8/28/24: I Got a Pfizer Updated Covid Vaccine

I decided to make this post because I've kept track of most of my previous covid vaccinations on this blog, and my cancer-related medical history is a big reason why I remain covid-cautious.

I got the new updated 2024-2025 covid vaccine on Wednesday, the first day it became available at my local CVS. I didn't have a choice for the brand and it happened to be Pfizer. Primarily I wanted to get my daughter vaccinated before she moved into her college dorm, and I was so relieved it was possible, since earlier estimates put the new vaccine roll-out in early September. Once I decided to get her vaccinated ASAP, it made sense to schedule my son to get vaccinated at the same time because he'll also be facing crowded classrooms again soon. Then it was just a matter of convenience to make it a group appointment for all of us.

My experience this time was pretty similar to my previous mRNA shots. I got the vaccine at 10:00 AM, and felt mostly fine all day. By the evening, though, my left arm (where I received the injection) hurt a lot, from my elbow through my shoulder and back. I couldn't raise my arm above my head. That night I hardly slept at all, I felt achy all over and couldn't get comfortable. Around 6:30 AM I had a headache and a fever of 100 F, so I took 2 Advil and went back to sleep. When I woke up again around 9:00 AM, I felt a whole lot better. For the rest of the day, besides feeling a little extra tired, I just had the sore left arm.

It occurs to me that since I had a lot fewer side effects with last year's protein-based Novavax vaccine, it might be worth it for me to hold out for Novavax each year instead of getting the first available mRNA vaccine. Apparently it takes longer to produce the protein-based vaccine, which means Novavax will almost always be released later than the mRNA vaccines from Pfizer and Moderna. But there's a lot to be said for the convenience of the whole family getting vaccinated together, and with my kids still in school, I think I'll always want them vaccinated as soon as possible when classes start.

8/25/24: I've Been Thinking About My Chemo Brain

I've posted before about having chemo brain, which can last years. I was previously least concerned about being unable to "find words", but now it's the symptom that bothers me the most, almost distressingly, as its frequency of occurrence has increased greatly.

Everybody has that experience of forgetting a word once in a while, when it's on the tip of your tongue but you just can't come up with it. This happens to me literally every day, multiple times a day. In fact, I'd say it happens any time I have any kind of conversation that goes beyond a few sentences. People with whom I'm speaking will generally graciously ignore my verbal bumbling, or chalk it up to aging, but I know a lot of people my age and older and the extent to which I can't produce the words I want is simply not typical.

This symptom, and chemo brain in general, sounds a lot like the "brain fog" that is often associated with long covid, and studies have actually linked the two.

My husband agrees that I am "not finding words" much more often compared to a few years ago, and I sometimes wonder if getting covid in December 2022 could have exacerbated the problem.

Recently, another possible factor has come to my attention. When I had both my ovaries removed, I knew that "increased risk of dementia and other changes in mental function" were possible, though my OB/GYN dismissed that particular concern based on lack of evidence, especially when weighed against the more immediate risks of breast cancer recurrence or ovarian cancer.

Now, a new study has come out connecting bilateral oophorectomy with reduced white matter in the brain. The article refers to other research that "found that patients who've had both of their ovaries removed before they hit menopause face a higher risk of cognitive impairment and dementia later in life."

But how much later? Is it possible that early signs of cognitive impairment might show up within a couple years? I got my ovaries out in June 2022, which means my post-oophorectomy period basically overlaps with my post-covid period. Might either or both these events have been a contributing factor to my increased inability to find words? 

Yet another consideration is my hormone therapy, which completely eliminates estrogen in my body. There's a lot going on between estrogen and the brain, and lots of research that studies it. I started taking an aromatase inhibitor right after finishing chemo, so again, those potential causes overlap, and also wouldn't explain the worsening of symptoms. Still, it probably doesn't help that one study found, "A pattern of decline in working memory and concentration with initial exposure to anastrozole was observed," with a caveat saying, "The longer term (> 18 months) effects of anastrozole on cognitive function remain to be determined." I am holding out just a little bit of hope that maybe I'll see some kind of improvement when I stop anastrozole in about 5 years.

Who knows. Without formal cognitive testing, including baselines, I'll never know for sure what's going on. It's just something I've been thinking about lately.

Suffice it to say, my medical history includes multiple things that could have negatively affected my brain function in very noticeable ways. It's just one more reason for me to continue to be covid-cautious; I can't do anything about having had chemo or a bilateral oophorectomy, and I choose to continue with anastrozole to help prevent cancer recurrence, but since every covid infection carries a risk of damage to the brain, I can try to preserve what brain function I have left by trying not to get covid again (by masking indoors, avoiding crowds, staying up-to-date with vaccinations, rapid testing before gatherings, meeting others outdoors when possible, using air purifiers and promoting ventilation with open windows where possible, monitoring wastewater data and staying informed, i.e., the type of things recommended by Yale School of Public Health).

8/22/24: Echocardiogram Results

Yesterday I had an echocardiogram. I'm sure the cardiologist is looking for any number of things in the results, but mainly I am interested in whether or not my ejection fraction is holding steady above 50%.

I got the results online and the first thing I noticed is that my online visit summary uses the word cardiomyopathy, which was interesting mainly because I don't recall my doctor actually using that word.

Anyway, I'm relieved that my ejection fraction is now 59%, which to me feels like a marked improvement from last year's 50-55%, though the report says "no significant change". It's still lower than my pre-Herceptin baseline of 63%, but I think it's high enough that I won't worry so much about it anymore.

8/15/24: Bone Density Test Results

I'm supposed to get a bone density test every 2 years while on anastrozole, which puts me at risk for osteoporosis.

Previous tests showed that I do have osteopenia, and this year's results are no different.

I had the imaging done yesterday and got the results online today. My T-scores this year are:

• Lumbar spine: -1.5 (down from -0.5)
• Right proximal femur: -1.6 (down from -0.9)
• Left proximal femur: -1.8 (down from -1.2)
  

The report describes the "change from previous" as "-8.8%, statistically significant change", but at least it's not in the osteoporosis range yet.

For the record, I do take both calcium and vitamin D to help prevent bone loss. I wonder if maybe my numbers would be even worse if I weren't taking these supplements.