Kevin Ellis (Bone Coach):   0:05
Welcome to the bone code show dedicated to helping you understand all things related to diet, lifestyle, bone health and how you can live and thrive with low bone density and osteoporosis. I'm your host. Kevin Ellis, certified health coach, health and wellness speaker and, above all else, your bone coach. After being diagnosed with osteoporosis in my early thirties, I transformed my health through diet and lifestyle and now help my clients and community members do the same through my online coaching practice. Bone coach dot com Look, there are no quick and easy cures for low bone density, but the choices we make every single day can have a powerful impact on our bones, our health and our general well being. I'll share the research, interview the experts and help you figure out how to get the conditions right in your body so you can better your bones through diet and lifestyle. Short disclaimer. I'm not a medical doctor, and this show should not be considered medical advice. Always consult with your health care team before making medical decisions and changes to your diet and lifestyle. But that being said, let's get on to the show. Welcome to this episode of Bone Coach podcast Kevin Ellis here. In this episode, I'll be interviewing one of the leading experts in parathyroid disease as she talks about hyper parathyroid is, um, an important cause of osteoporosis to rule out now. I briefly touch on hyper parathyroid ism in episode number three of the Bone Coach podcast on osteoporosis causes. But in this interview, we go in a much greater detail and will likely answer many of the questions you have. If you're newly diagnosed with osteoporosis or even if you've had low bone density for a long time and you come to find out you are actively losing bone by way of bone turnover marker testing and a 24 hour you're in calcium, you'll want to figure out why. Also, if you've had blood work done and have come to find you have low or elevated serum calcium, even within the normal range, normal or elevated p th parathyroid hormone and low vitamin D, you need to investigate this further. Hyper parathyroid ism could be the cause and, if left unchecked, can lead to excessive bone breakdown and ultimately osteoporosis. In this episode, an interview with parathyroid expert Dr diva Boone. You will learn all about what high prepared terrorism is, why it's important to rule out and what to do if you identify that you have it and so much more before we get to the interview. If you haven't done so already, I wanna encourage you to head over the bone coach dot com Drawing the Bone Coach community It's absolutely free. It's the fastest growing resource for weekly tips on how to improve your diet and lifestyle for better bone health. Again, it's absolutely free to sign up over a bone coach dot com. For this episode, you can find all the resource is mentioned. Show notes and contact info for Dr Diva Boone and the Norman Parathyroid Center over at bone coach dot com. Forward slash hyper parathyroid is, um, I do want to point out Also, the audio quality was a bit reduced the day of the actual recording. I had some issues with the microphone, some issues with set up, but what I would encourage you to do is continue to listen. The information here is incredibly valuable. Dr. Diva Boone is an expert in this field, and you're going to want to hear the entire thing, so stay with it till the end and enjoy the show. We have a special guest today, Dr. Diva Boone. Dr. David Boon is a parathyroid surgeon and the medical director at the Norman Parathyroid Center in Tampa, Florida After obtaining her medical degree from Cornell University, she completed general surgery residency at St. Luke's Roosevelt Hospital in New York City. While there, she received several awards for research. During her final year, she received the highest award for outstanding contributions to surgical education and research. After residency, Dr. Boone received additional fellowship training in endocrine surgery, specifically thyroid and parathyroid surgery at North Shore University in Chicago. She joined the Norman Parathyroid Center in 2014. Many would consider her and her colleagues the worldwide leaders of parathyroid disease, and she also enjoys surgical missions and has provided surgical care of patients in Nigeria, Myanmar and the Dominican Republic. What an honor to have you today, Dr Diva Boone. Welcome to

Dr. Deva Boone:   4:34
say thank you. I'm really happy to be here.

Kevin Ellis (Bone Coach):   4:38
Great. I'm glad. I'm glad you could be here. Um, well, first I wanted to. I wanted to get just a introduction to you. and your work And how you got involved with the Norman Parathyroid center in the first place.

