Making sure I am healthy enough to be sick.

It's rather ironic. Today I spent the afternoon at Abbott Northwestern making sure that I am healthy enough to start chemotherapy. Please don't misunderstand. I wouldn't want to start chemo if there is something else going on that needs to be treated but it is rather ironic to think that I have to have diagnostic testing to be sure that I am healthy enough to tolerate something that is sure to make me sick.

Today I had a CT (computerized axial tomography) scan of my chest. According to Zander, breast cancer can metastasize in patients who had lymph nodes that were clear of cancer cells. He also told us that the most common site for metastases is the bones. What they are looking for with this test is metastases. I am hoping that it is negative! It's an easy test. They inject some iodine-based dye into your vein and you just have to lay still for a few minutes.

The other test that I had is called a MUGA (Multiple Gated Acquisition) scan which is an extremely useful noninvasive tool for assessing the function of the heart. The MUGA scan produces a moving image of the beating heart, and from this image several important features can be determined about the health of the cardiac ventricles (the heart’s major pumping chambers). It is more specific and sophisticated than an EKG or an ultrasound. I needed to have an IV placed so they could inject me with a couple of things. The first thing they injected was pyrophosphate which makes the red blood cells sticky. I needed to wait around for about 30 minutes for this to circulate then I was injected with technetium which is a radioactive tracer. This attaches to the red blood cells (because they are sticky from the first injection) and makes them visible to the gamma ray camera. After that I just needed to lay there for about 15 minutes while they took the pictures. The photo is of a MUGA scan in process...that's not me in the scanner!

The MUGA scan is needed because adriamycin (one of my chemo drugs) can be toxic to the heart. Researchers believe that it is dose dependend and that it is rare in patients getting 4-6 cycles of chemo but "there may be long-term cardiac effects that we don't know about" (Love, 2005, p. 426). Love goes on to note that recent long-term studies of adriamycin use in women with breast cancer have found that "few" have heart problems even 10 years after therapy. She does add that one of her patients did have cardiac failure requiring a transplant...Swell. The MUGA scan will be repeated during and after my chemo.

On the way home in the snow, I had plenty of time to think about my day. I had another IV, was injected with iodine-based and radioactive dyes and exposed to x-rays and gamma rays. All in the name of health. How could this be anything besides ironic? Am I healthy enough to be sick? Will I tolerate the side effects both in the short- and in the long-term? And here's where we get back to statistics...80% of women experience this...35% never have this...and a "few" experience this. How many is a few? What side of the statistics will I fall into.

If only Zander had a crystal ball.

Reference

Love, S. M. (2005). Dr. Susan Love's Breast Book, 4th ed. Cambridge, MA: DaCapo Press.