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Old 11-21-2009, 05:09 PM   #1
DianneS
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Echocardiogram question

Hi ladies,

Ok...I did the Herceptin until Sept. '09. My echocardiograms have been staying at 71 since I began having them done last year. I had one in July that read 71 and then one done last week. It was 65.

I am wondering if echo changes are normal and why mine would drop 6 points. The doc said this is in the normal range and not to worry but of course I wonder why it would go down since I'm not on Herceptin and have not been since Sept. The only thing I did was begin on Tamoxifen Nov. 6, and I wonder if it could have affected the echo since I didn't feel great while taking it. I have since quit.

Any opinions? Thanks,
Dianne
__________________
Three years and 5 months NED
Dx: Aug 2008 right breast IDC with 50% of tumor DCIS, Stage II or IIA, tumor size: 2.1 cm
Grade 3
8/9 Richardson/Bloom test
ER+ weakly positive
Alred Score: 4 (suggesting I would strongly benefit from hormone therapy)
PR-,
HER2 positive +++
No vascular invasion
No lymph nodes involved
Surgery: Sept. 9, 2008 -Modified radical mastectomy, right breast. I chose to have a simple mastectomy on the left. Began Taxotere/Carboplatin/Herceptin November, 2008. Finished T/C March 2009. Finished #16 Herceptin Sept. 09. AI's and Tamoxifen made me sick. Began natural Tamoxifen which is Quercetin, I3C and a combo of other supplements. I am also a DES Daughter. There is now a link between DES exposure in utero and breast cancer!
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Old 11-21-2009, 05:17 PM   #2
tricia keegan
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Re: Echocardiogram question

I'm not sure Dianne, but maybe the herceptin was affecting it and it has'nt corrected itself yet?
My echo's went down to 58 by the time I finished herceptin.
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Dx July '05 IDC 1.9cm Triple positive 3/9 nodes positive
A/C X 4 ..Taxol/Herceptin x 12 wks then herceptin 1 yr
Rads x 36 ..oophorectomy August '06
Currently taking Arimidex..
June 2011 osteopenia/ zometa x1 yearly- stopped Zometa 2015 as Dexa show normal bone density.
Stopped Arimidex July 2014- Restarted Arimidex 2015 for a further two years on the advice of my Onc.
2014 Normal Dexa scan
2018 Mammo all clear, still NED!
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Old 11-21-2009, 05:24 PM   #3
Midwest Alice
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Re: Echocardiogram question

Hey Dianne,

I was so proud my MUGA score went up 9 points!! Yea!! My MDA Dr. said that they can swing up and down and not to be to excited about it. I had worked so hard to get my score up and was disapointed with his answer. So I decited to be excited about it any way!

So ........maybe they swing up and down and not to worry.
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04/08 age 50 III IBC Her2+++ ER/PR-8cm 14/14 Double M, Body and Brain CT/PET clear, ? on spine,Muga 53
06/08, 4 A/C, Neulasta
08/08, Herceptin/tax 12 every week
10/08, CT/PET clear, ? on pelvis, hips, MUGA 43, started Enalaprial for heart, Herceptin every 3 weeks
11/08 33Rads; 12/08 MUGA 48
2/09 MRI spine and bone scan, old mets to spine, Chest x-ray, blood work, IV NED,regular CPAP use,Zometa x6, first -flue like symptoms 2 days;Herceptin x3; stage 2 lymphoedema..sleeve and glove
4/09 Brain MRI - CLEAR; MUGA 54
7/09 chest ultrasound,
10/09 PET, brain and spin MRI NED Herceptin only. MUGA 59!!!
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1 Corinthians 10:13 "No temptation has seized you except what is common to man. And God is faithful; he will not let you be tempted beyond what you can bear. But when you are tempted, he will also provide a way out so that you
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Old 11-21-2009, 05:32 PM   #4
DianneS
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Re: Echocardiogram question

Hi Alice,

That's good it went up! I'm happy for you, and keep doing whatever you are doing to keep it going up. Are you exercising, or what?

