not enough thyroid
(22:51):
hormone.
So before we get too far, Iguess into each disease.
Let me jump into that DBQ.
So, as I normally do, I havethe DBQ in front of me and I'm
(23:13):
going to go through each pageand talk about some of the
questions that are asked and whythey're asked and what to
expect when the veteran goes infor a thyroid or parathyroid DBQ
or condition.
So if I look at page one, sothis is eight pages and this
particular DBQ again thyroid,parathyroid, are in the neck, so
we're just focusing on theendocrine system involving the
(23:36):
neck.
So page one containsinformation for the provider to
document their relationship withthe veteran and what evidence
was reviewed, and so typicallyit's just going to be if it's a
VAC and P examiner, then it'sgoing to be you know, claims
filed, reviewed.
If it's a private provider oryou're asking your doctor to
(23:57):
fill it out, then it's typicallyyou know medical records, maybe
service treatment records ifyou provide them, lab results
and anything that you havebrought to your clinician.
And this page, these questions,are standard for all of the
public-facing DBQs.
So if we go to page two, Ialways emphasize the very first
(24:20):
question at the top Does theveteran have, or has he or she
ever had a thyroid orparathyroid condition?
This is where we're saying youmust have a diagnosis.
You don't want to apply if youdon't have a diagnosis.
I emphasize that because of how, if you go in without a
(24:41):
diagnosis, your success rategoes down significantly.
That provider says no to thisquestion and they move on and
your claim is denied.
So I cannot emphasize enough,just as I have at every radio
show that you should be going inwith a current diagnosis.
So there's a list of medicalconditions that pertain to
(25:05):
specific diagnosis, that pertainto the thyroid and the
parathyroid.
The ones that are mostpredominant are the hyper and
hypothyroidism hyper andhypoparathyroidism.
When we say hyper, it meanshyperactive or overactive.
(25:25):
If we say hypoactive, it's aslowing or a decrease in
function.
We'll talk briefly about whatwe call goiters.
The VA references them asthyroid enlargement and whether
those goiters or that thyroidenlargement is toxic versus
(25:46):
non-toxic.
So there's other diagnosedconditions on there.
We're not going to hit on thosebecause they are not common.
If we jump down to Section 2 onpage 2, it talks about the
medical history and, believe itor not, the examiner should be
(26:06):
able to fill out this sectionwithout the veteran ever being
in the room.
And I say this because theveterans that are listening and
have heard me preach they havealready provided a beautiful
statement and supportive claimthat not only discusses the
onset but discusses the courseof their thyroid or parathyroid
(26:30):
condition.
So you want that evidence infront of that examiner before
you ever sit down to talk withthem.
And I want to give a specificexample that I just ran into.
Last week we got a request fora record review.
They want us to look to see ifcondition A is related to
(26:52):
condition B and I said, okay, Ireview the evidence and this
condition has affected him overthe last 20 years.
And that hurts that veteran,because I can't support that
(27:24):
veteran in saying, well, yes,this condition affected his
sleep, for instance.
I can't say that it affectedhis sleep over the last 20 years
because I don't have anyevidence showing that.
So you really have to discussthe course of that disease.
(27:44):
So let's use an example for thethyroid condition.
If a veteran talks about well,maybe the thyroid condition is
not the best one to say becauseI'm trying to think secondary
here.
Okay, let me give this exampleIf we're trying to tie sleep
(28:06):
apnea to PTSD, and in 2000, yourevent occurs and you tell me
about that event and then youjump 2024 and you tell me what
your current symptoms are, whathappened for those last 20 plus
(28:26):
years that has caused issueswith your sleep, that you think
that your PTSD has causedsleeping issues, if you don't
tell me that you've had sleepingtroubles or provide examples
with a timeline, then I cannotsay I can't fill in the gap for
(28:49):
you that this condition affectedyour sleep in 2001, 2002, 2003,
2004, 2005, and so on.
There's an absence of evidence.
I can't assume that your mentalhealth condition caused sleep
issues for 20 years.
You have to tell me that.
If that's the case, does thatmake sense?
J Basser (29:13):
If they don't tell you , you won't know right yeah
foundation is veterans.
You're gonna have to see if theexaminer examiner you need to
go ahead and look at your.
What you got and write up thestatement explains your
condition and you're in yourterms and let the examiner look
at it.
That might we'd have a lot ofproblems within the exam itself.
(29:33):
Yes, that makes sense, but ithas to be on what they have.
It can't be something new orsomething extra.
It has to be an evidence thatthey already have in the system.
Ray Cobb (29:46):
Yeah, that's where I'll refer back to my notes and
highlight them and just say,here's my notes where it talks
about it.
Do you need to see them?
A lot of times they'll say, ohyeah, thank you times they'll
(30:06):
say, oh yeah, thank you.
Bethanie Spangenberg (30:07):
So I can't emphasize enough that statement
of support acclaim and how itlays out your medical history
and what has happened.
And if it is the thyroid, tellme when you went and had an
ultrasound In your statement.
Tell me.
Tell me what happened when youstarted feeling your heart skip
or jump and then when you wentto go see your doctor and then
the ultrasound was done and thensurgery was done.
(30:29):
Tell me about what has happenedand how that has affected you.
Before you had surgery, you hadthese symptoms.
After surgery, you had thesesymptoms after surgery.
You had these symptoms.
To really lay it out there forthat examiner to understand what
has transpired with yourcondition that you're claiming.
So the next few questions on thepage two talk specifically
(30:53):
about types of different typesof treatment that a veteran may
have had for their thyroid orparathyroid condition and it
specifically asks aboutradioactive iodine.
It talks about surgery, any typeof genetic testing that may
have been done and that willvary based on the condition.
Not everyone will haveradioactive iodine, so that's
(31:18):
specific to hyperthyroidism.
Some will have the radioactivetesting done.
That is different than thetreatment, so treatment really
doesn't say a whole lot as faras, like, the rating schedule
goes, but the next section onpage three, we're going to dive
(31:42):
into that rating schedule.
So on page three, if the verytop section talks about the
signs, symptoms or residuals ofa thyroid condition, so the
thyroid specifically is abutterfly-shaped gland at the
(32:05):
base of the neck.
So if you push on your chestand you push up into there's a
little like hole is what I'mgoing to call it a little your
thyroid sits right about thereand it's in the shape of a
butterfly and at the tip of eachwing is your parathyroid glands
(32:27):
and so they sit on each.
There's four of them and theysit at the top of each wing of
the thyroid glands.
So you have four parathyroidglands.
So the thyroid and theparathyroid communicate and if
you have any type of thyroidcondition it can irritate the
parathyroid and vice versa.
(32:48):
So when an individual hasthyroid issues, they should also
be looking at the parathyroidfunction.
The residuals for question 3Ais they're trying to capture
what other body systems areaffected, and that's really
where the majority of theratings for thyroid conditions
(33:10):
and parathyroid conditions comefrom is the residuals, not
necessarily the disease itself,but the residuals, and we'll
talk about those residuals as wego through.
Question 3B has to do withhyperthyroidism, and earlier we
were talking abouthypothyroidism, the slow acting
(33:32):
or the slowed.
Thyroid 3B talks abouthyperactive or overactive
thyroid 3B talks abouthyperactive or overactive
thyroid.
So symptoms related tohyperthyroidism can be weight
loss, anxiety, rapid heart rate,can have some tremors, fatigue,
diarrhea, frequent bowelmovements.
(33:53):
You get hot a lot.
It's like man, it's really hotin here and you start peeling
off your coat or layers ofclothing and then hair changes.
You have thick hair.
So personally I and I always Ialways like to tell stories
because I feel like it sticks alittle bit better, and so they
(34:14):
always talk abouthyperthyroidism.
And women can be something thatwomen really like, because they
lose this weight, they havethis thick, beautiful hair, but
then they're tired all the time,and so I personally experienced
that when I went through mythyroid.
Issue is I had lost a bunch ofweight and I was like in
(34:36):
clothing that I hadn't worn formany years, and so, even though
I knew I had thyroid issues andI was tired all the time, it was
like man, I'm wearing clothesthat I bought years ago that I
couldn't wear before.
But again, sometimes thathyperthyroidism or thyroid
disease creeps up and you don'treally realize you had it until
(34:59):
you can.
You show up in the hospital forheart palpitations and here
you're in atrial fibrillation,and so they would do the workup
to see why you have AFib andthey find out that your thyroid
is a little active, a littleoveractive, and so for the
rating schedule forhyperthyroidism, you get a 30%
(35:22):
rating for six months after theinitial diagnosis and then it's
rated by the residuals.
