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All TopicsForum: Chemotherapy - Before, During, and After → Topic: Dangers of AC chemo long after treatment ends

Topic: Dangers of AC chemo long after treatment ends

Forum: Chemotherapy - Before, During, and After —

Regimens, side effects, and support from others going through chemo.

Posted on: Jan 5, 2010 05:58AM, edited Jan 5, 2010 06:02AM by navygirl

navygirl wrote:

Friends, I hesitated to put this out there because I don't want to scare someone off a treatment plan that they need. So, please take this as an individual experience being shared so that you can gather your own information and make the best decision for you.

For months I have been having fatigue. Then I was having shortness of breath while exercising or doing heavy yard/housework. Finally I could not breathe just walking across the living room or talking. I went to my PCP initially who thought I might have asthma, but wanted to run some other tests "just to be sure". In the mean time, I called my ONC to ask if there was anything about my treatment that we should be concerned about here ~ which is when I found out that yes, AC chemotherapy can cause congestive heart failure for years after treatment is complete. Needless to say, my family and I were dumbfounded. We discussed all the hazards that were there DURING the treatment...but no where did the conversation cover the fact that this treatment could cause me problems years down the road. It's easy to find this information - if you know what you're looking for. Unfortunately, while we researched this side effects of treatment we never found or were given the information about long term effects.

My ONC ran some tests and told me my heart was fine. The PCP, Pulmonologist and Cardiologist I have seen all say that it is not fine. In fact, they said the same thing: essentially I have borderline damage and a drop in my LVF. Now, while not severe enough to cause the current problem that brought me to them (we are still testing) this damage showing to my heart is indicative of having problems from having had chemotherapy. We will be watching this to track any progression I may have into congestive heart failure. 

In my experience I have found that I had 3 very important things (strikes) to consider that are possible links to people who have sustained heart damage long after treatment is completed.  

1. I have extensive family history of heart disease, heart attacks and strokes. While my blood pressure and heart rate were perfect and my initial muga scan showed above average performance, I most likely have a genetic factor that should have been taken into consideration.

2. Adrimyacin given concurrently with cytoxan (sp?) instead of getting one dose, then the other, is thought to be more likely to result in long term congestive heart failure.

3. AC given as a "push" or injection as opposed to given over a 90 minute IV drip is also considered more at risk for long term congestive heart failure. 

Had I had this information up front, there would have been more discussion with my ONC on how I was getting what I was getting. I can't say after the fact that I would have done anything different, it may not have changed a thing. But my decision would have been an informed one and there would be nothing to "what if" now.

I hope this helps future women coming here to ask the questions that I didn't and be better informed about what they are getting themselves into.  

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Posts 1 - 28 (28 total)

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Jan 5, 2010 06:11AM GramE wrote:

Dear Bonnie:   I cannot tell you how much I agree with your comments.  When I asked questions, I often got "that look".  Can they not understand that we face such a drastic change to our lives no matter what kind of treatment we have?   This is not an insignificant detour or bump in the road.  It is major and has major consequences forever.   

You know I had  many misgivings about radiation and opted not to do it.  The side effects and long term effects were minimized by my doctors.   But I witnessed first hand what DID happen to others who had radiation and i was not going to have that happen to me.  

Doctors act like dictators, in MY opinion, and  too often make light of what their decisions cause us to do, not knowing the full story.   You know where I am and how to get ahold of me - ANY time, I am here for you.   Hugs and prayers,   Nancy

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Jan 5, 2010 06:16AM somanywomen wrote:

I don't know if doctors just think that we are too stupid to understand future side effects by oh-so-many tests and treatments while dealing with BC, or they keep thier fingers  crossed it won't happen on thier watch...or they just don't want to waste thier time until after we actually have the se's......Seems they are not taught to teach!!...It's just like all the preventative things that could be taught to younger women to lessen thier chances of BC in this world of toxins that we live in.....where is the voice for this???

