Some advice regarding Herceptin

[Harpreet]

Hello, everyone.
I had a thread in the newcomers forum, but I guess this would be a more appropriate place to ask further questions. So making a new thread here.

I wanted to write in here with good news. But every good news comes with some shade of the bad... I wanted to go yay! when mom was going through her last chemo last Tuesday. But there was a slight complication. I'll just copy some blog posts here directly.

6th Chemotherapy
March 5, 2013 · by HC
Life just doesn’t get easy, does it? Just when you think you are nearing the end of a road, you see a bend that asks you to go a distance further. Mom had a bit of swelling on her legs a few days earlier… I thought it would be an after effect of the chemo. Today Dr Ghosh said that it was because of the Herceptin.

She asked us to do a 2-d Echo again. Mom’s ejection fraction has come down from 65% to 55% so Ghosh asked us to hold off the Herceptin. Thankfully, mom told her that the 350ml of Herceptin we have left would go to waste. That would be a little over 50 grand down the poop chute. So Ghosh said she understood but a 10% drop in the ejection fraction meant that the heart was being affected by the herceptin, so in order to be really sure it was okay, mom would have to go through a MUGA scan.

So we are all trying to get an appointment for mom to get this done – if all is well, the Herceptin can be used on Tuesday next, just within the window period of its expiry… Goddammit.

So right now, mom’s getting her Chemotherapy. Let’s see what happens with the Herceptin. I feel like screaming!!!!

Day 3 after 6th Chemotherapy
March 8, 2013 · by HC
Today we were supposed to go for the MUGA test. But -

Geeta woke me up at 10am in a panic. She thought mom had a stroke. Because mom was unresponsive and not speaking or moving. When I went up to her, her eyes were moving and she tried speaking but was stuttering with halted speech and broken words. I checked her limb movements. Asked her to move her fingers, hands, arms, toes and legs. But she couldn’t move her right arm properly. So Geeta and I freaked. But I did check her pupils and they dilated well.

I called Anand, bua, Dr Merchant and Bhavesh. Anand and bua because I wanted them to know and Bhavesh because I wanted him to take us to a hospital if need be. Dr Merchant said he would come home immediately.

In the meantime, I told Geeta to check her diabetes. And I put in a spoonful of sugar in her mouth. The diabetes came to 38! So I put in a spoonful of glucose in mom’s mouth. She started speaking a little and I told her to rest and not worry. Though Geeta and I were quietly freaking out…

I checked the diabetes again and it had come up to 73.

I realised it was hypoglycemia. Mom has had a history of neuropathy. She would get up at 4am with intense giddiness and she would also vomit at times. So Geeta and I both surmised that this must have been a reaction of the fall in sugar.

Dr Merchant came in, checked her reflexes, eyes, heart, and ruled out a stroke. I took mom to the loo and she had a motion. She told me she has also been going through a constipated phase. Her sugar fell to 58 again.

Dr Merchant gave her an intravenous drip with 50ml of Dextrose (glucose). In a bit, she started getting better. She ate food. Tea, and even a chocolate.

After the drip, mom’s sugar came up to 258 and she is now talking well, her arms and legs are fine.

But this was a scare.

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I am wondering if the MUGA shows that there is no problem with the heart, should we go ahead and take in the 6th treatment of Herceptin? Has anyone else gone through this problem? Is there any problem if the Herceptin treatment stops? Will 5 treatments instead of 17 be enough? I am very confused.

And I just reread the topic title - I should have added "some advice regarding Herceptin needed"

[NEDenise]

Wow!
That's a lot for you all to deal with. Thank God your mom has such devoted, and sensible children. She's done a fine job, and is reaping the vast benefits of her love and devotion to you over the years.

Your concerns are so far out the realm of anything I've experienced, I wouldn't dream of offering any advice. But, I will offer my prayers.

Please keep us posted about how things develop.
Denise

[vballmom]

What a difficult journey this can be! I'm sorry that you have hit another few bumps on the road. Your mom must be a very special lady to have raised such a fine and caring son! I also had a Herceptin break due to a lowered EF. I hope the MUGA turns out well for her. My doctors put me on Lisinopril and I am taking CoQ10 after much reading here (and the approval of my oncologist). My last echo showed an increase from 54% to 63%. I hope your mom's MUGA turns out well.

[Jackie07]

Hi,

Glad it was just a scare. Does your Mom test her blood sugar twice a day on a regular basis? My late Mother-in-law used to do that everyday...

About the MUGA ... I experienced the same thing during chemo (had swollen ankle/knee during the 4th one) The oncologist didn't say anything and I just attributed it to having walked too much [for exercise] while it's actually a sign of reduced heart function. I managed to finish chemo and then 4 weekly Herceptin before the MUGA went down further and had to stop.

It's been almost six years and seems the treatment had been effective (stage IIB with 2 lymph nodes invloved). I always comfort myself with the fact that there was a study done (in England) that 9 weeks treatment of chemo/Herceptin is about 98% effective compared to the whole year regiment.

[Harpreet]

Thanks for the prayers, Denise. Will keep you informed.

Thank you, vballmom. I am thinking that the MUGA will turn out well, but I don't have a previous MUGA scan to compare this one with. All we were asked to do was a 2D Echo which mom got good results from, all three times. The only thing that the last one showed was a decrease from 65% to 55% in the ejection fraction. I am also attributing it to a difference in the laboratory we got it done from. To mention why we didn't use the same laboratory: the last 2D was done last minute on the behest of the Oncologist. She wanted to check if mom was okay to go for her last chem cycle. So we had to do it at another collection centre than the one we normally use.

Thank you Jackie07. Yes, mom does check her diabetes regularly. This has happened before during the evening once, and it happens because of Dexamethasone. The doctor has asked her to alter her insulin intake and she does that - but this episode happened early in the morning when she was sleeping. So we had no knowledge until my sister woke up. Now of course, we both will have to have a nightly vigil to keep a tab on mom.

I am hopeful that the MUGA shows good results and mom can complete with the Herceptin treatment. I don't suppose Herceptin can also be the cause of the fluctuation in the diabetes, besides the heart?