Dr. Deva Boone:   4:51
So s so I did endocrine surgery. Fellowship. As as you mentioned. Um, I came down here. The truth is that I came down here, really? To just see what this what was happening at the parathyroid center here. This fair Thorin center is be famous for doing a lot of parathyroid surgery. So I came down here and they they only had three surgeons at the time, and I was I was really impressed. So was I spent just one day in Tampa. I didn't know anything about Tampa before I came down. I saw what they did. So I saw there set up at the hospital. And how they had the patient flow is the patient experience. And then the operation was just much better than anything I've ever seen. So So I joined. Um, and I stuck around because actually, treating occasions with your thyroid disease is probably one of the more satisfying things you can do as a surgeon, because people tend to feel very sick beforehand, and most of them feel lot better afterwards. So it's pretty. It's pretty satisfying operation.

Kevin Ellis (Bone Coach):   5:50
Yeah, that's I could see how that could be. So for people who are not familiar. So I had mentioned, you know, our audience is people who are typically unexpectedly diagnosed osteoporosis. They could be in their thirties, their forties or fifties, and they're trying to figure out what is the cause of their bone loss. And for people who aren't familiar with what a pair of thyroid or the parathyroid glands, even our could you give them an overview of the anatomy, the physiology, What they do, how they work?

Dr. Deva Boone:   6:21
Sure, yeah. So So for anyone who is newly diagnosed with parathyroid with osteoporosis, parathyroid disease is one thing that should be considered. A lot of people don't even know what the parathyroid glands are until they actually have a problem with them. But they're pirates are four glance. Your thyroid is down here such a the base of your neck. And everybody knows if I worried, that gets all the attention. But the parathyroid glands of these, these four little tiny things that are around the thyroid. Uh, they're about size of grain of rice, and you got four and their sole mission in life is to keep your blood calcium in a good range so that that is all they do. They make one hormone parathyroid hormone, and they try to keep your blood calcium in the right range. Now, when there's a problem, most often times there is a tumor on one of the parathyroid glands, and that parathyroid gland just goes rogue instead of instead of making a normal amount of parents are home. It starts making too much, and what happens is that the calcium in your blood rises now. It's counterintuitive because a lot of people who have higher blood cast signals they think, Well, that's good, right? You need calcium for your bones, so it's good to have a lot of calcium, but unfortunately the parathyroid is that hormone is actually taking the calcium out of your bones to put into the blood so people with parathyroid tumor is actually get osteoporosis because the the calcium is coming out of the bones. You actually de mineralized in them, giving you, ah, bone loss.

Kevin Ellis (Bone Coach):   7:49
And are there distinct types of hyper parathyroid ism to Could we define those?

Dr. Deva Boone:   7:56
There are so the most common type of parathyroid ism is her thyroid disease is primary hyper parathyroid ism, and that is what I described when you have one form, or sometimes all four parathyroid glands that are not doing their job of regulating the calcium. So just remember that all they do is try to regulate calcium. So if you're casting level's too low, they kind of turn on and they make more hormone. If the costume levels too high, they turn off. It's like it's like a thermostat in your house in the winter where you're if the If. If your temperature in your house drops down to the fifties, your thermostat shit sense that turn the heat on and get the temperature back up. Simpson goes too far than and it should turn off with Primary Harbor Pier authorities when you have a broken thermostat. So that gland that is has a tumor doesn't respond anymore to regular calcium levels. And though it just makes keeps making hormone even as the calcium goes high, that is classic primary hyper parathyroid ism. Um, there are other forms of the other major one to know is secondary hyper parathyroid ism, and actually this can also lead to significant bone loss. If not treated, but with secondary hyper parathyroid ism. It's not a problem that starts in the parathyroid glands. It's a problem that affects the parathyroid glands. So, for example, if you are very deficient in vitamin D or you don't get enough calcium in your blood and your blood calcium is consistently very low, you're parathyroid glands will do what they're meant to do, which is make more hormone, and they they don't really care where the calcium comes from. They really just care about the calcium in your blood, Um, and they will do whatever it takes to get the calcium in the blood up. And that means they will take calcium out of the bones and just just a note. When you know when we talk about calcium in most people's heads, they think that calcium is just important for bones. That's kind of what people think, I said. Calcium. What what to do with this all makes your bones strong, But calcium is is interesting because it's necessary throughout the body, and so the parathyroid glands don't care it all about your your bone calcium. They only care about the blood calcium, and the reason is that your nervous system, your blood clotting system. All of these things depend heavily on calcium. So for even for your thinking, for your brain to work your muscles to work, they depend on calcium. So that's why we so tightly regulate that calcium. Um, so back to the secondary primaries. The secondary is when your counsel is just too low for whatever reason, and you're you're parathyroid glands are having to churn out hormone. And they take counsel out of the bones because you're not getting it anywhere else.

