A couple days later, the phone rings again.
“Hi Heather, this is Tara, Dr. Rugo’s nurse practitioner. I’m so glad to finally get you on the phone in person!”
We’d been playing telephone tag for the better part of a week.
“Well, we got the results back from the echocardiogram you had the day before surgery.”
Herceptin can cause temporary damage to the heart muscle, bringing down the “ejection fraction” of the left ventricle of the heart. This number measures how efficient the heart is at pushing blood out to the rest of the body. My first echo, just before chemo starts, shows an ejection fraction of 70. Toward the end of chemo, a second echo shows that ejection fraction number had dipped to 50, on the low end of normal but still a big drop.
So Tara and Dr. Rugo cancel my next Herceptin infusion until a third echocardiogram can be done. Herceptin infinitely improves the outcome of women who have Her-2 positive cancers like mine, but it’s not great to cure the cancer at the cost of causing congestive heart failure.
“So what’s the number?” I ask.
“It’s 50 again,” Tara says. “I’m thinking that you were tense in your first test and that that number was artificially high. I’m going to make an appointment for you to have another Herceptin infusion, six weeks after your last. Then we’ll do another echo. If it’s OK, then we’ll go back to the every-three-weeks schedule for Herceptin.”
“Sounds like a plan,” I say. “Tara, may I ask you a question about the pathology report from surgery?”
“Sure,” she says.
“Well, are those pre-cancer, slightly abnormal cells they found in one sample anything to worry about? Dr. Hwang says not to worry. But pre-cancer can lead to cancer, right? If you were me, that would worry you.”
“That’s what the radiation is for,” Tara says.
“Ah.” I say. “That’s why the risk of recurrence without radiation is so high, I guess.”
The radiation makes a last pass and zaps the remaining abnormal cells that cannot repair the damage the radiation causes. That takes in both cancer and pre-cancer, apparently. Why didn’t they say so in the first place?