Tuesday, January 21, 2014

Intrathecal Methotrexate – Update

Chemotherapy (Photo credit: franziskas garten)
Yesterday I received my 12th infusion of intrathecal methotrexate. The process went smoothly. My oncologist is really getting the hang of it.
I have this treatment administered at a cancer infusion center. When I'm sitting in the waiting room, I wonder what the cancer patients make of me. I have rosy red, full cheeks, so I don’t look like I’m going through rigorous chemotherapy. But, I am obviously not a picture of health either. As I go from the waiting room to the special bed where I receive the spinal infusion, I pass by about 25 people sitting in recliner’s, having their particular brand of chemotherapy dripped into their veins. Do they think I have an even worse kind of cancer because I have to go to the bed section instead of the recliner section? These things are not important for me to know, yet I do wonder.
This treatment seemed to be working for a while. But if you read my end-of-year summary from a couple of weeks ago, it doesn’t seem to be working anymore. So why am I still taking intrathecal methotrexate?
I spoke with my neurologist about a week ago and explained to him that while I was on the treatment in 2012 I didn’t experience any disease progression. However, in 2013 the disease progression is back, and with the same veracity as before I started intrathecal methotrexate. Yet, there is no other treatment that we would like to try. There is no drug in the on deck circle. So we’re going to be extra patient with intrathecal methotrexate and give it another six months – three more treatments. If my disease still seems to be progressing at the standard rate, then we’ll stop the program at that point.
Assuming intrathecal methotrexate is no longer working, what happened? I can think of three possibilities:
  1.  Intrathecal methotrexate wasn't the real reason I plateaued in 2012. There is a natural ebb and flow to even progressive MS, and I just happened to be taking this treatment when I happened to be in a natural leveling off point in the disease progression.
  2.  I succumbed to the placebo effect. I didn’t really plateau in 2012; I just convinced myself that I did.
  3.  Intrathecal methotrexate is why I plateaued in 2012, but for unknown reasons it has simply stopped working.
Of these possibilities, I find item 3 the most likely. I don’t think it was the placebo effect because I’m a natural skeptic, and my wife corroborated my observations. The data that we used to verify the plateau was objective. I don’t think it was a natural plateauing action either, but I can never be sure.
I find it unlikely that intrathecal methotrexate will resume its positive effects on my progression, but stranger things have happened. I’ll update you again in the summer, if not sooner.
Come on stem cell treatments, I’m growing old waiting on you!

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  1. I hope it starts working again for you, whether it's the placebo effect or not. Placebo is a great drug, it often works for me!

  2. Maybe, the plateau will occur again. I, too, am waiting for the whole stem call treatment to become available for us. I'm watching Richard Cohen's experience with it.

  3. as i'm sure you know, the tisch center in NYC is starting stem cell trials. a local friend is getting involved in them. she's also been doing the meth treatments there in NYC. i am, like you, very excited in the prospect for stem cell therapy.

  4. Diane, thanks for your well wishes!

    Muffie, you are right. Maybe I'll catch another plateau.

    Stephen, Dr. Sadiq is very popular!