“There must be some way out of here,” said the joker to the thief, “There’s too much confusion, I can’t get no relief."....All Along the Watchtower..Bob Dylan Dx 9/28/2009, IDC, 1cm, Stage I, Grade 2, 0/2 nodes, ER+/PR+
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Jan 5, 2010 06:21AM ElaineD wrote:

So sorry to hear of your problem. I hope you don't mind if I make a comment? Since you are descended from a family who have extensive heart disease, how can you be confident that the damage to you has been caused by chemo? Could it not be the case that it would have happened irregardless of having chemo?  

Dx 11/4/2007, 5cm, Stage IV, Grade 3, ER-/PR-, HER2+
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Jan 5, 2010 07:11AM navygirl wrote:

Elaine, you make a very good point - and my best answer is - I don't know. I probably never will know for sure. The timing of it is what makes us suspicious that this is from the AC as opposed to a hereditary change that would have occurred anyway. I am now at the point where changes can and usually do occur. I thought it was important to speak up because until all this started I was not aware of the potential for the AC to cause problems a year and a half later.

I am grateful I know about this early in the game so that I can take extra measures to keep my heart healthy. 

life is short, play hard
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Jan 5, 2010 07:30AM AnacortesGirl wrote:

I'm so sorry this has happened to you. 

Thank you for posting this information.  Your hesitation to put it out here is understandable but the knowledge is powerful.  Being stage 3 I'm not going to back off (curently on the AC regimen).  But it's comforting to know that my family history doesn't fit the first criteria and I do get a 45 minute IV (shorter because I get it weekly) so I okay on number 3 also.  Thank you for helping to reduce one of my concerns.

Christy - BRCA2+; mets to bones and liver, Taxol/Sutent -> AC, BMX - no recon, Rads, Carboplatin, BSO, Veliparib trial (8/30/13-3/13/14) Dx 7/21/2009, ILC, 5cm, Stage IIIc, Grade 3, 14/17 nodes, ER+/PR+, HER2- Dx 9/9/2012, ILC, Stage IV, Grade 3, ER+/PR-, HER2- Hormonal Therapy 09/01/2010 Aromasin Hormonal Therapy 02/01/2011 Tamoxifen Hormonal Therapy 09/09/2012 Femara Chemotherapy 03/29/2013 Xeloda Hormonal Therapy 08/16/2013 Faslodex Chemotherapy 03/20/2014 carboplatin
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Jan 5, 2010 11:04AM , edited Jan 5, 2010 11:12AM by Tierney123

Wow - talk about timely.  I was just going to put a question out there about this myself.  My situation is this.  I am completely asymptomatic but was required to have an echocardiogram prior to my TE exchange surgery in a few weeks.  The requirement stems from a new protocol at my hospital for anyone who has had Adria in the past, prior to a surgery.  I figured it was just a routine thing to get out of the way, until the cardiologist called with the results and informed me that I have a lower than normal LVF (mine is between 40-45 and normal is 55-60).  The net is she wants me to go on an ACE inhibitor, which I'll be on for the rest of my life.  This will keep it from getting worse, and she said this kind of drop in efficiency is what they've seen as a side effect from Adria.  I did know that there was a side effect of heart damage, but didn't really worry about it since I'm young and otherwise in good health, with no history of heart issues (which is why I didn't have an echo prior to starting chemo).  

I just saw my onc this morning and he agreed with my inclination to get a second opinion, which I've scheduled for this week.  Since I've never had an echo before, I don't know if I've always been between 40-45 (if that's possible), if medication is really needed before I have symptoms, etc.  My onc has been doing this for 30 years, is involved with a lot of research, and doesn't routinely see this as a side effect (even though they warn about it) so I'm having a hard time getting my head around it.   The other thing we're unsure of is if the fact that I'm BRCA1 positive could play a role.  

I have loads of questions for the cardiologist and will post what I learn.    

 (Navygirl - can I ask where you learned about points #2 and 3 in your initial post, re: Cytoxan and method of delivery for Adria?  I have both of these counts against me, plus radiation to boot.  This was from my treatment in 2004.)

