Concerned about the side effects of anastrozole

Posted by tinalove @tinalove, Jan 31, 2016

I completed all treatments for breast cancer but now I am supposed to take hormone blocker, named anastrozole. im concerned about the side effects. Has anyone here taken it and did anyone have hair loss?

Interested in more discussions like this? Go to the Breast Cancer Support Group.

@einnoc

I had osteopaenia going in to treatment, and my experience(s) while on Anastrozole for 7 months, including my left knee totally blowing out and putting me in a wheelchair for 6 months, has led me to the very likely conclusion that the knee collapse (of an already fragile joint) was exacerbated by Anastrozole. I started out with the intention of being treated, start to finish, by Genesis in Davenport, given very bad interactions at Trinity in Moline since 2018. I wouldn't even go to Trinity for a simple mammogram after 2018, but the pandemic upended my plans to avoid the Illinois side of the river and the 33 radiation treatments I was told I needed, which was a fairly lengthy process, as you can imagine, did not help, so, having been told that I didn't even need an oncotype, I interpreted that to mean that my b.c. was a garden variety tumor that could just as easily be treated locally. Not sure that was a wise decision, but it is why I ended up back at Trinity and not at Genesis, where I had already selected a surgeon (Dr. Hartmann), who, among other pandemic crises, totally disappeared without a word to the patient(s) as to where he had gone or when he would be back. (It was very weird that those of us whom he was supposed to operate on were not told anything about the sudden cessation of his office. Since I had done some reading on optimal times to have surgery and knew that simply "hanging around" for months wasn't ideal, I tried to be positive and gave in to the idea of going to the much-closer Trinity for the radiation, despite bad experiences there during a breast biopsy in 2018. The reason I have not gone forward with more active treatment for bone loss is that I am "borderline" currently and the discussion(s) on taking biphosphanates (among other things) and on the veracity of Dexa scans are everywhere. With a T score of -2.2T currently, I filled, but did not take, such a pill. It was prescribed me by my endocrinology team at my request. I was told to step up my calcium intake (with D and K) and did. (There is some information out there about whether or not an uptake in calcium can contribute to heart attacks and strokes, so taking 600 mg. in the morning and 600 mg. at night is about all I've done, so far. My next trip in to see the endocrinology team is in early May. Meanwhile, I've been locked into major dental work ($10,000) since November and was glad I could truthfully say I had not taken the biphosphanates that they feared might weaken my jawbone prior to their implant procedures.

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I understand the need to avoid certain drugs while undergoing dental procedures; I postponed Prolia for a year for similar reasons. As to calcium supplements, I recently read an article by the Cleveland Clinic which shares the heart concerns for too much calcium in the blood. However, that's only if using supplements as opposed to the many calcium sources in our food which can have the opposite effect.
https://health.clevelandclinic.org/too-much-calcium-supplements

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@bevandjim4

I was on Anastrozole 18 months and stopped it because I felt like I was dying. My mammogram showed no growth but decided I would rather take the chance with breast cancer. I’ve been battling thyroid cancer since 2001 and have had 7 surgeries on my neck. Headed back to Houston to see if there’s another clinical trial for me since we just found out that the thyroid cancer has started growing again. I’ve had a trachea tube since 2017. In 2013 I had renal cancer in my right adrenal gland. Had that removed and found out I had breast cancer in 2022. So when the Anastrozole made me so sick I quit it. Will see what the Drs at MD Anderson have to say. I’ve been going there since 2004. I love to bake and the Anastrozole made me so tired that I couldn’t do it anymore. Been off for about 12 days and am back to cooking and baking.

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@bevandjim4, I also invite you to join the discussions in the Throid Cancer support group here https://connect.mayoclinic.org/group/thyroid-cancer/

In particular, see this discussion:
- Anyone else had thyroid tissue regrowth after a total thyroidectomy? https://connect.mayoclinic.org/discussion/thyroid-growing-back/

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@robbihm

You’ve given me some hope. I start Anestrzole in June. I’m 58. No joint pain and fairly fit so I’m just hoping I might do okay.

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Good idea to give it a go. Lots of people like me have minimal side effects. And I don't worry about recurrence. (Am sure my family would if I had ignored medical advice!)Make sure you have a bone density test first to establish a baseline, and have them regularly.

