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: 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. 

6/17/23: I've Been Taking Magnesium Supplements

As discussed with my medical oncology NP, I've started taking magnesium glycinate supplements. I'm hoping they will help decrease my hot flashes and anxiety, byproducts of the surgically-induced menopause that I'm in, thanks to my oophorectomy and hormone therapy. 

She recommended 300-400 mg daily. The product I bought at CVS says 1 serving is 3 capsules, which equals 360 mg total. Because magnesium supplements can sometimes cause diarrhea, my NP suggested taking it every other day to start, to make sure I don't have any digestive side effects. 

Always one to err on the side of caution, I decided to start with 1 capsule (120 mg) every other day. After about a week, I didn't notice any problems, so I moved to taking 1 capsule every day. 

After a few days of that, I also didn't notice any benefit, so I increased the dose to 2 capsules (240 mg) every other day, and 1 capsule on the alternating days. After a few more days, I had no diarrhea, and I think my anxiety and hot flashes did improve? It's hard to say, but it seemed less frequent, and it actually felt kind of subdued, like more in the background and less front-and-center. 

So now I am taking 2 capsules (240 mg) every day. This is less than the amount recommended by my NP, but I figure there's nothing wrong in trying to take the lowest effective dose, and it gives me some wiggle room in case I want to increase the dose later. 

Part of me does wonder if the supplements are truly helping, or if there is some kind of placebo effect, or wishful thinking. I'll keep it up and see what I notice over time.

6/1/23: Medical Oncology NP Appointment

Today's appointment was my first time going to the Cancer Center since the state's universal masking policy for medical facilities ended. I was so disappointed to see not a single employee wearing a mask. Besides me, I saw only 2 other patients in masks. This is a place where actual immunocompromised and high-risk people go to get life-saving medical care, and still nobody could be bothered to help protect them by mitigating the spread of COVID-19. This reality has been a very hard pill for me to swallow.

(Without giving away my location, I'll just note that the COVID-19 wastewater data for my county shows values almost as high as Winter 2020-2021 levels, relatively low compared to our ginormous Omicron peak, but certainly not objectively low.)

Interestingly, my NP told me that even though masks aren't required, they do still expect symptomatic people to wear masks. She said there was a woman recently who came in coughing, and when she refused to wear a mask, they actually sent her home and made her re-schedule! While this kind of policy doesn't address asymptomatic transmission, it's definitely better than nothing, so I appreciate it.

Now, about my appointment.

I don't know for sure if this was the first time this has happened, but I actually had nothing new to report. I still have all my usual side effects from surgically-induced menopause and anastrozole - joint stiffness, hot flashes, anxiety, poor sleep - plus lingering neuropathy from chemo, but none of that is new.

My NP said that even though I consider my hot flashes manageable, and they "only" happen a few times a day - an improvement from when they used to happen many times a day - she said I don't have to live with them, and she asked if I wanted to try Effexor, which can treat both hot flashes and anxiety. (I Googled the medication at home, and it turns out it's actually an antidepressant that is frequently prescribed off-label for menopausal hot flashes.) 

I'm not keen on taking medications if I can help it, so I asked about magnesium, which the Hormone Repair Manual recommended for hot flashes, and which Google says can also help with anxiety. My NP was supportive and said she takes magnesium herself, for other reasons. She recommended 300-400 mg daily in the form of magnesium glycinate. There are many forms of magnesium, and the Hormone Repair Manual also recommended magnesium glycinate. (My NP said magnesium citrate would be fine, too, but my local pharmacy didn't have it. She also said to avoid magnesium oxide because diarrhea is a common side effect.) My NP suggested I start by taking it every other day, just to make sure I don't have any negative side effects, before increasing to daily use. 

Moving on, we discussed my hepatology appointment, and then she did a physical exam.

She did not mention doing an EKG, so I asked if I should get one. Once again, my self-advocacy paid off; she confirmed that my notes said I should get an EKG every 6-12 months. My last EKG was 7 months ago, so she decided we could do one today, and then do them yearly moving forward. Getting an EKG is a little funny because it takes a while to position all the leads, but then the procedure itself takes just a few seconds, and all the leads that took so long to put on get taken right off. Anyway, I took a peek at my printout and saw that my QT/QTc was 424/424 ms, which is within the normal range. Yay!

Planning ahead, my NP said that I could make my next appointment in a year. Normally I have an oncology appointment every 6 months, but since I'm relatively stable right now (knock on wood), she said it's good enough for me to have my Breast Center appointment in 6 months (already on the calendar), and then my next oncology appointment 6 months after that. But, since my next Breast Center appointment is expected to be my last, they may have me go back to having oncology appointments every 6 months after next year. In the past I have been a little nervous about lengthening the time in between appointments, so she reassured me that I can always call if something comes up; surprisingly, I actually felt fine about not returning sooner, maybe because I haven't had any unexpected complications lately, but also because I'm not too eager to go back now that they've dropped their mask mandate.