A few of the chemotherapy drugs, especially one named Adriamycin, can (but don’t always) have a toxic effect on the heart. Before starting treatment with it, Dr Norman wanted to find out the current strength of my heart. If we suspect that my heart is getting hurt by the drug, we can retest and find out for certain.

The process began with the technician, Red, taking a few CCs of my blood. Then he sent us (my brother and I) away for a half hour while he mixed my blood with a radioisotope.

One coffee and snack later, we returned and Red gave my newly-radioactive blood back. Only slightly radioactive though; just enough to be able to be detected by their camera.

Next I laid down in a bed just like the ones used for the CT and PET scans. Red attached some electrodes to me that would configure their computer to time the scaning to my heartbeat.

A MUGA scan consists of three different viewing angles of the heart, each individually being collected for 4-8 minutes (they reposition the sensor plate between each series). During this time, the sensors are timed to take 20 snapshots per heartbeat.

Later, the tech can find which frame has the left ventricle fully expanded and which has it fully contracted. Then look at these two frames across each series.

From all of this they can derive an estimate of how much of the left ventricle’s blood gets squeezed out each time.

Normal range is from around 55%-75%.

Red said that I have what they call “a good squeezer” and that a quick estimate (by looking at a small set of the frames) is that I’m beating 74.5% of my left ventricle blood each time.

Woo hoo!

That should be the last active medical thing to happen to my body this week, but now I have to deal with removing my surgical wrappings. Peel peel peel. Eww.

And now I go to the dentist, where I will not be getting any cancer-related treatment.

He warned us that the lymph node may not actually have any information about what specific kind of lymphoma we’re looking at, or it may even contradict the indications of my bone marrow.

We also learned that he’s not entirely sure it’s lymphoplasmacytic lymphoma. I’m unusually young for it, and a lot of the diagnostic traits that point toward it could also apply to diffuse large b-cell lymphoma or (DLBCL). DLBCL is a much more common, and is also much more aggressive than lymphoplasmacytic lymphoma (LPL). On the positive side, a result of the increased aggression is an increased possibility of permanent remission.

Also, we’re getting the process started for a 2nd opinion from a lymphoma specialist at the Seattle Cancer Care Alliance. We’d really like to know for certain what this is before we start killing it.

We asked about the treatment plan Dr Norman is currently imagining. He’d treat LBL and DLBL very similarly: with a chemotherapy regimen known as R-CHOP. The “CHOP” part contains four different chemicals that have been used in chemotherapy for a long time. The “R” part stands for Rituximab, a monoclonal antibody that shows some good cooperative effects when paired with CHOP.

We’d likely do 6 cycles of R-CHOP, which is usually done with one day of infusions and then three or four weeks of recovery before the next one. Looks like about 6 months worth of chemo.

One side effect: the H part of CHOP, also known as “Adriamycin” is toxic to the heart. Dr Norman wants me to get a MUGA scan to make sure my heart is strong enough to take it. Scary!

Next steps:

• Group Health sends my medical records to SCCA
• Group Health’s corporate masters approve the referral to an SCCA oncologist
• I will call to get second-opinion scheduling started at the SCCA
• GH Bellevue’s surgery scheduler will call to set a time for my chest port/lymph node operation
• I will call to schedule a MUGA scan