If Breast Cancer Doesn't Kill You, Heart Failure Might

File this in the category of the stuff we should have been told but weren't. Many women diagnosed with breast cancer, are given chemotherapy as part of their treatment. One of the drugs commonly used is called Doxorubicin, also known Adriamycin or Rubex, or as us patients have been known to call it 'red devil', which carries a significant cardiac risk.

When you are given it in chemo the nurses put on masks and special gowns to protect them. No thought of the patients. I was told it could cause some cardiac issues but now I am learning that the danger is very real and very concerning.

"“Both breast cancer and cardiovascular disease share risk factors,” said Dr. Susan Gilchrist, a cardiologist at MD Anderson whose research focuses on cardiorespiratory fitness in cancer patients. "That includes weight gain, loss of exercise or sedentary behaviors, and metabolic dysfunction, which are a risks factor for breast cancer recurrence and cardiovascular disease.”

The greatest risk is from the chemotherapy drug doxorubicin, an anthracyclin. Eight treatments increase heart failure risk by 5 percent, up to a 48 percent increase after 14 doses, the doctors wrote in the statement.

But women with breast cancer are not encouraged to avoid treatment."

So there is a fairly significant risk of of cardiac damage but they are not going to encourage us to skip that treatment? If the you don't die of breast cancer, heart failure is more likely to kill you. Instead of skipping adriamycin for the benefit it gives, the advice is now to talk to your doctor. The problem with that idea (which is obviously written by someone who has not had cancer) is that patients with cancer care about only one thing when first diagnosed: get the effing cancer out of my body.

"“Any patient who is going to undergo breast cancer treatment — whether they have heart disease at the beginning or not — should be aware of the potential effects of the treatments on their heart,” said Dr. Laxmi Mehta, chair of the AHA writing committee and director of the Women’s Cardiovascular Health Program at The Ohio State University in Columbus, Ohio. “This should not deter or scare patients from undergoing breast cancer treatment, but should allow them to make informed decisions with their doctor on the best cancer treatment for them.”

With the statement, the Heart Association hopes to change perception of the biggest threats to women after beating cancer. Breast cancer survivors, over 65, are more likely to die from cardiovascular diseases, such as heart failure, rather than breast cancer."

That does not make me happy at all. I survive cancer and chemotherapy so I can die from heart failure? 

“We want patients to get the best treatment for their breast cancer,” said Mehta. “Everyone should have a conversation with their doctor about what are the side effects.”

Sorry not good enough. We need a better treatment for breast cancer that doesn't have such a hig risk of heart failure.

Things change, but they don't really

Last night I was lying in bed listening (with a tiny bit of insomnia) to the heavy rain come down and realized that I wasn't concerned that the roof might leak. This is a significant change, there were a few years where I would dread every forecasted rain storm and even make a point not to be home in case the roof did leak.

When we bought the house in early 2005, we knew we needed a new roof. We had some ice dam issues that first year which caused some ceiling damage too. We had the roof replaced in the summer of 2005. On New Year's Day 2006, I was working in my office upstairs and heard a drip. The roof was leaking in my office. We found a new roofer who would come that day and did some repairs. A few trips by the roofer and several hundred dollars later, we no longer had any drips but I had learned to hate rain. It would stress me out. What if the roof leaked again? We couldn't keep spending money on the roof, we had to pay for other things - a furnace, driveway paving, etc. I was stressed for every storm.

Last night I was not stressed by the rain and I started thinking. I knew the roof could leak at any time. This does happen sometimes. Roofs do leak - during hurricanes, or when big debris lands on them, or with ice dams, not just in regular rainstorms. But I wasn't concerned.

Last week I had my annual mammogram and physical and I wasn't stressed about cancer issues. I was stressed about other health issues on my never ending list of new medical issues. Have things changed? Not really. Just because I was not stressed about cancer cooties, doesn't mean the concern they may reappear has disappeared. It never really does.

