Baclofen Pump Refill

November 10, 2008

I have had my baclofen pump for about three months now.  It has made a huge difference in the quality of my life,  in the quality of my family’s life.  The other day was refill day.  This is the first time I had to have it refilled.  Someone recently asked me, if I had my refilled yet.  When I said no, they replied, “Oh, just wait.  That’s an experience.  Just wait.” Oh, great, I thought. That doesn’t sound fun.

But then I realized, it can’t be as bad as the surgery, or living with severe spasticity.  I thought maybe like most things people embellish for who knows what reasons. Still, it did make me a bit apprehensive. 

So, I arrived bright and early for my appointment.  I awoke at 5:30am so I could shower, have coffee, eat breakfast, get my family out the door to work and school, so I could leave on time for the hour and a half drive to my docs.  I really hate early morning drives.  It sets off vertigo whenI don’t have enough time to adjust to being awake. I don’t like driving in the early morning.

Well, it is a procedure for sure to get the pump refilled.  Not a bad procedure, just a procedure, especially the first time.  Seems there’s a first time for everything. The doc needs to find the tip of the pump so they can line up the template. The template finds the center of the pump which holds a small area in which a needle is inserted to first draw out the remaining meds then fill the pump with the new meds. Sounds easy enough. But, finding the tip the first time can be tricky.

The doc needed to really press and feel all round the pump. This is not a gentle operation as the doc needs to feel below the skin into the fat layer to find the outline of the pump.  Seems the tip of my pump is up under the ribs. Things got much easier when I told the doc how everytime I bend down I get a sharp shot to my ribcage. So, she proceeded to feel under the ribs for the tip. You can imagine how much fun that must have been. 

So once the tip is found and center marked. My mid-section is draped with a sanity cloth(has a hold in the middle for access to the pump) and the skin all around the pump is painted with the heavy thick yellow sanitizer. Pretty simple so far.

The doc got the needle and meds ready. Then told me I’d feel a pinch. I’m thinking like getting your blood drawn-a slight pinch. Well, the doc never said ‘slight’, I added that. It was quite a pinch. Just a point I am ready to say, “Hey, that’s beginning to hurt maybe something’s wrong,” it stopped. The needle found the pump reservoir. A few moments later and I was being cleaned up. All done. Simple as that.

It was sore for a few days. I guess it was to be expected considering there was a fair bit of manipulation around the pump.  All in all a pretty simple, easy procedure. I thought I would share this because when I spoke with others I got negative feedback about the experience. And I am not sure why.  Granted it is a bit more than having blood drawn, but only a bit more. Easy and simple.

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A month later

September 2, 2008

Wow, I can’t believe a month has passed since my baclofen pump surgery.  I continue to have the pump adjusted. It is a process like everything else in life. I go for weekly adjustments until we find the perfect dose. Meanwhile, life goes on.

I work with a physical therapist to help strengthen my legs and stretch out my muscles. This time there is light at the end of the tunnel. This is the third endeavor with the same pt. Bless her, she is extremely experienced in progressive ms, understands all that atypical ms encompasses and cares. Most of all she cares.

The last time I saw her, I was getting ready for the pump surgery-back in the beginning of June 2008. She tried to patch me up as best she could until the surgery, but was fighting an incredibly steep uphill battle. Finally conceding that despite her best effort I was losing ground. The best I could do was wait for the surgery, after which she would be of real help. The tears in her eyes as she had this heart to heart with me, touched me deeply. She cares about her patients. Her patients are real people struggling, fighting for better moments. The openness of her concession touched my heart so much that I really felt her pain. Felt and understood the helplessness of her words. She was in the business of making people better and I was the wrench caught in the cogs.

So, a month later with physical therapy script in hand, I sashayed into her office. With jaw dropped to the floor and tears in her eyes this physical therapist welcomed me back with open arms. Literally, open arms. Our smiles stretching from wall to wall. “Now this is something to celebrate! You have made my entire month by walking in here.”  Her words touched my heart. She had helped me out so much in the past, I was glad to see her eager face again.

