Quick back story—last May (2018), I fractured my pelvis from running. While I did run a lot of races that spring, far more than normal, I’d ramped up my running distances in a gradual, sane way. It wasn’t like I went from 9 miles a week to 30 miles a week from one week to the next, I did a good job building my distances. So that fracture was a complete surprise.
And because I’ve done strength training all my life (thank you, US Army, for the habits you instilled in me when I was young), I sure didn’t think I would have any issues with my bones. But I did, my DEXA scan wasn’t great and my PCP diagnosed me with osteopenia. He said it was mild, no need for any drug treatments and that I should continue with the running, strength training and take a calcium supplement. Being a (mostly) compliant patient, I added the calcium supplement to my diet and once I healed up from the fracture, began ramping up my mileage and got back into the strength training.
Flash forward to this past May when I saw my medical oncologist for a follow up visit post-surgery and to discuss the hormone blockers he wants me to take for the next five to 10 years. He reviewed all of my records again, and finally said that he thought I should see an endocrinologist about the osteopenia. Because of the osteopenia, he won’t prescribe an aromatase inhibitor for me even though it would be the normal course of treatment for a woman of my age with the kind of cancer I have. All of the AIs cause bone loss, so that’s right out.
Long story not so long I saw the endocrinologist this past Monday. I really like him—he both listened and heard me and took the time to fully explore my medical history. Here’s a great example: he asked if I’d been on steroids for lengthy amounts of time (no, although I’ve been on them off and on for lung issues), and asked about other diseases that can cause bone loss (celiac disease, and rheumatoid arthritis to name two). Then he said, “what about anorexia?”
OK now that’s the first time any physician has asked about eating disorders that way. Usually health care providers say something like “do you have an eating disorder” and I don’t usually respond honestly (unless it’s active). And I don’t know if there was something in my chart that led him to go with anorexia instead of bulimia, but combined with that question and the open, easy way he was talking with me—zero judgment, truly looking for information—I was honest. Yes, I said, I have had episodes in the past, seems to happen about once a decade, I’m super stressed and I just can’t eat. But then things resolve or ease up and I’m able to eat again. And there was no judgment. He was piecing together my history, all of it, so he could figure out the best path to take with this bone issue.
I almost never disclose that part of my medical history, or the sexual abuse from my bio father, or the suicide attempts or psych treatment to my medical team. Part of that is I’m deeply, deeply private, and most of it is I see the conclusions they jump to, and I catch a whiff of judgment about all of it (no, it’s not in my mind). But he wasn’t that way and man, I felt almost giddy with relief.
Back to my bones. I've lost a quarter inch in height over the last couple of years. That didn't bother him although I'm bothered. I'm not so tall that I can throw away quarter inches here and there. He said that my left hip values actually indicate osteoporosis, not osteopenia as originally diagnosed, and because my right hip fractured, that counts as osteoporosis too. I was really bothered by that change in diagnosis, too.
He wants to rule out easy-to-fix causes of bone loss so he’ll check for celiac disease, and he’s also having me do a 24-hour urine collection so he can check to see if my kidneys are tossing away calcium. If both come back normal (or as he said, as boring as all the rest of my labs, where boring = healthy and normal), then I have three drug options to choose from to treat the osteoporosis. I’m working from home today doing the collection. I’ll take that jug to his office tomorrow between two other cancer-related medical appointments, and get blood drawn for the rest of those labs. Once I get the lab results, and assuming that I don't have an easy-to-fix cause for the bone loss, I’ll cross that drug choice bridge.
And because I’ve done strength training all my life (thank you, US Army, for the habits you instilled in me when I was young), I sure didn’t think I would have any issues with my bones. But I did, my DEXA scan wasn’t great and my PCP diagnosed me with osteopenia. He said it was mild, no need for any drug treatments and that I should continue with the running, strength training and take a calcium supplement. Being a (mostly) compliant patient, I added the calcium supplement to my diet and once I healed up from the fracture, began ramping up my mileage and got back into the strength training.
Flash forward to this past May when I saw my medical oncologist for a follow up visit post-surgery and to discuss the hormone blockers he wants me to take for the next five to 10 years. He reviewed all of my records again, and finally said that he thought I should see an endocrinologist about the osteopenia. Because of the osteopenia, he won’t prescribe an aromatase inhibitor for me even though it would be the normal course of treatment for a woman of my age with the kind of cancer I have. All of the AIs cause bone loss, so that’s right out.
Long story not so long I saw the endocrinologist this past Monday. I really like him—he both listened and heard me and took the time to fully explore my medical history. Here’s a great example: he asked if I’d been on steroids for lengthy amounts of time (no, although I’ve been on them off and on for lung issues), and asked about other diseases that can cause bone loss (celiac disease, and rheumatoid arthritis to name two). Then he said, “what about anorexia?”
OK now that’s the first time any physician has asked about eating disorders that way. Usually health care providers say something like “do you have an eating disorder” and I don’t usually respond honestly (unless it’s active). And I don’t know if there was something in my chart that led him to go with anorexia instead of bulimia, but combined with that question and the open, easy way he was talking with me—zero judgment, truly looking for information—I was honest. Yes, I said, I have had episodes in the past, seems to happen about once a decade, I’m super stressed and I just can’t eat. But then things resolve or ease up and I’m able to eat again. And there was no judgment. He was piecing together my history, all of it, so he could figure out the best path to take with this bone issue.
I almost never disclose that part of my medical history, or the sexual abuse from my bio father, or the suicide attempts or psych treatment to my medical team. Part of that is I’m deeply, deeply private, and most of it is I see the conclusions they jump to, and I catch a whiff of judgment about all of it (no, it’s not in my mind). But he wasn’t that way and man, I felt almost giddy with relief.
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| Collection jug |
He wants to rule out easy-to-fix causes of bone loss so he’ll check for celiac disease, and he’s also having me do a 24-hour urine collection so he can check to see if my kidneys are tossing away calcium. If both come back normal (or as he said, as boring as all the rest of my labs, where boring = healthy and normal), then I have three drug options to choose from to treat the osteoporosis. I’m working from home today doing the collection. I’ll take that jug to his office tomorrow between two other cancer-related medical appointments, and get blood drawn for the rest of those labs. Once I get the lab results, and assuming that I don't have an easy-to-fix cause for the bone loss, I’ll cross that drug choice bridge.
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