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.