8/25/23: I Have Back Pain

I tagged this post with "hormone therapy" but I don't actually know that it's a side effect. I hope it is, because that would mean it might go away or improve after I stop taking anastrozole. 

First, some clarifications. In the past, I've talked about this side effect as joint-related. On 12/23/21, while on Tamoxifen, I wrote:

My joints always feel especially tight, particular when standing up after sitting for any length of time (doesn't even have to be very long); I just feel like an old person, hobbling along until my joints loosen up.

Then on 3/19/22, after I started anastrozole, I wrote:

My joint stiffness has gotten worse again... 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.

Looking back, I don't know why I characterized it as being a problem with my "joints" and "legs" when now it seems clear that being unable to stand up straight after sitting could be a lower back problem. I never took any human physiology classes, so what do I know. Also, I'm in my 40s and didn't think I was old enough to face back issues, but apparently it's normal to start noticing back pain around age 40!     

So I guess a better word to describe my symptoms might be "musculoskeletal", which incorporates muscles, bones, joints and connective tissues.

Anyway. About a week ago, I did some yard work and overdid it, so instead of needing just "a few moments" to stand up straight again after sitting, it took on the order of minutes. I paid extra attention to how I was sitting, being careful to sit up straight and support my lower back, and made sure to avoid bending over, using my knees instead. I moved around slower, but it was fine. 

Then yesterday, I forgot to pay attention while sitting down to breakfast, and when I got up - OMG. I mean, OMG!!!! I felt a sharp, shooting pain in my lower back that was unbearable. Not only could I not straighten up, I thought my legs would buckle under me! I hobbled my way to bed and managed, through great pain, to lie down. Then I lay there practically motionless for 2 hours, while my son brought me ibuprofen and cold packs. 

I never quite understood what it meant when people say they "threw out their back", but I am pretty sure that's what I did.

I spent all of yesterday mostly lying down in pain. This morning I was thrilled and relieved to have no trouble at all getting out of bed, walking around, and using the bathroom. But I know I need to continue babying my back, for who knows how long. I will follow this advice and these tips, and when I think I can handle it, will incorporate these exercises into my routine. I even ordered a standing desk to minimize my sitting.

Of course, these back problems could just be normal, age-related developments. But, muscle pain, and specifically back pain, could also be side effects of anastrozole. I'll add it to my list of concerns for my next oncology appointment.

8/16/23: PCP Appointment

I haven't been blogging all my PCP appointments because they aren't directly related to having cancer. But at my annual check-up my doctor did say something relevant, so I figured I should mention it. 

I told her about trying magnesium glycinate for hot flashes and anxiety, how I think it "may" have helped, and how I stopped and ended up not feeling either symptom while on vacation, but am getting them again now. She didn't seem too keen on supplements in general, suggested I could have experienced a placebo effect when taking the magnesium, and she said straight up, "I wouldn't take it," especially since I'm monitoring my heart these days. She then dove into a discussion of my recent stress test results, and I forgot to go back to ask what connection magnesium has with the heart.

Back home, I Googled it and found this article, which warns about getting too much magnesium, especially in the form of supplements. Both my doctor and the article said to first try getting more magnesium into my regular diet. I kind of wish my doctor had included measuring my magnesium level in my blood test, but she didn't, and I didn't think to ask for it. 

My doctor also didn't say this outright, but I inferred that she thinks I should try to maintain my vacation mindset all the time. I guess that is what I am trying to do with my efforts in meditation and exercise and finding little joys in each day (like having a quiet cup of coffee in the sun on my back patio).

So, I will be putting the magnesium glycinate on hold for now, and make a note to ask my cardiologist about it next time.

8/9/23: My Cardiologist Called Me

She called to discuss my stress test results and said overall everything looks fine, she did not see anything alarming in the results. Yay!

She did mention that my heart function, i.e., my ejection fraction of 50-55%, was on the lower end of normal. She noted that it was comparable to my last measurement of 57%, so it's "normal" for me and not necessarily an indication of poor heart function; as long as it stays over 50%, I should be fine. I pointed out that my pre-Herceptin baseline was 63%, and she agreed that the decrease could have been caused by Herceptin, but there's no reason to think that it will go down any further. 

She confirmed we'll have an appointment next June (already scheduled), and at that time, she will probably schedule me for another echocardiogram to be done as a 1-year follow-up, just to make sure my ejection fraction is stable.

8/9/23: Magnesium Update

Back in June, I took magnesium glycinate for a few weeks (240 mg daily, with breakfast), and I really felt like it was helping! I definitely had fewer hot flashes and fewer anxiety episodes. When I did feel anxiety, it seemed more subdued. 

One interesting thing, though, is that I still got 2-3 hot flashes a day (way less than usual), but when I got them, they felt stronger than before. I always figured I was lucky because, even if I got a lot of hot flashes, at least they were brief and mild; I usually did not sweat. With the magnesium, though, I would just start to sweat, and then the hot flash passed. 

