8/24/22: Hepatology Appointment

I dare say today's phone appointment was a pleasant conversation!

The doctor carefully reviewed the up-and-down trend of my LFT results over the past year. He said my current results are "completely normal" and indicate normal liver function!

I asked if that means I no longer have fatty liver disease? He said yes, given my BMI and LFTs, I can say I do not have fatty liver disease. 

I know by now that doctors never order tests to confirm normal results, but I figured I'd ask anyway if I should get another FibroScan. He said sometimes, imaging results are "consistent" with fatty liver, but when a biopsy is performed, there's no fat. The FibroScan also looks for scarring, and the important thing is that my prior FibroScan showed little to no scarring. Since everything now points to normal liver function, there's no need for a FibroScan. 

I was impressed that the doctor spent a surprising amount of time reviewing my hormone therapy regimen, even asking about my ovary removal and side effects. I told him that my side effects on anastrozole (mostly just joint stiffness in my fingers, since other symptoms like hot flashes and vaginal dryness can be attributed to menopause) are worse than when on Tamoxifen, but better than when I was on exemestane, and I consider them manageable. He emphasized the importance of finding the right balance between treatment and side effects; he didn't say it outright (presumably because these medications are squarely in my oncologist's domain) but it's clear to me that since Tamoxifen was the probable culprit leading to my liver problems, I'm unlikely to have a recurrence of fatty liver as long as I can withstand the side effects of other medications and stay off Tamoxifen. 

I had one final question about whether or not to worry about my ferritin number still being a little elevated. Because my ferritin was very high (538) around the same time my LFTs were high, and it has since decreased to only being a little high (202), the doctor said it's likely related to the fatty liver, and he's "not concerned".

I'll have one final follow-up in 6 months just to make sure everything is still normal.

8/24/22: Cancerversary

Actually, the 3-year anniversary of my double mastectomy was yesterday. Maybe it's kind of a good thing that I forgot and didn't realize the significance of the date until today, because it implies that the experience marked by the date is not occupying a huge place in my psyche?

Interestingly, to me, it feels like I've been managing my cancer treatment forever, so "3 years" sounds like a surprisingly short period of time. On the other hand, when I focus on just those words - "3 years" - then it strikes me as a long time. It's weird how time, something that is objectively measured, can feel so subjective. 

I also realized I haven't posted any photos in a while, so here are a few new ones.

This is me now.

I never did go back to wearing contacts after stopping during chemo, so I wear glasses all the time now.

I haven't cut my hair since I shaved it. I'm thrilled that it's grown back as thick and as black as before, especially because I know that for some people, post-chemo hair can grow back white or gray, or with a different texture. The top is still a bit thinner than it used to be, but it's the kind of thing that maybe only I can notice, so I try not to let it detract from the gratitude of having a full head of hair again.  

I like that it's long enough to help camouflage my flatness, but truth be told, probably 98% of the time my hair is up in a messy bun because of the heat of hot flashes. Since getting my ovaries out, the hot flashes have been stronger and more frequent. It finally dawned on me that maybe this is why so many women cut their hair short as they get older! 

Anyway, here are a couple photos of my port scar. 

I can't remember exactly when I stopped using the scar cream every night, but for months now I've been applying it maybe 3 or 4 times a week. At this point, I figure I'll just finish the tube and be done with it. When I first took these photos, I didn't think the scar looked any better, but when I compared them to my last photos from over a year ago, it does look better. Maybe the scar cream helped, or maybe it's just the passage of time. Who knows!

8/17/22: Blood Draw and LFT Results

I was originally supposed to have an in-person appointment with my hepatologist this week, but the doctor's office called last week and asked if I wanted to change it to a telehealth appointment next week (presumably due to the current Delta-level plateau in COVID-19 cases in my state). From what I remember of my first hepatology appointment, an actual physical exam didn't seem critical, so I agreed to a phone appointment. (They also offered a video option, but I'm more comfortable on the phone.)

The office said the doctor would put in a lab order, so I should get my blood drawn the week before (this week), and the results would be ready in time to be discussed at my appointment. They asked which location I wanted to go to for the blood draw, which I appreciated because the hepatologist's office isn't the most convenient site for me.

Earlier this week, before making the drive to get my blood drawn, I decided to call the lab to confirm that the orders were ready. My penchant for double-checking everything paid off, because the lab had no orders for me! I had to call the hepatologist's office and tell them my expected lab orders weren't ready, and then follow up with the lab again later.