So residuals can be the atrialfibrillation, you can have some
heart changes.
From the thyroid, the frequentbowel movements, you can
(35:50):
actually develop what they callexopsalmus, but where the eyes
pop out and it looks like youhave buggy eyes.
Sometimes hyperthyroidism iscalled Graves' disease and
that's really what a lot ofpeople know hyperthyroidism as,
and there's commercials outthere for the eye disease.
I don't know if you've seenthose or not.
Any questions about it?
J Basser (36:13):
Gray's is listed in Title 38.
Gray's is listed in Title 38,Part 4.
There you go.
Bethanie Spangenberg (36:25):
So any questions about the hyperthyroid
or Graves' disease.
J Basser (36:33):
Ladies, if you got it, enjoy it, but you know, get it
fixed it, you know, get it fixed.
Bethanie Spangenberg (36:48):
Thyroid issues tend to also cause
reproductive health issues, bothmen and women, so that can be
something that can pop up as aresidual or some issues there,
some issues there.
So if we look at 3C, it has todo with thyroid enlargement and
(37:11):
this is also known as goiters.
We call this goiters.
They're just growths on thethyroid and you'll look at old
history or old medical books andthey'll show pictures of
goiters and they associatedgoiters with iodine deficiency
and that's why all of our saltis now iodized is because we
were lacking iodine in ourdietary system or all of our
(37:32):
lovely processed foods.
We weren't getting enoughiodine and so the treatment for
goiters was iodine, and sothat's why we have iodized salt,
just to help prevent any typeof goiter development.
J Basser (37:51):
Again here, In case we get nuked yeah.
Bethanie Spangenberg (37:58):
Oh gosh, yeah, oh gosh.
Now goiters or the thyroidenlargement is broken down into
toxic or non-toxic.
So if you have a goiter orgrowth that has no symptoms but
you do have like swelling orlike the obvious neck swelling,
(38:19):
like I was talking about for thepictures, or difficulty
swallowing or hoarseness, that'swhere you will get rated on
what they call disfigurement andwe've talked about the
disfigurement before or you'llget rated for your other
symptoms, your other symptoms.
If it is toxic, they're goingto base the rating off of what
(38:44):
the hormones show.
So if your goiter is toxic andit's causing excessive thyroid
hormone release, then they'regoing to rate you based off of
your hyperthyroid or overactivethyroid hormones and vice versa.
So not a lot of meat on thatone.
Ray Cobb (39:11):
Any questions about goiters.
J Basser (39:12):
Can that also be a secondary to diabetes or
something else?
Bethanie Spangenberg (39:17):
Your goiters are typically going to
be from something else.
We don't see a lot of thenon-toxic goiters anymore.
That's very rare.
The toxic goiters we do see,and that's mainly you'll get a,
and they're not as obviousbecause we get more medical care
(39:38):
than we used to, and sosometimes we'll have patients
that come in and they notice aswelling in their neck and I say
you know my neck, I was lookingin the mirror, I was doing my
makeup and it just looks off,and so you'll get an ultrasound
of the thyroid and you'll find agoiter.
A lot of times the goiters areincidental on scans anymore.
(40:02):
We'll pick them up on the scansbefore the patient ever comes
in and complains of it.
It is very rare that we see thehoarseness or the difficulty
swallowing from a goiter.
Usually people seek medicaltreatment before it gets to that
point.
(40:28):
I can see that.
So if we go down to 3D, this ishypothyroidism that we talked
about before.
Hypothyroidism talked about thesymptoms weight gain,
depression, fatigue, cold,intolerance.
Those are the big ones.
(40:49):
The rating is 30% after theinitial diagnosis and then rated
by residuals.
However, if you have what theycall myxedema with a series of
symptoms, they will give you a100% rating.
This is not a realistic rating.
This is not something thatveterans should be trying to
(41:11):
capture or trying to get themyxedema.
What that is is that is acombination of your hypothyroid
symptoms in addition to swellingin the legs, and this occurs in
those with untreatedhypothyroidism or undiagnosed
(41:36):
thyroid disease.
So I've never seen this occur.
It is very rare.
A lot of times the patientspresent to the emergency room or
they can even go into a coma ifit's to the point that the body
is not getting any thyroidhormone and so it's not able to
regulate the body's endocrinesystems.
(41:59):
So, aside from the swelling inthe legs, they have to have cold
intolerance, muscular weakness,heart involvement, such as low
blood pressure, low heart rate,swelling around the heart and a
mental disturbance.
In order to get that 100%, youhave to have all four of those
(42:23):
components the mentaldisturbances, dementia, slowing
of thought or depression.
If somebody has myxedema withdementia, that is a significant
like it has been going on forsome period of time that they
have progressed to develop thismyxedema.
(42:45):
It is rare.
This is not where you hang yourhat if you're trying to get a
disability percentage forhypothyroidism.
I bring it up just because itis.
You know several questions inthe DBQ that are being asked,
but it is not something youdon't want.
This condition in your license.
(43:06):
Any questions about that?
No, no no, no.
(43:27):
So the last one, last questionon page three has to do with
thyroiditis.
Thyroiditis is justinflammation of the thyroid and
there's no actual percentage tocapture here.
If it's normal function, it'szero percent.
Excuse me, it's like yourthyroid hormones are normal,
it's 0%.
If it's overactive, then you'rebased off of hyperthyroid
(43:49):
schedule reading.
If it's hypoactive, then it'sbased on the hypothyroid
schedule.
So very straightforward on thatone.
So very straightforward on thatone.
So if we move on to page four,we're going to transition into
the parathyroids and theparathyroids again, those four
little glands that sit at thetip of the butterfly wings in
(44:12):
the thyroid.
If an individual has surgicalremoval of their thyroid, the
parathyroids need to bemonitored for a period of time.
Sometimes you can remove thethyroid tissue and keep the
parathyroids intact.
If they are manipulated orirritated too much, you can
(44:38):
cause damage to the parathyroidsand then develop a parathyroid
issue.
And so for a series of severalmonths after you have your
thyroid removed, they have towatch your parathyroid function.
So that's how close they worktogether and in their space.
That's how close they are.
So 4A talks about the residuals.
(45:01):
Here again, the residuals arereally what gets your rating
percentages for parathyroidfunction.
4b talks specifically abouthyperparathyroidism.
Symptoms are typically subtle.
Parathyroidism Symptoms aretypically subtle.
This is an overactiveparathyroid function and it
(45:31):
causes excessive calcium to bereleased into the bloodstream.
If the parathyroid doesn'tfunction correctly, symptoms are
fatigue, muscle weakness, heartarrhythmias.
That's similar to what wetalked about in the thyroid
condition.
Hyperparathyroidism can alsocause bone fragility and kidney
stones.
What happens is the parathyroidbecause it's saying, telling
(45:55):
the body it needs more calciuminto the bloodstream, telling
the body it needs more calciuminto the bloodstream, it pulls
the calcium from the bone inorder to get the calcium into
the blood, and so that's wherewe see fractures that are
occurring with a little pressure, like you know, like we tripped
over something or some minortrauma happened and a bone broke
(46:18):
.
That's typically how we findparathyroid issues.
Well, that's not enough force.
That shouldn't have broke.
What else is going on?
Do you have something elsegoing on in your body?
And so often that's the firstsign of there being parathyroid
issues and an individual is anabnormal or atypical fracture,
bone fracture.
(46:38):
Any questions?
J Basser (46:52):
regarding the parathyroid, at least the
hyperparathyroid.
Bethanie Spangenberg (46:59):
How common is that?
J Basser (47:02):
It's not.
Bethanie Spangenberg (47:04):
It's not, I would say more of your
parathyroid issues, againbecause of how the endocrine
system functions.
It's usually something else inthe endocrine system that's
malfunctioning in order to causethe parathyroids to act up.
We see it when there'sparathyroid issues in young kids
(47:25):
, like even tumors can putpressure in the brain, and then
it tells the parathyroid to notfunction correctly and then it's
like okay, wait a minute.
They were hitting in the shinwith a ball baseball practice
and they broke their leg.
That should not have brokentheir leg, and so when we see
(47:47):
stuff like that, we start toquestion you know what else is
going on?
J Basser (47:51):
Yeah, that's why I started looking for cancer and
all kinds of stuff.
Bethanie Spangenberg (47:56):
Yeah, yeah .
J Basser (47:57):
Oh, my mother hit cancer in her arms and reached
down to pick a dog up.
Her arm snapped and took.
