Last night we began the MTX infusion around 6:30 or 7pm. It finished near 11pm or midnight. I’ve had a bit more nausea this time around, but nothing so bad that we can’t stay ahead of it with Lorazepam (Ativan). This also has the side-effect of making me a little loopy; I completely forgot that Dr Norman came by to visit this morning!

It is very important to have a teammate that has all of his/her marbles, because sometimes you lose yours. Thanks Jana!

He came back by to reiterate that he DID, in fact, stop by and to re-mention what we’d discussed earlier.

As for the rest of the day, he schedule calls for 24 hours of “grace” before we start sending in the rescue dose of Leucovorin.

The Methotrexate works (generally) by pretending to be one of the nutrients needed during the cell replication process. When a cell (let’s suppose a lymphoma cell) starts to duplicate, it needs raw materials like Folic acid. MTX finds the places that are seeking Folic acid and grabs onto them, locking them down. Without the ability to absorb Folic acid, the cell ends up starving to death.

The “rescue dose” of Leucovorin is able to sneak around some of the MTX lock-down. We give the MTX 24 hours to work on starving the really fast dividing cells, and then bring in the Leucovorin to start saving the stuff that hasn’t already been caught replicating.

Early bird gets the chemo.

This morning I got to be a teaching aide, too! A program coordinator stopped by and asked if I would mind having a second-year UW medical student come in to ask about my patient history and perform some physical examinations. I said “sure!” and for the next hour and a half Preetma asked me about the events leading up to today and did a basic patient physical examination. Not long after, her entire group (along with the coordinating instructor) piled into the room and Preetma was prompted to give a very condensed 5-minute summary of my how-did-we-get-here story.

The instructor had some of the other students examine points of interest regarding my neurological signs, which revealed that some less obvious things still remain to recover. My left eye seems to still exhibit a bit of nystagmus at its extent and my uvula remains a bit deviated to one side (though my velopharyngeal inadequacy feels resolved).

After the session with the class we all chatted for a bit about Jana and my perspectives on what make for effective relationships between doctors and patients.

And now I’m back to working on my computer and enjoying the entirely reasonable room service offered here. My view out the window, while a bit hazy, is nice and interesting. Out of the corner of my eye I can see I-5 and the commute that I’m not stuck taking.