  

Dx 5/1/2009, IDC, 1cm, Stage I, Grade 3, 0/3 nodes, ER-/PR-, HER2-
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Jan 5, 2010 11:12AM kmmd wrote:

navygirl, saw your name come up and wanted to post, hadn't "seen" you in awhile.  Sorry to hear about the trouble you are having, hope you are in the group of people it ends up reversible in and you start feeling better (you too Tierney)

www.youtube.com/watch?v=vrpJD2... Keep breathing is my new motto. Kate
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Jan 5, 2010 01:47PM navygirl wrote:

Thanks kmmd...part of what I found out is that the people who have immediate cardiac change (while still getting treatment) it is almost always reversible, but when the damage occurs after the treatment -sometimes years down the road, it is not reversible. Right now I'm focusing on stopping it where it is :) 

Tierney, from what I read about them, the best measure of the LVF is a MUGA scan - an echo can give an estimate but the MUGA is more accurate on the flow measurement. I am getting a copy of the MUGA I had to see what that had in comparison. Echo is good for identifying thickening of the walls, blockages, flap problems etc., but for whatever reason is not as accurate on the LVF so you may not be as low as it shows. If it's possible to get a MUGA I would ask about that to compare. 40-45 is pretty low and I'd think you wouldn't be that low to start without some other issue involved, but hey - I'm no cardiologist!

The information I referenced was I believe from a paper on the National Institutes of Health/National Cancer Institute (NCI) website, but I am not 100% certain. I was researching "Adrimyacin long term effects". I'll see if I can find it again as I read quite a few links to it. 

Anacortes...I'm glad it gave you some peace of mind. That always helps too... 

life is short, play hard
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Jan 5, 2010 04:47PM Tierney123 wrote:

Thanks for the MUGA scan suggestion!  I'll check on the NCI website and google around in general, but thanks for your input.

Dx 5/1/2009, IDC, 1cm, Stage I, Grade 3, 0/3 nodes, ER-/PR-, HER2-
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Jan 7, 2010 12:12PM Tierney123 wrote:

Hi again - 

Saw the cardiologist today for a second opinion.  We're going to repeat the echo (he wants to read it, whereas the MUGA is performed and read by a radiologist) in a few months, after my TE exchange surgery.  There's an outside chance that the echo provided a falsely low number due the angles they used to measure, potentially related to having tissue expanders in.  So - no meds yet; I'm going to wait and see what the picture looks like in 3 months.

I have a follow-up question to you fabulous ladies.  One of my frustrations is that I don't know what my heart function was like prior to receiving the chemo because I didn't have an echo pre-Adria.  Per my oncologist, it's not standard care unless you are older and/or have a history of heart issues, and I was young and in good health.  But, per my breast surgeon (at Georgetown) it's standard protocol there to be tested before and after.

I'm trying to get a sense of how common it is to get an echo ahead of time.  Can folks weigh in as to whether or not you had the test, and if you did, were there any other factors (like family history or other health issues) or was it just part of the routine?

 Thanks! 

  

Dx 5/1/2009, IDC, 1cm, Stage I, Grade 3, 0/3 nodes, ER-/PR-, HER2-
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Jan 7, 2010 12:17PM Titan wrote:

I had an echo prior to chemo (had 4 ac and 4 taxol)....It is standard care where I go.  I was 49 at the time (considered young by breast cancer standards).

It was called a "limited" one though...took about 30 minutes if that.  I did not have another echo once chemo was over but my onc. keeps asking me if I'm short of breath and checks my ankles to see if they are swollen.

Dx 3/18/2009, IDC, 1cm, Stage I, Grade 3, 0/5 nodes, ER-/PR-, HER2-
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Jan 7, 2010 12:27PM SoCalLisa wrote:

I had a friend in her forties that had AC...and unfortunately had a heart attack about 18 months

after the chemo

Biography: DX 11/2000 LCIS,DCIS,IDC 2B, Grade 1, ER+,PR+ Her2Neg 1 pos node Lumptectomy, CMF chemo X 6 mos, DX 8/2001, IDC same breast--Mastectomy , Left Breast Lumpectomy... Tamoxifen, one year...Armidex, Four years
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Jan 7, 2010 12:35PM lewing wrote:

Navygirl, thanks for posting, and sorry for the problems you're experiencing.  Heart damage from adriamycin was a huge concern of mine.   

