Prakash Chandran (Host):  This program is a community service and is not intended to be a substitute for medical advice. Listeners having questions about their health should make an appointment to see their personal physician. Any opinions or statements made during the program are those of the individuals or physicians making the statements and are not the opinions or statements of the hospital.

This is “Healthy Conversations,” a podcast presented by Adventist Health.

When you’re facing a diagnosis of a hormonal condition like diabetes or thyroid disease; your doctor might suggest you see an endocrinologist. It’s an area of medicine that isn’t commonly understood so I’m really excited to learn about it today. here with us to discuss is endocrinologist Dr. Krystal Valdez. Dr. Valdez thank you so much for educating us today.

Krystal Valdez, MD (Guest):  Good morning Prakash. Thank you for inviting me. I’m so excited to talk to you about my field. 

Host:  Yes, I’m very excited as well. So, I would love to start by you just describing at a high level, what you do as an endocrinologist.

Dr. Valdez:  Well to understand what we do first I want to talk to you about what the endocrine system is because a lot of people might have some questions about it. So, the systemic part of the body that deals with the hormones and hormones are the chemical messengers that are produced by the endocrine glands. These messengers go to different tissues and organs and these help manage certain bodily functions such as temperature control, heart rate, blood pressure, digestion, water and sugar balance, mood, reproduction and lots of other processes. 

Host:  I understand. So, it seems like the endocrine system is the thing that controls the different hormones in our bodies and endocrinologists will measure to make sure the levels and functions are performing correctly. Is that right?

Dr. Valdez:  Correct. Yes, you’re right. 

Host:  Okay, so what conditions or diseases do you commonly measure or treat?

Dr. Valdez:  Well the most common patients that we see are patients with diabetes and I see a whole spectrum of the disease from newly diagnosed diabetes to uncontrolled diabetics that primary care sometimes refer to me because they are having a hard time controlling their A1cs and sugars. Those are the bulk of the patients that endocrinologists treat. 

Other common disorders are thyroid disorders whether with deficiency or excess of the hormones. It’s the ultrasounds of thyroid nodules or those are lumps or bumps in the thyroid. And also if they have history of thyroid cancer or what is diagnosed as thyroid cancer. Other less common conditions that I see are pituitary and adrenal disorders. Those are other endocrine glands in the body. I also see hormonal problems on bone health, calcium problems and I also deal with transgender medicine. 

Host:  So, that’s quite a wide range of things that you deal with because there’s so much that the hormonal system has control over. So, I’m curious as to when someone comes in, how do you go about measuring their hormones or detecting if there is a disorder that is going through the body?

Dr. Valdez:  Yeah. So, typically when they come in, they would already have sort of a pre-diagnosis. The primary care provider or whoever referred the patient, they are already thinking of some endocrine disorder. My role is to just confirm or to verify if they do have some form of disorder. With diabetes; it’s relatively easy because there are certain blood tests that we do. There are tell you if your sugar is high and so when they come in here; it’s more of just introducing medication or what their therapy is. In the other endocrine disorders, that’s how they don’t get complicated because then I would be the one doing the workup like again confirming the diagnosis, doing some dynamic testing to confirm or to rule out the endocrine disorder that the primary care or primary care provider is concerned about. 

Host:  And I’m curious, before someone goes to their primary care physician who then refers them to you; what symptoms might a patient express to know that there is a hormone imbalance?

Dr. Valdez:  Right. It is hard because again, hormones are affecting all systems in the body. So, it might all be nonspecific. In diabetics, the most common symptom that they would complain to their primary care provider would be significant weight loss, or significant amount of urine. They notice that they are urinating more that usual. They feel thirsty or dehydrated all the time. 

In other endocrine disorders; the most common that I hear about is fatigue which is a nonspecific symptom but that’s the most common problem that patients complain to the provider and then the provider would look for some endocrine causes. 

Host:  And so tell us a little bit about the experience a patient might have visiting an endocrinologist. Let’s say that I – there was a deficiency with me, my primary care physician referred me to you. What can I expect during my first visit?

Dr. Valdez:  Well, what typically happens is for me to get the history from patients. What brought them to seek consult to the primary care provider or to me, how long have they been noticing the symptoms. What other associated symptoms come with it. Is there anything that triggers their symptoms? Is there anything that is relieving? So, first it’s just history taking learning more about the problems and then once I have an idea, how to move forward; it’s mostly just talking about how the workup will go. What sort of tests will I order such as stress tests or imaging studies and then I will usually bring them back earlier once I get the results to discuss how to move forward. Is this something that is of concern, do we still need to defer the testing once we have a diagnosis. I would prescribe what to do, what sort of recommendations to give such as medications, surgery, and those sort of things. 

Host:  I see. So, one of the other things that I wanted to ask that you touched upon was servicing the transgender community. Because in that case; there’s not necessarily a disorder; but you might service them in another way. So, maybe can you talk a little bit about that?

Dr. Valdez:  Yes. I usually would have these patients usually have a mental health provider or somebody who already diagnose them with gender euphoria and then they would send them to me so we could discuss about hormonal transition. So there is male to female transition or female to male transition. My role as an endocrinologist is to sort of help them transition using medications, hormonal medications and to discuss with them what the expectations for hormonal transition, what sort of side effects to consider or to look out for and just helping them get the results that they want from their transition. 

Host:  Yeah, it’s great to know that those services are offered and also really good to know that there’s this field that handles everything that goes on with the hormonal health of the body. And it makes me think about these preventative measures. That’s something we always hear about an ounce of prevention is worth a pound of health. So, can you tell us the importance of potentially diet and physical activity to promote this endocrine health?

Dr. Valdez:  Right. With any – it’s not only limited to the endocrine, but I think it’s just general health is to know which foods are not good for you, especially for diabetics. They cannot really have a lot of sugar loading, so they need to watch out for carbohydrate intake, or sugar intake. Apart from that, just having a regular form of exercise everyday at least 30 minutes everyday exercise. That helps you with just feeling better, preventing diseases, keeping your weight down and then the usual preventive medicine like avoiding smoking, avoiding excessive alcohol intake or illicit drug use. Again, these are not limited to endocrine problems but for general health. 

Host:  Yeah, it is really important to live that healthy lifestyle Dr. Valdez and I really appreciate you taking the time to educate us here today. Is there anything else that you want to share with our audience before we sign off?

Dr. Valdez:  I’m just happy to be part of this community. I just started here just a few months ago. But I do find that this area is very lovely, people are very appreciative and I’m just happy to serve the community. 

Host:  Absolutely. And thank you so much for serving and educating us today. My guest today has been Dr. Krystal Valdez. I’m Prakash Chandran. Thank you so much for listening. 

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