A MUGA is different from an echocardiogram. One (MUGA) involves dyes and the echo does not. Just so ya know.....I am told an echo is better but I can't remember why the doc told me that. Both tests are good for finding out what the old pumper is up to.

Stay well,
Dianne
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Three years and 5 months NED
Dx: Aug 2008 right breast IDC with 50% of tumor DCIS, Stage II or IIA, tumor size: 2.1 cm
Grade 3
8/9 Richardson/Bloom test
ER+ weakly positive
Alred Score: 4 (suggesting I would strongly benefit from hormone therapy)
PR-,
HER2 positive +++
No vascular invasion
No lymph nodes involved
Surgery: Sept. 9, 2008 -Modified radical mastectomy, right breast. I chose to have a simple mastectomy on the left. Began Taxotere/Carboplatin/Herceptin November, 2008. Finished T/C March 2009. Finished #16 Herceptin Sept. 09. AI's and Tamoxifen made me sick. Began natural Tamoxifen which is Quercetin, I3C and a combo of other supplements. I am also a DES Daughter. There is now a link between DES exposure in utero and breast cancer!
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Old 11-21-2009, 05:38 PM   #5
DianneS
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Re: Echocardiogram question

Hi Tricia,

Top of the morning to you there in Eire! I believe it's a 9 hour difference? Or you're just up late

It's possible my score went down after my last Herceptin but strange that it was at a steady 71 the whole time I was taking Herceptin.

Did your score go back up? How long did it take? Did you notice anything different when it dropped a bit, such as energy levels, etc?

BTW I am Irish as well, have an Irish passport and would dearly love to visit Ireland again. My granddad was from Tipperary area. How is your weather there? We are having tons of rain and lots of wind here in western Canada but no snow yet.

Dianne
__________________
Three years and 5 months NED
Dx: Aug 2008 right breast IDC with 50% of tumor DCIS, Stage II or IIA, tumor size: 2.1 cm
Grade 3
8/9 Richardson/Bloom test
ER+ weakly positive
Alred Score: 4 (suggesting I would strongly benefit from hormone therapy)
PR-,
HER2 positive +++
No vascular invasion
No lymph nodes involved
Surgery: Sept. 9, 2008 -Modified radical mastectomy, right breast. I chose to have a simple mastectomy on the left. Began Taxotere/Carboplatin/Herceptin November, 2008. Finished T/C March 2009. Finished #16 Herceptin Sept. 09. AI's and Tamoxifen made me sick. Began natural Tamoxifen which is Quercetin, I3C and a combo of other supplements. I am also a DES Daughter. There is now a link between DES exposure in utero and breast cancer!
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Old 11-21-2009, 05:54 PM   #6
Midwest Alice
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Re: Echocardiogram question

Exercising yes ........... and.. lost 30+ lbs, gave up sugar, flour and processed foods, and take coQ-10.
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Alice
04/08 age 50 III IBC Her2+++ ER/PR-8cm 14/14 Double M, Body and Brain CT/PET clear, ? on spine,Muga 53
06/08, 4 A/C, Neulasta
08/08, Herceptin/tax 12 every week
10/08, CT/PET clear, ? on pelvis, hips, MUGA 43, started Enalaprial for heart, Herceptin every 3 weeks
11/08 33Rads; 12/08 MUGA 48
2/09 MRI spine and bone scan, old mets to spine, Chest x-ray, blood work, IV NED,regular CPAP use,Zometa x6, first -flue like symptoms 2 days;Herceptin x3; stage 2 lymphoedema..sleeve and glove
4/09 Brain MRI - CLEAR; MUGA 54
7/09 chest ultrasound,
10/09 PET, brain and spin MRI NED Herceptin only. MUGA 59!!!
1/11 Hip replacement 7/11 Hip 2 replacement
4/12 4 years!! Herceptin
6/12 start reconstruction finish in 12/12
2/14 Herception - 6 years!!!