I'm fascinated (and perplexed, and frustrated, and sometimes angered) by the different protocols that different institutions follow.  In my case, I had a MUGA  pre-chemo . . . as a standard practice, not because I had any particular risk factors.  None since, so I don't know if my LVEF has changed.  But I'm not having any symptoms.

Linda

Dx 1/15/2008, IDC, 1cm, Stage IIa, Grade 1, 1/14 nodes, ER+/PR+, HER2- Hormonal Therapy Arimidex Chemotherapy Adriamycin, Cytoxan, Taxotere Surgery 03/13/2008 Mastectomy (Left); Lymph Node Removal: Axillary Lymph Node Dissection (Left)
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Jan 7, 2010 12:56PM cmb35 wrote:

I had an echo prior to chemo (standard practice, and I had also had some chest pains and a slightly irregular EKG the same time I was dx), but it was very brief and done by a technician - I never saw a cardiologist. My onc heard a heart murmur at my one year appt, which had never been heard before. I had another echo at that time, which confirmed the heart murmur, but was told it wasn't an issue.

I don't honestly know enough about it to know if it could be related to the AC/T, and I guess, being triple negative, I feel like I needed the AC/T to fight the cancer, so as happens so often with this beast - a rock and a hard place!

Dx 5/27/2005, IDC, 1cm, Stage II, Grade 3, 1/15 nodes, ER-/PR-, HER2-
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Jan 7, 2010 12:58PM Luah wrote:

I too worry about this, being on dose dense AC with the A pushed (I am going to ask about IV), yet I feel being triple negative, I have to be as aggressive as possible. I did read up on some of the studies on the long-term effects on A, and as I recall once you are over 400 mg (? not sure of measure, I'll be up to 416 by last treatment), the risk of LVF was about 5%, so not trivial but certainly less than my odds of cancer recurrence.  

I had an EKO and muga prior to treatment, but wouldn't it make sense to do that again midway to see how your heart is holding up?   Are any of you getting that? I wonder what good a baseline is if they don't use that to make treatment decisions, only to blame the chemo for later damage.  I know for 2-3 days following treatment, I get a pounding heartbeat sometimes, even a fluttery feeling with irregular pulse, that just passes in a few moments. I thought this might be the steroid, but the sheet I have doesn't list that as a SE. So I've reported it to my onc's nurse today... haven't heard back yet. 

We've been through some things together/With trunks of memories still to come/Long may you run (Neil Young). Lx, ALND, 4 DD AC &12 weekly Taxol, 31 rads, completed Jul 10 Dx 9/14/2009, IDC, 2cm, Stage IIb, Grade 3, 1/14 nodes, ER-/PR-, HER2-
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Jan 7, 2010 01:09PM LRM216 wrote:

Luah - I too am triple neg, and at my onc's suggestion and along with much research, I too chose the DD AC x4 every two weeks and the DD Taxotere x3 and completed it on 9/10/09.  I was also 62 (going on 40!) at diagnose with no other health probs.  Did have an echocardio prior to the chemo and all went fine.  At the end of chemo, I presumed I would go for another echo to test the heart.  I was a bit dismayed when she told me, no, only if you have any problems with the heart, otherwise, no testing.  Since I am am still standing erect,and breathing ok, and waking up each a.m. - I presume I am ok, until such time as I see a problem, I guess they don't do anything.

