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Jan 15, 2020 11:30PM
Jan 15, 2020 11:58PM
I'm overdue for my Medicare "wellness visit." I'm seeing my MO again in March, but I think my primary would like me to come in by Feb. to re-do my CBC, lipid profile and glucose/a1c to see whether the 14 add'l lbs. I've lost since Oct. have brought down my glucose and LDL-C and brought my HDLs back up. Before letrozole, I had great lipids & glucose and didn't even need to track a1c; my HDLs were in freak-of-nature territory (>90). But letrozole raised my lipid profile, and the statin I was put on jacked my glucose into triple digits and my a1c up as high as 6.3. By Oct., the initial weight loss had taken my a1c back down to 5.8 and lowered my total cholesterol, but also lowered my HDL into the low 60s. I've been mildly anemic off & on for years (usually why I got rejected as a blood donor), even before breast cancer. The weight clinic NP is not happy with 5.8, saying I'm still "pre-diabetic," but my MO and primary are thrilled. Neither of them are bothered by my lipid profile, saying that with my low Framingham score and at my age, I am at greater risk of diabetes than of cardiovascular disease; and if my a1c stays at or below 5.8 I'll be fine. Unfortunately, my fasting glucose still is >100. My mom got Type 2 in her 70s, her mom in her 80s, and my sister had gestational diabetes at 41. So my genes may get me yet.
I did get tested for the BRCA, Chek2 and PALB2 mutations after my lumpectomy when I mentioned to my MO at our initial post-op visit that I'm Ashkenazi Jewish (my surgeon never asked about my ethnicity). At 64, I wasn't on Medicare yet, but my United PPO didn't bat an eyelash and paid 100%. Until I got my results back, I had to put radiation on hold in case I would have to go back in and do a BMX. And we didn't know whether I'd need chemo till my OncotypeDX (also covered 100%) results came in. Fortunately, my OncotypeDX came back "low-risk," my nodes & margins were clean, and I tested negative for the mutations. I had a small (the radiologist said "tiny") tumor in a very large breast (size 38 or 40 I)--"high & outside" at that--and a candidate for the short targeted Canadian partial-breast rads profile, so avoiding radiation was not a priority for me. I don't regret my decision, but what was right for me might not be right for other women. My BFF, who was 70, had extensive multifocal hormone-negative Grade 3 DCIS with comedonecrosis; she was widowed with no desire to date again, and hadn't even worn a bra since she was 35. They don't give chemo for pure DCIS no matter how high-grade, and since she was hormone-negative wouldn't need endocrine therapy. BMX meant no radiation unless >3 of her nodes were positive (none were); so for her, BMX without reconstruction would be the only treatment she'd need. Turns out she had multifocal ADH in the other breast, so she made the right decision for her. (She said it was my cancer--and nagging from my husband, who's her primary care doc & cardiologist--that motivated her to get her first mammogram in >20 years).
I opted for BCBS' 0-deductible Plan F (grandfathered-in, no longer being sold, replaced for new insureds by the lower premium Plan G which does carry a relatively low deductible) and Humana Enhanced Part D (which had the largest formulary of all the plans I checked). I have no interest in an Advantage plan--the only good managed-care experiences I've ever had were when we lived in Seattle and were able to buy into Group Health co-op; and the first 18 years we lived in Chicago when we had Rush-Anchor HMO. The latter's network was limited to Rush-Presbyterian-St. Luke's, its affiliated hospitals and the Anchor outpatient clinics, but Rush is one of the country's top hospitals and all their docs topnotch. It was a true HMO in that the premiums paid for everything--no deductibles or co-pays. Whenever I was hospitalized, each time all I paid for were TV, Starbuck's and the paper. Then Rush sold it first to PruCare, then Unicare, then Wellpoint, and it all went to hell in a handbasket. Because I had a plethora of preexisting conditions, they tried first to get me to drop them and then to cancel me any way they could--misspelling my name, juxtaposing digits in my ID number, entering the wrong diagnostic codes so that my gatekeepers' referrals would be denied, even getting the address of my husband's office (which paid our premiums) wrong so that they missed a quarterly bill. I got the cancellation notice the day we were about to go on a trip--my boss had to get a cashier's check for the delinquent premium and take a taxi to their Loop HQ to reinstate our coverage. By then (1997) our premiums were $18K/quarter and had high co-pays and rising deductibles for everything. We switched to United Healthcare's PPO and never looked back. Had we not, I'd never have been able to get my knees replaced by the best surgeon in town, nor use Evanston Hospital & the NorthShore system for my cancer treatment--neither of them were in Wellpoint's network. I can afford to pay now for my freedom to choose, and do so gladly.
Now for diet--I'm stuck at about 158 lbs., but at least I'm down to a size 1.5 jeans and 1 in everything else at Chico's--and M (10-12) everywhere else. (Started out at size 18/20 or 2X, and Chico's size 3 or even 4). I might not make it as far as my self-declared goal of 150, but might just be happy with keeping my BMI below 29 for now. I have my next weigh-in four weeks from now, so we'll see what the NP says. One of my other docs says some of my stubborn bulk and weight may actually be loose skin--but I frickin' HATE shapewear, especially Spanx, so I'm still a bit wary of tight-fitting clothes that display the contours of my "muffin top." But more & more, I'm finding fit isn't enough if a garment isn't also flattering--and that often turns out to be curve-hugging. Seems like only yesterday I was dressing in flowing tunics, wide-leg knit pants & "swing" cardigan jackets to hide the weight; now I love those cute little short jean and "scuba" zip jackets, skinny jeans and tees. I have gone from "plus" to truly "petite." My even shorter (4'11") mom went from a size 16 down to 6 after she got diagnosed with diverticulosis and her doctor told her to "stop eating junk;" she became a clotheshorse in her final few years (if she could have moved into the Boca Town Center mall, she would have).
Once I've maintained my eventual goal weight for at least a year, I'll start thinking about loose-skin-removal surgery--if only for relief of intertrigo (skin fold yeast infections, TMI, I know)--and getting my big droopy L boob reduced and lifted to match my R (which the lumpectomy actually made rounder and perkier). Both will be covered by Medicare--the breast reduction for symmetry, upper back pain relief and less underbust intertrigo; the skin removal for prevention of those yeast infections. But right now I don't want to put aside enough idle time to recuperate from discretionary (i.e., less necessary than elective) surgery.
Diagnosed at 64 on routine annual mammo, no lump. OncotypeDX 16. I cried because I had no shoes...but then again, I won’t get blisters....
9/9/2015, IDC, Right, 1cm, Stage IA, Grade 2, 0/4 nodes, ER+/PR+, HER2- (IHC)
9/23/2015 Lumpectomy: Right
11/2/2015 3DCRT: Breast
12/31/2015 Femara (letrozole)