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@einnoc

Hearing the remark from an oncologist at MD Anderson that Anastrozole is "the drug best tolerated by their patients" makes me less likely to go to MD Anderson. If I did go there because of their reputed expertise, I'd ask you for the name of the oncologist who made that statement so I could avoid that person. Anastrozole has semi-crippled me and caused me the most pain I have ever experienced from anything in 76 years of life; I find it very difficult to swallow that individual's remark without some sort of statistical data to back it up.

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Anastrozole seems to be the drug of choice in Australia for estrogen-fed cancers. We have some world leading cancer research centres here. I've been taking it for two years with very few side effects, if any.

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@freckle1

Anastrozole seems to be the drug of choice in Australia for estrogen-fed cancers. We have some world leading cancer research centres here. I've been taking it for two years with very few side effects, if any.

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Happy to hear that you are having few side effects.
I had every side effect in the book and then my left knee blew out, leading to injections of anti-inflammatory drugs (32 ml of one; 6 ml of Durolane; Tramadol for pain) and I could not walk for over 6 months. After the meniscus-tear-like symptoms abated, my left knee (which was injured in a bicycling accident in 1997) did not return to "normal." I have to brace it to walk at all, and it doesn't appear that it is ever going to be "right" again. The thing is, I had been in a nationwide study (the MOST study) of those with a family history of arthritis and/or previously damaged joints from 1997 to 2020. I made numerous trips to Iowa City, Iowa to the University of Iowa Hospitals and Clinics and was X-rayed (hips, knees) and had MRIs of my left knee each and every time, to track the disintegration of my/our fragile joints. With that history, I should never have been given any of the A.I. drugs and told the only side effect was "a little stiffness in your hands and fingers when you wake up first thing in the morning, and it goes away when you quit taking it." Because I am also a Type II diabetic I also know that my bone density declined from -1.4T to -2.4T during this time, which is from osteopaenia to osteoporosis, which gives me a whole new set of problems to deal with. It's not enough to have to worry about my onco score of 29 and diabetes and fibromyalgia, now I get to debate whether or not to take biphosphanates for bone loss/osteoporosis. I'm in the midst of $10 grand worth of dental work right now from 2 teeth simply splitting below the gumline, and my dental insurance tops out at $1500 annually. So, while I am happy to hear that others are dodging the Anastrozole bullet, it got me right where I live, and taking Anastrozole has caused me a great deal of pain, suffering and money. A good doctor would have told me to avoid A.I. drugs and possibly recommended Tamoxifen, which does not "inflame" joints and attack your bone density to quite the extent that Anastrozole, Laetrozole and Exemestane can, Obviously, my oncologist in a smallish rural area was not great, not informed, and not helpful. He only saw me 2 times in 8 months and he still denies that the side effects I mention above had anything to do with taking Anastrozole from Feb 1, 2022 until my knee blew out (Sept. 15, 2022). I've changed doctors, but the damage is done and appears to be irreversible.

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@einnoc

Happy to hear that you are having few side effects.
I had every side effect in the book and then my left knee blew out, leading to injections of anti-inflammatory drugs (32 ml of one; 6 ml of Durolane; Tramadol for pain) and I could not walk for over 6 months. After the meniscus-tear-like symptoms abated, my left knee (which was injured in a bicycling accident in 1997) did not return to "normal." I have to brace it to walk at all, and it doesn't appear that it is ever going to be "right" again. The thing is, I had been in a nationwide study (the MOST study) of those with a family history of arthritis and/or previously damaged joints from 1997 to 2020. I made numerous trips to Iowa City, Iowa to the University of Iowa Hospitals and Clinics and was X-rayed (hips, knees) and had MRIs of my left knee each and every time, to track the disintegration of my/our fragile joints. With that history, I should never have been given any of the A.I. drugs and told the only side effect was "a little stiffness in your hands and fingers when you wake up first thing in the morning, and it goes away when you quit taking it." Because I am also a Type II diabetic I also know that my bone density declined from -1.4T to -2.4T during this time, which is from osteopaenia to osteoporosis, which gives me a whole new set of problems to deal with. It's not enough to have to worry about my onco score of 29 and diabetes and fibromyalgia, now I get to debate whether or not to take biphosphanates for bone loss/osteoporosis. I'm in the midst of $10 grand worth of dental work right now from 2 teeth simply splitting below the gumline, and my dental insurance tops out at $1500 annually. So, while I am happy to hear that others are dodging the Anastrozole bullet, it got me right where I live, and taking Anastrozole has caused me a great deal of pain, suffering and money. A good doctor would have told me to avoid A.I. drugs and possibly recommended Tamoxifen, which does not "inflame" joints and attack your bone density to quite the extent that Anastrozole, Laetrozole and Exemestane can, Obviously, my oncologist in a smallish rural area was not great, not informed, and not helpful. He only saw me 2 times in 8 months and he still denies that the side effects I mention above had anything to do with taking Anastrozole from Feb 1, 2022 until my knee blew out (Sept. 15, 2022). I've changed doctors, but the damage is done and appears to be irreversible.

