Back at Dana Farber, in the infusion ward awaiting the last few injections and infusions of the CODOX-M treatment, it includes: more Vincristine (the stuff that makes my hands and feet tingle), and 3000 mg/m^2 of Methotrexate delivered intravenously – this is the big one that penetrates my brain for any Burkitt’s cells that my be lurking there; it takes multiple hours and requires my blood to be slightly basic so that the Methotrexate doesn’t crystallize in my blood stream. At some point I expect to get transferred over to Brigham & Women’s but presumably when that is, is a factor of when a suitable bed shows up. I wasn’t sure if I was neutropenic, but I showed up with a mask anyway and they put me in a private room. Finished up my last home infusion of the antibiotic vancomycin this morning, so 1 expect 1) They’ll take more blood cultures to see if the infection cleared up, and 2) they’ll be re-accessing the port on my portacath to put a bigger needle in.

With my new wireless laptop I find there is a local network here at Dana Farber, but it’s private. So no joy there. At least over at B&W I can dial in.

[later] Settled in over at Brigham and Women’s and checked out by the resident. I’m becoming quite an old hand at this! The nurse is going to put in another needle into my portacath. I have what’s called a “double lumen” which means there are two chambers that can be accessed. Right now only one of them is accessed. Judging by my correspondence with other Burkitt’s patients there are a variety of different methods of semi-permanently accessing the veins. All of them, of course, have the advantage that they save the patient numerous sticks, but I wonder what the pros & cons of the various methods are. These are the methods I’ve heard about: Portacath; Groshong; Hickman; and I suppose there are variants of those, and others. How does the medical team decide which method to use?

My Portacath has the disadvantage that the fairly thick needles have to be changed weekly. The first time I had the needles changed I didn’t know what to expect, but now, so long as it’s been done by someone who knows what they’re doing (i.e. no student nurses) it’s not too bad. When I go home and I don’t need it they just take the needles out and I can take showers and baths as normal, without having to get wrapped up in plastic wrap. Note: despite what anyone may tell you, Tegaderm works much better than Press ‘n’ Seal!

Re the earlier question I raised in my blog recent about how doctors decide which regimen to use, here’s the response I received from my oncologist:

“The choice of regimens is largely physician/institution dependent. I view HyperCVAD and the Magrath regimen (the one you are on) as essentially equivalent as the drugs in both regimens are nearly identical, just some differences in the schedule.”