Bethanie Spangenberg (48:03):
Yep, yep.
Ray Cobb (48:04):
Oh goodness what did we do Question Bethany, if you
is thyroid problems, can theysometime be inherited?
Bethanie Spangenberg (48:25):
time be inherited.
So the reason or the thoughtprocess behind the genetic
component of, or hereditarycomponent of, endocrine diseases
is because of how the immunesystem works and how your body,
basically the DNA that'sinherited from your mother and
father.
So if, for example, my childrenare more likely to get diabetes
(48:49):
because I am a diabetic and ithas to do with the genes that
they carry.
So endocrine or autoimmunediseases can occur if the person
has the susceptibility in thewrong environment.
So let's say I'm going to usediabetes again because that's
(49:23):
the one I preach about and mostcomfortable with.
So let's say that for somereason my body found a and it's
immune system so thymus is yourimmunity.
My thymus found a cell anddecided that it was an enemy and
that cell was actually a friend, like the beta cells in the
pancreas.
So something in the immunesystem triggered the body to
(49:48):
attack those beta cells or thosehealthy, good cells.
And now that the body hasattacked those cells, those
cells malfunction or are killedoff by the body.
There is a geneticpredisposition and then you
expose the individual to thewrong environment and it will
trigger that to occur.
(50:09):
Now, if you also think about it, if as a child, you not only
have your parents' genes, butyou also have the same
environment.
For most children, mostchildren are raised by their
biological parents.
So not only is the adult inthat same environment, but the
(50:30):
child is in the same environment.
So now you have that storm ofgenetic susceptibility in the
environment, triggering theonset of that dysfunction.
So, yes, thyroid, yes, diabetes, yes, all these endocrine
diseases have a geneticpredisposition.
(50:53):
But that doesn't mean thatyou're going to what viruses
they have.
If they're exposed to mold,chemicals, dioxins, agent Orange
, once you expose those injuriesin that environment, it can
(51:21):
attack the body.
Ray Cobb (51:24):
Yeah, and that explains it.
I have this individual I know afriend and their mother had
thyroid problems and theirsister had thyroid problems and
from listening to theconversation tonight I'm
beginning to think that thatperson may have thyroid problems
(51:45):
and don't know it because ofsome of the things you talked
about with the weight gain orthe weight loss and the heart
AFib mainly things of thatnature.
So I think I could reach out tothat person and tell them they
may want to ask their doctorabout checking that thyroid, if
(52:06):
he hasn't already.
Bethanie Spangenberg (52:08):
Correct, and even if you have a strong
family history, you want to haveyour thyroid checked regularly.
The same with diabetics.
For some reason, type 2diabetes is in both my
grandmother, my mother's, mymaternal grandmother, my
(52:29):
maternal grandfather, my uncle,which is my mom's brother, my
aunt and my other aunt, but mymother is the only person that
does not have diabetes Of theall five of those individuals.
Out of six people, my mother isthe only one that doesn't have
type 2 diabetes.
(52:49):
So there's the geneticcomponent.
But why?
Her environment might bedifferent.
Maybe she doesn't carry thatgene, maybe everybody else just
had the susceptibility and thesame environment, or the injury.
Ray Cobb (53:10):
Okay.
Bethanie Spangenberg (53:13):
The one thing I like to talk about when
it comes to calcium and in thebody is calcium does a lot in
our body, from the electricalsignals in the heart to muscle
(53:41):
contraction, to signaling thenerves in our fingers to move,
and the strength in our bones orpair of bones.
The calcium is used to regulateso many body functions and so
the parathyroid can affect anyof those conditions.
And I don't think we realizewhen we talk about our health
and our well-being, we don'treally realize how much calcium
does play a role in our body'sfunction.
So I just always like to talkabout that.
(54:05):
For hyperparathyroidism, ifit's overactive, typically what
will occur is they will go inand they will take out some of
the parathyroid glands.
Of the four, they may take outtwo and leave two and then
monitor to see how thingsprogress out to and leave to and
then monitor to see how thingsprogress.
(54:27):
So if it is a truehyperparathyroid issue, then
they will remove it.
If it's a secondary issue, thenthey'll try to treat.
You know why it's being asecondary issue, such as a tumor
in the brain.
When we look at the DBQ, we'reoh my gosh, I didn't realize the
(54:51):
time.
When we look at the DBQ on pagefour, the questions that go
through.
There there's six questions.
It's specifically tied to whatis in the rating schedule and
(55:12):
typically, just like it was forthe thyroid, it's a temporary
rating schedule for a six-monthperiod and then they rate on the
residuals.
So there's not a whole lot ofof meat in the parathyroid
either.
If we turn to page five,there's only one question for
hypoparathyroidism and therating again is temporary for
(55:36):
certain months after thediagnosis and then rate it based
on the residuals.
Looking at section five is thephysical examination and there
is a requirement for thatexaminer to touch on the neck to
feel the thyroid.
(55:57):
They are to capture their pulseand blood pressure and they are
also assessed, their reflexesto test the reflex response.
Reflexes to test the reflexresponse.
Clinically we'll see anincrease or hyperreflexia if the
(56:19):
thyroid is elevated and we willsee a decrease in the reflexes
if the thyroid is low.
And that just helps to supportwhat we may be seeing in the lab
work.
And based on the symptoms,we'll do reflexes and then, if
they're consistent, you knowthat helps us clinically.
The last few sections of the DBQare the standard questions.
(56:41):
Talks about scars anddisfigurement, talks about
tumors and tumors and masses,and those are standard in all
the DBQs.
The diagnostic testing ispretty straightforward.
When we have any type ofthyroid or parathyroid issue, we
find it on lab first.
That is normally how it occurs.
(57:03):
Then the individual goes for anultrasound or even a CT scan of
the neck and then we refer themto a specialist for either
biopsy or medical intervention.
On page seven it talks aboutfunctional impact.
Again, you put that in yourstatement of support of claim
(57:25):
you talk about how yourcondition may be affecting you.
Your statement in support ofclaim you talk about how your
condition may be affecting you.
And then the last page is forthe examiner's information and
any additional remarks theexaminer may have.
When a veteran goes in to thisexam, they can expect anywhere
from 30 minutes to an hour ormore if they find, or the
(57:47):
examiner finds, that there areresiduals associated with their
thyroid condition.
And, believe it or not, that wasit.
J Basser (57:57):
But if they find residuals, that means there's
got to be more DBQs.
That's not good.
Bethanie Spangenberg (58:02):
Now, that is, that is what is supposed to
happen and it's funny that youbring that up.
That is what is supposed tohappen.
And it's funny that you bringthat up because just this
Tuesday, two days ago, my unclewent in for his comp and pen
exam.
He in the 1980s.
He was in a motor vehicleaccident.
He was a passenger in a vehicleand was thrown out of the
(58:23):
vehicle and had a fracture ofthe upper arm and it was a
spiral fracture, so it is notgrown back correctly and it's
actually compressed the nerve.
They would not assess the nervecondition because it wasn't in
the exam request.
They were only going toevaluate the bone condition.
(58:46):
So the examiner told him thathe had to go back and file for
the nerve damage related to thatbone fracture and that's not
what's supposed to be done.
J Basser (58:56):
It's supposed to be a similar benefit.
You find that you're supposedto do it, but since they're
preaching that, now it shouldbecome a burden symptom.
Yep, just like diabetes and allits secondaries.
Burden symptoms, that's Yep,just like diabetes and all its
secondaries.
Bethanie Spangenberg (59:11):
They're taught and they're prompted to
do their residuals, and theydon't.
J Basser (59:17):
Okay, since we ain't got much time left, bethany,
give us your website real quickbefore we shut her down
wwwvalor4vetcom.
Okay, if you guys need an IMOor any medical things like this,
especially dealing withintestinal questions, reach out
(59:40):
and touch her.
She'll be glad you did Withthat.
Saying, guys, we're out of time.
This is John on behalf ofBethany and Ray Cobb.
We'll be signing off for now.
You have been listening to theExposed Pet Podcast.
Any opinions expressed on theshow are the opinions of the
(01:00:01):
guest speakers and notnecessarily the opinions of
Exposed Pet, exposedpetcom orBlogTalkRadio.
Tune in next week for anotherepisode of the Exposed Pet
Podcast.
Thanks for listening.
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 another episode of the
Exposed Vet Radio Show on thisSeptember 5th 2024.
My name is John Stacey.
They call me Basher.
(00:25):
Folks probably remember Basherbetter than John Stacy.
We're going to bring you a goodshow today.