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I am so sorry you have had all these terrible side effects of this medication. I honestly was going down the same road with it and I told my dr no more. I had a knee replacement about 10 years ago and the medicine was affecting the other knee and joints. My oncologist told me to stop with the anastrozole and I am now awaiting what my next medication will be. I do not want the cancer to return but I cannot live the way I was on that medicine. It affected every part of me. My oncologist stated my blood tests reveal I am not far into menopause, and he thinks that may be why my I'm experiencing the problems I am. If the next one does the same thing, I will trust God and come off of it. I cannot go 5-10 years in that condition. I pray you get some relief and help. Praying for you.

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@traci999

I am so sorry you have had all these terrible side effects of this medication. I honestly was going down the same road with it and I told my dr no more. I had a knee replacement about 10 years ago and the medicine was affecting the other knee and joints. My oncologist told me to stop with the anastrozole and I am now awaiting what my next medication will be. I do not want the cancer to return but I cannot live the way I was on that medicine. It affected every part of me. My oncologist stated my blood tests reveal I am not far into menopause, and he thinks that may be why my I'm experiencing the problems I am. If the next one does the same thing, I will trust God and come off of it. I cannot go 5-10 years in that condition. I pray you get some relief and help. Praying for you.

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I was 76 years old when I was put on Anastrozole. I had given birth to two children (one a 9 lb. boy) and had an abdominoplasty (major surgery), plus various dental things (root canals, crowns) but the pain I experienced from Anastrozole was a 10 on a 10-point scale and the worst pain I have ever experienced from anything. I was up in the night rummaging through my bathroom drawers trying to find something---anything---that could help with the pain. For instance, I knew I had left-over oxycontin from a root canal, but, in reading the contraindications, I learned that you cannot take it with a benzodiazepam and I take Lorazepam nightly (1 mg.) to sleep, so that was out. Throughout this frustrating (and painful) experience I was never asked how I was doing by my oncologist and I also found myself on the phone talking to 3 places (Medicare 2x; Des Moines; and the Trinity Hospital billing people) trying to sort out why Medicare had denied payment for the bone scan that my oncologist finally got around to ordering for me that took place in late May. (Keep in mind that I should have been given a bone scan prior to starting on Anastrozole, which I had been on since Feb. 1, 2022.) My back was absolutely killing me and the weird thing was that I had never had back pain prior to taking Anastrozole, although, when I delivered my second child (at the age of 42) and they injected my spine with the epidural, the pain was significant and the anaesthesiologist had commented that the reason it hurt so much more in 1987 than in 1968 was because "You're a lot older now, and you probably have arthritis in your spine." I credit that latter comment with being the reason I could just barely function with the pain in my back, whereas I had never in 76 years of life had what you would call "a back ache," although there were times that I would go lie in the hottest bath water I could stand to alleviate some stiffness. But pain? Yikes! The pain was horrific, and just never quit. I had insomnia for the entire 7 months of faithfully ingesting 20 mg. of Anastrozole daily, and nobody (but me) really seemed to care. Nevertheless, I persevered, doing what was asked of me, pushed to the breaking point. The breaking point came on 9/15/2022 when I was simply walking along a Chicago street on my way to meet a girlfriend for lunch. There was no injury, like a fall. My left knee simply quit working and became extremely painful, to the point that I had to call an Uber to get home. (The restaurant was going to be a 1.8 mile walk, round trip, so it was not a huge distance. My girlfriend had selected it to save me the horrendous