Kevin Ellis (Bone Coach):   10:46
No one. And that's a fantastic explanation on both of those. And so when someone is looking to identify if they have either one of these conditions usually the first the first place it would start is with blood work. Or if, if a proper work up has been done, they've gotten their lab work back. What are they looking for in their lab work to help identify if they could even potentially have hyper parathyroid ism,

Dr. Deva Boone:   11:15
right? So most people will be getting regular blood work even before they're diagnosed with osteoporosis. They probably gotten something blood work, and the important thing is to track the calcium. So with primary hyper pair of fire is. And when you have a parathyroid tumor, the classic finding is that your calcium is high and four adults. That means that it's above about 10.0, UM, or 2.5 in the sum of the European countries. Um, but if it's above that 10.0, even if the lab doesn't say that it's high, that's actually pretty high for an adult. Now younger people can have lower levels can have higher levels, rather, so when you're in your twenties, you could have a to a 10.5. But really, you're a 50 year old, a 40 year old, really, 10.5 would be too high. It would be much too high, Um, and that would be a sign that you probably you may have parathyroid disease. Now, the way to confirm that. And a lot of times doctors will check the PCH, the parathyroid hormone level in people who are just getting diagnosed with osteoporosis to see if that's a factor. Um, but the first step is really seeing the council level Councilman was high. You need to check a p th level. Um, as I said, the parathyroid glands. They're pretty simple glands. They do one thing, and they do it with one hormones just parathyroid hormone so that they're pretty easy to figure out. If you've got a high calcium level on a parathyroid hormone level that is not in the very low range, then you got a parathyroid tumor until proven otherwise. Um, and just a note. It is a little bit confusing because I just said you could have a normal p th level and high calcium. And that's diagnostic of parathyroid disease. And that's true. Um, and the reason is that the parathyroid glands should be responding to your your calcium levels. So if the council levels high, those parathyroid gland should be turning off. And should you should have kind of a A p th that is very, very low under 20. If it's not, that means the parathyroid glands, like a broken thermostat there still there, still making hormone even though the calcium levels too high, Um, for the other situation is actually easy to tell Primary from secondary, because primary hyperthyroidism has low constant levels, and the range that's given on your lab slip is not really correct. So the range given on the laps, it will go from 8.8 to 10.3 as their normal range. Really, most adults are gonna be in the mid to high nine's. If you have a council level, it's consistently in that low nines or high eight area. You're you have a low calcium level and your pH levels are going to rise with time. And they're going to take calcium, um, out of the bones. And there are few kit conditions that will cause secondary hyperthyroidism woman again. Is that later?

Kevin Ellis (Bone Coach):   14:05
Well, yeah, I I think what? It's so important. What you just mentioned is that you can have labs that are within the normal reference ranges and could possibly even be told that that's normal. And if you're noticing these things in your own lab work, it might be a good idea to get a second opinion from someone. So or even, you know, call down to the Norman Parathyroid Center in Tampa, Florida, and get a consul with someone like Dr Diva Bone.

