Herceptin/MUGA Scan

[robind]

Need help...advice how to handle this.
My oncologist in Sept. told me that when I was finished with Herceptin, I would need to have a final MUGA scan. That would be for January. My oncologist is out on maternity and I saw another...she said I did not need a muga, my heart never had any problem and even if there were a problem, there would be nothing that could be done. OUCH. I came right back and said, well, I'd go and see a cardiologist.
Now, I'm not going to panic here but...my confusion is real here. One says one thing and the other says something exactly the opposite. My oncologist isn't due back till April and I probably won't be seen by her until June. So...do I push to have it done??? Does everybody have that final MUGA regardless of the numbers of each one while on Herceptin. Please, I'd appreciate any and all answers on this one.
Thanks so much...HAPPY HOLIDAYS TO ALL
Robind

[Midwest Alice]

Different onc, different plans. If the stand in onc knows how upset you are I would think she would go ahead and order one for you. You could see a cardiologist. I feel the way you do and I would want a end MUGA.

Hope this helps

[robind]

Thanks Midwest Alice. I've been thinking about this most of the day today. Part of me feels that because all the muga scans showed no concerns whatsoever, that perhaps I should just leave it at that. And, now with the recent discussion about cat scans and such, do I want to push for a test that still is putting a dye into my heart along with other things. I could just ask for an electrocardiagram...maybe that's what I should do. Then, the other side of me feels that if my oncologist brought it up to me months ago...because she felt it should be done. Maybe I'll concentrate about it after the holidays. Thanks for your reply. Happy holidays.

[Joe]

Robind,
Did they give you a baseline MUGA when you started Herceptin? and have you had others? What were the results?

Herceptin is cardiotoxic in a small population of HER2 patients and weakens the heart. If your ejection factor (this is what the MUGA measures) drops below 50%, the oncologist discontinues Herceptin and your heart bounces back !!! In the majority of cases the damage is not permanent.

I really wouldn't worry too much. FYI an echocardiogram works just as well.

Regards
Joe

[Sandra in GA]

Robind,
I hope this gives you some comfort. I understand your stress and confusion over a change of plans, however I will share my recent experience with you. I have just completed the treatment phase of a phase II study down at Mayo in Jacksonville. It was to look at the cardiac safety and tolerability of Herceptin and lapatinib (Tykerb). I had my last Herceptin Nov. 10th and took the last Tykerb NOv. 17th. During the study I had an echocardigram every three months. I saw my onc. Dec. 10th after I finished and he did not order another echo on my completing the Herceptin. I can tell you also that even though I didi not reaalize I was extremely fatigued, I am feeling better and better each passing day. I know my heart is stronger even if I had no problems during my treatments with my scores. I hope you will soon begin feeling stronger and stronger also. This feeling of strength will let you know you are doing well.

I also feel sure that since this study looked at the cardiac safety, if an end of treatment measurment was needed, aother echo would have been done.

Take care and have a Merry Christmas!

Sandra

[robind]

Thanks Joe. Actually all the muga's I had, including the base were in the 60's. There was never any concern while on Herceptin. It just troubles me that my oncologist who mentioned I would have to have a final one is not around until April and another doctor said it totally wasn't necessary. I must say, I feel much better reading your note.
Thanks so much for answering, I appreciate that you took the time. Have a very happy holiday.

[robind]

Sandra in GA. Thanks for answering and sharing. So, now I have a question and I never thought of this before. Why do a muga is an echocardiogram is the same or as effective???
I've been most fortunate. I've felt terrific and strong truly since the end of last January when radiation was over. I never had any real difficulties while getting Herceptin, including fatigue. I realize, I truly was fortunate. I do feel though that because I was so ill during the months of chemo, which included infection on top of infection and needing blood transfusions...I did deserve a break...Herceptin was okay for my heart as all my MUGA's were in the 60's.
The best to you, I hope you are getting your strength back and feel better and better each day. Have a wonderful Christmas, and best wishes for the new year. I hope for good health for all of us. Robind

[Sandra in GA]

Robind,
I am no expert. I only know that they can also get the ejection factor from some measurements they take when they did the echos on me. Mine also were never a concern. I was very conderned when they did the first one before beginning Herceptin and Tykerb because they told me that if my factor was below 45, I could not be in the trial. Thankfully, it was in the 60's and 50's during the trial. I appreciate your very thoughtful response. Have a great day!
Sandra
PS I did see where they are using the MUGA in another trial. I was the last one to finish the trial I was in and only got a spot because so many had dropped due to the diarrhea the Tykerb casuses. I don't know when they began this trial. It may be that using the echo is now out dated. Just a thought.

[robind]

I'm going to take the advice of Joe and not worry about this. Based on all the ejection factor results from each MUGA being consistently in the 60's range...I'm comfortable in the belief that my heart was unscathed. One less thing for me to think about at this juncture
Thanks for all your input. You just get strong!
Merry Holidays.

[Lizard]

I got a baseline MUGA before beginning my chemo (4 ACs every other week). Then another MUGA after I finished AC (to see the impact of the cardiotoxic Adrimyocin) before beginning 12 weekly Taxol/Herceptin doses.

I was also under the impression that I was going to get a follow up MUGA after I finished my weekly Taxol/Herceptin to see the impact Herceptin had on my heart. To me it would only make sense measure against something that had already been taken.

But then my oncologist surprised me with an order for an echocardiogram instead, which he assured was just as good as a MUGA and told more information. I asked 2 radiologists what the difference was and both assured me that you could measure the contraction of the left ventricle ejection fraction in the echo against the same in the previous MUGAs IF you can get a good image in the Echo. I was told by one radiologist that getting a good image from an echo is sometimes difficult if the patient is obese, which doesn't impede MUGAs.

All finished with, "and it's cheaper" (the echo), so I'm wondering if it boils down to avoiding arguments with insurers. My guess is that if 2 mugas show above 50, then the insurance agencies start pressuring doctors to switch to the cheaper version.

[Jackie07]

It could have also been influenced by the latest report on 'over scanning' (CT scans) Perhaps the doctors are now more concerned about the danger brought on by unnecessary radiation exposure.

[Westcoastgirl]

I have found over and over again when I go to the chemo lab that women with the same diagnosis/age as me but a different onc have different treatments. It bothered me at first but I came to realize there are many ways to skin a cat. I will not have a MUGA at the end of my Herceptin treatment and will not worry at all about it. My MUGA scores went down but then recovered while still on Herceptin. Others I know had such things problems as enlarged hearts from Herceptin and they did not have a final MUGA because as soon as we are off Herceptin the heart recovers and returns to whatever is normal for you. Don't worry about this at all. You have done well so put it behind you.

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I meant Echocardiogram, not EKG.

Sorry.

Joanna

[Sandra in GA]

Thank you Joanna for posting this information about the risks of the MUGA and the echocardiogram. I am glad I had the echos.
Sandra

[Chelee]

That's the first I've heard that...thank you for sharing it with us. I always had ECHO's thank goodness. I'm exposed to enough radiation doing all the other scans and regular x-rays. So thanks so sharing this information...I'm sure it will be eye opening to many here.

Chelee

[vlcarr]

They did a baseline ECHO on me before I could start the Tykerb/Herceptin trial.

I had another at the end of the trial which was 3 months later. My onc also wants one at the end of chemo and than again when I finish Herceptin. So, I've never had MUGAs but ECHOs.

Wishing you the best in your recovery.

[bee123]

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