I barely notice the pump anymore. Once in a while when I move into a certain positions the pump bumps into my ribs. That I feel. Otherwise, not so much. We (hubby, son and I) nicknamed the pump ‘Tigger’ because it keeps me bouncing. Meanwhile, they (hubby and son) jokingly consider me a cyborg. I’ll gladly take that label.

I move so easily now. Still not as naturally as one should move, but so naturally that I can easily forget, if even for a moment, ms has changed my life. Have you ever been caught in a wind that starts at the top of the trees and blows threw you as it sweeps past. I was caught in one of those winds the other day. So what you say. Well I was actually able to throw out my arms and enjoy the sweep breeze because I didn’t have lofstrand crutches attached to my arms. 

We ( I include myself before ms) take movement, simple, easy, graceful, natural movement for granted. The simple beauty of walking naturally, of moving with ease, without thinking about it, without mechanical assistance is something we should all take a moment and enjoy. Really, take a moment a walk, simply walk, take a few steps. Concentrate on just each step. Feel each foot fall, feel the ground, the floor underneath your feet. It is truly a wonderful sensation.

That is probably the greatest lesson I have learned this past month, these past few years living with ms: take each moment as it comes, enjoy every moment, see the simple beauty by keeping your eyes and your mind where your feet are. In this way you are always awake and aware enough to enjoy and live each moment. Good stuff. At least good enough for now.

Hey, look ma no crutches!

August 22, 2008

Well, I am three and a half weeks post surgery.  And look ma, no cruchtes!  That is right. I shed my afos (ankle/foot orthotics) and forearm cructhes.  I don’t even use a cane.  I am walking normally.

I forgot that your feet actually go one foot in front of the other when you walk. For so long my feet went out to the side.  In fact, my neuro-rehab doc described my walk as that of a Zombie: stiff legged and painfully slow. She even reminded me that I should have been in a wheelchair were it not for my stubbornness, and unyielding decision to stay upright until I couldn’t anymore. Giddy with excitement over the results, this doc had me walking for everyone.  And I was glad to oblige.

I also found out that I am more of the exception than the norm with my baclofen pump results.  Most people with mulitple sclerosis, whether primary progress, atypical ms, or your normal garden variety do not get the pump so early or have such great results.

Now, after so many months with this blog, I know what you’re thinking. Why? Why are my results, well quite frankly atypical?  I asked the same question. I even asked why they don’t implant the pump on more people who are still mobile. They tend to have many people who are immobile, even with twisted limbs before a pump is implanted.

Again, relativity and everyone’s ms is different, comes into play. See, in regards to my spasticity I am described as looking more like a spinal cord injury patient. From my trunk down to my toes I have pretty equal severe spasticity. Even leg weakness was bilateral and pretty even; although, my right side is the weaker side but only slightly.

So, most of the time patients have only one side with severe spasticity. Because the pump dispenses lioresal (liquid baclofen) through a catheter implanted directly into the spinal canal, spasticity is relieved bilaterally.  If one side is severely spastic and one side not so much then the result of the pump will be one side too weak to work properly and one side somewhat relieved.  Not good results.

I guess in that case I am lucky. Because of the bilateral severity, I am reaping the wonderful relief that the baclofen pump promises. Imagine that, being so inhibited, being so spastic, being so affected actually works in my favor. Ironic, really. And I love irony.

The other major reason my docs don’t see such great results is that many people choose not to have the pump implanted. I would like to say I don’t understand why someone would choose not to have the pump implanted. But I can’t.

Back in February of this year, my neuro-rehab doc told me I needed the baclofen pump after botox injections were unsuccessful. As I explained somewhere else in this blog, botox is injected in isolated muscles to relieve spasticity. Due to insurance red tape, I needed to max out on oral baclofen AND have unsuccessful botox treatment before being covered for implantation of a baclofen pump.

