Tamoxifen vs Aromatase Inhibitors and Safety

PamEP - Wow, thank you for all of this. I will take a look at those links.

I always think it should be up to the patient in the end. I don't mind a doctor saying "I hear what you are saying, but here's what you need to think about..." like my BCS did when I told her I didn't want steroids given during surgery due to my diabetes and she said that it was used as a preventative for laryngospasm which could be fatal, so she wouldn't recommend forgoing it, because I don't know everything obviously.

I just hope that I am listened to. I'm certainly open to discussion. I just don't want to be steamrolled.

I just noticed that you and I were diagnosed almost on the same day - I was diagnosed on 7/29/2021. I also have Stage 1A, Grade 2 though with no node involvement (4 sentinels removed) and had a lumpectomy. Did you have your radiation yet? Are you starting hormone therapy in conjunction with radiation or after?

Hi jul (Jane). Thanks for responding to my post.

Yes, I am a very involved patient. An endocrinologist who was an excellent doctor, extremely smart, said to me once "No one cares about your health more than you do". I looked at him funny, as I was raised to never question authority, and he repeated it again. He told me never to forget that, because it's true. Not that doctors don't try to do their best for each patient, not that they don't care. But they do not care as much as you do about your own life and your quality of life.

Years ago we had a very sick kitty. Our vet referred us to a well-regarded animal hospital where we met with a doctor who had a great deal of experience. He formulated a plan, which we ran by our regular vet. He took one look at it and said - scientifically this makes sense, but for your kitty, it does not. It's way too aggressive for her and would do more harm with side effects than good. He looked at the whole of her, not just the studies that these meds would work. We ended up going back to the animal hospital and talking to the specialist, and he admitted that it was science that propelled him to formulate the plan, and our vet was right. At 18 yrs of age, with other health conditions, the plan WAS too aggressive.

I will share one more story. We suddenly lost our beloved dog in March of this year. She was taken to our regular vet for itching, and given a steroid shot. She was no better a week later, so went back and saw another vet in that practice. I sent a note along with a recap of the prior visit, reminding her that Abby had been given a steroid shot a week prior, just in case she failed to look at the history and notes. She put Abby on Cytopoint, antibiotics and an NSAID (Rimadyl). Had I been on my game, I would have researched these meds before I gave them to her. But I was busy starting my business, and didn't do what I usually do. So I blindly trusted what the vet prescribed. Unbeknownst to me, steroid and NSAIDs should never be given together or near each other in time. Our dog suffered a perforated intestine, sepsis, went into septic shock, required ER surgery, made it through the next day at we got a phone call at 1:30am that she had gone into cardiac arrest (most likely from the meds they were using to get her BP up) and died. Alone. We never got to say goodbye.

After Abby died, I called our vet (the one who treated her most often and who had given her the steroid shot) and told him she had passed away and that the 6 vets who had treated Abby had mentioned the steroid/NSAID combo as a contributing, if not the single cause factor. His response was "I give that all the time together". He is not a "bad" vet, he just is not as cautious with potential serious side effects as he should be.

This is deeply personal to every one of us, but if I am "saved" from a breast cancer recurrence, new occurrence by hormone therapy, but I die of a heart attack as a result of the medication that "saved" me from the recurrence, I don't consider that a good trade-off. Obviously I am aware that no drug is perfect, and each have very serious side effects. I just need to make sure that any MO considers MY risk factors seriously and treats me accordingly. If my individual risk of recurrence is 2%, but there is an 85% risk of a potential fatal cardiovascular event is that a good trade off if the hormone therapy only cuts that risk by 50% down to a 1% chance of recurrence? Obviously, MOs want to help the patient, they don't want ANY recurrence. But at what cost? Those are reasonable questions to ask of a doctor.

So that is why I am an involved patient. I have have had numerous instances of doctors not being careful, dismissing my medical history, downplaying the serious side effects of meds, ignoring me when I tell them I am extra sensitive to meds, and it has landed me in the ER multiple times.

So that is why I am "involved" and research, and ask questions. I know that no one on this board is me, but it's helpful to have knowledge from people in the same situation, just as it would have been helpful for me to have knowledge that steroids and NSAIDs can be a very dangerous, even deadly combination before I gave the prescribed NSAID to me dog. Yes, that's common veterinary medicine knowledge, but as a vet tech friend told me, vets make mistakes, they are busy, they miss things. Had I been on my usual "dog boards" I might have seen something like that, or I could have been warned if I had inquired.

So I will research so that I am educated and can ask the right questions. I will continue to ask questions of other people. I will listen and confer. I will respect the doctor's experience, but I will not be dismissed or steamrolled. If I have chosen the right oncologist, together, we will come up with a plan that takes everything into account - benefit of hormonal therapy, serious side effects of each, how my complicated medical history plays into the risk/benefit analysis. And I will visit with my cardiologist and my nephrologist and endocrinologist so that they can weight in. At the end of the day it's my decision, because it is my life, not the doctors.