9/15/26: PCP Appointment

I don't always post about PCP appointments because they are not specifically cancer-related, but today's appointment definitely involved cancer-related issues.

First, I have to say, more than 7 years after being diagnosed, cancer is still not some "bump in the road" that is in the rear-view mirror - and I don't think it ever will be for me. For the rest of my life I will have to address health issues that are very likely a consequence of cancer treatment - at least in part - and I honestly kind of resent that.

Today there were two possibly cancer-related issues to address: rising cholesterol and osteoporosis. 

On average, menopause happens at age 52, and when it occurs before age 45, it's considered "early menopause". Because of my treatment for hormone-positive breast cancer, I went through medically-induced menopause, first in a potentially temporary manner at age 43 when I started Lupron injections (a form of ovarian suppression) in 2019, and then permanently soon after I turned 46 when I got my ovaries removed in 2022. 

The declining estrogen in menopause is linked to both rising cholesterol and bone loss, which can lead to osteopenia and osteoporosis. My cholesterol started increasing in 2022, crossed into the low end of the "high" range in 2023, and has stayed there ever since. Kaiser Permanente says women age 50 and older are at risk for osteopenia, but I was first diagnosed with it at age 43, and it just keeps getting worse. 

In addition to the lack of estrogen caused by ovary removal / menopause, my ongoing hormone therapy has me taking a daily aromatase inhibitor, a pill that lowers my estrogen even more by preventing it from being made from sources other than the ovaries. 

Now, can I know for sure that my cholesterol wouldn't be as high, or my osteopenia wouldn't be so bad, if I hadn't had medically-induced early menopause or hormone therapy due to cancer treatment? Of course not. Who knows. But my feeling is that menopause and hormone therapy have had a mild to moderate affect on my cholesterol and a giant affect on my bones. 

So what're we doing about these two issues.

For cholesterol, nothing for now. My PCP characterized my cholesterol as "stable", and my cardiologist previously said that it's not at the point of having to worry yet. It just annoys me that it continues to stay high, even though I've adopted a number of the recommended lifestyle changes for improving cholesterol. Since I already have a cardiologist, I suspect my PCP would just defer to her anyway. 

And speaking of deferring to specialists, that's exactly what my PCP is doing about my osteopenia. She referred me to the hospital network's "Bone Center" in the endocrinology department. I was surprised because my oncologist didn't even mention endocrinology. My PCP explained how treatment for osteopenia/osteoporosis is generally not long-term, like some are even limited to like 3-5 years at a time. And since I'm younger than the average osteopenia patient, any treatment plan should take into consideration my life expectancy, balancing my current condition with potential future needs. Moreover, because my osteopenia is likely linked to hormonal changes due to menopause, seeing an endocrinologist, a specialist in hormone-related disorders, makes sense. 

I have to admit, at first I felt really burdened by this referral. Another specialist?! Like, COME ON!! But while I was on the phone making the appointment, I started to feel better. When the scheduler said I could see someone in a suburban satellite office, I was so relieved I wouldn't have to drive into the city!! I was a little wary when she offered up a nurse practitioner instead of a doctor, but I've had good luck with nurse practitioners, plus she said the NP specializes in post-menopausal women with osteoporosis! So I think I'll be in good hands. I'll have to wait a while to find out, though, since my appointment - the first available - isn't until the end of February.

9/12/26: Cost Update

Wow, I haven't done a cost update in over a year.

Our health insurance has a July-to-June coverage year, so this update includes my cancer-related costs through all of the last coverage year (which ended in June 2026) til now. 

We have a high deductible health plan, which means we pay a lot out of pocket at the start of each coverage year, and then at some point towards the end of our coverage year we meet the deductible, and the remaining appointments until the end of June are fully covered.  

Thankfully, prescriptions work differently, and my anastrozole is always fully covered. 

So for this update, I'll list the amount billed / retail price (which gets added to the "total cost"), and then in parentheses I'll include the amount I had to pay after insurance processed the claim (which gets added to the "cost to me").

One more note: Usually there are two charges for each appointment, one for the hospital and one for the provider. As of the time of this post, however, only the hospital charge for my last oncology appointment shows up on my health insurance online account. 