We've got a guy riding sideshuttle today from the great
state of Tennessee, mr Ray Cobb.
How are you, ray?
Ray Cobb (00:37):
I'm doing great.
It's a nice day down here, alittle cooler, sun shining,
slight breeze blowing.
It's been great.
I've been out all day.
J Basser (00:45):
It's been pancake hot here today.
I don't know, I don't know.
We've got a treat today, folks.
We've got this young lady thatcomes on.
She's on about once a month andwe make it a squall and pledge
to bring her on once a monthbecause she's nothing but a
bushel basket of information andwe went over several DBQs in
(01:05):
the past.
But today we're going to getour shoulder pads on and our
football helmets and ourmouthpieces in and we're going
to tackle the endocrine system.
Dbq Bethany how are you doing?
Bethanie Spangenberg (01:19):
I'm doing well.
I'm doing well.
I'm excited for tonight's show.
This will actually mark off ourendocrinology section of the
DBQ, so finish strong on thatsection and keep moving on.
Talked about you know the rain.
(01:42):
A couple shows we did thissummer.
Somehow I was recording or wewere doing the show during a
rainstorm and I had talked aboutlike how we really weren't
getting rain and just a coupledays ago they actually declared
a natural disaster for ourcounty because of how bad the
drought has been in Ohio.
(02:03):
So I just thought about that asa follow up to all my
complaining about the rain, orme cheering for the rain, I
guess.
J Basser (02:12):
There's an Indian website out there you can
actually learn how to do thatrain dance and maybe it'll help
it rain you know I've talkedabout that quite a bit.
Bethanie Spangenberg (02:21):
So I, um, I have a family member that's
lived, grew up in Southern Ohioand then moved out to California
.
He married a California ladyand came back and that
California lady she was born andraised in LA and she decided to
build a garden this year.
So they came back to SouthernOhio, built a garden and I guess
(02:44):
she went outside and startedwatering the garden and her
husband started yelling at herlike hey, you're not supposed to
water the garden.
And I'm like no, no, no, no, no, it's okay, you can water your
garden.
Like, I understand there's adifference between what you do
in california and here, but wedon't have any rain.
You need to water your garden.
You'll get nothing.
I I just found it comical thatI guess you don't know how to do
(03:08):
a garden.
J Basser (03:09):
I had a friend in San Diego that lived in a big house
in Rosecrans.
We talked every once in a while.
He ate him on grass, it'salways as dry and how fair as it
can be.
He had his asphalt company comein and they asphalted his whole
yard and he painted it green.
Bethanie Spangenberg (03:28):
Oh my gosh .
Ray Cobb (03:31):
Well, my son used to work for a company and he was
the manager of it.
And what they did?
They sold AstroTurf.
And they would go in and take aguy's yard up and put some rock
and things down and cover itwith astroturf.
Never had to mow the yard again.
Bethanie Spangenberg (03:53):
Man well, how do you grow your garden?
I guess, To put it in a raisedbed, a window box, exactly.
J Basser (03:59):
No we just leave you a little place out for that.
It's good to take that dirt outevery once in a while and put
some good topsoil in there andthe best topsoil you can get.
If you know anybody that's gota farm, ask them if you can
borrow some dirt out of theirbarn.
That would be all you need.
Ray Cobb (04:14):
Oh yeah.
J Basser (04:17):
That corn would be over your head.
Bethanie Spangenberg (04:21):
Yeah, it's actually interesting to see
because you know we drive aroundhere to the different
cornfields and they're justreally struggling and we haven't
seen anything like this forseveral years.
I don't know.
But I just had to follow up onthat because the last two shows.
I think it was a majorthunderstorm and you could hear
it in the background of theradio.
(04:41):
And I'm like of all the timesto rain, it has to be at 7 pm
Eastern time on the firstThursday of the month.
Ray Cobb (04:51):
You can't rain any other time I heard it too.
J Basser (04:55):
I heard it too.
I think you were sitting in thecar waiting for somebody to
come out of a tractor orsomething, but anyhow, I thought
you had that cassette goingwith golf books that kept
raining.
Ray Cobb (05:04):
I didn't know, oh shoot.
Bethanie Spangenberg (05:09):
But today we're going to talk about the
endocrine system and it's a bigone, but the VA has it really
tied down to, I'm going to say,two sections, and it's the
thyroid and the parathyroid, andthat's really what we're going
to hit home today.
J Basser (05:24):
Yeah, okay, we love this.
I've got thyroid issues.
You can go right ahead.
You know what I mean.
Bethanie Spangenberg (05:30):
Well, I want to introduce the endocrine
system first, because you know,we talk about the cardiovascular
system, which is the heart andthe blood vessels.
We talk about, you know, theurinary system or other systems
in the body, and the endocrinesystem isn't as clear in its
name as some of the other ones,but the endocrine system is a
(05:50):
lot of different organs andglands that regulate hormones
and signals for body function.
So if I start at the top andwe're looking at the brain or
the head, we have thehypothalamus, the pituitary
gland and the pineal gland andall of that sits in the center
(06:11):
of the brain and that controlsand helps to regulate hormones
such as sleep cycles ortemperature regulation, hunger,
behavior, and it's also part ofthe feedback system.
So if we're not making orgetting enough thyroid hormone
in the system, the pituitarygland will send out function as
(06:33):
far as signals go.
Then if we drop down into theneck, the neck contains your
thyroid and your parasyroidglands and in the center of the
(06:56):
chest right where they wouldjust above, where they would
start doing chest compression.
So right in the center, justabove the bottom part of the
sternum, is called the thymus.
A lot of people don't hearabout the thymus.
It has to do with more ofimmune regulation and sending
(07:17):
out, like battle the battle, thecells that fight off the battle
.
Excuse me, they're the battling.
How do I want to word this?
If there is a virus, the thymuswill trigger the immune system
to release cells to fight thatvirus.
(07:38):
So they're the battle cells iswhat I'm trying to say.
The battle cells is what I'mtrying to say.
And then, if we drop down intothe abdomen, we have the
pancreas, which we've beaten uppretty well when we talk about
diabetes.
But the pancreas also releasesdigestive hormones or digestive
(08:02):
enzymes.
And then at the top of ourkidneys sits the adrenal glands.
And then, if we drop lower intothe genital region, we have the
ovaries and testicles.
So all of those systemscommunicate to regulate hormones
and regulate our immunity.
They also help with growth ofour youth.
(08:22):
So when we're young, growth ofour youth.
So when we're young, or if wehave broken bones or if we get
injuries, it helps to repair andalso helps with reproduction.
So there's a lot that goes onwithin the endocrine system and
they all work together, they allcommunicate together as I said
previously about the thyroidhormone and the pituitary gland
(08:44):
but they all regulate our bodysystem or our systems to work
together.
We say, and the research hasshown that endocrinopathies, or
diseases of the endocrine system, occur in threes.
So typically what we see in theclinic is if an individual
(09:14):
develops diabetes, about 10 to15 years later we'll see them
develop some other type ofendocrine disease, such as hypo
or hyperthyroidism, and then weadd another 10 to 15 years and
then they start to developanother endocrine disease.
And so, when we talk about itin the terms of service
(09:38):
connection, if you have anendocrine disease and you go on
to develop another one, if youhave an endocrine disease and
you go on to develop another one, you need to consider filing as
a secondary because of how theendocrine system functions
together.
J Basser (09:57):
Does that make sense?
Yeah, it makes sense.
It's kind of you know, put themin the same bag.
I think you need to know beforeyou even do it, or they're
going to deny it.
It's what they do.
Bethanie Spangenberg (10:06):
I would agree a thousand percent,
because that is what we see, andI get surprised by that,
because the research is thereand it is very clear that these
endocrine diseases are notstandalone diseases because of
how they communicate, becausethey are a regulatory system.
(10:28):
So if you have one part of thesystem that's malfunctioning,
something else in the body hasto make up for it, or they're
going to change or modify theirfunction to accommodate to that
original dysfunction.
And so we see it clinically.
The research is there.
Yet we're looking at all thesenegative nexus opinions, and
(10:52):
that's where the disconnectbetween clinical medicine and
doing VA disability does notline up, like why are we
changing our clinical thoughtprocess because we're doing a
DBQ or we're writing a nexusopinion when clinically it is
very clear what happens andtranspires in the body?
So I think that's why it'simportant to talk about the
(11:14):
endocrine system and talk aboutthese, because diabetes is so
prominent and then thyroid tofollow.
So, but you're right, I think alot of times you have to go in
with a nexus.
J Basser (11:30):
It's sad, but you do.
