Wednesday, May 21, 2008

thumpity thump (or rather, whoosh, whoosh)

Last week, my appointment with my oncologist was cancelled. Apparently, he was very sick with a high fever. Having a cancer patient's selfishness, my first thought was, "Oh! It's good that I won't be coming into contact with him then!" Then, my more empathic self remonstrated and I wished him well, poor man.

The nurse who works with him was kind enough to confirm my CT results. The tech who did the scan (or rather her radiologist boyfriend) was right. My scan was clean and there is still no sign of cancer on the liver.

However, the nurse also told me that my heart scan revealed that my ejection fraction (the measurement of my heart's ability to pump blood) was down to 48%. Fifty-five per cent is considered normal (before I started treatment, my EF was 56%), so this is not as bad as it sounds. It is however, a fairly significant drop and likely an indication that the Herceptin is putting a strain on my heart (a common side effect of this drug).

This is not the first time this has happened. Adriamycin (the 'red devil') was also very hard on my heart, so we waited a couple of months to start the Herceptin, in order to give my heart a chance to rebound.

According to my oncologist, it is easier for the heart to recover from Herceptin than from Adriamycin. We've discussed the possibility of taking a break from Herceptin (while continuing with the chemo) if damage should occur, so I am confident that this is what he will suggest when I speak to him tomorrow.

I am really reluctant to stop the Herceptin, since it has worked so well for me. There is a voice in my head (one of several. You have them, too. Don't lie) yelling, "Don't mess with what's working!" But the truth is that it's not working if I need to start taking heart medication or worse, end up with heart failure.

So, if my oncologist suggests doing chemo only for the next couple of months, I will agree (what choice do I have?). I will wait for my heart to rebound (it's weird because I don't feel any different, really).

But I am just a little nervous.

And chemo won't be as much fun without the Demerol.


Dee said...

Hi Laurie,
Jeanne is here with me and we just wanted to say that whatever decision you make will be the one that's right for you. Jeanne says she will email you when she gets home - probably Thurs or Fri.

I had an ejection fraction of 41 (using a MUGA scan) in January and because of that, my doctor started me directly on Tykerb. The week before that, I had a pretty bad case of the flu - with a few days of chills and fever and a very bad sore throat that lasted three weeks. Sooo . . . I was referred to a cardiologist, who said that he didn't like MUGA scans and preferred echograms. So, I had an echo and my ejection fraction was in the high 50s (or maybe 60? can't remember). In the end, the radiologist thought that the MUGA might have underestimated my EF and the echogram might have overestimated it. Who knows? In the end, they think that the flu gave me a temporary case of cardiomyopathy.

I think in your case, if you've been using the same test and it has gone down, it is something to watch. I'm thinking that you had a cold or something recently and maybe that gave you some temporary cardiomyopathy?

Tykerb, that Jeanne calls the "son of Herceptin" is gentler on the heart. I like taking it - I don't need to get it via IV and take it in pill form every morning. And, it works on the blood-brain barrier.

We're thinking about you, Laurie. Hang in there.

laurie said...

Thanks, Dee (and Jeanne!). Thanks for this very helpful and supportive comment.

My onc tends to alternate between the MUGA and the echo...the last few tests have been MUGAs. I will ask him about the difference and the consistency of these tests. I have not been sick recently. I am not worrying too much yet, as I do think my heart will bounce back.

Hard not to worry a little, though...

Rebe said...

Laurie, are you on a weekly schedule of herceptin? Or every month? Possibly changing the schedule will give your body a chance to rest in between each dose. I'd stick with the herceptin as long as it's working. The tykerb Dee mentioned is what is used after herceptin stops working.

And if something ain't broke, don't try to fix it.