10/16/25: Anastrozole (generic): $545.99 (Covered by insurance)
1/12/26: Anastrozole (generic): $545.99 (Covered by insurance)
4/10/26: Anastrozole (generic): $545.99 (Covered by insurance)
6/15/26: Medical Oncologist Appointment Hospital + Blood Work: $1,035.00 (Covered by insurance) 
6/26/26: Cardiologist Appointment + EKG: $440.00 (Covered by insurance) 
6/26/26: Cardiologist Hospital + EKG + Blood Work: $510.00 (Covered by insurance) 
7/9/26: Anastrozole (generic): $545.99 (Covered by insurance)
8/18/26: Bone Density Radiologist: $138.00 (I paid $26.25)
8/18/26: Bone Density Hospital: $1,082.00 (I paid $325.15) 

Total cost to date: $486,575.30
With insurance, cost to me: $17,260.03

9/8/26: I Got a Moderna Updated Covid Vaccine

I always want to get the Novavax protein-based covid vaccine because I've had better luck with it in terms of side effects than with Pfizer or Moderna, both of which usually knock me out for 1-2 days. But with cases rising in my area, coinciding with the annual surge among kids at the start of the new school year (plus my husband is a teacher), I figured it'd be best to just get the earliest available 2026-2027 option, and our local CVS happened to be offering Moderna.

Given my track record of bad side effects with mRNA covid vaccines, I made a point to drink water before the shot and also to stay hydrated afterwards. I aimed to drink 70 oz. of water and ended up drinking 80 oz. before going to bed. I also tried to keep my left arm active.

So I got the shot in my upper left arm around noon on Saturday, and it began aching within an hour. Interestingly, it progressed only to a soreness in the upper arm area - it didn't become painful and it didn't restrict my range of motion (as has happened in the past). I was a bit more tired than usual in the evening and went to bed early, but all that water took its toll and I woke up every 1-2 hours to use the bathroom. Thankfully, I was able to fall right back asleep, except the last time, which was just before dawn. I was still tired so I laid in bed for hours just to keep resting.

Notably, when I finally got out of bed, I didn't have any of the side effects I'd had before - no fever, no chills, no body aches, no persistent headache. I did have a little headache, which felt consistent with the inability to fall back asleep in the early morning. I also felt more tired than usual, but not like a heavy fatigue. 

For all of Sunday, my left upper arm continued to feel sore, and I felt kind of sluggish. I went to bed early again, and by Monday morning the soreness had subsided enough that I could at least lie on my left side. I woke up feeling refreshed, like I did sleep enough, but still had low energy, which continued all day. Tuesday (today) was my first day feeling back to normal.

Overall, side effects felt on par with what I experienced with the protein-based Novavax vaccine, which is to say, a lot fewer than what I had previously with mRNA vaccines. I was all set to credit the 80 oz. of water I drank, but then just this morning I learned that there are TWO versions of Moderna available this year! According to that link: "Moderna has developed mNEXSPIKE, a next-generation COVID-19 vaccine that uses only one-fifth the mRNA dose of their Spikevax vaccine." 

Nothing in the process of making my CVS appointment told me which Moderna vaccine I would be getting, but when I log into my CVS account now, I can see under "Prescriptions" that I got "Mnexspike 2026-2027", the newer lower-dose mRNA vaccine! Moderna reports that "rates of solicited local and systemic adverse reactions were generally similar between the 2 vaccines", but I'm inclined to think that for me personally, even though the 80 oz. of water probably didn't hurt, it was likely the low-dose vaccine that led to me having far fewer side effects this year. 

8/18/26: Bone Density Test Results

I went in for my bone density test at 10:00 AM this morning, and at 3:00 PM I got an email notification saying the results are available online.

I appreciate the efficiency of being notified directly of any test results, but I admit I miss the days when the doctor's office would call or send a letter. Of my and my family's various doctors, some will send an online message to explain or interpret test results - even just to say "results are normal" - but from others there is radio silence, and unless I initiate a call to the office, I'm just supposed to wait until the next scheduled appointment to discuss results. 

In this case, my oncologist who ordered the test had said that depending on the results, my PCP may want to start some kind of treatment to help slow down or prevent further bone loss. So maybe that means I shouldn't expect any communication from my oncologist, and I'll just plan to discuss the results with my PCP at my appointment next month.