You got to realize all thesepeople that are doing the
adjudication of these claims.
They're not medicalprofessionals.
They don't have a license topractice medicine, plus they're
not attorneys either.
They don't have a license topractice medicine, plus they're
not attorneys either.
You know they don't have alicense to practice law.
Bethanie Spangenberg (11:45):
We'll get that quick, you know.
And then, when we look at theDBQs that are available for the
endocrinology system, theendocrine system.
The VA has three DBQs.
The two primary DBQs are thediabetes mellitus, which we've
discussed, and then the onewe're going to talk about mainly
(12:06):
tonight is the thyroid andparathyroid.
The third one is everythingelse that has to do with the
endocrine system and it's oftenthe very rare diseases that,
honestly, I've probably onlyseen two or three of these
diseases in 15 years.
Am I 15 years now?
(12:27):
Where am I at 2009.
So, yeah, 15 years of practice.
I've only seen two or three ofCushing's syndrome or Addison's
disease, and those are diseasesaffecting the adrenal glands, or
diabetes insipidus, which is adifferent kind of diabetes where
the kidneys make you urinate alot, or even some of the hyper
(12:51):
or hypopituitary dysfunctions.
(13:11):
We don't see a lot of those.
Those are when you go to thespecialist or the
endocrinologist, or in thebigger cities they're going to
see some of those diseases.
So if you have one of thosediseases.
You really should be relying onyour medical evidence from your
specialist to prove ordemonstrate the symptoms and the
(13:32):
residuals of that condition.
I would not rely on a VAcompensation attention examiner.
I would try to get yourspecialist to write the evidence
there to write the evidencethere, but we're not talking Go
ahead?
J Basser (13:46):
Is that pituitary issue itself?
Is that where the people thathave that issue that they never
stop growing and they want to beabout eight foot tall before
they die?
Bethanie Spangenberg (13:55):
Yeah.
J Basser (13:55):
So, pituitary.
Bethanie Spangenberg (13:57):
Yes, they call it giantism?
Or they?
Have different names for it.
But, yes, that's where thegrowth hormone, the pituitary,
doesn't regulate the growthhormone appropriately and it can
go both ways you can havereally little people and you
have really tall people.
But it also has severalhormones, so not only the growth
(14:21):
hormone but the thyroidstimulating hormone, the
prolactin, and there's severalmore.
The pituitary dysfunction istypically recognized in use
because of some of thedysfunctions that we see or the
abnormalities in their growthcycles that we see, the
(14:45):
abnormalities in their growthcycles that we see, but those
are the ones that are rare andthat again compensation and
pension examiner should reallynot be.
They're not experienced enough.
Even I'm not experienced enoughand that really that evidence
needs to lay a anendocrinologist or a specialist
(15:06):
for those particular ones.
So that's.
We're not even going to attemptthose because that trying to
spit out some of that content, Iwould lose absolutely everybody
so today our focus is thyroidand parathyroid.
J Basser (15:24):
Good, you know, most people have had thyroid issues
over the last time, you know,but I'm taking that medicine
levothyroxine for hypothyroidism?
Ray Cobb (15:44):
Yes, is that?
The one I take every morning,when I get up a little bitty
pink one On your stomach with afull glass of water.
J Basser (15:52):
Yep, yep, that's going to be your thought.
Bethanie Spangenberg (15:55):
That's it.
J Basser (15:56):
Yep, I've been taking that for several years.
Ray Cobb (16:02):
Well, and it's actually Go ahead yeah.
Bethanie Spangenberg (16:08):
There's actually a delay when people are
diagnosed with the endocrineconditions because a lot of
times the diseases will.
There's not like an instantmoment or there's not like a
sudden symptom that you feelwhen you start to develop an
endocrine disease.
It's something that happensover time and you start to
(16:28):
develop symptoms and you startto go, oh, that's not normal,
but I can cope.
And then a year or two can goby and symptoms persist and
you're coping just fine, butthen it gets worse and then a
couple of years go by and thenyou're like okay, I can't, I
can't cope anymore.
So a lot of your endocrinediseases they'll pop up with
(16:51):
symptoms over a long period, andso in order to capture the
exact moment when things wentwrong is very difficult, and so
people will experience symptomsfor several years before they
ever get a diagnosis of anendocrine disease.
Ray Cobb (17:07):
I don't know that I had any symptoms of any of it,
but does it show up when youhave your blood work or your
urine?
J Basser (17:14):
test or anything.
Blood work.
Bethanie Spangenberg (17:17):
Yes, blood work.
And so again going back towhere these endocrine diseases
come in, threes the typicalscreening for diabetics who do
not currently have a thyroiddisease.
They are to be screened forthyroid disease once a year,
whether they have thyroid issuesor not or whether they have
(17:38):
symptoms or not, because thatcan occur very slow, very subtly
, no symptoms.
And part of the screening as aclinical standard for patients
with diabetes is to check theirthyroid gland every year, check
their thyroid hormone, makingsure everything in that area is
(18:00):
normal, that's TSH right.
Yes, that's the screening, andthen, once you get into
treatment, there's a few otherlabs that they typically do.
Now I've seen some in theclinic where, for the lack of a
(18:24):
formal term, it'll start topeter out, the thyroid will
start to kind of not likefunction correctly, and so
you'll get one abnormal TSH orthyroid stimulating hormone.
And the provider's like, oh okay, well, it's a little bit off,
this is the first time it's off,we'll repeat it again in three
months.
And then three months goes byand it's normal.
And then a year is like, okay,well, now it's normal, there's
(18:47):
no issues.
And then a year goes by andit's abnormal again.
Or you're asking about it to beretested because something's
not right.
So clinically I've seen whereyou'll get an abnormal TSH.
And then the provider's like,oh okay, well, let's repeat this
again in three months.
And I don't know why, becausethe evidence shows that once it
(19:09):
starts like you get thatdysregulation, yeah, three
months later it may be normal,but that high TSH is a signal
that something's not right.
So we can't just repeat it inthree months and then pretend it
never happens.
And I've seen that a lot.
So if you have an abnormal TSH,you really need to stay on top
of it to see, because any time aTSH is elevated is not normal
(19:32):
and so you have to monitor.
If you're a patient, you'relistening.
You're a veteran, you know thatyou've had an abnormal TSH in
the past, but it's been, youknow, a year since you've had it
tested, three months sinceyou've had it tested.
You really need to push to stayon top of it.
J Basser (19:51):
What's some of the issues?
Like I know, you can get arapid heart rate, things like
that, or slower heart rate,things like that.
A lot of people try to say,well, it could be a potassium
issue, things like that.
So there's a lot of confusionwith that.
Bethanie Spangenberg (20:06):
So if we focus only on hypothyroidism,
you think the thyroid is reallythe metabolism, your fat
breakdown, how your energy isutilized, and so if you have a
low thyroid, your metabolism isslowed, so you're not burning
(20:26):
fuel, you're not burning fatlike you should be, and the
symptoms are weight gain, slowheart rate, muscle weakness or
cramps.
You can get a puffy face, puffyeyes, joint stiffness, swelling
in the legs, depression,fatigue, constipation and
(20:49):
tolerance of cold.
In the room You're alwayssaying, oh, it's cold in here,
it's cold in here.
You're always asking for asweater, for a blanket.
You need extra blankets atnight because it's really cold,
or even brain fog.
Those are many of the symptoms.
Now, the subtle symptoms thatkind of creep in is the weight
gain, the fatigue and thedepression and cold intolerance.
(21:11):
Those are the ones that kind ofhit you first and you're like
okay, there's something going on.
J Basser (21:26):
Well, so if you've had one reading and then it went
back to normal and maybe lateron you'll have another high
rating, so basically, once youhave a high rating, it's worth
jumping all over to kind of getsomething.
Because it's one reading meansthere's something wrong, right?
Bethanie Spangenberg (21:42):
Correct One elevated reading.
It's not one of those thingswhere it's like you know well
your blood sugar, you'renon-diabetic.
You go in for labs and you'relike, oh well, your sugar is a
little high today.
Let's repeat it again in threemonths.
Well, your sugar can be highbecause you didn't fast long
enough, or you ate too muchsugar beforehand, or maybe you
(22:04):
are showing some prediabetes Forblood sugar.
Yeah, you can repeat that inthree months and see what it's
doing the thyroid.
It's not that way.
Once your thyroid stimulatinghormone is elevated, at that
point your brain is telling yourbody that you are not getting
enough.
So it is already saying there'ssomething not right here.
(22:27):
We need more thyroid hormone.