Linda 

Life isn't about waiting for the storm to end, it's about learning to dance in the rain ... Age 62 at diagnose Dx 2/23/2009, IDC, Right, 1cm, Stage Ia, Grade 3, 0/1 nodes, ER-/PR-, HER2- (FISH) Surgery 03/06/2009 Lumpectomy in one or both breasts: Lumpectomy in my right breast Radiation Therapy 10/20/2009 Chemotherapy 04/24/2009 Adriamycin (chemical name: doxorubicin), Cytoxan (chemical name: cyclophosphamide), Taxol (chemical name: paclitaxel), Taxotere (chemical name: docetaxel)
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Jan 7, 2010 01:09PM LRM216 wrote:

Luah - I too am triple neg, and at my onc's suggestion and along with much research, I too chose the DD AC x4 every two weeks and the DD Taxotere x3 and completed it on 9/10/09.  I was also 62 (going on 40!) at diagnose with no other health probs.  Did have an echocardio prior to the chemo and all went fine.  At the end of chemo, I presumed I would go for another echo to test the heart.  I was a bit dismayed when she told me, no, only if you have any problems with the heart, otherwise, no testing.  Since I am am still standing erect,and breathing ok, and waking up each a.m. - I presume I am ok, until such time as I see a problem, I guess they don't do anything.

Linda 

Life isn't about waiting for the storm to end, it's about learning to dance in the rain ... Age 62 at diagnose Dx 2/23/2009, IDC, Right, 1cm, Stage Ia, Grade 3, 0/1 nodes, ER-/PR-, HER2- (FISH) Surgery 03/06/2009 Lumpectomy in one or both breasts: Lumpectomy in my right breast Radiation Therapy 10/20/2009 Chemotherapy 04/24/2009 Adriamycin (chemical name: doxorubicin), Cytoxan (chemical name: cyclophosphamide), Taxol (chemical name: paclitaxel), Taxotere (chemical name: docetaxel)
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Jan 7, 2010 01:45PM navygirl wrote:

I think if I had not been triple positive, I probably would not have gotten the echo/muga before chemo. I had to be on herceptin which for them the protocol is check before, midway through, and after. I can't be sure what they do if you are getting chemo alone. I know I requested a copy of the MUGA today and it shows me at 65% -which while it is still within normal limits - is down from the 85% I started at. Overall, to me, it seems that the Cardiologist has a stronger criteria or expectation of what my tests should show.  From my conversations with all 3 doctors involved now, no one disagrees that the chemotherapy seems to have started a chain reaction with my immune system that they have they have not yet figured out or come to understand. 

For those of you who have already gone through Chemo, or have no choice BUT to go through Chemo (as many of us don't) the one take away I'd like for you to have is know what the symptoms are for heart failure. Know what your blood pressure and Heart Rate are so you know if there is a sudden unexplainable change. We have to be more vigilant than the average joe! 

life is short, play hard
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Jan 7, 2010 01:46PM Leah_S wrote:

I had an echo before starting the adria. Standard here is an EKG but I have a functional murmer (that's a heart murmer that does nothing & causes no problems, that's why it's called "functional") so to be on the safe side my onc asked for the echo. Everything was fine, and when I finished chemo I asked about doing another one. He didn't think it wa necessary since I had no symptoms but since I was nervous and wanted it (and it's completely noninvasive) he ordered one and all was fine.

I still worry about heart problems in the future, since not only did I have the adria but I also had rads for a left-sided cancer and there's family history of heart problems to consider. Well, no symptoms right now and I'll do what I can to remain healthy.  I guess that's all any of us can do.

Leah

Dx 11/3/2008, IDC, 1cm, Stage IV, Grade 3, 6/17 nodes, ER+/PR+, HER2-
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Jan 7, 2010 01:58PM navygirl wrote:

ps. I meant to broach the subject of why I wasn't made aware of all this going into this, but I was met with such concern and compassion for what has transpired - that when my Onc. and staff went through all that has transpired over the last two weeks, and we discussed the current plan and where we go next -that I just never go to say "hey, how come". While it frustrates me that I wasn't made aware - I do think that there must be a fine line from their perspective, on how much information is too much information to give out. You want to give the patient all the info they need, but you don't want to overwhelm them either. I'm in no way defending the idea that information should be deliberately with held, I'm just thinking I wouldn't want to be the one to have the job either! 

life is short, play hard
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Jan 7, 2010 03:54PM GramE wrote:

I had a MUGA before starting dose dense A/C, after that and before taxol and herceptin, then another before lumpectomy and an EKG - all unchanged from the first baseline results.