1 Corinthians 10:13 "No temptation has seized you except what is common to man. And God is faithful; he will not let you be tempted beyond what you can bear. But when you are tempted, he will also provide a way out so that you
can stand up under it."

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Old 11-21-2009, 07:51 PM   #7
Laurel
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Re: Echocardiogram question

Dianne,

Your ejection fraction can change by 5 pts depending on the technician doing the echo. Believe me, 71 is stellar, and a 65 is also quite impressive! You can put one worry to bed tonight.
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Dx'd w/multifocal DCIS/IDS 3/08
7mm invasive component
Partial mast. 5/08
Stage 1b, ER 80%, PR 90%, HER-2 6.9 on FISH
0/5 nodes
4 AC, 4 TH finished 9/08
Herceptin every 3 weeks. Finished 7/09
Tamoxifen 10/08. Switched to Femara 8/09
Bilat SPM w/reconstruction 10/08
Clinical Trial w/Clondronate 12/08
Stopped Clondronate--too hard on my gizzard!
Switched back to Tamoxifen due to tendon pain from Femara

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Old 11-21-2009, 08:14 PM   #8
Jackie07
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Re: Echocardiogram question

Laurel's right. Sleep tight!

[MUGA is much, much more expensive than Echo. 'I think' as long as your Echo is within range, the doctor won't bother prescribing MUGA.]
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Old 11-21-2009, 11:21 PM   #9
DianneS
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Re: Echocardiogram question

ok, guys.....I will try and not worry too much about it.

I guess I should be more concerned that I can't take anything for my weak ER+. That's such a small group of women that I guess nothing much has been studied to see if we benefit, or not. Dang.

Dianne
__________________
Three years and 5 months NED
Dx: Aug 2008 right breast IDC with 50% of tumor DCIS, Stage II or IIA, tumor size: 2.1 cm
Grade 3
8/9 Richardson/Bloom test
ER+ weakly positive
Alred Score: 4 (suggesting I would strongly benefit from hormone therapy)
PR-,
HER2 positive +++
No vascular invasion
No lymph nodes involved
Surgery: Sept. 9, 2008 -Modified radical mastectomy, right breast. I chose to have a simple mastectomy on the left. Began Taxotere/Carboplatin/Herceptin November, 2008. Finished T/C March 2009. Finished #16 Herceptin Sept. 09. AI's and Tamoxifen made me sick. Began natural Tamoxifen which is Quercetin, I3C and a combo of other supplements. I am also a DES Daughter. There is now a link between DES exposure in utero and breast cancer!
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Old 11-21-2009, 11:53 PM   #10
SoCalGal
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Re: Echocardiogram question

Hi Diane
The LVEF can vary and anything over 50% is normal. My last test was 74%. The one before was 65%. I don't think there are symptoms until you are very low. Walking seemed to help mine increase or it was a cooincidence
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1996 cancer WTF?! 1.3 cm lumpectomy Er/Pr neg. Her2+ (20nodes NEGATIVE) did CMF + rads. NED.
2002 recurrence. Bilateral mastectomy w/TFL autologous recon. Then ACx2. Skin lymphatic rash. Taxotere w/Herceptin x4. Herceptin/Xeloda. Finally stops spreading.
2003 - Back to surgery, remove skin mets, and will have surgery one week later when pathology can confirm margins.
‘03 latisimus dorsi flap to remove skin mets. CLEAN MARGINS. Continue single agent Herceptin thru 4/04. NED.
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Old 11-22-2009, 06:36 AM   #11
Sheila
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Re: Echocardiogram question

Just as an FYI, if you have had reconstruction with an implant on the left as i have, it is very hard to get an accurate reading through an echo and ususally you will need a Muga scan....the implant blocks getting accurate results.
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L. Mastectomy 2/25/2002
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Old 11-22-2009, 10:37 AM   #12
Laurel
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Re: Echocardiogram question

Dianne,

Unlike Sheila I have not had any difficulty with my echos and my implants (silicone), however that may be dependent on our body types, positioning of the implant, etc. I prefer the echos as they do not involve any radiation and are very quick. Much is based upon the experience and skill of the technicians, and additionally on the skill and expertise of the M.D. interpreting the echo. I am really quite envious of that 71!

