Yesterday, I received a call to schedule my hepatology appointment, which I made for today. That's the absolute fastest I've ever gotten an appointment with a specialist.
I've had really good luck with all my specialists, and I liked this one, too, even though I had to wait 30 minutes in the exam room before he came in. I had a book, and no time constraints, so I didn't mind.
The hepatologist said he was not particularly concerned about my liver. The numbers that are high are only mildly high, not high enough to really worry about yet. He said sometimes, certain medications (like Tamoxifen) might cause blood test numbers to go out of whack, in a way that indicates fatty liver disease, but the liver might not actually be fatty.
For now, the plan is to monitor my condition. He ordered additional blood tests, and depending on the results, he might want to order a FibroScan, which he described as a "mini-ultrasound" that can more accurately diagnose the state of my liver.
He went through some family medical history and lifestyle questions, and said the fatty liver is likely due to the Tamoxifen.
He said I do not need to stop Tamoxifen at this time. He will follow up with my oncologist to discuss my case, and I guess they will figure out together if I should stick with Tamoxifen, or try switching back to exemestane.
I asked if stopping Tamoxifen would allow my liver to recover? He said maybe. But it might also just stay the same, and not get any worse.
I also asked if continuing Tamoxifen would make the condition worse? He said it could get worse, or it could stay the same.
So, who knows. He did say that when the condition worsens, it takes time. So if things start to look more than just mildly concerning, there's time to stop Tamoxifen later. Fatty liver disease can lead to cirrhosis, and then to a liver transplant, but he said those outcomes are unlikely when the fatty liver results from Tamoxifen.
I asked if I should stop drinking entirely, but he said a couple drinks a week is still okay. I think I'll stop having casual drinks at home, though, and just drink alcohol on special occasions.
On my way out, I scheduled a 6-month follow-up appointment, and then went to the lab to get my blood drawn.
Up until now, I've felt pretty confident in all my covid-related safety precautions. But today, waiting to be called for my blood draw, I definitely had the highest risk of exposure since this pandemic started. The waiting room was very small, only 3 seats, but at times there were as many as 7 people in there, and certainly not enough space for everyone to stay 6 feet apart. I had to wait about 30 minutes, the longest amount of time I've spent in the smallest room I've been in with the most number of total strangers whose covid status I knew nothing about. Everyone wore masks, though there were some surgical masks with visible gaps, but at least no cloth masks. If I get covid in the next week or so, I'm pretty sure I'll know where I got it.
Just for the record, non-alcoholic fatty liver disease is a chronic liver condition that puts me at higher risk for serious covid illness. Having a history of cancer is already a risk factor, plus I'm not sure if my reduced heart function during Herceptin still exists or not. (The last time my heart function was tested, it was at the lower end of normal, but still below my baseline measurement from before starting Herceptin.) So, yeah, I'll continue to take covid precautions seriously.
Incidentally, one person in the waiting room commented on how uncomfortable masks were, so I took the opportunity to introduce the room to KF94 masks, and the Bluna Facefit brand in particular. I know they are in high demand and difficult to find in stock right now, but at least I can put the information out there. I don't want people to get discouraged with masks when there really are comfortable, breathable options out there.
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