In February 2008 I had my botox follow-up. The botox only relieved my calf muscles to the detriment of the rest of my leg and torso muscles. I went into that appointment in severe pain because the rest of my spastic muscles were trying to compensate for the now less spastic calf muscles. Basically, my whole gait was thrown off (again! -first time of course is because of MS) creating a great deal of strain on my legs and lower back. 

Yet, I still said “NO!” to the pump. I wanted to try botox once more. So, May 2008 was the target date for the next botox injection. Meanwhile, I was sent to physical therapy. I spoke with hubby, family, and friends. All said, “TAKE THE PUMP!”  Oh, no. I was too young for such a permanent, drastic move. My physical therapist, wonderful woman who is blunt. Which I really like. Give it to me straight. She said “If you got worse after the first botox treatment, what makes you think the second one will help?” Great question, don’t you think. I had no answer for her. I had to admit that botox wasn’t going to work. 

Left with no other option, no other feasible, reasonable, sane option, I informed my neuro-rehab doc in May 2008, that I did indeed want the baclofen pump. Three months later and I am a different looking person.

As my doc says, “You don’t even look like anything is wrong!” Good stuff really. I am even getting used to having this baclofen pump in my side. I am beginning to think of it as my little ticker-it’s what keeps me going physically. Well that and ten months of chemo (Cytoxan). Hubby, son, friends and family keep me going psychologically.

Recovery from Surgery

August 12, 2008

Well, it’s been two weeks since my surgery to implant my baclofen pump.  The surgery itself went great. I am healing nicely and the pump is working great.  I am still not fully weaned from the oral baclofen, but making good progress. 

Apparently, my body does not like either anesthesia or percocet.  That was the one hitch during the recovery in the hospital.  So, on Monday July 28 I was trying to recover from surgery while getting sick.  Oh yeah, one more thing. Because implanting the pump is one HUGE lumbar puncture, you must lay flat for the first 24 hours.  I knew this going into the surgery but didn’t count of being sick from the meds.  The next day they switched me from percocet to vicoden.  Much better! Sigh of relief!  

The nurse, which I had the prior day, even said “I bet you second guessed your decision yesterday.”  That was and understatement.  But, I did keep reminding myself that having a baclofen pump is a process. First you must heal from the surgery while transitioning from oral to liquid baclofen and going through physical and occupational therapies.

The big question of course is did it work? Does it work?  Yes!  For me, the pump is working.  I am walking with only a cane now.  I packed away the forearm crutches and leg braces.  There are still some nagging stiffness, but as I said I am still transitioning.  

I guess one of the hardest parts of this whole process for me, and it is really why I didn’t initially jump at the idea of a pump, is the idea of having this device in my body.  It is like a mental game I play.  Do I want to live the rest of my life (41 years old now) with this artificial device in my body?  Yes, it definitely helps me walk, reduces pain level, and most importantly I can the relief in my son’s and my husband’s faces.  So I logically and intellectually tell myself this is the best.  

After all the chemo and now the pump I feel better than I did three years ago when I first walked into my current neurologists office.  The catch is with atypical multiple sclerosis that acts just like primary progressive multiple sclerosis I can’t help but think I am on borrowed time.  Really when you look at life there are no guarantees of health or longevity so in a way we are all on borrowed time.  Makes me want to make a difference in this world, even more than I did before.  I feel a pulling toward helping people because through all of this I have learned that we are all suffering in some way whether it is outwardly visible or inwardly destructive.  All of this, the past three years, I have met people that have no health issues that are miserable, unhappy or people who seem to have it all yet they are nasty or not quite right. We all suffer somewhere.

