2/4/22: My Medical Oncology NP Called Me

She called to review my abdominal ultrasound results. This time I didn't hide the fact that I had already seen the report online, which stated very clearly the results were "consistent with steatosis." It was easy enough to Google "steatosis" to see that it's the medical term for fatty liver disease. 

This time, contrary to what she said in the last phone call, she brought up the Tamoxifen connection herself. Sounds like my oncologist knew about the association, and maybe this was just the first time my NP was seeing it. 

Anyway, they are referring me to a hepatologist. I'm supposed to wait for them to call me to schedule the appointment, but given what happened last time, I specifically asked for a time frame, and the NP said if I don't hear from them by next Wednesday, I should let her know rather than call the hepatology department myself. 

I appreciate that she spent some time talking with me about what I should discuss with the hepatologist, so I could be sure to ask the right questions. I'll definitely want to ask about whether or not the benefits of taking Tamoxifen outweigh the potential problems of having fatty liver disease. Should I stop Tamoxifen? And even if I did, would my liver improve, or just not get any worse? I don't want to decrease my chances of cancer recurrence with Tamoxifen only to have fatty liver disease shorten my lifespan.

My NP mentioned that if the hepatologist advises stopping Tamoxifen, then we'd have to look into other hormone therapy options, which includes maybe giving exemestane another try. I switched from exemestane to Tamoxifen because my estradiol numbers were too high, but my last two blood tests (in June and December 2021) had estradiol in the desired "<5" range, so maybe it's still an option.

Actually, the NP clarified that the hepatologist alone wouldn't be able to make a judgment call regarding Tamoxifen, and that the hepatologist and my oncologist will probably have to discuss it together. I like that all my specialists are in the same hospital network, so they really do feel like a team, working together and having access to each other's notes, everyone seeing the same "big picture".