Dr. Deva Boone:   14:36
All right, well, you can always you know, me too way. Get a lot of questions like that. Um, and I don't mind, uh, answering those, either. If if anybody is confused about the lab because it's usually pretty straightforward for me to look at labs, figure it out and and let you know whether or not it's something you need to pursue. Um, But, yes, you can have labs that are read by the lab as completely normal. An example would be a 50 year old woman, and she's been diagnosed last year. Process. She checks her labs, her counsel is 10.2 and her PCH level is 60. She's not a parathyroid tumor until proven otherwise. Um, it needs an operation, but her her lab could actually read. All of that is normal, but it's not really corrected for age, and it's that's a big thing.

Kevin Ellis (Bone Coach):   15:25
So you just provided one example there. What are some other common scenarios that you see in your practice?

Dr. Deva Boone:   15:32
You mean diagnostic Waas?

Kevin Ellis (Bone Coach):   15:34
Yes, yes. So patients come in and they've got X, y and Z lab work, and they're trying to figure out what are the most common scenarios that you see.

Dr. Deva Boone:   15:43
So the most common thing, uh, that people will find is one. They have a high high calcium level. The thing that throws off a lot of doctors and some patients is the fact that most parathyroid patients will have low vitamin D levels. And this gets confusing because number. I did say that if you had a very severe vitamin D deficiency, you would have a low calcium and that would cause secondary hyper pair of thyroid is, um, um, only explain that for a second. So the main role for vitamin D, actually one of the main roles in your body it does. It does a bunch of stuff, but one of the main roles is to help your intestines absorb calcium. So when you take a vitamin D, you are aiding in the absorption of calcium through your intestines. Um, if you take a lot of calcium, your you take a lot of vitamin D. Rather, you're going to going to raise your house and level, okay, But there's an interaction with parathyroid hormone and vitamin D, so vitamin D exists in several forms throughout your body, actually, and you may hear you know you have to get in the sun for because one of the forms requires sunlight to, you know, to activate well, so there's an inactive form in an active form that actually gets that that that reaction occurs in your kidneys, and that depends on vitamin D. So the inactive form of vitamin D will turn into the active form when parathyroid hormone stimulates that. All right, Um, and what's interesting about vitamin D is that when we measure vitamin D, when you when you go to the doctor, you just want to check your vitamin D level. They will check that inactive form. They don't check the active form, the reasons that the active form breaks down much faster. So the inactive form for most people is a better indication of your long term vitamin D status for you and me, and it would be a good indicator of our overall status. For people with parathyroid, disease is a very poor indicator because all of that in active is getting converted to the active form because of the overactive pair of thyroids, so they don't really have a vitamin D deficiency, but they are diagnosed with a vitamin D deficiency, and what happens is that a lot of doctors will see that, and they will see that the vitamin D is low. The calcium is high. The parathyroid hormone is high, and they will think that the vitamin D has caused that. No, it's the parathyroid hormone has caused the bottom. You need to be low, and then they'll start throwing vitamin D of the patient, which only makes the calcium higher because you're helping absorb more calcium. So it's it's Ah, that's the confusing thing is that is a vitamin D levels. Um, low vitamin D with a high calcium is almost always a pair of thyroid problem. You have to check the parathyroid hormone, obviously, but that's a common scenario.

Kevin Ellis (Bone Coach):   18:30
So I would suspect that, you know, if a patient even is told early on that Hey, you've got low vitamin D. You've got high calcium. You know, your P th is If they're normal, are elevated. They should maybe just take more vitamin D, and that'll fix the problem. Maybe that might require them looking into it a little bit further.

Dr. Deva Boone:   18:50
Yeah, that you really should. I don't really fault primary care doctors for not remembering that whole interaction with vitamin D, because certainly before I was parathyroid expert, I didn't remember that that parathyroid hormone stimulated the conversion from the 25 hydroxy to the 1 25 die hydroxy. You know, you may I may have learned it in med school, but I don't recall it, but ah, but there is a tendency to kind of see ah, bad lab value and then have a knee jerk reaction to it. Really, if if any doctor tells you they want to start vitamin B because you have a low vitamin D, you should ask what your counseling level is, because that would tell them that that that's the clue. If your calcium is high but you're buying the level's low, don't take more vitamin D, check a parathyroid hormone and and possibly get parathyroid surgery to fix the problem, but not not take vitamin D.

