Limitations of Medical Tests and Chemo Toxicity

The life of a cancer survivor (because while I'm a patient, I'd rather be thinking of myself as a survivor) is never dull. I mean, no one's life is ever dull, but here in Cancer Land, it seems that there is always something going on. This week-end is a case in point.

I had an echogram of my heart last Monday, ordered by the cardiologist, who thinks that they are more accurate than MUGA scans for estimating the ejection fraction (EF) of your heart. (See my post entitled "I'm a Medical Puzzle OR Both Good and Bad News".) Dr. Kenyon called me Friday afternoon with the results. According to the echogram (which is an ultrasound of the heart), my ejection fraction is 65! Right up there in the normal range. A strong heart, etc.

So, Dr. Kenyon called the radiologist to ask about the MUGA results, which was 41 (below normal). The radiologist said, "It's possible that I underestimated it". Then he called the cardiologist, who said, "It's possible that I overestimated it".

Will this make a difference in how I'm treated? If you recall, the low EF was the grounds for not giving me onto Herceptin and putting me directly on Tykerb, a relatively new targeted therapy. Herceptin is given via IV and Tykerb is taken as five little orange pills every day.Dr. Kenyon said that, no, we'd continue with the current course. He even consulted with a breast cancer specialist who was down here from Portland. That doctor told him that if Tykerb seems to be working for me, then to keep with it, especially since it doesn't seem to affect the heart as much as Herceptin. I think (my opinion as I'm sitting here typing) is that I do have an increased risk of heart damage, because of the adriamycin I took before, so why push it? In other words, go the route where the long-term side effects may be lessened, which seems to be Tykerb. Okay. Fine with me.

Dr. Kenyon did say something along the lines that there are limits on these tests. I've decided that I'm going to average the two results, which gives me an EF of 53, which is normal. Cool. And, it seems that I won't have to worry about long-term heart damage while I'm on Tykerb.

On to chemo toxicity. Last week, on Tuesday, I started noticing mouth sores. My acupuncturist felt that my body was trying to rid itself of toxic heat, which was manifesting in the mouth sores, the dry skin on my face, how I felt thirsty and dehydrated, etc. I'd also started breaking out, first, with little white pimples, which is what Jeanne Sather in Seattle has had to deal with while on Tykerb. But the past few days, my chin and nose really started to break out with what I call larger, red, angry pimples. Then, Friday night and through Saturday, I noticed that my gums and my lips started to feel inflamed. One of the other moms of a student in Eddie's class brought me enchiladas for dinner on Thursday - I had some on Friday, too. (They were delicious, by the way!!! Thanks, Norma!) On Friday, when the enchilada sauce got on my lips or my gums, boy, it felt like those tissues were going to catch fire! They felt inflamed all through Saturday, even with the pizza I had for lunch. My acupuncturist did tell me to stay away from spicy foods. Now I believe her! I'm not sure I'd say it was painful, but it sure didn't feel good. So, I swished with the aloe vera juice several times last night, to cool things down. I'd also started putting aloe vera gel on my face - to cool things down, keep the skin moist, and hopefully the antibiotic properties of the gel would help the breakout.

I also decided NOT to take the very last dose of Xeloda for this two week period. (I take Xeloda for two weeks, then I'm off a week; I skipped the last dose on day 14.) I figured that my body was trying to tell me that I'd had enough. Guess what, I woke up this morning, and while I still had the little whiteheads, the red, angry, bigger pimples weren't there. My mouth and my lips don't feel inflamed and there's only one sore remaining. It was the right choice. I'll talk to Dr. Kenyon about dosing when I see him on Wednesday.