6/26/26: Cardiology Appointment

Last Friday I had my annual cardiology follow-up.

First, some background. I've been tracking my blood pressure at home and on average it's 115/80. According to this website, a "normal" reading is below 120/80. My diastolic number (the bottom one) is frequently over 80, so that's essentially what I'm tracking and hoping to bring down.

At the appointment, the medical assistant took my blood pressure, and it was 128/79 - only the systolic (top) number was high, which was unusual for me. My cardiologist later said she considers the threshold of concern to be 130/80, so she thought my measured blood pressure was fine, but personally I decided to chalk it up to "white coat hypertension", which I think I've experienced before.

Anyway, as I said, it's usually the bottom number I'm worried about. I've searched online and asked my cardiologist before, and having only the diastolic number be elevated seems to be kind of a mystery. This website literally says, "Doctors do not know precisely why it happens, but obesity, high triglyceride levels, smoking, and alcohol may contribute." None of those apply to me, so who knows. Today the cardiologist kind of implied that it "doesn't matter" which number is high because the treatment for high blood pressure is the same whether it's the top or bottom number that's high, or both. 

Since my blood pressure is on the borderline for being high, she strongly advised me to: 

• Do 150 minutes of cardio exercise per week (She said brisk walking is fine.)
• Do 30-60 minutes of strength training per week (She said even 10 minutes twice a week with 5 lb. weights would be good.)
• Drink more water (I think she suggested at least 30-40 oz. a day, which seems low, so maybe I'm misremembering... I generally aim for (and usually fall short of) 60-70 oz. per day.) 

As she said all this, I actually felt disappointed in myself because I've already been trying to do all those things for reasons in addition to cardio health, but have been struggling with doing them consistently. The exact same recommendation for walking helps to lower breast cancer recurrence risk, the strength training was already recommended by my oncology NP to help prevent bone density loss, and my cardiologist herself talked to me 2 years ago about staying hydrated for heart health.

I have this cycle where I do 1 or 2 or all 3 things really well for a stretch, but then life gets busy and I fall out of the habit, and then I have to work hard to re-establish routine. Life has been very busy since mid-May so I've been well out of practice for a while. But now it's doctor's orders to do these things, so I will redouble my efforts!!

My EKG showed "no significant change" from last year, which is to say, it's still a little weird. She reminded me that various parts of my cancer treatment - specifically, Herceptin, Lupron, and aromatase inhibitors (which I am still currently taking) - all can be "cardiotoxic", which is why I was sent to cardiology by oncology in the first place. So even though I continue to not have any symptoms like breathlessness or fatigue or palpitations, and my doctor continues to be "not worried" about the abnormal EKG, she still wants to have yearly follow-ups, just to keep an eye on everything.

Finally, I got sent for another blood draw. Apparently there's this one test she ordered - lipoprotein (a) - that's supposed to be a good indicator of whether or not my risk for a cardiovascular event is elevated. Depending on the results, she might want to consider treatment with medication even earlier. Of course I'd rather not be taking any more medications, but I guess we'll see.

6/15/26: Medical Oncology Appointment

Today I had my annual oncology follow-up. My appointments are supposed to alternate between the medical oncologist and medical oncology NP, but for some reason, I was scheduled with the NP for 3 years in a row, so I hadn't seen my oncologist since 2022!

I first got a blood draw for a full panel of tests. I was a little surprised because I couldn't even remember the last time I had my blood drawn for an oncology appointment. At home later, I checked my records, and it was back in 2022 when I last saw my oncologist! Anyway, today I had to go to the phlebotomy department in the main part of the hospital; since my last blood draw, the small dedicated phlebotomy lab in the cancer center is now only used for limited purposes.

The very nice medical assistant who took my vitals gave me another surprise when she said my height is 5' 5". I thought I was 5' 5.5"! Again, I checked my records at home, and last year I was 5' 5.25". At the time, I probably chalked it up to a slight mismeasurement, but I can't ignore two years of declining measurements in a row. Yikes. Surely bone loss is to blame; more on that later.

The medical assistant also told me the doctor was running behind schedule, and indeed by the time I was shown to an exam room, it was 50 minutes past my scheduled appointment time. Then I had to wait at least another 15 minutes for my oncologist. But I didn't mind, I didn't have any other place to be. The way I see it, my appointments are relatively routine now, and other cancer patients probably need her attention a lot more than I do. Plus, I like the idea of a doctor spending as much time as necessary with a patient. I used the time to start this blog post, check email, etc.

While waiting in the exam room, with the door open, my medical oncology NP walked by and popped in to say hello. It was very quick but also very friendly, just enough time for her to ask about my kids and for me to tell her about my youngest graduating high school and heading off to college. When I finally saw my doctor, she was so pleasant and kind and spent maybe a good 30 minutes with me. I didn't feel rushed at all.

I was surprised - again! - when the doctor asked about my eye appointments; I didn't realize she would have access to the fact that I recently got an eye exam and was referred to an ophthalmologist for an "enlarged optic nerve". I super appreciate when all my doctors in the same giant hospital network can see each other's notes, but I know the ophthalmologist is not in that network. Maybe my oncologist just saw the referral from my PCP, who is in the same network? Who knows. However she got to see it, I do like the convenience and comprehensiveness of all my doctors being able to see my medical activity across specialties.

We talked about my various symptoms and side effects from menopause and hormone therapy, e.g., joint stiffness, neuropathy in fingers and toes, hot flashes (much reduced from initial frequency), vaginal dryness, and increased anxiety. I told her about the new neuropathy in my left toe, though at this point, I've pretty much just accepted that all the discomforts are part and parcel of having had cancer.   

My oncologist confirmed that it'd be difficult to separate which symptoms are from menopause, and which might be side effects of taking anastrozole, the difference being that side effects could potentially improve when I stop hormone therapy. (I've got 4 more years to go, for a total of 10 years of hormone therapy.) Anastrozole is an aromatase inhibitor, and she said there is one more medication in the same family that I could try, called letrozole. I previously took exemestane, and got switched to anastrozole to see if I'd have fewer side effects on it, which I did. My doctor said I could try switching to letrozole, if I want, just to see if side effects are even better, but I guess I sort of feel like I'm in a steady routine now, so I'm loath to rock the boat by switching medications. It's good to know it's an option though. 

As usual, I had a physical exam as well, which went fine.  

Finally, I am due for a bone density test (because aromatase inhibitors cause bone loss), so will call tomorrow to schedule that. My oncologist said to try to get an appointment before my next PCP appointment, so my PCP can see the results and talk with me about whether or not to start treating my osteopenia (which hopefully has not progressed to osteoporosis).