Jury Duty

I received a jury summons. While the court claims to enforce six feet of social distancing, their video about covid precautions shows that the seats in the jury box are not spaced far enough apart.

When I talked to my doctor last week, she said I'm moderately immunocompromised. In my response to the court online, I asked to be excused and uploaded a letter from my doctor. Now I wait to see if they accept or reject my request.

Zometa Side Effects

At my every-three-weeks infusion Friday, I was given a new drug, Zometa. It has a long list of side effects: dizziness, headache, flu-like symptoms (such as fever, chills, muscle/joint aches), cough, vision problems, diarrhea, constipation, tired feeling, joint or muscle pain.

The side effect I was most concerned about was dizziness. But my doctor was most concerned about pain. I was given Tylenol before the infusion and directed to take more when I get home. The infusion lasted only 20 minutes. I felt fine in the evening, just a little bit tired.

The next morning I went to the farmers market. After I got home, I felt very tired and had to take a nap. That's when I got the flu-like symptoms. I didn't feel well at all and was shivering even though I didn't really feel cold. I didn't bother taking my temperature because I had taken Tylenol.

In the afternoon I got up to eat and attend my support group session. After the session ended, I went back to bed and slept fitfully till the next morning. At one point I woke up and noticed muscle pain in both arms, joint pain in the fingers of my left hand, and muscle pain in both thighs. Thank goodness I took more Tylenol or the pain would have been worse. 

Most of the pain was gone by morning. I still felt tired but was fine after a few hours. The side effects lasted 48 hours. My doctor said they usually last 24-72 hours.

I will get Zometa every six months.  The dose I was given was 3 mg, which is what the endocrinologist suggested a couple of weeks ago. The good news is that the side effects usually happen at the first infusion only. But not always. For some patients it happens at every infusion. 

Endocrinologist Consult

My next phase of treatment is to take an aromatase inhibitor (AI) pill daily for 5 years. AI causes bone loss. Since I already have osteoporosis, I will be given an IV infusion of a bisphosphonate called Zometa every 6 months to minimize bone loss. However, side effects of bisphosphonates include atypical femoral fractures (AFF) and osteonecrosis of the jaw. 

The risk of AFF is higher for Asian women, and that's what I'm most concerned about. I had a visit with Dr. Deborah Kado at Stanford yesterday. She said I should be more concerned with hip fracture than AFF. She recommended the following. I'll just paste what she entered in the visit notes.

1. Agree with recommendation for IV Zometa for 3-5 years, particularly if she is to start an AI. Given patient's body size and Asian heritage (that is associated with increased AFF risk per Kaiser Southern California data as well as Canadian data), may consider a slightly decreased dose of 3mg every 6 months instead of 4 mg (though there are no trial data to support this recommendation). Asian treating MD's from Taiwan, Toronto and Japan have recommended decreased bisphosphonate doses in Asian females because of the elevated AFF risk. 
2. Vitamin D3 supplementation, 1,000-2,000 IU daily; may recheck level in about February (target is 30-50ng/mL of Vitamin D 25-hydroxy level
3. Calcium intake up to 1200 mg daily, preferable through dietary sources (see sources below)
4. Diet full of daily fresh fruits and vegetables
5. Work on balance daily, mindful of posture 3 times daily (see handout below)
6. Visit the dentist regularly, and floss daily
7. When move to Kaiser (possible plan), recommend Dr. Joan Lo to follow-up on osteoporosis clinical care. 

I will probably take a break from Zometa after 5 years. My Vitamin D level last January was 32. The balance recommendation is probably so that I don't fall and break my hip. The dentist is for avoiding osteonecrosis of the jaw. #7 mentions Kaiser because I will have to switch insurance soon. More on that later.