What Now?

[Katweb]

In March-2007 ,I was diagnosed with Inflammatory invasive ductal carcinoma with lymph nodes involved(On the left breast).Had a 3 cocktail chemo prior to surgery. Taxoteer,carboplatin& herceptin every 3 weeks for over 4 months. Had the mastectomy, radiation for six weeks every day .We were to folow up with ayear of herceptin, after last ECHO &  PET scan the Dr. stopped the herceptin about 2 months short of the year.I am so glad about that.Now he has me waiting for a 3 month check up-where I understand another Pet& Echo will be done. The nurse gave me the cd ROM of the Pet scan on that visit.THE CONCULUSION ON TH ECHO"mildly dilated left ventricle with decreased ejection fraction of about 40%.-What does that mean? Also in same visit Dr. told me-looked like lymph nodes are effected to my right side on my lungs. Dr said he would talk to radation Dr., might be swollen from  the treatments he gave, I saw the cd & you can see the spot on the right  side lung for sure. I have set an appt a cardiologist which requested my records. My heart hearts so bad! other Dr. acts like its ok,Also with this 3 month waiting period I plan to see another Onocoligisist for 2nd opinion. will take CD Pet Scan & recent Echo with me & records. In the mean time, I have developed neuropathy in my hands,saw a nueroligist,, nurse ARNP-gave neurontin for pain, stops burning & jabbing, numbness always& locking up of fingers. She ordered a MRI to rule out the on set of MS, weakness in hands in legs. Will get report 20th of this wek . Had to go to another hospital I have medicaid w/ share of cost,only some hospitals will take this,as I have to meet my share of cost every month.I have questions on ,my heart & the spot on right side on lungs-concerned -in Fl

[Dennis MD]

Hi.
How are you feeling now?
Do you have a baseline 2D echo?  Your 2D echo showed depressed systolic function as evidenced by the 40% ejection fraction.  This could be the result of chemotherapy.  I agree with a referral to a cardiologist for further evaluation and management.
Do you have a previous PET scan?  Did your latest PET scan show increased tracer activity in the right side of the lung?  That can help in detecting whether you have a recurrence or not.  
You may ask for a second opinion from another medical oncologist.  

[Katweb]

I posted a very  detailed MSG from a  recent echo & pet scan. It took me a long time & w/ the neuropathy in my hands ,was very hard. I am sorry maybe I did something wrong in posting this back to you,I'm new @ this. Did you receive my answer on the echo & pet tests?

[Dennis MD]

Hi.
Just want to clarify whether you have a baseline 2D echo and PET scan before you started treatment.  That should be compared to your recent 2D echo and PET scan for any changes.
Chemotherapy can have an effect on the heart.  Herceptin can cause heart problem.  Your overall systolic function is depressed already.  With a depressed systolic function, there is a risk for heart failure.  That could be the reason why herceptin was discontinued and a referral to a cardiologist was suggested.
As for your PET scan result showing “spot on the right side of lung”, that could mean a recurrence of cancer.  But that should be investigated further to be more certain of what it is.
I agree with your decision to seek further opinion from another oncologist.

[Katweb]

Thanks again. I do have the orginals of the PET & ECHO & will look @ them tonight.Will keep you posted-Kathryn

[Katweb]

MRI conculsions on brain & spine reports came back. The brain : normal MR Brain without and with contrast! Thank God for that good report!
Please help me to understand the conculsion on the spine, here goes:
Degenerative disk disease with marginal spondylosis and focal protrusions multilevel. The findings produce encroachment of the neral foramen @ C-3 C-4  C-4 C-5 & C-6-C-7.Posterior lateral disk protrusion on the right  @ C-5 C-6 with marginal spurring comprises the spinal canal with flattening of the anterior lateral spinal cord and encroachment on the right neural foreman.
Also there is a asymmetric emlargement of th rightthyroid lobe. Evaluation with thyroid ultrasound recemmended. ....That was it.
Also my appointment with the cardioligist( because of the 40 % ejection enfraction, with the Hercepten) is set for  Monday 3/24/08. Thanks again, Dr. Dennis.
I hope my journey will help someone in  the community. At least to feel like we are not alone in this !!- Katweb

[Dennis MD]

Hi.
It’s good to know that your cranial MRI showed normal result.  The result of your spinal MRI showed degenerative changes that could be age related; and also some disc herniation.  That can explain the numbness and pain you are experiencing in your hands.  I suggest you bring this result to a neurosurgeon or spine surgeon for further evaluation.
Good luck on your appointment on Monday.  

[kattwebb]

Dont know if you got my last comment. As you can see the site would not take my last log in  & had to be katt-webb- with the extra t& b. Hope u get this one. I was in the hospital ,last week, thought I was having a heartatack. My second opinon heart Dr. came to me in the hospital,did a stress test on heart.He said normal was 55 mine was 60. That was a drug induced stress test. Dont know why they did not do an ECHO? Are they diffrent? Anyway, also had a ultrasound & biopsy on my thyroid & am now on synthroid.Had 2 nueoligists stoppedby-I am on nuerotin- for the nueopathy in my hands. Told them I was happy w/ my current Dr. for that.
Getting back to your last question: Do I have the old & newest Echo to compare? Yes I do.First was done11/6/07-last one 2/5/08-
1st interpretation:1. Tecnically a very difficult study w/ only really subcoastal views available.2.There appears to be grossly normal left ventricular function.  No M-Mode measurements available. 3.Poorly seen aortic valves,grossly normal.4. Right heart grossly appears normal. 5. Estimated Rv systolic pressure 26 w/ mild TR.  That was-11/6/07
Newest  Intrerpation: 2D and M-Mode evaluation of the cardiac chambers were obtained.Left ventricular end diastolic dimension appers to be normal. End systolic dimension apperars to be enlarged @ 4.3 cm. Left ventricular wall thickness apperars to be normal. Contractilly is globlally decreased @ about 40%. Left atrium appers to be of normal size. Aortic root apprears to be of normal size. This is technicall limited study due to lack of appropirate acoustic window due to mastectomy. Within the windows, mitral valve, tricuspid and aortic valve appear to be structurally normal and functioning well. if clinically indicated, reccommended resting MUGA scan for evaluation of left ventricular function.Conculsion !. Mildly dilated left ventricle with decreaced ejection fraction of about 40%.2. normal valvular function.  That was 02/05/08.
On my last PET scan-1/29/08-says, Chest-there has been a interval enlargement of a low right paratrecheal lymph node. This node measuring 13x11mm.This node