A few minutes ago, I got off the phone with my oncologist (Dr. Kenyon). I had a MUGA scan yesterday and he called me with the results. My "ejection refraction" (a measure of the percentage of total volume in your left ventricle that is ejected with each heart beat) was 41. Normal is 50 or higher. This means that I have some heart damage and therefore Herceptin is NOT recommended. Dr. Kenyon called me a "medical puzzle", meaning that because of my history and current condition, he's not quite sure how to advise me in terms of my treatment path. So, I am relieved because I won't have to do Herceptin (and endure another injection - yesterday for the MUGA scan, the techs stuck a needle in my three different times and couldn't get the vein! They had to call in an IV nurse - and now I have four needle marks with some bruising!). But the news was colored by the fact that I may have permanent heart damage.
Now, my heart damage may be due to the adriamycin, one of the chemo drugs I had five years ago, in which case, the damage may be permanent. Or, since I had the flu last week and may still be dealing with the after effects of the flu, it might be temporary damage due to a viral infection. In any case, Kenyon will consult with a cardiologist and ask this doctor how they want to approach the problem. I may, therefore, have to do more cardiac tests. Or, they may recommend waiting a couple of months, redo the MUGA scan and see if the damage is viral/temporary or adriamycin/permanent. So, now I wait to hear what they want to do in terms of my heart. Kenyon asked if there was any history of heart damage in my family and other than my dad having high cholesterol, my grandmother with high blood pressure, and my maternal uncle had heart bypass surgery, there isn't any. In other words, there isn't a strong family history. And, I've been able to live a more or less normal life activity-wise. I used to be a runner, but my knees have forced me to walk now; I play softball, volleyball, and tennis. I'm pretty active - I walk up steps, etc. So, there was no indication that I might have heart damage.
I had more or less decided that my treatment path included Herceptin and inducing menopause and go on aromatase inhibitors. Now, Herceptin isn't an option (although if the heart damage is temporary, then we'll go ahead with it). We're continuing with inducing menopause and I will have my first shot to chemically induce it on Monday. We'll do that for a couple of months until I have the surgery for the permanent implants and will have my ovaries removed at the same time.
Also, awhile back, Dr. Kenyon consulted with Dr. Livingston in Tucson and with the local tumor board. Their recommendation was to consider radiation to that area and the fact that I'm having implants is good because it's less likely that the radiation will hit the bones. So, I also have a consult with the radiation oncologists coming up.
Kenyon also mentioned that Livingston suggested a bone scan since a PET scan doesn't always pick up on bone cancer, so I may also have a bone scan in my future.
Livingston also suggested chemo as did Kenyon, but I'm refusing it since I still believe pretty strongly that it hasn't spread elsewhere and with this latest news that adriamycin may have caused permanent damage . . . I just don't want to chance other kinds of permanent damage with any of those other chemo regimens.
So, there you have it folks. I can't take Herceptin; I could take chemo but I have decided against it; I may have radiation; and I am going into menopause and may take aromatase inhibitors. The good news is that at least for now, I don't have to take Herceptin and the bad news is that I may have permanent heart damage.
I saw a local acupuncturist today and I liked her quite a bit. I'll work with her over the next few months and see if there are other ways to address my medical issues.
Everyone, have a happy Friday! I don't have any appointments tomorrow, which means that I can actually work 5 or 6 hours on work! I plan to work on one presentation/article and redo my "to do" list so I know how to prioritize my time in the next few weeks. Yippee! Take care, everyone.
Thursday, January 17, 2008