Kevin Ellis (Bone Coach):   19:42
So someone finds out that they've got elevated P th and elevated serum calcium, and they want to learn Maur or figure out if they do, in fact, have primary hyperthyroidism. What would their next steps be in that case?

Dr. Deva Boone:   19:59
So we have a nap, which will show you most, um, but really, it's so easy to diagnose yourself with this that most patients could probably diagnose themselves at this point, um, on our website at parathyroid dot com goes over a lot of these scenarios and kind of lab results. Um, there are borderline situations, but really I calcium and a high p th is kind of the easiest scenario. If you've got that, then then you have your thyroid disease. You don't really need anything else. You don't need imaging studies you don't need. Um, you know, you don't test your urine, those air Really straightforward labs. Um and, uh, any any doctor, any endocrinologist will probably be able to figure that out, But you don't need to see an endocrinologist. Really? You just need to see an endocrine surgeon.

Kevin Ellis (Bone Coach):   20:49
And when you say hi, Petey age, what is the range? The bottom of that range that you're talking about

Dr. Deva Boone:   20:56
PCH is interesting, right? Because, uh, it really depends on what the calcium level is for a normal calcium level. So a 9.8, for example. I expect to see the PCH in a true normal range. So about maybe 20 to 60 most people walking around probably gonna have PJ shelves in the thirties and forties. Um, but around 20 to 60 that being normal if you're to see. But it depends on the calcium. So if you have a council level 8.5, for whatever reason, I expect your parathyroid glands to make more hormones. I actually expect that number to be much higher. Um, that's not because you have a pair of thyroid problem. That's because the parathyroid glands were doing their job. Now, if you have a high council level, a normal parathyroid gland would produce less p th so you'd see a pH level that's, you know, under 20. But normal. True, normal can only be really said that it's normal when the council levels also normal. That's around 22 60

Kevin Ellis (Bone Coach):   21:53
and and so then the next step after lab testing to identify if there is, in fact a parathyroid tumor, what would that be?

Dr. Deva Boone:   22:01
You know, there are various symptoms and other findings related to a pair of fire disease, but the diagnosis is really just based on lattes. It's not based on imaging studies, and this is confusing for a lot of people, because if I tell you that you have a tumor anywhere else, it would likely be diagnosed with an imaging study like a cat scan or you get an M R I and they find a mass. And that's how you know that you have a tumor with the parathyroid. It's different. Um, the glands and the tumors are so small that a lot of times they won't be seen on any scans. So we're talking about, you know, I said, glands that were the size of a grain of rice, um, the tumor could be says a reason. It may not show up on any scan, and they blend in with the thyroid look like a little left out may not show up at all, but so we can't diagnose it. Based on that, we have to do it just by the labs. And we know there's only one thing in your body that makes parathyroid hormone, and that's the parathyroid gland. So if there's a problem with parathyroid hormone, it's a problem with your pair of pirates

Kevin Ellis (Bone Coach):   23:06
for imaging. If if a patient does end up having imaging done, what would the different imaging be? That could be done?

Dr. Deva Boone:   23:14
So uh, so we do system E T scans. They're the most accurate. It's a nuclear medicine test, Um, where you get injected with a ah, very small dose of a radioactive tracer that will get picked up by your thyroid, your pair of thyroids, your salivary glands. Um and, uh, it won't show normal parathyroid glands, but parathyroid tumors will actually take it up at a higher rate, and they will be right on the scan. It's not 100%. It's it's probably the best. It depends a little bit on where you're gonna get done. Who's doing the test? But I would say it's by one of the more sensitive tests. Um, there are other things out there like CAT scans. Uh, casket is not great. It's it's getting better. But I think that the cat scans really overkill for a first time operation. Ah,

Kevin Ellis (Bone Coach):   24:09
lot of radiation.