cost of driving my car to the joint and then having to pay the inflated parking rates charged in Chicago.) i struggled down Michigan Avenue to a convenient care that is roughly one block away, after the Uber delivered me to my Indiana Avenue digs. I was X-rayed (no break) and the doctor who saw me said I needed injections, which required a more specialized facility that could give those injections. I had seen ads for a joint pain clinic located in Oak Brook and called them. They sounded like exactly what I needed, but it meant driving there in Rush Hour Chicago traffic (I don't live in Chicago full time, but have a place there.) I made an appointment and gave myself 3 hours to make it there and it took all but 15 minutes of that 3 hours. The Dr. on Michigan Ave on 9/19 (4 day after the injury) had given me a prescription for pain medication, but I was so crippled up that I couldn't walk across the street to the pharmacy to pick it up, and I know almost no one in Chicago who might have helped me. So, I drove to Oak Brook where a board certified doctor who had once practiced in Dubuque (Iowa) X-rayed me again and recommended that I come in for a series of injections over time (14 in all). The problem with that was that I was leaving for Texas for the winter in less than a week. I had to secure a cane and a wheelchair and I decided (after consulting with my hometown doctors at the OAR in Moline, IL) to hope that the problem was a meniscus tear that might repair itself in time. (My Moline doctors said that they could SEE cartilage on the surface of my patella in their x-rays). Therefore, I was reduced to hobbling with a cane, bracing my left knee and rationing the few Tramadol (50 mg.) pain pills I was able to secure. I only got 15 of them, total. These had to be used judiciously to help me as I attempted to cover SXSW, which required me to stand for long periods (not to mention walk in and out). I was Red Carpet for "A Small Light," a National Geographic special about the woman who hid Anne Frank and even had an interview with the principal actresses in that award-winning piece, but it was tough. I was just fortunate that a nice elderly lady, seeing my plight, let me enter the theater in advance of the arrival of the cast to walk the Red Carpet, and then I was able to hobble back out to the Red Carpet at the Stateside Theater when they actually showed up. The other side effects of the Anastrozole included brain fog, blurry vision (attributed to dry eyes by the otphalmologist), teariness, mood swings, excruciating body aches and pains in any damaged joint and in my back, the aforementioned insomnia, and vivid violent nightmares. My surgeon, (who actually did see me and acted like he cared whether I lived or died), after listening to my side effects, went to his office phone himself and called my oncologist's office, saying, "You need to see this patient." I don't think my oncologist would have bothered to meet with me on October 6th (3 days after my first post-operative mammogram) if Dr. McKenzie had not called. During the meeting with me Dr. McKenzie, hearing of my logical concern about recurrence (the oncologist had refused to order an oncotype, so I had no data to work from) suggested that I might request that a ki67 test be done on the tumor to gauge its aggressiveness, which would give me some peace of mind. During the October 6th meeting that resulted from the surgeon's phone call to the oncologist's office, I (finally) got to ask the oncologist face-to-face for the ki67 Dr. McKenzie recommended. His response was to say, "I won't order that for you. You'll have to get someone else" and to get up and walk out! I had tried to tell him of all of the side effects I was experiencing at an earlier point and his response then was to say, "Don't take it then" and to get up and walk out. When I saw him on October 6th (my last time of putting up with this guy) I was in a wheelchair and he adamantly denied that the Anastrozole could have been a precipitating factor in my crippling, saying, "You're just old." I now doctor in Iowa City (a 3 hour drive) and in Texas, where the attitude is quite a bit more in line with the compassion that we all deserve.

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Has anyone had any increase in blood pressure and/or any cardiac issues while taking Anastrazole?

