3/29/22: The Cancer Center Called Me

It felt kind of random. A person I didn't recognize said my usual medical oncology NP had asked her to call me to let me know about my blood work results (which I already saw online). She said my estradiol number is low, as expected, and that my LFTs (liver function tests) are "bouncing around" and were sent to my hepatologist. The blood work was done 11 days ago, and I didn't expect any follow-up, so I guess it's just nice to know that someone is still checking up on me. 

Although, she did not say anything about my bone density test results, and I did expect a follow-up for that. I had forgotten all about it and didn't think of it myself until after the phone call ended, otherwise I would have mentioned it. I guess there's not much to say about it anyway, since the report said "statistically nonsignificant change" from last time. 

Meanwhile, I still haven't heard from my hepatologist about my FibroScan results. I'm not really worried because I feel like I've gotten enough information online, though it would be nice to know his thoughts on what "severe steatosis" means for me.

3/19/22: FibroScan and Blood Work Results + Anastrozole Side Effects

I saw my FibroScan report posted on the online patient portal. I'm not entirely sure what the results mean, practically speaking, so I'm hoping I'll hear from my hepatologist, who can put the results into context. 

Here's what the report said:

CAP score: 395 dB/m 

Fibrosis score: 6.1 kPa

According to the Memorial Sloan Kettering Cancer Center, my CAP score means I have grade 3 steatosis ("S3"), which means more than 67% of my liver is fatty. The range for this score is 100 to 400 dB/m, so my number is quite high, and the report called it "severe steatosis".

The same web site categorizes my fibrosis score as "F0 to F1", which means "no liver scarring or mild liver scarring". Since the range is actually 2-7 kPa, and my score is on the high side of that, I figure maybe that means I have some mild scarring. 

I don't meet with my hepatologist again until August, but in the meantime, it sounds like I should try to adhere to the usual "healthy lifestyle" suggestions: lose weight, exercise more, eat a healthy and balanced diet, don't drink alcohol, drink more water.

Meanwhile, I got my blood drawn at my last Lupron appointment, so I also checked my LFT (liver function tests) results online. My ALT and AST continue to trend upwards, though they're still within 2-3 times the upper limit of normal, which this site calls "mildly elevated." I've been off Tamoxifen for about a month now, but maybe it will take a few months for these LFTs to settle down? I found this random Quora answer that says it can take 6-12 months to reverse grade 3 fatty liver.

Some good news is that my estradiol continues to be <5, so I'm still good for taking anastrozole (a post-menopausal medication). 

By the way, I have definitely noticed some side effects with the anastrozole. 

My joint stiffness has gotten worse again. It feels worse than when I was on Tamoxifen, but not as bad as when I was on exemestane. As usual, it's mostly in my fingers, and it's worst in the mornings when waking up. I also have it in my legs, and its worst when standing up from a sitting position. After standing up, I usually have to walk around for a few moments before I can actually stand up straight and walk normally.

I'm still getting hot flashes. They seem less frequent than when I was on Tamoxifen, but more severe in that the heat feels stronger, though the duration is probably the same as before. 

One new thing I've noticed is an increase in mucus, in both nose and throat. I don't know if it's a side effect or seasonal allergies. Recently, I've had to purposely cough a lot to clear phlegm. It doesn't feel like an illness cough, though I've taken a couple at-home rapid antigen covid tests and they've been negative. I think I've forcefully cleared my throat so much that there's a spot in the middle of my breast bone that hurts when I cough. I'm not sure what to make of this, but will mention it to my medical oncology NP when I speak with her in April. All I've found is this site that lists "cough" as a side effect of anastrozole, and this site that lists "cough" and "cough producing mucus" as "less common" side effects.

3/17/22: FibroScan

Wow, today's appointment was super quick.

Not including my time in the waiting area (which was like 5 minutes), the procedure itself only took about 5 minutes. I guess I would have known that if I had looked up what to expect with a FibroScan ahead of time.

The technician had me lie on my back and just lift my shirt high enough to expose my rib cage. It was like an ultrasound, but the probe pulsated. It felt like a tiny fist gently punching me in the rib cage, not at all painful.

3/11/22: Bone Density Test Results

I checked the online patient portal and got my bone density test results. 

These are my T-scores:

• Lumbar spine: -0.5
• Right proximal femur: -0.9
• Left proximal femur: -1.2

I'm still in the osteopenia range. Compared to my previous test results, it looks like my right proximal femur got a little worse.

The report describes the "change from previous" as "-2.0%, statistically nonsignificant change", which makes it sound not too concerning.

3/10/22: Bone Density Test

A couple days ago, I got an automated phone call with covid-19 screening questions. Checking in for today's appointment, though, I think it was the first time since this pandemic began that I was not asked any screening questions in person. To be honest, it made me feel uneasy; covid protections are being rolled back everywhere (because the CDC moved the goalposts), yet my county still has high community transmission. 

I did not feel particularly comfortable in the waiting area, where there were 4-6 other people in the room at any given time. Thankfully, the hospital is still requiring masks, but there was no distancing or capacity limit, and no visible indications of good ventilation or air purification. 

I arrived 15 minutes early, as instructed, and filled out a questionnaire about my medical history as it relates to bone health. Then I waited another 15 minutes to be called.

My technician was a friendly guy. He had me change into a gown, but said I only needed to take off my jeans; I could wear my shirt under the gown. I laid down flat on my back on the table. The technician positioned my legs, and the machine scanned my body. Then he re-positioned my legs, and the machine scanned my body again. The whole procedure took less than 10 minutes.