Dr. Deva Boone:   24:10
It's a lot of radiation. It's actually a lot more radiation than when you get the radioactive trace to her. Um, so the cat scan is is pretty pretty. I don't know. I think it's overkill. Um, an ultrasound is a great test. When you put the probe here, it's just like like a sonogram anywhere else. Um, that's really good for looking inside the thyroids. That's very good for seeing if there are thyroid nodules or if there's a parathyroid tumor inside the thyroid. But a lot of times that will not show the parathyroid tumor, and that's okay. Um, a lot of our patients, you know, we do an ultrasound, we do a sesame scan, and we won't find a parasite or a tumor on a lot of them. Um, and it doesn't matter, because we're gonna go in and look at all four parathyroid glands anyway.

Kevin Ellis (Bone Coach):   24:57
Great. So then could you walk through that process? So we've determined. Okay. Primary have a parathyroid is present. There's a tumor present. You're going to do something about that. What does that look like for the patient?

Dr. Deva Boone:   25:10
So we try to make it as easy as a product of a process. It's possible, but basically, we have patients go to our website. They fill out an online form. Um, it's pretty tailored to pair of thyroid disease. So all the questions were kind of taylor. Two different symptoms that you'd see with parathyroid. There they are, disease. Um, and then you go through with our coordinators, collect up all your information and records. Are we? Then the pair of the one of the parathyroid surgeons then usually give somebody a call. We do have an office, but most of our patients are coming from far away. So we do consults, be a phone call. Um, and then you get scheduled for surgery and that the surgery's an outpatient surgery. Um, you come in, you spend about half a day with us, but you come in, we do the sesame be scans at 1/2 hour test. Um, you meet the surgeon again, you talk to them. Ah, a lot of times we're meeting people for the first time, actually. So meeting your surgeon, talking with them, uh, you go back the operations quick, it's It's usually under half an hour. And that's, you know, when we could look at all four glands and get you back into the recovery room, Uh, and you go home about an hour and 1/2 or two hours after that. And the big question, most people have his window. I what am I gonna feel different? Most people will actually feel relief from a lot of the symptoms within the first few weeks, and those symptoms are things like fatigue. Um, not being able to sleep through the night, just having low energy um they also have bone pain, especially if they do have bone loss. But you could have bone pain without having any bone loss on a Texas can. Um, that gets better right away, so that's very satisfying for them. And, ah, you know, other things can improve over time. Things like your bone density will actually improve over the next couple of years.

Kevin Ellis (Bone Coach):   26:59
That's that's great. And even with the lab, Margaret's how How quickly does the calcium to the calcium levels in the blood normalized?

Dr. Deva Boone:   27:07
Well, so that could take a couple. That calcium level takes a couple days to drop the parathyroid hormone of actually drops immediately, and we check the parathyroid hormone in the recovery room. We did not check it in the operating room. Um, that tends to be less reliable, so we don't We don't use that. But, um, if you check in about 45 minutes after their operation, it will be at that point back in the suppressed rage. And the reason it goes into the suppressed range and not normal range is because the other glands are actually suppressed. When you've got a parathyroid tumor, you got one parathyroid gland pumping out lots of hormone. Those other glands actually were doing their job and their sensing the high calcium and they're turning off. So those other glands are making very little parathyroid hormone. Um, so when you test it for five minutes after the operations, pretty accurate, you'll see PH levels under 20.

Kevin Ellis (Bone Coach):   27:55
What are some other commonly asked questions or concerns that you received from patients? And if you could possibly address those now because our audience might have similar questions?

Dr. Deva Boone:   28:07
One is the deer bones get better. And and since this is an osteoporosis podcast, I'll just mention the the main area that where you see a lot of bone loss in parathyroid disease or you see the the most significant bone loss is actually in the radius, and it's not always checked. Ah, a lot of times when people are getting scanned or getting any screen for osteoporosis, they will check the lumbar spine and they'll check the hip. And that's it. Um, anyone with parathyroid disease really should have the radius check so that the forearm, because that distal cortical bone is often where we see the most bone loss. So someone without opinion and the hip may actually have osteoporosis once you check that radius. Um, afterwards, we do see significant improvements in most patients. Not everyone will show great improvements in their bones afterwards, but your bones actually do build back up. So your bones are not like, like, little concrete sticks. I mean, they actually are constantly breaking down and building back up, as you know. And so once you once, you kind of change that that ratio of breaking down to building up by taking away that that constant p th you're gonna actually Seymour building up happening? Um, and some people do see significant changes about upto. Half people will see you kind of significant, like over 5% changes in their bone density over the first year or two. Um, but most people will see some improvement.