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@einnoc

I was 76 years old when I was put on Anastrozole. I had given birth to two children (one a 9 lb. boy) and had an abdominoplasty (major surgery), plus various dental things (root canals, crowns) but the pain I experienced from Anastrozole was a 10 on a 10-point scale and the worst pain I have ever experienced from anything. I was up in the night rummaging through my bathroom drawers trying to find something---anything---that could help with the pain. For instance, I knew I had left-over oxycontin from a root canal, but, in reading the contraindications, I learned that you cannot take it with a benzodiazepam and I take Lorazepam nightly (1 mg.) to sleep, so that was out. Throughout this frustrating (and painful) experience I was never asked how I was doing by my oncologist and I also found myself on the phone talking to 3 places (Medicare 2x; Des Moines; and the Trinity Hospital billing people) trying to sort out why Medicare had denied payment for the bone scan that my oncologist finally got around to ordering for me that took place in late May. (Keep in mind that I should have been given a bone scan prior to starting on Anastrozole, which I had been on since Feb. 1, 2022.) My back was absolutely killing me and the weird thing was that I had never had back pain prior to taking Anastrozole, although, when I delivered my second child (at the age of 42) and they injected my spine with the epidural, the pain was significant and the anaesthesiologist had commented that the reason it hurt so much more in 1987 than in 1968 was because "You're a lot older now, and you probably have arthritis in your spine." I credit that latter comment with being the reason I could just barely function with the pain in my back, whereas I had never in 76 years of life had what you would call "a back ache," although there were times that I would go lie in the hottest bath water I could stand to alleviate some stiffness. But pain? Yikes! The pain was horrific, and just never quit. I had insomnia for the entire 7 months of faithfully ingesting 20 mg. of Anastrozole daily, and nobody (but me) really seemed to care. Nevertheless, I persevered, doing what was asked of me, pushed to the breaking point. The breaking point came on 9/15/2022 when I was simply walking along a Chicago street on my way to meet a girlfriend for lunch. There was no injury, like a fall. My left knee simply quit working and became extremely painful, to the point that I had to call an Uber to get home. (The restaurant was going to be a 1.8 mile walk, round trip, so it was not a huge distance. My girlfriend had selected it to save me the horrendous cost of driving my car to the joint and then having to pay the inflated parking rates charged in Chicago.) i struggled down Michigan Avenue to a convenient care that is roughly one block away, after the Uber delivered me to my Indiana Avenue digs. I was X-rayed (no break) and the doctor who saw me said I needed injections, which required a more specialized facility that could give those injections. I had seen ads for a joint pain clinic located in Oak Brook and called them. They sounded like exactly what I needed, but it meant driving there in Rush Hour Chicago traffic (I don't live in Chicago full time, but have a place there.) I made an appointment and gave myself 3 hours to make it there and it took all but 15 minutes of that 3 hours. The Dr. on Michigan Ave on 9/19 (4 day after the injury) had given me a prescription for pain medication, but I was so crippled up that I couldn't walk across the street to the pharmacy to pick it up, and I know almost no one in Chicago who might have helped me. So, I drove to Oak Brook where a board certified doctor who had once practiced in Dubuque (Iowa) X-rayed me again and recommended that I come in for a series of injections over time (14 in all). The problem with that was that I was leaving for Texas for the winter in less than a week. I had to secure a cane and a wheelchair and I decided (after consulting with my hometown doctors at the OAR in Moline, IL) to hope that the problem was a meniscus tear that might repair itself in time. (My Moline doctors said that they could SEE cartilage on the surface of my patella in their x-rays). Therefore, I was reduced to hobbling with a cane, bracing my left knee and rationing the few Tramadol (50 mg.) pain pills I was able to secure. I only got 15 of them, total. These had to be used judiciously to help me as I attempted to cover SXSW, which required me to stand for long periods (not to mention walk in and out). I was Red Carpet for "A Small Light," a National Geographic special about the woman who hid Anne Frank and even had an interview with the principal actresses in that award-winning piece, but it was tough. I was just fortunate that a nice elderly lady, seeing my plight, let me enter the theater in advance of the arrival of the cast to walk the Red Carpet, and then I was able to hobble back out to the Red Carpet at the Stateside Theater when they actually showed up. The other side effects of the Anastrozole included brain fog, blurry vision (attributed to dry eyes by the otphalmologist), teariness, mood swings, excruciating body aches and pains in any damaged joint and in my back, the aforementioned insomnia, and vivid violent nightmares. My surgeon, (who actually did see me and acted like he cared whether I lived or died), after listening to my side effects, went to his office phone himself and called my oncologist's office, saying, "You need to see this patient." I don't think my oncologist would have bothered to meet with me on October 6th (3 days after my first post-operative mammogram) if Dr. McKenzie had not called. During the meeting with me Dr. McKenzie, hearing of my logical concern about recurrence (the oncologist had refused to order an oncotype, so I had no data to work from) suggested that I might request that a ki67 test be done on the tumor to gauge its aggressiveness, which would give me some peace of mind. During the October 6th meeting that resulted from the surgeon's phone call to the oncologist's office, I (finally) got to ask the oncologist face-to-face for the ki67 Dr. McKenzie recommended. His response was to say, "I won't order that for you. You'll have to get someone else" and to get up and walk out! I had tried to tell him of all of the side effects I was experiencing at an earlier point and his response then was to say, "Don't take it then" and to get up and walk out. When I saw him on October 6th (my last time of putting up with this guy) I was in a wheelchair and he adamantly denied that the Anastrozole could have been a precipitating factor in my crippling, saying, "You're just old." I now doctor in Iowa City (a 3 hour drive) and in Texas, where the attitude is quite a bit more in line with the compassion that we all deserve.