We need more thyroid hormone.
That is when it's starting togo out, it's starting to not
function normally.
And so you repeat it in threemonths and it's like, oh, is
this fine?
No, it's not fine.
You need to stay on top of it,because you've already seen that
the brain is telling the bodythere's not enough thyroid
(22:51):
hormone.
So before we get too far, Iguess into each disease.
Let me jump into that DBQ.
So, as I normally do, I havethe DBQ in front of me and I'm
(23:13):
going to go through each pageand talk about some of the
questions that are asked and whythey're asked and what to
expect when the veteran goes infor a thyroid or parathyroid DBQ
or condition.
So if I look at page one, sothis is eight pages and this
particular DBQ again thyroid,parathyroid, are in the neck, so
we're just focusing on theendocrine system involving the
(23:36):
neck.
So page one containsinformation for the provider to
document their relationship withthe veteran and what evidence
was reviewed, and so typicallyit's just going to be if it's a
VAC and P examiner, then it'sgoing to be you know, claims
filed, reviewed.
If it's a private provider oryou're asking your doctor to
(23:57):
fill it out, then it's typicallyyou know medical records, maybe
service treatment records ifyou provide them, lab results
and anything that you havebrought to your clinician.
And this page, these questions,are standard for all of the
public-facing DBQs.
So if we go to page two, Ialways emphasize the very first
(24:20):
question at the top Does theveteran have, or has he or she
ever had a thyroid orparathyroid condition?
This is where we're saying youmust have a diagnosis.
You don't want to apply if youdon't have a diagnosis.
I emphasize that because of how, if you go in without a
(24:41):
diagnosis, your success rategoes down significantly.
That provider says no to thisquestion and they move on and
your claim is denied.
So I cannot emphasize enough,just as I have at every radio
show that you should be going inwith a current diagnosis.
So there's a list of medicalconditions that pertain to
(25:05):
specific diagnosis, that pertainto the thyroid and the
parathyroid.
The ones that are mostpredominant are the hyper and
hypothyroidism hyper andhypoparathyroidism.
When we say hyper, it meanshyperactive or overactive.
(25:25):
If we say hypoactive, it's aslowing or a decrease in
function.
We'll talk briefly about whatwe call goiters.
The VA references them asthyroid enlargement and whether
those goiters or that thyroidenlargement is toxic versus
(25:46):
non-toxic.
So there's other diagnosedconditions on there.
We're not going to hit on thosebecause they are not common.
If we jump down to Section 2 onpage 2, it talks about the
medical history and, believe itor not, the examiner should be
(26:06):
able to fill out this sectionwithout the veteran ever being
in the room.
And I say this because theveterans that are listening and
have heard me preach they havealready provided a beautiful
statement and supportive claimthat not only discusses the
onset but discusses the courseof their thyroid or parathyroid
(26:30):
condition.
So you want that evidence infront of that examiner before
you ever sit down to talk withthem.
And I want to give a specificexample that I just ran into.
Last week we got a request fora record review.
They want us to look to see ifcondition A is related to
(26:52):
condition B and I said, okay, Ireview the evidence and this
condition has affected him overthe last 20 years.
And that hurts that veteran,because I can't support that
(27:24):
veteran in saying, well, yes,this condition affected his
sleep, for instance.
I can't say that it affectedhis sleep over the last 20 years
because I don't have anyevidence showing that.
So you really have to discussthe course of that disease.
(27:44):
So let's use an example for thethyroid condition.
If a veteran talks about well,maybe the thyroid condition is
not the best one to say becauseI'm trying to think secondary
here.
Okay, let me give this exampleIf we're trying to tie sleep
(28:06):
apnea to PTSD, and in 2000, yourevent occurs and you tell me
about that event and then youjump 2024 and you tell me what
your current symptoms are, whathappened for those last 20 plus
(28:26):
years that has caused issueswith your sleep, that you think
that your PTSD has causedsleeping issues, if you don't
tell me that you've had sleepingtroubles or provide examples
with a timeline, then I cannotsay I can't fill in the gap for
(28:49):
you that this condition affectedyour sleep in 2001, 2002, 2003,
2004, 2005, and so on.
There's an absence of evidence.
I can't assume that your mentalhealth condition caused sleep
issues for 20 years.
You have to tell me that.
If that's the case, does thatmake sense?
J Basser (29:13):
If they don't tell you , you won't know right yeah
foundation is veterans.
You're gonna have to see if theexaminer examiner you need to
go ahead and look at your.
What you got and write up thestatement explains your
condition and you're in yourterms and let the examiner look
at it.
That might we'd have a lot ofproblems within the exam itself.
(29:33):
Yes, that makes sense, but ithas to be on what they have.
It can't be something new orsomething extra.
It has to be an evidence thatthey already have in the system.
Ray Cobb (29:46):
Yeah, that's where I'll refer back to my notes and
highlight them and just say,here's my notes where it talks
about it.
Do you need to see them?
A lot of times they'll say, ohyeah, thank you times they'll
(30:06):
say, oh yeah, thank you.
Bethanie Spangenberg (30:07):
So I can't emphasize enough that statement
of support acclaim and how itlays out your medical history
and what has happened.
And if it is the thyroid, tellme when you went and had an
ultrasound In your statement.
Tell me.
Tell me what happened when youstarted feeling your heart skip
or jump and then when you wentto go see your doctor and then
the ultrasound was done and thensurgery was done.
(30:29):
Tell me about what has happenedand how that has affected you.
Before you had surgery, you hadthese symptoms.
After surgery, you had thesesymptoms after surgery.
You had these symptoms.
To really lay it out there forthat examiner to understand what
has transpired with yourcondition that you're claiming.
So the next few questions on thepage two talk specifically
(30:53):
about types of different typesof treatment that a veteran may
have had for their thyroid orparathyroid condition and it
specifically asks aboutradioactive iodine.
It talks about surgery, any typeof genetic testing that may
have been done and that willvary based on the condition.
Not everyone will haveradioactive iodine, so that's
(31:18):
specific to hyperthyroidism.
Some will have the radioactivetesting done.
That is different than thetreatment, so treatment really
doesn't say a whole lot as faras, like, the rating schedule
goes, but the next section onpage three, we're going to dive
(31:42):
into that rating schedule.
So on page three, if the verytop section talks about the
signs, symptoms or residuals ofa thyroid condition, so the
thyroid specifically is abutterfly-shaped gland at the
(32:05):
base of the neck.
So if you push on your chestand you push up into there's a
little like hole is what I'mgoing to call it a little your
thyroid sits right about thereand it's in the shape of a
butterfly and at the tip of eachwing is your parathyroid glands
(32:27):
and so they sit on each.
There's four of them and theysit at the top of each wing of
the thyroid glands.
So you have four parathyroidglands.
So the thyroid and theparathyroid communicate and if
you have any type of thyroidcondition it can irritate the
parathyroid and vice versa.
(32:48):
So when an individual hasthyroid issues, they should also
be looking at the parathyroidfunction.
The residuals for question 3Ais they're trying to capture
what other body systems areaffected, and that's really
where the majority of theratings for thyroid conditions
(33:10):
and parathyroid conditions comefrom is the residuals, not
necessarily the disease itself,but the residuals, and we'll
talk about those residuals as wego through.
Question 3B has to do withhyperthyroidism, and earlier we
were talking abouthypothyroidism, the slow acting
(33:32):
or the slowed.
Thyroid 3B talks abouthyperactive or overactive
thyroid 3B talks abouthyperactive or overactive
thyroid.
So symptoms related tohyperthyroidism can be weight
loss, anxiety, rapid heart rate,can have some tremors, fatigue,
diarrhea, frequent bowelmovements.
(33:53):
You get hot a lot.
It's like man, it's really hotin here and you start peeling
off your coat or layers ofclothing and then hair changes.
You have thick hair.
So personally I and I always Ialways like to tell stories
because I feel like it sticks alittle bit better, and so they
(34:14):
always talk abouthyperthyroidism.
And women can be something thatwomen really like, because they
lose this weight, they havethis thick, beautiful hair, but
then they're tired all the time,and so I personally experienced
that when I went through mythyroid.
Issue is I had lost a bunch ofweight and I was like in
(34:36):
clothing that I hadn't worn formany years, and so, even though
I knew I had thyroid issues andI was tired all the time, it was
like man, I'm wearing clothesthat I bought years ago that I
couldn't wear before.
But again, sometimes thathyperthyroidism or thyroid
disease creeps up and you don'treally realize you had it until
(34:59):
you can.
