Loose Strife

This morning Laura and I (and Naomi) went to see the cardiologist. He listened and discussed her symptoms (lightheadedness, unsteadiness, occasional falling, fainting, low blood pressure, and lots of migraines). Like the rest of the doctors, he thought that everything except the low blood pressure was probably neurological and not symptomatic of a problem with her circulatory system. Still, he ordered another echocardiogram (fancy term for a heart sonogram) to compare to those from the time of her surgery. The echo was done right away and the cardiologist phoned with results this afternoon.
Laura’s heart function has decreased from “excellent” to the “low end” of “normal”. Damage (“toxicity”) to the heart is a well known side effect of one of her chemotherapy drugs called Adriamycin. There are standard procedures for monitoring dosage and heart response. This upcoming chemo round would have been the maximum allowable without augmenting her treatment with another drug that has been shown to protect the heart from Adriamycin’s toxicity (but isn’t administered from the beginning because it reduces the anti-tumor effectiveness of Adriamycin). After further chemos Laura would have been scheduled for a heart monitoring test similar to what she had today. The upshot of all this is that while heart damage is a well known side effect, it doesn’t usually appear so soon and with Laura’s current dosage.
Having a heart that functions at the low end of normal sounds bad, although there is that word “normal” still in there. We’re not clear yet on what it means for Laura’s long term health. But it probably means that she won’t be running any marathons and, in the long term, has an increased risk of heart failure. That risk was already present just by taking Adriamycin, but a weakened heart probably increases that risk.
This afternoon the cardiologist talked to Laura’s oncologist and we then also spoke with her onc to discuss the implications. If Laura’s CT and bone scans next Monday suggest that further chemotherapy is needed, then she would be switched to a different drug. As I mentioned in a previous post, more chemotherapy would likely be recommended if significant cancer progression or regression is observed (implying that either cancer is returning so more attack is needed or that cancer is still significantly retreating implying that more mileage can be gained by additional chemo treatments). If regression is modest, then Laura may go on a chemo break and her condition will be monitored to see if it remains stable.
In addition to the drop in heart function, the cardiologist also noticed a mass associated with the pericardium. He couldn’t say whether it was scar tissue or a blood clot from her surgery or if it was a tumor. The oncologist thinks that a tumor would be unlikely since other signs indicate cancer regression. The hope is that the so-called “contrast dye” high resolution CT scans on Monday will help resolve this question. If not, a different kind of scan called a PET may be done.
You might also be wondering about the migraine issues and possible drug interactions. Laura dropped one of her drugs, which was being prescribed primarily as an appetite stimulant, but that change had no apparent effect on the headaches, etc. She also changed her dosage of the anti-migraine drug so that she was taking two horse pills at night instead of 10 pills throughout the day. For the past three of four days she has had a return of severe migraines, frequently occurring throughout the day (once an hour and sometimes many in a single hour), and the headaches have even caused her to throw up a couple times. She changed back to her previous dosage schedule, but hasn’t seen any improvement, yet. So the dosage change may just be coincidental with the migraine recurrence.
It all takes us back to pre-hospital times last month, but Laura still says she’s feeling better than those days. She’s been in bed a lot again. I think the headache pain is fatiguing. But the temperatures have recently been up in the 40s, ice and snow have melted on the driveway and roads, and Laura took a slow walk outside for about 20 minutes yesterday. And she’s been eating a pretty normal diet.