Then continuing Herceptin for total of a year - Muga abt 4 months later and finally convinced onc for an echocardiogram (due to the radioactive dye used for muga) and she agreed.  No change reported and I am not as young as most of you - almost 64.    I figured is echo showed problem a Muga could be done, but not needed.   

Yes, Bonnie - we can never be too "informed", IMHO.   Many times in my life, not involving medical decisions, the worst case scenario was given to me and I then felt I was making the most informed decision.  I do not like surprises and the "usually there are no problems".  

As a side comment - what on earth would we (I) have done without the internet and this site?  Hugs and Blessings,   Nancy 

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Jan 8, 2010 05:32PM navygirl wrote:

Nancy...we'd have been screwed without the internet and this site! I wouldn't have known to ask about the OncoDX test which changed the whole treatment plan for me! 

life is short, play hard
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Jan 8, 2010 06:30PM otter wrote:

navygirl, I'm so sorry to hear about your heart problems. Whether or not they resulted from your chemo, your onco should have made the SE's clear before you started.  As you said, it's important that we have all the information we need to make the decisions that are best for us. 

My story started out a lot like yours.  There's a long history of heart disease and strokes in my family.  I'm on BP medication and a statin myself.  In addition, I have mitral valve prolapse, and one of the long-term complications of that, as well as heart disease in general, can be left ventricular failure. Just great!

So, when my first onco told me I would be getting AC (Adriamycin & Cytoxan), I was concerned.  I already knew Adriamycin could cause long-term heart problems, because I'd had 8 weeks to research the issue while waiting for my Oncotype DX score.  But, when I mentioned my concerns about my family history and my own risk factors, my onco blew off my question.  He literally brushed his hand to the side and said, "Oh, I'm not worried about that."  He told me I needed to trust that the decisions he made would be in my best interests.  And, he said I "read too much."

Because so much time had elapsed since my surgery, my onco said he wanted me to start chemo "ASAP".  I asked if there would be any pre-chemo testing, and he said he would order an echocardiogram and blood work right away. (He said that was standard procedure.)

For a variety of reasons, I fired that onco and requested a different one. I met with my new onco 3 days later.  She told me she was advising chemo as well, and she, too, would recommend AC.  I asked her about the cardiac effects, and she said she didn't normally worry about those unless the patient was older (she said "in her mid-60's") or had pre-existing heart problems.  I mentioned my history of high BP and mitral valve prolapse, and my family's history of heart disease.  She replied, "Yes, those things would make me reconsider whether AC would be the best choice."  I asked about TC (Taxotere & Cytoxan), and she said she thought TC would be an appropriate alternative for me.  She did warn me, though, that the short-term SE's from TC tended to be worse than those with AC, even though TC had fewer long-term effects.

So, I was very fortunate to find an onco who would work with me and let me participate in the decisions.  I'm also very lucky that she encourages me to read journal articles, and she likes to talk with me about clinical trials and research results. What if I had never protested the way my original onco was handling things?  BTW. both those oncos work in the same department of the cancer center where I was treated.  It was "against policy" to assign me a different onco in that same hospital, but my breast surgeon (also a terrific doc and a wonderful person) listened to my request and got the policy overruled on my behalf.

otter 

Dx 2008, IDC, Stage Ia, Grade 2, 0/3 nodes, ER+/PR-, HER2-
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Jan 8, 2010 06:48PM Diana63 wrote:

I had CHF last year, exactly 1 year after treatment ended. I had a muga scan before chemo and my heart was at 58%, 1 year later it was working at 12%. I was going to a doctor every week at the time, and complained about shortness of breath and leg weakness. He said its just the chemo working its way out of your body. Basically acting like I was being a baby, and to just drink more fluids and exercise. Do you believe that?

