Tuesday, June 26, 2012

Intrathecal Methotrexate Update, June, 2012

gec_02_img0116Yesterday I had my third treatment of intrathecal methotrexate, delivered via a spinal tap. Unlike my previous treatment, today I am no worse for the wear.

For a description of how I ended up on this experimental protocol, and for the scientific evidence that supports it, click here.

For an account of what went wrong with my previous infusion and caused me to lie flat on my back for nine days, read this post and then this post.

The Manhattan neurologist, Dr. Saud A. Sadiq, who has researched this treatment in progressive MS patients, prefers to employ a thin, 25 gauge needle to deliver the drug into the patient's spine. The local physician who is helping me on this, an oncologist who treats some of his cancer patients in this manner, was resistant to use such a thin needle. However, after my previous debacle where I had a nine day headache and two blood patch repairs, he agreed to give it a try this time around.

The procedure went well, and he had no difficulty with the 25 gauge needle. The infusion itself was relatively painless, but more importantly I had no post-lumbar puncture headache. The literature, and a couple of anesthesiologists I spoke to, supports the idea that these thinner needles are much less likely to generate a post-lumbar puncture headache than the standard sized needles. I like doctors who consider my recommendations and implement them.

It's easy for me to put into perspective the discomfort I sometimes feel during and after these procedures. All I have to do is be observant as I roll through this oncologist’s treatment room and see the dozen or so cancer patients tethered to their chemotherapy bags. At best they will be extremely uncomfortable for weeks, and at worst they will suffer long, agonizing deaths. That makes what I'm going through, in terms of treatment discomfort, minor by comparison.

But I do envy them in one respect. If I was given the opportunity for a more intense and risky treatment, but with the possibility of a complete cure, like these cancer patients have, I might not say no. That option simply doesn't exist for me though.

So, is my treatment working thus far? I told you that I could not make an accurate assessment in less than six months, and it's only been four months. You people are just unbelievable sometimes…

Note: To see all of my intrathecal methotrexate posts, click here. They are listed in reverse chronological order.


  1. Well, I was hoping that at the very least you would be tapping your toes by now. Is that too much to ask?

    I'm glad this one went well for you, Mitch. May the others go as smoothly.

  2. Hey Mitch, riding along with you. I'm doing monthly cytoxin. Thanks for putting into words the cancer thing. I feel guilty thinking at least they can try for a reprise....and possibility of "cure"...oh G-d, not saying I'd rather have cancer! You know what I mean! Thanks for sharing....

  3. In bed for 9 days...that is bad!!! glad this time it went better.

  4. It bothers me that you had to do your own research (as you always do) to draw the conclusion that needle size made the difference instead of the local doctor already knowing that. I guess when we grew up, we thought doctors were omniscient and knew the right thing all the time. NOPE. I watched James' parents and my own parents go with that philosophy, never asking questions. I have had to "run interference" with medical people many times....often not well received. (Wow, football analogies!)

  5. Webster,

    Thanks for your well wishes.


    Ya, I know what you mean. Good luck with your cytoxin.


    Breakfast in bed is one thing, but nine breakfasts in bed is a bit ridiculous!


    It really doesn't bother me that I had to bring this issue to the attention of my doctor. There's just so much information out there that it's impossible for every physician to know everything, so it becomes our responsibility to be informed. It sounds like you're comfortable taking the bull by the horns!