Kevin Ellis (Bone Coach):   29:36
No, that's that's, ah, pretty significant improvement. And you brought up a great point Is that Ah, lot of times when a Dex a scan is done, you're only getting the hip in the spine, and sometimes you have to request or even ask toe have that forearm done. And even if you can't get it in the office, you may have to go to an imaging center somewhere else and have that done separately. So that's a great point that you did bring up.

Dr. Deva Boone:   30:02
And not everyone you know needs to get that checked. But I would say anyone with parathyroid disease should get the radius checked.

Kevin Ellis (Bone Coach):   30:08
Well, is there anything else that you think would be important for for the listeners to know?

Dr. Deva Boone:   30:15
Uh, you know, this thing? The thing about parathyroid disease. So there are some people who are who are diagnosed because their bones, they have osteoporosis. Um, we do know the natural history of parathyroid disease, which is, if you let it go untreated. Most people will have some bone loss, and it will lead to osteo opinion. Osteoporosis not guaranteed, but it usually will leave there. So I don't really wait for that to occur before recommending surgery. We usually recommend people get these old tumors out before they cause osteoporosis, But there are a lot of people who their doctor actually knows about it. Some people actually know that they have a parathyroid tumor, and the doctor doesn't recommend treatment until they break a bone or develop osteoporosis. Uh, so obviously I disagree with this, uh, because we can prevent that from happening. We can prevent further bone loss from happening by actually just taking the take the tumor out. But that is calm when the other. The other thing is that if you're diagnosed with osteoporosis and you find out you have parador disease, you're actually one step ahead of a lot of people because ah ah, lot of times the presenting symptoms are very non specific. So the most common symptoms are fatigue. It's just kind of, well, everybody's tired, right? You know, everything causes right, right? Everything causes fatigue s so that's so that's not attributed to it. And then the next most common one is kind of brain fog. Like I feel like I can't concentrate. Well, isn't everybody who gets older, you know, doing that? Um, the next one is difficulty sleeping through the night, you know, waking up after a few hours, not being able to go back to sleep. But a lot of people complain of that. So, you know, we find that they're these non specific symptoms that a lot of doctors will not associate with parathyroid disease. So even if they know that you have it that you may not. They may not tell you that it's related or that it will get better. But what we find is that when you when you do three people and you follow up a few months later, um, their quality of life has significantly improved and their symptoms have significantly improved. They feel better. They're doing more. Um, you do find all that. So even though every everybody has fatigue, everybody's you know, that's, um, some aches and pains. Ah, lot of these things really do improve with these patients once you get that taken care of. So even if you don't have osteoporosis, it's it's a good idea to get it treated.

Kevin Ellis (Bone Coach):   32:37
So fatigue. Uh, you know, if you've got bone pain, Uh,

Dr. Deva Boone:   32:42
right, you know, foggy, specific bone, things pretty specific. It rarely occurs. Um, if you're getting if you're if you are getting bone pain and most people don't even don't even know what bone pain feels like because most people aren't gonna ever feel it. Uh, but people will describe it as kind of feeling like it's deeper than the muscle. So, like there's like it's sore. But it's deep, deep, deep, deeper than the most they don't know that it's bone pain, but that's kind of what people describe us as bone pain. Um, and if you're getting that, that that's that's a really good reason. Have parathyroid surgery because that usually improves. Like when you wake up, it's it's gone.

Kevin Ellis (Bone Coach):   33:22
That's amazing. That really is amazing. Well, so how can people find and get in touch with you, your team, The Norman Parathyroid Center? Because I'm going to link to all that information in the show notes for today so that they can easily access that and get in touch with you all if you need to.

