Tag Archive | MUGA

Lots of Checkups

The doctors keep checking up on me, just to make sure everything’s going fine. I know it’s going fine, but they need to check and see. I had a final checkup with Dr. Kang last week. I won’t need to see him for six more months and then we’ll have the discussion about whether we can put in the implant. Until then, I’ll just get by with a formed bra. One of these days I’ll head over to the Pennsylvania Artificial Limb and Brace Company to get my self a real prosthetic.

This week, I had some internal check-ups. A MuGA and a mammogram. I had a different technician for my mammogram, and she had a hard time getting the right position for the side-ways mammogram. She kept getting my shoulder pinched in the machine. Even less comfortable than just getting my breast squished. No results from either test, which I’m sure means they’ll be fine.

Next week, no doctor’s appointments. Hooray! I’ll have time to do some work around the house.

Maintenance visits

I had two other doctor’s appointments last week – a MuGA scan and a Herceptin treatment. The MuGA was first. I had the same technician I had the first time (this is scan #3). He’s a talker, which is nice because then I learn all kinds of little tidbits about the procedure. It was the first scan since my mastectomy, which limits any bloodwork or injections to my left arm. I wasn’t looking forward to two injections in the same arm, but I needn’t have worried. The tech called for an IV instead. The only downside to an IV is I could feel the cold from the saline flush moving through the vein in my hand. I couldn’t taste the saline like I can when they use my port, though.

I thought to get a picture of the cylinder the tech carried the technetium injection in.

The lead holder for my technetium injection

The lead holder for my technetium injection

The body of the hypodermic needle is also jacketed in metal, but the cylinder is solid lead. Apparently, it gets dropped all the time, which explains all the dents in the cylinder. I tried to pick it up, and it is seriously heavy (which probably explains the dropping). That’s good enough for me to add lead to my element collection.lead

Friday was my every-three-weeks Herceptin treatment (which is why I’m still getting the once every three month MuGA scan). I brought a really good book I was reading with me, so I was all set to sit quietly for my half-hour injection. I did get interrupted once by a Mercyhurst art therapy intern. She had just started at the Cancer Center and was wondering if I was interested in doing an art project. I’m always up for a bit of art, so I said sure.

The project she had brought was to make a road sign, real or imaginary, that reflected your mental state. Once I drew the sign, I was supposed to write why I had chosen that particular image.

My road sign

My road sign

As you can see, I chose to go with “Slow. Road work ahead.” Sometimes it feels like I’m never going to be done with treatment, or I’m never going to feel like my old self again. I know it’s not true, but my brain isn’t always rational. So, the sign was an acknowledgement that it takes time to be done and healed. I was quite surprised how much better I felt after drawing the sign and talking about it. The big box of freshly sharpened colored pencils probably helped a bit as well.

Last chemo!!!

You can’t see me, but I’m doing a little chair dance today. My last cycle of chemo is currently infusing to my body, and I am very happy about that. I won’t consider chemo to be over until all the side effects have cleared out, but today is a momentous occasion nonetheless. I will continue to come to the RCC every three weeks for a year in order to get my Herceptin infusions, but that is a biological and not chemo. Those infusions will be much easier than chemo. The infusion itself is only 30 minutes, I won’t need bloodwork or to meet with Dr. Li prior, and I won’t see all the chemo side effects.

This is the IV stand an infuser for the eight drugs I get each chemo cycle.

This is the IV stand an infuser for the eight drugs I get each chemo cycle.

I met with Dr. Li yesterday to get the results of my blood work and MuGA test. My red blood cell count, hemoglobin and hemocrit all came back higher. They’re still lower than the normal range, but higher than I’ve had in the past. My liver enzymes are still high, but at least they didn’t go up. I was disappointed the levels didn’t go down, since I was good and didn’t do too much physically this time. Dr. Li said I was fine, though, since they were stable and the other liver measurements were within normal ranges. My MuGA came back with my heart function at the maximum measurable level

StatsGuy came with me to chemo since it was the last one, and we celebrated just a bit by ordering lunch from the Panera in the plaza across the street.

Me and StatsGuy sitting at the RCC

Me and StatsGuy sitting at the RCC

Now that chemo is about done, I’m moving on to the next treatment – surgery. I meet with Dr. Engel two weeks from today to find out how much surgery he’ll be doing and the time frame. I’m hoping for early December for the surgery – StatsGuy won’t be teaching and I have family events scheduled for Christmas.

Second MuGA test

I’m just about done with chemo (have I mentioned there’s only one left!), which means I’m entering a new phase of testing. Today I had my second MuGA test. MuGA stands for Multi-Gated Acquisition. One of the potential side effects of Herceptin, which treats a specific mutation in my cancer, is heart failure. Since heart failure is generally considered a bad thing, I have to get a MuGA test every three months to make sure my heart is still functioning fine. This was first test since I started Herceptin, but I had one before treatment to get a baseline number.