Anyway, my last bone density test in 2024 showed "osteopenia of bilateral proximal femurs and lumbar spine," which I think is why I previously only blogged about T-scores for those 3 locations: left proximal femur, right proximal femur, and lumbar spine.

But this time, the report says "osteopenia of lumbar spine, bilateral proximal femurs and left forearm." The left forearm part is new.

Also, previously, I only blogged about T-scores. This time, however, in a couple cases, my T-score was the same, though the actual bone mineral density measurement was lower. So now I'm going to include those bone mineral density measurements as well.

Lumbar spine:

• T-score unchanged: -1.5
• Bone mineral density: 0.995 g/cm2, down from 1.002 g/cm2 in 2024  

Left proximal femur:

•  T-score: -2.1, down from -1.8 in 2024
• Bone mineral density: 0.737 g/cm2, down from 0.781 g/cm2 in 2024

Right proximal femur:

• T-score unchanged: -1.6
• Bone mineral density: 0.801 g/cm2, down from 0.811 g/cm2 in 2024

Left forearm:

• T-score: -1.9, down from -0.8 in 2024
• Bone mineral density: 0.567 g/cm2, down from 0.648 g/cm2 in 2024 

Suffice to say I'm pretty bummed, even though the results aren't unexpected, given my hormone therapy on top of being post-menopausal. I've been taking my Calcium and Vitamin D supplements diligently, but I'm going to have to redouble my efforts at doing weight-bearing exercises. 

7/2/26: Cardiology Blood Test Result

My lipoprotein (a) test came back normal. Yay! That's one less thing to worry about.

6/26/26: Cardiology Appointment

Last Friday I had my annual cardiology follow-up.

First, some background. I've been tracking my blood pressure at home and on average it's 115/80. According to this website, a "normal" reading is below 120/80. My diastolic number (the bottom one) is frequently over 80, so that's essentially what I'm tracking and hoping to bring down.

At the appointment, the medical assistant took my blood pressure, and it was 128/79 - only the systolic (top) number was high, which was unusual for me. My cardiologist later said she considers the threshold of concern to be 130/80, so she thought my measured blood pressure was fine, but personally I decided to chalk it up to "white coat hypertension", which I think I've experienced before.

Anyway, as I said, it's usually the bottom number I'm worried about. I've searched online and asked my cardiologist before, and having only the diastolic number be elevated seems to be kind of a mystery. This website literally says, "Doctors do not know precisely why it happens, but obesity, high triglyceride levels, smoking, and alcohol may contribute." None of those apply to me, so who knows. Today the cardiologist kind of implied that it "doesn't matter" which number is high because the treatment for high blood pressure is the same whether it's the top or bottom number that's high, or both. 

Since my blood pressure is on the borderline for being high, she strongly advised me to: 

• Do 150 minutes of cardio exercise per week (She said brisk walking is fine.)
• Do 30-60 minutes of strength training per week (She said even 10 minutes twice a week with 5 lb. weights would be good.)
• Drink more water (I think she suggested at least 30-40 oz. a day, which seems low, so maybe I'm misremembering... I generally aim for (and usually fall short of) 60-70 oz. per day.) 

As she said all this, I actually felt disappointed in myself because I've already been trying to do all those things for reasons in addition to cardio health, but have been struggling with doing them consistently. The exact same recommendation for walking helps to lower breast cancer recurrence risk, the strength training was already recommended by my oncology NP to help prevent bone density loss, and my cardiologist herself talked to me 2 years ago about staying hydrated for heart health.

I have this cycle where I do 1 or 2 or all 3 things really well for a stretch, but then life gets busy and I fall out of the habit, and then I have to work hard to re-establish routine. Life has been very busy since mid-May so I've been well out of practice for a while. But now it's doctor's orders to do these things, so I will redouble my efforts!!

My EKG showed "no significant change" from last year, which is to say, it's still a little weird. She reminded me that various parts of my cancer treatment - specifically, Herceptin, Lupron, and aromatase inhibitors (which I am still currently taking) - all can be "cardiotoxic", which is why I was sent to cardiology by oncology in the first place. So even though I continue to not have any symptoms like breathlessness or fatigue or palpitations, and my doctor continues to be "not worried" about the abnormal EKG, she still wants to have yearly follow-ups, just to keep an eye on everything.