Did you have time to google around about Dim and Calcium D-glucarate?
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Dx'd w/multifocal DCIS/IDS 3/08
7mm invasive component
Partial mast. 5/08
Stage 1b, ER 80%, PR 90%, HER-2 6.9 on FISH
0/5 nodes
4 AC, 4 TH finished 9/08
Herceptin every 3 weeks. Finished 7/09
Tamoxifen 10/08. Switched to Femara 8/09
Bilat SPM w/reconstruction 10/08
Clinical Trial w/Clondronate 12/08
Stopped Clondronate--too hard on my gizzard!
Switched back to Tamoxifen due to tendon pain from Femara

15 Years NED
I think I just might hang around awhile....

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Old 11-23-2009, 10:56 AM   #13
Joan M
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Re: Echocardiogram question

Dianne,

A MUGA scan is usually considered the most accurate test of the left ventricle ejection fraction, which Herceptin affects. A low LVEF is a sign of possible congestive heart failure.

However, an echo can take the place of the MUGA. The MUGA is a nuclear test involving a shot in the vein of a radioactive isotope. In my case, and since I get other scans with contrast, I decided to switch to an echo last year, as there's no contrast medium.

As pointed out, the normal range of the LVEF is 50%-70%. A MUGA gives an exact percent. However, an echo is often reported in a range, because sometimes it's hard to get an exact number.

Unless you're having problems, the echo is fine.

Also, the protocol for Herceptin calls for discontinuing the drug if the LVEF score drops more than 10% between scans, even if the percentage is still within the normal limits.

Joan
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Diagnosed stage 2b in July 2003 (2.3 cm, HER2+, ER-/PR-, 7+ nodes). Treated with mastectomy (with immediate DIEP flap reconstruction), AC + T/Herceptin (off label). Cancer advanced to lung in Jan. 2007 (1 cm nodule). Started Herceptin every 3 weeks. Lung wedge resection April 2007. Cancer recurred in lung April 2008. RFA of lung in August 2008. 2nd annual brain MRI in Oct. 2008 discovered 2.6 cm cystic tumor in left frontal lobe. Craniotomy Oct. 2008 (ER-/PR-/HER2-) followed by targeted radiation (IMRT). Coughing up blood Feb. 2009. Thoractomy July 2009 to cut out fungal ball of common soil fungus (aspergillus) that grew in the RFA cavity (most likely inhaled while gardening). No cancer, only fungus. Removal of tiny melanoma from upper left arm, plus sentinel lymph node biopsy in Feb. 2016. Guardant Health liquid biopsy in Feb. 2016 showed mutations in 4 subtypes of TP53. Repeat of Guardant Health biopsy in Jana. 2021 showed 3 TP53 mutations, BRCA1 mutation and CHEK2 mutation. Invitae genetic testing showed negative for all of these. Living with MBC since 2007. Stopped Herceptin Hylecta (injection) treatment in March 2020. Recent 2021 annual CT of chest, abdomen and pelvis and annual brain MRI showed NED. Praying for NED forever!!

Last edited by Joan M; 11-23-2009 at 11:03 AM..
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Old 11-23-2009, 11:13 AM   #14
PinkGirl
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Re: Echocardiogram question


Hi Dianne
I had Muga's and while on Herceptin my number ranged between 58 and 62.
I had another one done 3 months after finishing Herceptin and it was up to
71.

I think your numbers are geat! Nothing to worry about there.

I was told that Muga's are more accurate but invasive. I guess it's just
what they preferred to do at the Cancer Centre I went to.
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Dx Aug/05 at age 51
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Sept 7/05 Mastectomy
4 FAC, 4 Taxol, no radiation
1 year of Herceptin
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