In the myriad of tests I’ve had in the past six months, the MuGA is probably the easiest. The worst part is it requires two injections – one to prime my red blood cells, and one to inject the technetium that will then attach to my red blood cells, with about thirty minutes between injections. I had the waiting room all to myself, and I got to sit and read my book in peace. As an added bonus, the view from the waiting room was lovely:

View of the Erie Bayfront from the waiting room.

View of the Erie Bayfront from the waiting room.

I don’t remember the view from the first time, but I was probably a bit more stressed and distracted. This time, I spent some time at the window, enjoying the view of Presque Isle in fall colors and the bayfront. The hospital is built on a little rise just a block from the water, and it was quite a relaxing view.

As I said, MuGA tests are easy. You lie on a board under a sensor panel for about ten minutes. It’s a good thing I’m not claustrophobic, though, since the sensor panel is only about six inches above your head while you’re in there. I did learn some interesting things about the test from the technician afterwards. The technetium has a half-life of six hours, so it will be completely gone from my body within twenty-four hours. Because of the short half-life, the hospital gets technetium shipments three times a day and the technetium is produced as a byproduct of radioactive decay of molybdenum. The source of the molybdenum is either Canada or South Africa. I was sure to share those elemental facts with Mr. Curiosity, who immediately asked if he could get some molybdenum. I had to remind him we have a strict no radiation policy in our house.

Element added: I’m totally counting molybdenum

Tests to clear up the previous tests

One more round of tests before the chemo starts. I needed an abdominal CT scan with contrast and a vaginal ultrasound to check on the abnormalities the PET scan found. I would also need a baseline MUGA test.

ba56The CT scan required a 6-hour fast, so I got up at 5:45 for a quick breakfast, and went back to bed. There was no way I’d make it to noon without some food in my stomach, and I really didn’t want to start my day that early. Turns out the fasting was to allow the barium contrast in my gastrointestinal tract to show up most strongly. I had to drink 900 mL of barium sulfate in about a half an hour. I got berry flavor, which wasn’t actually too bad. The worst was the slightly thick texture of the drink which made me gag occasionally, but I managed to get it all down. Once I finished the barium, it was time to get into the CT scanner – just another table that slides through a tube. I also needed IV iodine to add contrast to the blood vessels. Since I have a PowerPort, they actually got to use my port for the first time – yeah! Nurse said I had good blood return, so the port was working well. 153The iodine injection caused the weirdest sensations. It made the inside of my ears feel hot, and made me feel like I was peeing, although I wasn’t. It only lasted a minute or two, but it was quite odd. The CT scan was quiet, but I did have to hold my breath a couple of times. The nice thing was there was a counter on the machine that told me how many seconds longer I would have to hold my breath, so I wasn’t wondering how much longer every time.

Elements added: Barium and Iodine

The ultrasound to look at my ovaries was the easiest test yet, since there were no injections needed. I just had to drink a lot of water before getting there so I had a full bladder for the first half of the test. I did get to empty the bladder before the tech did the intravaginal part of the test. Once again, I got talking to the tech, and she showed me the ovaries and where the developing eggs were on the ovaries.

The final test of the week was a MUGA scan (or Multi-Gated Acquisition scan). Because my tumor is HER2 positive, Dr. Li is adding Herceptin to my drug regimen. One of the less common (2-4% chance) side effects in heart failure, which would definitely count as a bad thing. So, as a precaution, everyone on Herceptin has periodic tests of their heart to make sure it’s fine. There’s a lot of natural variation in heart efficiency, though, so you need a baseline test to compare with future tests.

A MUGA scan uses radionucleotides, specifically tc43technetium, attached to your red blood cells to get a picture of how efficiently your ventricles contract. Technetium will attach to different cells in your body, depending on what loading medication they give you. I got the loading medication (a sn50tin-based solution), and then sat in a waiting room while it moved throughout my bloodstream. After about 20 minutes, I got the technetium injection, and then moved to the machine to measure my heart function. There, I laid under a set of white plates for eight minutes and was done. Since I had been talking quite a bit with the tech (are you sensing a theme here?), he called me over and showed me the pictures the machine took. It was pretty awesome seeing the blood move through the heart, and the walls of the heart moving. The scan is set up to compare the ratio of the left ventricle at minimum and maximum contraction. Once again, I was radioactive for the day, and a bit longer than the PET scan since the technetium has a half-life of six hours.

Elements added: Technetium and Tin

CT results showed the mass on my kidney was a cyst (yeah – not renal cancer!) and there’s a cyst on the ovaries. Ultrasound was inconclusive – there’s a mass on an ovary, but it wasn’t clear with it is exactly (probably the cyst seen on the CT). MUGA showed good heart functions to start with. All set to start chemo now!