Dr. Deva Boone:   33:37
Sure. I mean, S o. You know they can go to the website. It's parathyroid dot com Um, and, uh, there is a link on there. If you If you go to the page couple of times that you'll see a link that where you can ask us a question, you can also just give your dear listeners my email address. Um, as long as I don't get signed up for too many nice things stand, but

Kevin Ellis (Bone Coach):   34:01
I don't have it.

Dr. Deva Boone:   34:04
But now that the moment is, it's easy. It's D, as in the first letter, my first name. Boone B O N E at her thyroid dot com. Um, and I take these questions all the time. So, uh, so I can usually help people out pretty free quickly. Most people, really, it's kind of the question is, the question is, usually do I have this, Um, and if you have your lives, I can usually tell you it's is often a problem because people will be told. So anything you told you know you have osteoporosis, your constant little bit high. But it's not an issue. People e mail me is a well, I think it's an issue, isn't it? And they just need that reassurance to say, Yeah, that's that's a problem, You know, you've got a parathyroid tumor. Um, you get that taken care of. Um, the other thing that's important for your listeners, which I haven't talked about, is for Ko and Tim lows. Um, if you've got osteoporosis and you're and you're doctor wants to prescribe for KO or Tim Lows, the one thing you need to know about those drugs is that they are essentially parathyroid hormone, um, which a lot of people don't realize. And I think a lot of doctors seem to forget as well. So if you have a high calcium level, you definitely do not want to take Forteo or Tim lows. Um, we've got a parathyroid tumor. You've already got too much p th It's a little bit non intuitive because if I tell you that a parathyroid tumor has produced too much p th and that causes bone loss ball, how does an injection of P. T. H build your bones back up? Because that's the main thing with Forteo and Tim losses that they build your bones back up. It seems to be with the timing. So if you have a constantly elevated parathyroid hormone, it does cause bone loss. If you have that kind of cyclical, you know, injection of it actually stimulates the bone, initially simulates a little bit of breakdown, but then stimulates phone building. So it's that that timing of is that that is different. But if you do have a pair of fire, a Gymboree definitely should not be taking Forte or Tim lows. And, uh, although it should not happen, it should never happen. I have seen people put on these drugs when they have clearly have a parathyroid tumor. So they have high calcium. Hi, Petey Agent. Although their doctors theoretically should be checking that they do sometimes end up on these drugs. So I would just make sure that your listeners check that first, check your housing level and people before you two start Forte or Tim. Lois, that's that's very important.

Kevin Ellis (Bone Coach):   36:35
Absolutely. Well, I think you've provided some fantastic information and insight for our listeners today. And I want to thank you, Dr Boon, for taking time to share this information with us again. I'm gonna link to all of Dr Bones information in the show Notes. Thank you all for listening, and I'll talk to you soon.

Dr. Deva Boone:   36:55
Okay. Thank you for having me on.

Kevin Ellis (Bone Coach):   36:58
I hope you enjoyed this episode on hyper parathyroid ism. As I mentioned, Dr Diva Boone is an expert in the field, a pair of thyroids. If you have questions or you need to get in contact with her or someone of the Norman Parathyroid Center, I'm gonna include all that information in the resource is section of the show notes at bone coach dot com. Forward slash hyper parathyroid ism. One last reminder. If you haven't done so already head over the bone coach dot com Sign up for that free seven day osteoporosis kickstart. It's gonna tell you the exact information you need right now to start improving your bone health and build stronger bones again. That's that bone coach dot com. Also, if you haven't done so already, be sure to hit that button and subscribe to the bunco podcast to make sure you never miss an episode that could help to improve your bone health. We have some amazing bone health experts that will be joining us on the show. I want to make sure you can learn from their expertise. If you're enjoying this podcast, you're finding the information helpful. Please head over and leave a positive rating or review that helps more people find us. More people figure out how to help improve their bone health, and I just want to be a part of that journey for them. So thanks again for listening. I'm your bone coach, Kevin Alice. See you in the next episode.