You show up in the hospital forheart palpitations and here
you're in atrial fibrillation,and so they would do the workup
to see why you have AFib andthey find out that your thyroid
is a little active, a littleoveractive, and so for the
rating schedule forhyperthyroidism, you get a 30%
(35:22):
rating for six months after theinitial diagnosis and then it's
rated by the residuals.
So residuals can be the atrialfibrillation, you can have some
heart changes.
From the thyroid, the frequentbowel movements, you can
(35:50):
actually develop what they callexopsalmus, but where the eyes
pop out and it looks like youhave buggy eyes.
Sometimes hyperthyroidism iscalled Graves' disease and
that's really what a lot ofpeople know hyperthyroidism as,
and there's commercials outthere for the eye disease.
I don't know if you've seenthose or not.
Any questions about it?
J Basser (36:13):
Gray's is listed in Title 38.
Gray's is listed in Title 38,Part 4.
There you go.
Bethanie Spangenberg (36:25):
So any questions about the hyperthyroid
or Graves' disease.
J Basser (36:33):
Ladies, if you got it, enjoy it, but you know, get it
fixed it, you know, get it fixed.
Bethanie Spangenberg (36:48):
Thyroid issues tend to also cause
reproductive health issues, bothmen and women, so that can be
something that can pop up as aresidual or some issues there,
some issues there.
So if we look at 3C, it has todo with thyroid enlargement and
(37:11):
this is also known as goiters.
We call this goiters.
They're just growths on thethyroid and you'll look at old
history or old medical books andthey'll show pictures of
goiters and they associatedgoiters with iodine deficiency
and that's why all of our saltis now iodized is because we
were lacking iodine in ourdietary system or all of our
(37:32):
lovely processed foods.
We weren't getting enoughiodine and so the treatment for
goiters was iodine, and sothat's why we have iodized salt,
just to help prevent any typeof goiter development.
J Basser (37:51):
Again here, In case we get nuked yeah.
Bethanie Spangenberg (37:58):
Oh gosh, yeah, oh gosh.
Now goiters or the thyroidenlargement is broken down into
toxic or non-toxic.
So if you have a goiter orgrowth that has no symptoms but
you do have like swelling orlike the obvious neck swelling,
(38:19):
like I was talking about for thepictures, or difficulty
swallowing or hoarseness, that'swhere you will get rated on
what they call disfigurement andwe've talked about the
disfigurement before or you'llget rated for your other
symptoms, your other symptoms.
If it is toxic, they're goingto base the rating off of what
(38:44):
the hormones show.
So if your goiter is toxic andit's causing excessive thyroid
hormone release, then they'regoing to rate you based off of
your hyperthyroid or overactivethyroid hormones and vice versa.
So not a lot of meat on thatone.
Ray Cobb (39:11):
Any questions about goiters.
J Basser (39:12):
Can that also be a secondary to diabetes or
something else?
Bethanie Spangenberg (39:17):
Your goiters are typically going to
be from something else.
We don't see a lot of thenon-toxic goiters anymore.
That's very rare.
The toxic goiters we do see,and that's mainly you'll get a,
and they're not as obviousbecause we get more medical care
(39:38):
than we used to, and sosometimes we'll have patients
that come in and they notice aswelling in their neck and I say
you know my neck, I was lookingin the mirror, I was doing my
makeup and it just looks off,and so you'll get an ultrasound
of the thyroid and you'll find agoiter.
A lot of times the goiters areincidental on scans anymore.
(40:02):
We'll pick them up on the scansbefore the patient ever comes
in and complains of it.
It is very rare that we see thehoarseness or the difficulty
swallowing from a goiter.
Usually people seek medicaltreatment before it gets to that
point.
(40:28):
I can see that.
So if we go down to 3D, this ishypothyroidism that we talked
about before.
Hypothyroidism talked about thesymptoms weight gain,
depression, fatigue, cold,intolerance.
Those are the big ones.
(40:49):
The rating is 30% after theinitial diagnosis and then rated
by residuals.
However, if you have what theycall myxedema with a series of
symptoms, they will give you a100% rating.
This is not a realistic rating.
This is not something thatveterans should be trying to
(41:11):
capture or trying to get themyxedema.
What that is is that is acombination of your hypothyroid
symptoms in addition to swellingin the legs, and this occurs in
those with untreatedhypothyroidism or undiagnosed
(41:36):
thyroid disease.
So I've never seen this occur.
It is very rare.
A lot of times the patientspresent to the emergency room or
they can even go into a coma ifit's to the point that the body
is not getting any thyroidhormone and so it's not able to
regulate the body's endocrinesystems.
(41:59):
So, aside from the swelling inthe legs, they have to have cold
intolerance, muscular weakness,heart involvement, such as low
blood pressure, low heart rate,swelling around the heart and a
mental disturbance.
In order to get that 100%, youhave to have all four of those
(42:23):
components the mentaldisturbances, dementia, slowing
of thought or depression.
If somebody has myxedema withdementia, that is a significant
like it has been going on forsome period of time that they
have progressed to develop thismyxedema.
(42:45):
It is rare.
This is not where you hang yourhat if you're trying to get a
disability percentage forhypothyroidism.
I bring it up just because itis.
You know several questions inthe DBQ that are being asked,
but it is not something youdon't want.
This condition in your license.
(43:06):
Any questions about that?
No, no no, no.
(43:27):
So the last one, last questionon page three has to do with
thyroiditis.
Thyroiditis is justinflammation of the thyroid and
there's no actual percentage tocapture here.
If it's normal function, it'szero percent.
Excuse me, it's like yourthyroid hormones are normal,
it's 0%.
If it's overactive, then you'rebased off of hyperthyroid
(43:49):
schedule reading.
If it's hypoactive, then it'sbased on the hypothyroid
schedule.
So very straightforward on thatone.
So very straightforward on thatone.
So if we move on to page four,we're going to transition into
the parathyroids and theparathyroids again, those four
little glands that sit at thetip of the butterfly wings in
(44:12):
the thyroid.
If an individual has surgicalremoval of their thyroid, the
parathyroids need to bemonitored for a period of time.
Sometimes you can remove thethyroid tissue and keep the
parathyroids intact.
If they are manipulated orirritated too much, you can
(44:38):
cause damage to the parathyroidsand then develop a parathyroid
issue.
And so for a series of severalmonths after you have your
thyroid removed, they have towatch your parathyroid function.
So that's how close they worktogether and in their space.
That's how close they are.
So 4A talks about the residuals.
(45:01):
Here again, the residuals arereally what gets your rating
percentages for parathyroidfunction.
4b talks specifically abouthyperparathyroidism.
Symptoms are typically subtle.
Parathyroidism Symptoms aretypically subtle.
This is an overactiveparathyroid function and it
(45:31):
causes excessive calcium to bereleased into the bloodstream.
If the parathyroid doesn'tfunction correctly, symptoms are
fatigue, muscle weakness, heartarrhythmias.
That's similar to what wetalked about in the thyroid
condition.
Hyperparathyroidism can alsocause bone fragility and kidney
stones.
What happens is the parathyroidbecause it's saying, telling
(45:55):
the body it needs more calciuminto the bloodstream, telling
the body it needs more calciuminto the bloodstream, it pulls
the calcium from the bone inorder to get the calcium into
the blood, and so that's wherewe see fractures that are
occurring with a little pressure, like you know, like we tripped
over something or some minortrauma happened and a bone broke
(46:18):
.
That's typically how we findparathyroid issues.
Well, that's not enough force.
That shouldn't have broke.
What else is going on?
Do you have something elsegoing on in your body?
And so often that's the firstsign of there being parathyroid
issues and an individual is anabnormal or atypical fracture,
bone fracture.
(46:38):
Any questions?
J Basser (46:52):
regarding the parathyroid, at least the
hyperparathyroid.
Bethanie Spangenberg (46:59):
How common is that?
J Basser (47:02):
It's not.
Bethanie Spangenberg (47:04):
It's not, I would say more of your
parathyroid issues, againbecause of how the endocrine
system functions.
It's usually something else inthe endocrine system that's
malfunctioning in order to causethe parathyroids to act up.
We see it when there'sparathyroid issues in young kids
(47:25):
, like even tumors can putpressure in the brain, and then
it tells the parathyroid to notfunction correctly and then it's
like okay, wait a minute.
They were hitting in the shinwith a ball baseball practice
and they broke their leg.
That should not have brokentheir leg, and so when we see
(47:47):
stuff like that, we start toquestion you know what else is
going on?