I had to go to the ER and was told I had CHF, then they said chemo cant cause CHF. I said then why was my muga scan last year ok and now its not? I am just now getting better from CHF, I don't know what % my heart is working at now but I am feeling better than I have in 2 years. I had 47 pounds of fluid on my body, and they took a litter out of each lung.  Now my cardiologist says that chemo did cause it, which I already knew that.

All I can say to all of you ladies if you have shortness of breath, during or after treatment dont let them tell you it's nothing to worry about. My heart may not have gotten that bad if the doctor had listened to me and sent me to a cardioligest right away.

“Be still, and know that I am God” (Psalm 46:10). Dx 10/6/2007, IDC, 5cm, Stage IV, Grade 3, 4/9 nodes, ER+/PR+, HER2-
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Jan 9, 2010 07:10AM navygirl wrote:

Otter and Diana...thank you both for sharing. Clearly there is more work to be done on the doctors behalf in listening to the patients!

With everything that is going through our heads at the time of diagnosis, it's easy to not get all the information. There are so many aspects of treatment to consider, we need help overturning all the stones! I am so glad these boards are available for women to come to and get the benefit of our collective experiences. 

life is short, play hard
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Jan 9, 2010 09:03AM , edited Jan 9, 2010 09:04AM by MaryNY

Navygirl: so sorry to hear what you are going through.

It took me a long time to make a decision on chemo. I wanted to avoid the taxanes because I have reason to believe that I would be high risk for neuorpathy. My onc agreed with me and suggested AC. I knew about the cardiac risks with Adriamycin and was concerned when my MUGA score came back very low — 41%. Onc sent me to a cardiologist who did an echo and said my heart was healthy and I was fine to proceed. I never saw the results of the echo.

I completed four dose-dense treatments of AC in December and am now half-way through CMF. I was given the Adriamycin as a push and the Cytoxan via drip. I did not know there was the option to give the Adriamycin as a drip. I think the push typically took about 20 minutes. Would it be given much more slowly via drip?

Mary ~~ lumpectomy 8/10/2009, Oncotype DX 18, Chemo 10/28/09--2/1/10 AC*4, CMF*4 Dx 5/19/2009, IDC, 1cm, Stage IIa, Grade 2, 2/6 nodes, ER+/PR+, HER2-
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Jan 9, 2010 09:25AM DianeKS wrote:

Hi Mary,

  Generally, Adriamycin is given push as it is a vesicant.  A type of chemo drug which can be extremely damaging to veins if not given by an experienced oncology nurse, along with alot of fluid. In fact that is one of the reasons the team prefers a PICC or port in place before giving it, although depending on the pt. not absolutely required.  Not a 100% guarantee that all will be well with a line either, but infusing it over a longer time also has it's own risks.

 I don't know if some centres give it over 90 mins.

Diane

'Be thou a smooth way before me...'. Dx with mets to bones May, 2011, first dx 2006, BRACA2 Targeted Therapy 07/26/2013 Tykerb Chemotherapy 09/05/2014 Gemzar
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Jan 9, 2010 02:31PM Luah wrote:

My second treatment of AC was done by a new nurse at the cancer center (although she said she'd be in oncology for 30 years) and I was horrifed to see the A pushed in something under 5 minutes (which I now understand is the minimum).  I had no reaction at the time, but who knows later...

Otter, congrats to you for being so well-informed and advocating on your behalf. I wish I had spoken up at the time - I had reservations about the nurse, but didn't make a fuss, and should have. I also like to do a lot of research and the first time I met with my onco she seemed a bit irritated with me, but she has since improved and is now receptive to my questions and challenges, and listens!  Sometimes I think it takes them a while to figure out what kind of patient they have in front of them - some pts like to turn their care over to a trusted expert - and some like to take a  more active role. On the other hand, some docs will never get it!

We've been through some things together/With trunks of memories still to come/Long may you run (Neil Young). Lx, ALND, 4 DD AC &12 weekly Taxol, 31 rads, completed Jul 10 Dx 9/14/2009, IDC, 2cm, Stage IIb, Grade 3, 1/14 nodes, ER-/PR-, HER2-