Shoulder Still Frozen

Had my fifth physical therapy session on Tuesday. There's been no improvement in sideways motion of my shoulder, so I decided to stop the sessions. I'm hoping my shoulder will suddenly go back to normal this summer when it will have been two years since my frozen shoulder started. If not, I'll either request PT or see an orthopedist again. I had an x-ray done in February and saw an orthopedist then, but nothing out of the ordinary was found.

Lingering Side Effects

 It's been almost six weeks since my last Kadcyla infusion, but I still have some lingering side effects.

• Runny nose. My nose has always been runny, but it got worse with chemo and Kadcyla. It has eased up now but is still worse than normal. Occasionally I get a little bleeding.
• Split nails. My nails have gotten brittle and split quite often. I think I even lost the nail in my little toe but didn't notice till it had grown back. I bought a bottle of nail treatment with keratin that's applied like nail polish. It even smells like nail polish. It flakes off easily though, and I have to reapply it every couple of days.
• Acid reflux. I had been taking omeprazole (Prilosec) daily for a year and decided to stop a few weeks after my last Kadcyla. But I still get acid reflux, and now I burp a lot. So I'm back on omeprazole for a while.
• Bleeding gums. Not sure if Kadcyla is to blame for this. In the past when I'd notice bleeding, it goes away after a day or two. But for the past year, it happens quite often and in more than one location, and it takes a while to go away.
• Styes. I got a lot of styes from chemo and Kadcyla. I thought it had stopped, but I got another one a couple of weeks ago. Again, I don't know if Kadcyla is to blame for the latest stye.

I used to get fatigue after every infusion. At least it's gone now.

Port Removal

On February 28, my port was removed. They refer to the removal as a procedure, not minor surgery. But it was done in a surgical room by a PA, and I was prepped as if for surgery, complete with heart rate monitor and continuous blood pressure monitor. The only difference from surgery is that it was done under local anesthesia. 

Lidocaine injections are very painful, so I applied EMLA cream to my port area two hours before the procedure, hoping it would help with the pain. I thought it did initially, but at one point I went, "Ow!" when the PA injected the lidocaine too fast.

The procedure was like this except it took much longer, maybe 15-20 minutes. Because I've had the port for 15 months, a lot of tissue had grown around it, and the PA took her time removing it to avoid breaking the port.

I was nervous about the procedure and cried a bit at the beginning. Then I spent the rest of the time trembling in fear. A sheet was placed over my head, so I couldn't see what was happening, but I knew what was happening (thanks to the video 😛), and it scared me. If the PA noticed my shaking, she didn't say anything.

To close me up, she put in "a couple" of internal stitches. I think it was more like half a dozen. Then she applied glue on my skin. No bandage needed.

I didn't have much pain afterward. I took Tylenol at first, but in the evening, Tylenol wasn't helping, so I took Advil instead. One more Tylenol the next morning, and that was it. No more pain after 24 hours.

Last Infusion

My last infusion was on February 14. Just like traditional chemo, the side effects from Kadcyla are cumulative. I was mostly tired and slept a lot for the next week or so. The last couple of days I've been burping a lot too even though I still take omeprazole (Prilosec) daily. 

I was also given a dose Zometa. No side effects unlike the first time.

Tomorrow they will remove my port. Dreading the procedure. I hope it's not painful.

Busy January

I suppose I should update. Due to omicron, I put myself on lockdown for the month of January except for doctor's visits. Unfortunately I had many appointments in January:

2 blood draws
2 infusions
1 oncologist visit
1 echocardiogram
1 pap smear (cancelled after I checked in)
1 ultrasound
1 mammogram

In addition, there were also five other visits: twice to PAMF and twice to Stanford to get CDs of the mammograms and ultrasounds done at those facilities, and one visit to Kaiser to deliver the CDs. Even though all three facilities use Epic Systems for their medical records, they don't share the mammo & ultrasound files because they're too big.

I was due for a follow-up screening mammo in January, but it got changed to a 3D diagnostic mammo and ultrasound because I was concerned about recent skin changes on my breast -- darkened and scaly skin. They may be delayed effects of radiation. I also noticed a lump below my incision. It may be just scar tissue. The tests didn't show anything of concern.

After my last infusion, I felt very slight nausea off and on for two days. I always get Zofran before the infusion. It was only recently that I started feeling some nausea. It's happened only one other time, I believe in December.

That was #13 out of 14 infusions. Just one more left.

Billing Woes

Back in October, around the time that Pa died, Stanford sent me a bill for $324.52. This was odd because I had already paid my max out-of-pocket for the year. When I looked into the claim, it showed an NPI number (National Provider Identifier) for a doctor I've never heard of and was out of network. That's why Cigna only partially covered the claim.

My doctor's name is Jennifer L. Caswell-Jin. The doctor on the claim is Jennifer L. McNally. Same first name and middle initial. I remember having to make several phone calls to Stanford and Cigna and spending a lot of time on hold. Stanford finally agreed to review the claim. I believe I also asked Dr. Caswell about Dr. McNally, and she had never heard of her.

Stanford never got back to me, and the bill disappeared from my account, so I thought they fixed the problem and resubmitted the claim to Cigna. But this morning I received an email about the bill. It's back on my account. Stanford's billing department is closed today for the holidays. I called Cigna (and got a poor Filipina working on Christmas Day). They confirmed that the claim was not resubmitted.

I will have to try Stanford again on Monday. They'd better be open then. If they still give me problems, I can call Cigna and request a 3-way call with Stanford.

Update: The problem was on Cigna's end and has been resolved.

Kaiser Switchover Complete

My insurance coverage with Kaiser started on Nov. 1. I selected Dr. Zhuo as my PCP because I liked her  profile on the website. I had a phone visit with her on Nov. 8. She referred me to the oncologist recommended by someone in my support group. I had a video visit with Dr. Chuang on Nov. 17. 

That same day I also had a video visit with an endocrinologist, Dr. Vu. Unfortunately I could not get an appointment with Dr. Joan Lo in Oakland, the endocrinologist recommended by my Stanford endocrinologist. Dr. Vu said I could continue with the 3 mg Zometa dosage I received at Stanford.

On Nov. 21 I went to Kaiser Santa Clara for a blood draw. Unlike at Stanford, Kaiser does not do the blood draw on the same day as the infusion. That means I have to get poked with a needle twice as often. 

My infusion was the next day. The infusion center has only a few private rooms. Most have beds, but those are given only to patients that need a bed. Only two rooms are available to healthier patients. I was lucky and got a private room, but it was tiny and had a reclining chair instead of a bed. I prefer a bed because it makes it more convenient when applying ice packs to my hands and feet to avoid neuropathy. 

Overall the transition to Kaiser went smoothly, and my infusion was delayed by only five days. I was expecting a two-week delay. It's nice that Kaiser is only 5 minutes away, and they don't charge for parking.