[AlaskaAngel]

Hi Anne,

Would the "pot luck" of the system there be flexible enough for to you to possibly have access to the services of a qualified internist, as opposed to a GP, for the more specialized situation in your case because of your prior coexisting heart condition?

I am not near a major medical center, much less a major cancer center, so specialized care is a bit limited for me in some ways as well, but I have had access to an internist here after completing the chemotherapy and radiation, not a GP.

Your situation is a little harder to consider because of the invasion putting you at higher risk, yet with some potential for drugs like tamoxifen or an AI to be protective. The joint discomfort with the drugs is the trade-off, and that leaves the caregivers and you in the soup. (They, however, don't have to bear the discomfort to get whatever benefit may work for you, whereas you do.) I was enough of a maverick to independently discontinue the tamoxifen and refuse the AI successfully, but you are at higher risk for recurrence because of the invasion.

It sounds like the interval before receiving another echo is scheduled may be to try to give your weakened heart some additional time to show signs of any recovery, to allow them to make a more accurate evaluation.

I think a cardiologist evaluation or perhaps an internist evaluation once they have the info from the echo would help by at least allowing you to find out whether cardiac manipulation with common cardiac drugs stands a chance of working in your situation or not, to help you to separate that factor out when making your decision about other difficulties with anti-estrogen therapy. Since the swelling is improved once you get going for the day, but the AI makes it harder to get going, maybe while you wait for the echo and are seeking an appointment with a cardiologist or an internist I wonder if taking the AI every other day would help.

(On a "scientific curiosity basis" ONLY, I wonder if those with a low level of ER/PR get equal benefit from a lesser dose, the same dose, or a higher dose of an AI, but that is pure speculation on my part!) I doubt any research has been done to determine that, though.

A.A.

P.S. Gosh, Bonnie, I appreciate your thoughts on this too. I just wish it was as easy to take the drugs as it is to prescribe them!