Numbers Game in Here Be Dust

Back in March, my partner and I had walked into our hospital’s old satellite blood draw facility about a mile from home. She needed routine tests done. We were told then and there about the change in procedure due to our hospital’s acquisition. We could go to a different, stand-alone facility about 15 miles away or continue to use the hospital’s satellite facility if we wanted to pay close to 50 times as much.

No way was that going to happen. Not surprisingly, all of the hospital’s satellite phlebotomy centers shut down not long afterward. In the meantime, we made the 15-mile drive for my partner’s blood tests.

Our old satellite center had been for walk-ins only, so we didn’t know that we could make an appointment in advance, rather than wait for hours at the new place. This was particularly hard on my partner, who does not do well with fasting blood tests, let alone delays. (Between her skewed sleep cycles and her hunger intolerance, I have driven her to the hospital at around 3 a.m. for a routine blood test because she couldn’t wait for the satellite facility to open at 7. We no longer have that 24/7 option unless we want to pay something exorbitant.)

I was prepared to drive those 15 miles to the new-to-us stand-alone facility for my own routine, non-oncological blood tests. Fortunately, I got online first, to set up an appointment on their website.

The facility had no openings on the day I chose, but I was surprised to see that they now have a satellite center in my town – not one mile from home but a quarter-mile from home, right next to my supermarket. Cool! I set up my appointment there and sauntered in before I did my shopping.

I might have been their very first customer. I didn’t ask that question, but I did ask how long the satellite center had been in town and learned that it had just opened up two days before. One phlebotomist was on duty and she still had unpacking to do. I mentally thanked the gods of good timing.

She was wonderful. I explained that I still had my chemo port in case my persnickety veins put up a fuss, but she wasn’t equipped to draw blood through a port. Instead she reached immediately for a butterfly needle and had her three tubes filled in no time. Her 25 years of experience served us both well. I was out of there several minutes before my appointment time, having shown up about 15 minutes early, with no other patient in the place. We also chatted a bit, since she’s new to the town.

When I first moved here I had to pay a dollar a page to get test result printouts from my GP. Later on I could pick them up from my hospital’s satellite center at no charge. Now I have an online account with the new facility, which – after a stringent check to make sure I am who I say I am – emailed me five days later with news that my results were ready to download. (I’m already on SeeYourChart to get test results, vitals, and notes from my cancer center.)

I’m happy to report that my cholesterol levels are normal (total cholesterol is the lowest among the records I have at 161). Vitamin D level is the low end of normal at 33 (the lower-bound of normal is 30). But my thyroid function has taken a dive after being normal for as long as it’s been tested. That said, my TSH has been climbing (mostly) steadily since at least as far back as 2007 and has now busted beyond normal range at 5.61:

The higher the number, the lower the functionality. Those results (and the above graph) are in a memo I’ve delivered to both my medical and radiation oncologists. (The years 2011 and 2012 are missing because I had skipped my check-ups. Those were especially tough caregiving years for me and I had neglected my own health as a result.)

From what I’ve read so far, the anastrazole I’m on does not cause or contribute to hypothyroidism. According to the Mayo Clinic, radiation therapy (mainly to the head and neck, but also to the upper chest) can cause subclinical hypothyroidism. My GP does not believe this applies to my own radiation treatment, and considering my near-steady climb in TSH I agree with her. Aging can also cause hypothyroidism, especially after one passes 60. I’m not there yet, but at almost-57 I’m getting close.

Among hypothyroidism’s effects is increased cholesterol, especially LDL, but my cholesterol readings including LDL have decreased. Interestingly, the weight gain I had attributed to anastrazole seems to be leveling off and I have returned to my maintenance baseline. Weight gain is also an effect of hypothyroidism, but I have both ramped up my exercise and lowered my caloric intake. Perhaps my body has adjusted to a new set point, at least for now. Peripheral neuropathy is another effect of hypothyroidism – so is my “trigger toe” due to that, or (as my oncologist has said) to chemo’s delayed effects? Mysteries abound.

My GP will have me tested again in about six weeks. Depending on the results, she may recommend levothyroxine (generic Synthroid) to increase my thyroid function. According to Drugs.com anastrazole does not interact with levothyroxine, but anecdotal evidence suggests that anastrazole may make levothyroxine more bioavailable. That info is in the memo to my oncologists.

My partner had been put on levothyroxine for a TSH level lower than mine (but still high). Unlike me (but see caveats 1 and 2), she had been suffering from various symptoms of an underactive thyroid.

Caveat 1: My partner has MS, which might also have caused some of her symptoms.
Caveat 2: I experience what I have been calling leftovers from chemo, but maybe part of that is the hypothyroidism kicking in.

My GP also calls my vitamin D level “low” despite it being just barely in the normal range. She recommended that I take 1000 IU/day of D3. I had already been taking that amount since May 8, 2014 (the day I started chemo) and had raised it to 1500 IU/day on Dec. 6, 2014 (the day I started anastrazole). I again increased my dose by 800 IU beginning on August 5 with the addition of a multivitamin at the suggestion of my oncologist. My low-normal D reading had therefore come despite my taking 2300 IU/day for the previous two weeks. I’ve now thrown another 1000 IU into the mix and have given that info to my oncologists as well.

(For comparison, my partner had been told to take 5000 IU/day of D3 to raise her low level. She currently takes 2000 IU/day to maintain a normal level.)

My Creativity Heals group had a coloring session on Thursday. I created two new sheets for the occasion:

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After the meeting I delivered my entry on behalf of Citrus Aid to the Sassy Cups competition. (More about Citrus Aid and Sassy Cups is at the end of this entry.)