J Basser (47:51):
Yeah, that's why I started looking for cancer and
all kinds of stuff.
Bethanie Spangenberg (47:56):
Yeah, yeah .
J Basser (47:57):
Oh, my mother hit cancer in her arms and reached
down to pick a dog up.
Her arm snapped and took.
Bethanie Spangenberg (48:03):
Yep, yep.
Ray Cobb (48:04):
Oh goodness what did we do Question Bethany, if you
is thyroid problems, can theysometime be inherited?
Bethanie Spangenberg (48:25):
time be inherited.
So the reason or the thoughtprocess behind the genetic
component of, or hereditarycomponent of, endocrine diseases
is because of how the immunesystem works and how your body,
basically the DNA that'sinherited from your mother and
father.
So if, for example, my childrenare more likely to get diabetes
(48:49):
because I am a diabetic and ithas to do with the genes that
they carry.
So endocrine or autoimmunediseases can occur if the person
has the susceptibility in thewrong environment.
So let's say I'm going to usediabetes again because that's
(49:23):
the one I preach about and mostcomfortable with.
So let's say that for somereason my body found a and it's
immune system so thymus is yourimmunity.
My thymus found a cell anddecided that it was an enemy and
that cell was actually a friend, like the beta cells in the
pancreas.
So something in the immunesystem triggered the body to
(49:48):
attack those beta cells or thosehealthy, good cells.
And now that the body hasattacked those cells, those
cells malfunction or are killedoff by the body.
There is a geneticpredisposition and then you
expose the individual to thewrong environment and it will
trigger that to occur.
(50:09):
Now, if you also think about it, if as a child, you not only
have your parents' genes, butyou also have the same
environment.
For most children, mostchildren are raised by their
biological parents.
So not only is the adult inthat same environment, but the
(50:30):
child is in the same environment.
So now you have that storm ofgenetic susceptibility in the
environment, triggering theonset of that dysfunction.
So, yes, thyroid, yes, diabetes, yes, all these endocrine
diseases have a geneticpredisposition.
(50:53):
But that doesn't mean thatyou're going to what viruses
they have.
If they're exposed to mold,chemicals, dioxins, agent Orange
, once you expose those injuriesin that environment, it can
(51:21):
attack the body.
Ray Cobb (51:24):
Yeah, and that explains it.
I have this individual I know afriend and their mother had
thyroid problems and theirsister had thyroid problems and
from listening to theconversation tonight I'm
beginning to think that thatperson may have thyroid problems
(51:45):
and don't know it because ofsome of the things you talked
about with the weight gain orthe weight loss and the heart
AFib mainly things of thatnature.
So I think I could reach out tothat person and tell them they
may want to ask their doctorabout checking that thyroid, if
(52:06):
he hasn't already.
Bethanie Spangenberg (52:08):
Correct, and even if you have a strong
family history, you want to haveyour thyroid checked regularly.
The same with diabetics.
For some reason, type 2diabetes is in both my
grandmother, my mother's, mymaternal grandmother, my
(52:29):
maternal grandfather, my uncle,which is my mom's brother, my
aunt and my other aunt, but mymother is the only person that
does not have diabetes Of theall five of those individuals.
Out of six people, my mother isthe only one that doesn't have
type 2 diabetes.
(52:49):
So there's the geneticcomponent.
But why?
Her environment might bedifferent.
Maybe she doesn't carry thatgene, maybe everybody else just
had the susceptibility and thesame environment, or the injury.
Ray Cobb (53:10):
Okay.
Bethanie Spangenberg (53:13):
The one thing I like to talk about when
it comes to calcium and in thebody is calcium does a lot in
our body, from the electricalsignals in the heart to muscle
(53:41):
contraction, to signaling thenerves in our fingers to move,
and the strength in our bones orpair of bones.
The calcium is used to regulateso many body functions and so
the parathyroid can affect anyof those conditions.
And I don't think we realizewhen we talk about our health
and our well-being, we don'treally realize how much calcium
does play a role in our body'sfunction.
So I just always like to talkabout that.
(54:05):
For hyperparathyroidism, ifit's overactive, typically what
will occur is they will go inand they will take out some of
the parathyroid glands.
Of the four, they may take outtwo and leave two and then
monitor to see how thingsprogress out to and leave to and
then monitor to see how thingsprogress.
(54:27):
So if it is a truehyperparathyroid issue, then
they will remove it.
If it's a secondary issue, thenthey'll try to treat.
You know why it's being asecondary issue, such as a tumor
in the brain.
When we look at the DBQ, we'reoh my gosh, I didn't realize the
(54:51):
time.
When we look at the DBQ on pagefour, the questions that go
through.
There there's six questions.
It's specifically tied to whatis in the rating schedule and
(55:12):
typically, just like it was forthe thyroid, it's a temporary
rating schedule for a six-monthperiod and then they rate on the
residuals.
So there's not a whole lot ofof meat in the parathyroid
either.
If we turn to page five,there's only one question for
hypoparathyroidism and therating again is temporary for
(55:36):
certain months after thediagnosis and then rate it based
on the residuals.
Looking at section five is thephysical examination and there
is a requirement for thatexaminer to touch on the neck to
feel the thyroid.
(55:57):
They are to capture their pulseand blood pressure and they are
also assessed, their reflexesto test the reflex response.
Reflexes to test the reflexresponse.
Clinically we'll see anincrease or hyperreflexia if the
(56:19):
thyroid is elevated and we willsee a decrease in the reflexes
if the thyroid is low.
And that just helps to supportwhat we may be seeing in the lab
work.
And based on the symptoms,we'll do reflexes and then, if
they're consistent, you knowthat helps us clinically.
The last few sections of the DBQare the standard questions.
(56:41):
Talks about scars anddisfigurement, talks about
tumors and tumors and masses,and those are standard in all
the DBQs.
The diagnostic testing ispretty straightforward.
When we have any type ofthyroid or parathyroid issue, we
find it on lab first.
That is normally how it occurs.
(57:03):
Then the individual goes for anultrasound or even a CT scan of
the neck and then we refer themto a specialist for either
biopsy or medical intervention.
On page seven it talks aboutfunctional impact.
Again, you put that in yourstatement of support of claim
(57:25):
you talk about how yourcondition may be affecting you.
Your statement in support ofclaim you talk about how your
condition may be affecting you.
And then the last page is forthe examiner's information and
any additional remarks theexaminer may have.
When a veteran goes in to thisexam, they can expect anywhere
from 30 minutes to an hour ormore if they find, or the
(57:47):
examiner finds, that there areresiduals associated with their
thyroid condition.
And, believe it or not, that wasit.
J Basser (57:57):
But if they find residuals, that means there's
got to be more DBQs.
That's not good.
Bethanie Spangenberg (58:02):
Now, that is, that is what is supposed to
happen and it's funny that youbring that up.
That is what is supposed tohappen.
And it's funny that you bringthat up because just this
Tuesday, two days ago, my unclewent in for his comp and pen
exam.
He in the 1980s.
He was in a motor vehicleaccident.
He was a passenger in a vehicleand was thrown out of the
(58:23):
vehicle and had a fracture ofthe upper arm and it was a
spiral fracture, so it is notgrown back correctly and it's
actually compressed the nerve.
They would not assess the nervecondition because it wasn't in
the exam request.
They were only going toevaluate the bone condition.
(58:46):
So the examiner told him thathe had to go back and file for
the nerve damage related to thatbone fracture and that's not
what's supposed to be done.
J Basser (58:56):
It's supposed to be a similar benefit.
You find that you're supposedto do it, but since they're
preaching that, now it shouldbecome a burden symptom.
Yep, just like diabetes and allits secondaries.
Burden symptoms, that's Yep,just like diabetes and all its
secondaries.
Bethanie Spangenberg (59:11):
They're taught and they're prompted to
do their residuals, and theydon't.
J Basser (59:17):
Okay, since we ain't got much time left, bethany,
give us your website real quickbefore we shut her down
wwwvalor4vetcom.
Okay, if you guys need an IMOor any medical things like this,
especially dealing withintestinal questions, reach out
(59:40):
and touch her.
She'll be glad you did Withthat.
Saying, guys, we're out of time.
This is John on behalf ofBethany and Ray Cobb.
We'll be signing off for now.
You have been listening to theExposed Pet Podcast.
Any opinions expressed on theshow are the opinions of the
(01:00:01):
guest speakers and notnecessarily the opinions of
Exposed Pet, exposedpetcom orBlogTalkRadio.
Tune in next week for anotherepisode of the Exposed Pet
Podcast.
Thanks for listening.
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