After my first cancer diagnosis, I learned to despise the words 'but with your medical history we need to be sure...' Every little medical blip put me to the front of the cancer line. Eventually, my stress settled down and I wouldn't be as concerned about every issue. Then another cancer diagnosis, totally unrelated but very stressful, came along and I returned to the front of the cancer line for everything.

With two cancer diagnoses and three years of waiting for a clean mammogram, my stress level is finally settling down. Maybe my breast cancer is not going to come back but 'with my medical history, they always need to be sure'.

So last week, I wasn't as concerned that they might find cancer cooties related to my breast cancer as it has not been as problematic in the past year. In fact I passed last year's mammogram and with a second clean one this year, I was feeling pretty comfortable with it and wasn't freaking out that they might find something else during it.

Its the other cancer issues that cause me stress but that doctor isn't until July. I have another thyroid ultrasound in July to see if they can figure out what is the 'detectable but too small to biopsy' thing is that is hanging out where my thyroid used to be. So I think I have just deferred my stress for a different doctor appointment.

I can still stress about my mysteriously caused heart rate issues but that doesn't look like cancer. It could be caused by my thyroid levels being messed up but it doesn't look like cancer. I'll have my echocardiogram in a few weeks and learn more then. I'll save more stress for then.

So things did change, the roof didn't leak and my mammogram was clean and I wasn't stressed. I have learned that I can always find something new to stress about with my health. And with 'my medical history, they need to be sure'.

That Lovely Place to Wait

I feel like I should run around quoting 'Candide', where the cast runs around wishing for the best of all possible worlds in the middle of the Spanish inquisition where its 'oh what a day for an auto-da-fe'. Basically incredible amounts of optimism in the midst of chaos and bad things.

Yesterday I had a wonderful time at the hospital. I met with my back pain doctor and we discussed my back and how it actually feels better these days due to my new drugs and my actually making it to the gym regularly. He also gave me a greatly appreciated cortisone injection in my left hip which has been full of bursitis recently. My back feels okay - meaning it doesn't give me nearly constant pain, but it is not and will never be cured so don't jump up and down with optimism for me. I don't have to see him for four months instead of the usual three.

Then I went for my mammogram and changed into a lovely gown and sat around and waited but then finally got a clean result on the first try which was very nice. I changed back into my clothes.

Then I went back to check in for my bone density scan and changed into another set of lovely pajamas. The test is quick and boring. I then changed back into my clothes again.

My last scheduled stop was at my primary care for a physical with my new doctor. We talked and decided that the biggest concern is my blood pressure/pulse/heart rate. She measured my pulse at 106 but my BP was 128/86 which isn't bad but still higher than it used to be. We talked about my eating habits, my salt intake, exercise schedule, weight gain/lost, etc. We also talked about the impact of my thyroid level (which won't settle down) on heart rate etc. Weight loss would be good as well - but I already knew that and will try some more.

Finally, this is what I know. I have tachycardia - meaning fast heart rate - which is not a good thing. After changing back into my clothes again, I was sent for an EKG (which meant another lovely gown) and I brought the tapes down to the doctor to read. She said my heart rate was normal but fast. So I guess the good news is it doesn't look like I am about to drop dead. But then I had a chest x-ray (another clothes change - at this point they recognized me in diagnostic radiology where my mammogram and bone density scan took place) as well as a full set of blood tests.

I also am scheduled to have a fasting blood test next week, an echocardiogram, and then back to see her in a month to finish my physical (we never got past the cardiac issues) and discuss the results of all my tests. Next week I will stop by and get the results of all my tests to review (and over-analyze and over-research online) in private as well

So two doctors, five tests, and five clothes changes later, I am in the lovely place to wait called 'you have something wrong with you that could be very bad but we don't know quite what it is yet or how we are going to treat it'. I hate this place. But I do like my new doctor and think we can work together on this.