12/30/21: My Medical Oncology NP Called Me

My NP called to discuss the results of my blood work.

I already saw my results online, but I played dumb as if I hadn't. I just wanted to hear how she would present the results, assuming a clean slate; I guess I'm a little afraid that if I let on that I already know something, they might assume I know more than I do, and I'll miss out on some piece of information. 

Anyway, she confirmed the estradiol number is good, so they may not check it again for another year.

She said some numbers regarding liver function were a little high, and asked if I had taken Tylenol or had any alcoholic drinks prior to the blood draw. I told her about having a couple drinks the night before to celebrate the start of school vacation, and she said the lab results are definitely consistent with having had some alcohol. Just to be sure, they will check again when I go in for my next Lupron appointment, and I should make sure not to drink alcohol for 3-4 days before getting blood drawn!

What I find interesting is that it's not generally instructed to not drink alcohol before a blood draw, which to me implies that a properly functioning liver should result in "normal" lab numbers even if the patient had a drink or two the night before. It's not like I drank a whole lot, it was really only 2 glasses of wine, I think. Apparently, both chemo and Tamoxifen can affect liver function. I don't have any of the symptoms of liver damage, but I wonder if maybe my liver now just has to work a little harder than it used to.

The NP didn't mention the "Baso" number, so I guess I won't worry about it. 

12/24/21: I Checked My Lab Results Online

My estradiol was <5, which is good, that's what's expected while on Lupron.

A couple other measurements were out of the normal range, though. 

My "ALT" and "AST" numbers were both slightly higher than normal. These values are related to liver function, and this site says ALT and AST levels are considered "mildly elevated" when they are 2-3 times the upper limit of normal. Mine are only a little bit high, so I don't think it's problem, plus, thankfully, the online patient portal allows me to see the provider's notes, and my NP had already made note of the unexpected values and put some context around them; she wrote that she would call me (presumably after Christmas) and ask if I had recently taken Tylenol or had alcohol. In fact, I did have about 2 glasses of wine the night before!

My "Baso" number was also just above the normal range. Apparently, basophils are responsible for the histamines in allergic reactions. I still have a baseline runny nose, for unknown reasons; maybe it's seasonal or environmental allergies after all, who knows.

12/23/21: Lupron + Medical Oncology NP Appointment

Wow, I had such a nice appointment with my medical oncology NP today.

We started out just talking about the state of the pandemic, Christmas plans, kids in school. It sounded like we were pretty much on the same page about everything, which was reassuring because usually I feel like I'm the weirdo for being more risk averse than those around me. It occurred to me that maybe we would be friends if we had met in some other context, or maybe she is just very, very good at her job and making her patients feel comfortable!

We went over all my side effects, which now feel manageable and stable. I mentioned my hot flashes, very slight neuropathy persisting in the first 3 fingers of both hands, and waking up 1-2 times every night (because of a hot flash or having to pee). I also talked about how my joints always feel especially tight, particular when standing up after sitting for any length of time (doesn't even have to be very long); I just feel like an old person, hobbling along until my joints loosen up. I said my husband keeps telling me it's age-related, and I just need to stretch in the mornings, but she disagreed and said she's sure it's a side effect of the Tamoxifen.  

The NP had me change into a gown for a breast exam, which went fine.

She realized my standing order for lab work had expired a couple days earlier, so she put in a new order, and I got my blood drawn after the appointment. I'll check the online patient portal for results.

I forgot to ask when my next appointment will be. My last one was 6 months ago with my medical oncologist, so I am assuming my next one will be in 6 months with my medical oncologist, too. I guess I'll see what shows up in my online patient portal appointment list. 

After the appointment, and after the blood draw, I went upstairs for my Lupron shot. I got one of my old familiar nurses, which was nice, especially because she's the one who is the best at giving totally painless shots.

12/13/21: I Get Anxiety with My Hot Flashes

I noticed something about my hot flashes (presumably a symptom of chemically-induced menopause, thanks to the Lupron shots).

Moments before onset, I get a wave of anxiety. I don't like this at all, because I tend to have anxiety issues already (though not formally diagnosed). 

At first, I wasn't sure which was coming first - the anxiety or the hot flash? I thought maybe my anxiety was a trigger for hot flashes. And maybe that does happen sometimes. But most of the time, I am just going about my business not feeling anxious in the slightest, and suddenly I will feel super anxious, and then moments later, I get a hot flash. 

My hot flashes are brief, but frequent. I get them pretty much every hour while I'm awake. I get the wave of anxiety, and then I feel super warm. I always wear short sleeves under a sweater now, so I have to take off the sweater and put my hair up in a ponytail. I also try to keep a hand fan close by, to help cool me down. If I take off layers and use a fan, I usually don't sweat. It passes after just a couple minutes, and then I'll put the sweater back on and let my hair down. 

I also get 1-2 hot flashes every night. I have to throw off the covers for a while, and then I'll huddle back under them after it passes. 

I guess in the scheme of things, these hot flashes aren't like a huge problem. But they sure feel disruptive.