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I hope you will get the care you deserve with your new doctors.

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@baylaurel

I hope you will get the care you deserve with your new doctors.

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I hope so, too, Baylaurel. I am in search of the test or clinical trial that will seek out the errant cancer cells that too often lie dormant in our bodies until years after the discovery of the tumor and are (somehow) activated and come back to kill you. My Iowa City oncologist, upon meeting with me, said I was the healthiest of the 22 women he had seen that day and added, "Cancer isn't going to kill you. Something else will kill you first." He is also the doctor who told me that, 3 years prior, the cut-off for having chemo was 29, not 25. That encouraged me, as I can consider my onco score to be "borderline" with that reasoning. Of course, I've seen the man 3 times. The first time he was (somewhat) dismissive of my concerns and, when I sent him the extensive litany of everything I had endured in the Illinois Quad Cities up to that point in writing, and asked him for a recommendation for a "good" oncologist in the Quad Cities, he said, "Why do you think everyone from the Quad Cities comes here for treatment?" and laughed. He is also the physician who told me, 3 days before I was to be radiated 33 times at Trinity Hospital in Moline, that Iowa City would not have radiated me at all! On my 2nd visit to see him, he said he was going to do a breast exam on my next (3rd) visit, which was in October. I went in October. No exam. In fact, I barely saw him at all. His "minions" did the work-up and the weighing and the blood pressure and he barely stuck his head in the door and said, "Hi" and left. He seems to be a very knowledgeable doctor and I like him well enough (although not as much as Dr. Uyeki in Austin who literally went to war with the hospital for me) and most of the time I tell myself that everything he has said to me, so far, lines up with the idea I originally had that, although I had b.c., my presentation was generally positive and, as Dr. Goswami at Genesis in Davenport said, "You did everything right. You're going to be fine." But then I remind myself that it was that "magical thinking" that kept me from going to Iowa City immediately (or Chicago, where I also have a place) and caused me to accept my Illinois oncologist's dismissive attitude and unwillingness to "go the extra mile" in ordering an oncotype, for instance, or humoring my surgeon and ordering a ki67. "Knowledge is power" and, given my college major, I felt and was powerless to advocate effectively for myself in the early days of treatment. I (sometimes) regret the chemo I didn't have as a result of my first oncologist's horrible attitude, and sometimes---given the side effects from everything that I have tried---I am glad I slipped through that crack. I wish I had listened to my friend's husband---a PhD from the Netherlands who researches in the area of cancers---and gone to a Top Notch hospital that was "rated" as one of the Best in the Nation, because the treatment and compassion shown me at the hospital nearest my home in Illinois fell down on many of those benchmarks. I was fortunate that we winter in Texas and I fell under the care of a doctor who is truly dedicated to saving his patients and spent time with me to hear me out and answer all my questions. It was particularly noteworthy because there was an ice storm that week and most of his regularly scheduled appointments had to be canceled (people in Austin don't know how to drive if there's ice). He spent over an hour with me. We were working on getting him all the information he needed to "go to war" to get my oncotype for hours, as I recounted which facilities I had had mammograms at over the years, and---ever since being treated very poorly at Trinity Hospital in Moline, Illinois during my 2018 biopsy, I had vowed to never go back there (That joke is on me, because it was the hospital I had to go to for the 33 x-ray treatments and my fears turned out to be more than justified.) Like all hospitals or schools, you can have a good doctor in a bad system, or you can have a bad doctor in a good system.

The verdict, for me, is out on the other parts of their system, since I do think that both my radiologist and my surgeon did their best and performed their duties well. (One could ask if the treatment was "cutting edge," since Iowa City did not agree that radiation was even merited). But the oncologist who has held sway there for years is truly a narcissist who, on paper, knows his stuff, but whose system of dealing with patients needs serious adjustment, for the good of both the patients and himself. I am still surprised that he hasn't been sued over situations like the one I only learned about (from my employees) after I had had it with him and his dismissive attitude.

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