Finally, I got sent for another blood draw. Apparently there's this one test she ordered - lipoprotein (a) - that's supposed to be a good indicator of whether or not my risk for a cardiovascular event is elevated. Depending on the results, she might want to consider treatment with medication even earlier. Of course I'd rather not be taking any more medications, but I guess we'll see.

6/15/26: Medical Oncology Appointment

Today I had my annual oncology follow-up. My appointments are supposed to alternate between the medical oncologist and medical oncology NP, but for some reason, I was scheduled with the NP for 3 years in a row, so I hadn't seen my oncologist since 2022!

I first got a blood draw for a full panel of tests. I was a little surprised because I couldn't even remember the last time I had my blood drawn for an oncology appointment. At home later, I checked my records, and it was back in 2022 when I last saw my oncologist! Anyway, today I had to go to the phlebotomy department in the main part of the hospital; since my last blood draw, the small dedicated phlebotomy lab in the cancer center is now only used for limited purposes.

The very nice medical assistant who took my vitals gave me another surprise when she said my height is 5' 5". I thought I was 5' 5.5"! Again, I checked my records at home, and last year I was 5' 5.25". At the time, I probably chalked it up to a slight mismeasurement, but I can't ignore two years of declining measurements in a row. Yikes. Surely bone loss is to blame; more on that later.

The medical assistant also told me the doctor was running behind schedule, and indeed by the time I was shown to an exam room, it was 50 minutes past my scheduled appointment time. Then I had to wait at least another 15 minutes for my oncologist. But I didn't mind, I didn't have any other place to be. The way I see it, my appointments are relatively routine now, and other cancer patients probably need her attention a lot more than I do. Plus, I like the idea of a doctor spending as much time as necessary with a patient. I used the time to start this blog post, check email, etc.

While waiting in the exam room, with the door open, my medical oncology NP walked by and popped in to say hello. It was very quick but also very friendly, just enough time for her to ask about my kids and for me to tell her about my youngest graduating high school and heading off to college. When I finally saw my doctor, she was so pleasant and kind and spent maybe a good 30 minutes with me. I didn't feel rushed at all.

I was surprised - again! - when the doctor asked about my eye appointments; I didn't realize she would have access to the fact that I recently got an eye exam and was referred to an ophthalmologist for an "enlarged optic nerve". I super appreciate when all my doctors in the same giant hospital network can see each other's notes, but I know the ophthalmologist is not in that network. Maybe my oncologist just saw the referral from my PCP, who is in the same network? Who knows. However she got to see it, I do like the convenience and comprehensiveness of all my doctors being able to see my medical activity across specialties.

We talked about my various symptoms and side effects from menopause and hormone therapy, e.g., joint stiffness, neuropathy in fingers and toes, hot flashes (much reduced from initial frequency), vaginal dryness, and increased anxiety. I told her about the new neuropathy in my left toe, though at this point, I've pretty much just accepted that all the discomforts are part and parcel of having had cancer.   

My oncologist confirmed that it'd be difficult to separate which symptoms are from menopause, and which might be side effects of taking anastrozole, the difference being that side effects could potentially improve when I stop hormone therapy. (I've got 4 more years to go, for a total of 10 years of hormone therapy.) Anastrozole is an aromatase inhibitor, and she said there is one more medication in the same family that I could try, called letrozole. I previously took exemestane, and got switched to anastrozole to see if I'd have fewer side effects on it, which I did. My doctor said I could try switching to letrozole, if I want, just to see if side effects are even better, but I guess I sort of feel like I'm in a steady routine now, so I'm loath to rock the boat by switching medications. It's good to know it's an option though. 

As usual, I had a physical exam as well, which went fine.  

Finally, I am due for a bone density test (because aromatase inhibitors cause bone loss), so will call tomorrow to schedule that. My oncologist said to try to get an appointment before my next PCP appointment, so my PCP can see the results and talk with me about whether or not to start treating my osteopenia (which hopefully has not progressed to osteoporosis).