I might consider increasing my dose to 3 pills a day (360 mg daily), just to see if it helps with the lingering hot flashes and anxiety. I wouldn't expect the anxiety to go away completely, since some of it is situational and related to mental health, not just menopause; but maybe the hot flashes could improve even more?

I admit, one reason I don't want to increase my dose is because magnesium glycinate is expensive. It's like $30 per bottle. If I take smaller doses, each bottle will last longer.

Anyway, I actually stopped taking the magnesium for most of July because we traveled a lot and it would've been just one more thing to remember. We went to a subtropical climate, where it was very hot and humid outdoors all the time, and indoors it was always very comfortably air conditioned. Surprisingly, I did not have any hot flashes or anxiety at all! I wonder if it's hard to have, or feel, a hot flash when your body is already very hot and sweating; indoors, the air conditioning was perfectly cooling, unlike at home, where we keep the thermostat higher to save in energy costs. Plus, because of the heat, I was careful to stay sufficiently hydrated all the time, which probably helped too. Even my situational anxiety was non-existent, I think because I was in vacation mode and having so much FUN! 

So, we're back home now, and I've noticed my hot flashes and anxiety have returned. But now that I know it's possible for my body to not have them, I'm going to work harder on my mental health by trying to walk and meditate even more regularly. 

Oh, did I mention I was trying meditation? I actually subscribed to the Insight Timer app. I found a couple people whose guided meditations I like; my favorite is David Gandelman. It does take a lot of time and trial and error to find personalities and styles that fit with what I like, especially when there is such a fine line between meditation and alternative healing. 

8/8/23: Cardiology Stress Test

Yesterday I had my cardiology stress test, which was recommended at my last cardiology appointment.

My cardiologist had told me that the doctor on duty to attend to the test may not be her, and it wasn't. It was another woman, who was masked! She was the only other person in the office, besides me, to wear a mask. 

I was told to avoid caffeine for 2 hours before the appointment, and to wear sneakers and comfortable clothes.  

There were 2 people in the room with me the whole time, a nurse (I think, she may have been a medical assistant, I'm not sure) and a technician. They were both very nice, but not talkative, which was okay with me. 

They had me change into a johnny from the waist up. The nurse put a bunch of leads onto my torso, all of them connected to a belt they had me wear, so the wires didn't get tangled. They did an echocardiogram and an EKG and also took my blood pressure, for baseline values.  

Before we could start, we had to wait for the cardiologist to come in and give the okay. The nurse told me the doctor was in with another patient, and we actually waited for like 15 minutes, in almost complete silence. Haha. It was fine. I really don't mind when doctors are late, because I always figure, if I'm the patient the doctor is with, I'd want them to take the time to make sure I got the care I needed.

The stress test was divided into 3-minute intervals, designed to quickly increase a person's heart rate while they walk. There was a treadmill right next to the examination table, and in front of the treadmill was a big poster showing a numerical scale, with numbers corresponding to descriptions like "very light" and "very, very hard". During each 3-minute interval, the nurse asked me to describe the level of exertion I felt, and she also took my blood pressure while I walked.

First, the treadmill was set to a slow speed and small incline.  For this first part, I think I said the effort felt "light".

After 3 minutes, the treadmill incline and speed automatically increased. I described the exertion at this point as in between "fairly light" and "fairly hard" - it wasn't either, it just felt fine.

After 3 more minutes, the treadmill incline and speed automatically increased again. This time, I think I said the exertion felt "fairly hard". Towards the end of this 3-minute interval, the cardiologist said I was doing well above average! 

The nurse asked if I wanted to do the next level, which many people don't even get to. She said the setting would be very fast, and some people choose to jog it. I was curious to see how fast the last setting would be, so I said yes to trying it. At the 3-minute mark, the treadmill incline and speed increased again. I did it as a very fast walk, which I described as "very hard"! They had me do it only for 2 minutes, instead of 3.

After a total of 11 minutes, they stopped the treadmill, and I was instructed to keep walking until the treadmill came to a complete stop. Then I had to lie down on the exam table and roll onto my left side as quickly as possible so that the technician could do an echocardiogram while my heart rate was at its peak. The nurse also took some EKG readings and measured my blood pressure.

The cardiologist looked at all the data in real time and said nothing jumped out at her as problematic. She was very reassuring, but was also careful to say that it would take a few hours to review the details, and she would send the report to my cardiologist.

Back at home, later the same day, I was able to see my report in the online patient portal. The word "normal" appeared a lot, so I hope it means everything is fine! The only thing I really noticed was that it said my ejection fraction is 50-55%. Back when I was getting regular echocardiograms while on Herceptin, my baseline pre-Herceptin ejection fraction was 63%, and my last measurement after stopping Herceptin was 57%. So, it does appear that my ejection fraction never fully recovered from Herceptin. I'll have to remember to ask my cardiologist if this is something I should be concerned about.