So I got my blood drawn yesterday, and then got an email late last night saying the results were available online. Interestingly, because I got my blood drawn at my usual satellite hospital's regular lab - and not the Cancer Center lab which is affiliated with the main hospital - the results aren't in the online patient portal that I usually use. Even though all my doctors are in the same hospital network, I have to use 3 separate web sites, each with its own account, to access my records: one for the main hospital, one for satellite hospitals, and one for my PCP. Yep, it's confusing.

Anyway. My liver function tests look good!! Here's a history of all my results, including the hormone therapy pill I was taking at the time. The first number is ALT, the second number is AST. The red numbers are out of range and indicative of non-alcoholic fatty liver disease.

08/16/22 26 22 Anastrozole

08/08/22 26 26 Anastrozole

06/10/22   46 34 Anastrozole

05/13/22   57   41 Anastrozole

04/15/22   78   56 Anastrozole

03/18/22   86   63 Anastrozole

02/18/22   79   65 Tamoxifen

02/08/22   74   51 Tamoxifen

01/21/22   62   53 Tamoxifen

12/23/21   65   49 Tamoxifen

06/10/21 25 22 Tamoxifen

12/23/20 18 18 Exemestane

So the main questions I'll have for my hepatologist are: Does having ALT and AST values within normal range automatically mean that my liver is no longer fatty? Getting a FibroScan is what actually confirmed how fatty my liver was, so will I get another FibroScan to confirm improvement?

8/8/22: I Checked My Insurance Claims Online

This list covers all my cancer-related medical costs through the end of June. Since we already met our insurance deductible for the coverage year, the only costs to us were the co-pays on my BSO surgery-related prescriptions.

Surprisingly, while compiling these numbers, I noticed right away that my Lupron injection in June cost a whole lot more than usual. The cost of Lupron has varied over the months and years, but generally has always been less than $1,000. Suddenly, this June, the price of one injection was over $5,000! I have no idea why.

Our insurance coverage year starts on July 1, which means our $4,000 deductible will be reset. So the next time I post a cost update, I'll have more out-of-pocket expenses to report.

4/29/22: GYN Surgeon Appointment: $608.00
5/10/22: Pelvic Ultrasound Radiologist: $839.00
5/10/22: Anastrozole (generic): $545.99
5/13/22: Lupron (Including Blood Work): $930.16
6/10/22: Medical Oncology NP & EKG Hospital + Lupron (Including Blood Work): $7,085.80
6/10/22: Medical Oncology NP Appointment: $326.00
6/10/22: Cardiologist EKG: $27.00
6/13/22: PCP Appointment + EKG: $385.00
6/14/22: COVID-19 Test: $375.00
6/14/22: Cardiologist & EKG Hospital: $227.00
6/14/22: Cardiologist Appointment: $481.00
6/14/22: Cardiologist EKG: $27.00
6/16/22: BSO Surgery Hospital: $1,627.88
6/16/22: BSO Sugery Surgeon: $2,167.00
6/16/22: BSO Surgery Anesthesiologist: $1,820.00
6/16/22: BSO Surgery Pathologist: $274.00
6/16/22: Prescription Ibuprofen: $15.49 (out-of-pocket co-pay: $2.57)
6/16/22: Prescription Docusate Sodium "Colace": $6.98 (not covered by insurance, out-of-pocket cost: $6.98)
6/16/22: Prescription Oxycodone (didn't use): $11.99 (out-of-pocket co-pay: $1.07)

Total cost to date: $460,800.23
With insurance, cost to me: $10,207.69

8/8/22: PCP Appointment

Today I had my annual physical with my PCP. There was nothing noteworthy about it in terms of my own health, but she did say something that I wanted to write down for the record. 

She asked how old my daughter is, and though it's too early now to be thinking about it, she said my daughter should start getting mammograms when she is 10 years younger than I was when I got breast cancer. Back at home, a Google search returned one result that said screening should start 5 years before the earliest age of diagnosis of a family member, and another result that listed various guidelines based on a number of different risk factors, including a recommendation for the 10-year rule for certain situations. My PCP tends to always err on the side of caution, so I'm not surprised her guidance falls more on the conservative side.

Technically I was diagnosed at age 43, but I found the first lump at age 42. Using that number, that means my daughter should talk to her doctor about getting mammograms as early as age 32. She's literally only half that age now - and who knows how much medicine will change in the next decade and a half - so it's nothing she needs to be burdened with at this time, but certainly something I should keep tucked into the back corner of my mind.