Back to the pump.  On the afternoon of July 29 I was transported to a rehab hospital where they should have adjusted the pump and given me PT and OT.  I somehow slipped through the cracks and no doctor made any adjustments.  In fact, I never saw a doc there despite my constant asking and badgering.  So on Friday August 1 hubby (who was by side the entire week, even sleeping the first night in the hospital because I was so sick) and I left the rehab hospital.  Filed a complaint and walked (Yes, I walked) out of that hospital and into my neuro-rehab doc’s office where she explained the entire pump, precautions, expectations, and made the first adjustment.  

Both the neuro-rehab doc and the surgeon went over the pump before the surgery.  I was well aware of what I was getting into before I jumped.  I know since we (hubby and I) made the decision to undergo implantation of the baclofen pump I have heard other people say they were not prepared for or expected too much from the pump.  Again, I think this is what is wrong in the medical field.  Too many docs and others see us as patients (things like a chair,the manilla file folders that keep our medical history) and not people.  I have learned to ask any and all questions, to research as much as I can.  And most of all I feel very lucky and happy to have the doctors I have.  Nothing can replace trust and caring when it comes your health.

Baclofen Pump

July 27, 2008

Tomorrow, July 28, I undergo surgery to implant the baclofen pump (ITB Pump-Intrathecal baclofen Therapy Pump). Medtronic makes the pump; click Medtronic to learn more about the pump. I will on a short hiatus while I go into rehab. Then I’ll be back blogging about my experiences. Hopefully, someone else that has to go through the same surgery can read about this and get a real world understanding of what happens.

I undergo surgery around 7:30AM tomorrow. The procedure takes about 90 minutes. A small incision is made just below the skin into the layer of fat at waist level on either right or left side. The pump is wrapped in cloth and inserted into the incision. The another smaller incision is made in the lumbar region of the back at the spine. A small catheter is tunneled from the pump to the lumbar region and inserted into the intrathecal space of the spine.  I am stitched up and recovery begins while liquid baclofen begins it drip into the spine.

Afterwards I need to lay flat for 24 hours to avoid a massive headache as this procedure is like one mega lumbar puncture. Then I am whisked away to the rehab hospital for four to seven days. Probably seven days.

Why rehab? Well, mainly to wean me off the oral baclofen. Additionally, rehab will help to strengthen muscles that are currently spastic, teach me how to use muscles the correct way again. You know, things like that. My oral baclofen will be reduced from 110mg a day to 80mg a day. Rehab will adjust the pump will continuing to reduce the oral baclofen.

Within seven days I will be released, sent home and hopefully feeling much better than I do right now. I am hoping the painful spasms will end so I can stop taking pain pills. Potentially, fatigue will lessen as 110mg daily of baclofen increases fatigue.

I am both eager to have an ITB pump and work at rehab. Having a positive outlook has been an advantage for me through Atypical Mulitple Sclerosis, most likely Primary Progressive Multiple Sclerosis. I know I have a choice in my outlook. I do not expect certain things to happen so I am usually pretty happy most of the time. 

I went through the ‘Why Me’ phase years ago. It wasn’t helpful. I came to the conclusion why not me. What made me so special that I actually thought I was above getting sick, hurt, etc. Because I am surrounded by people who care, love and support me I am glad that I have Multiple Sclerosis. Sounds weird?!? I guess it is, but I hope that because I have MS, maybe I can lessen the hardship of one other person who also has MS.

I can send out good thoughts and feelings to others who are suffering from MS. And not just the physical and mental effects of MS, but also the emotional toll it takes on their spouses, children, friends, families. So often I hear from others about domestic upheaval from the sheer emotional and financial toll from MS, espeically Primary Progressive Multiple Sclerosis. I mean PPMS can be a very isolating disease as sufferers have great difficulty moving about their communities for both daily living issues and SOCIAL CONNECTIONS.

In any event I will blog more when I return. Until then I wish you all well.

Yesterday, I went for my ITB Therapy screening test.  Or my test dose for the Baclofen pump. Currently, I am on 110 mg daily of Baclofen, which I’m sure adds to my fatigue issues. And lately, it isn’t enough to loosen my hips and torso.  The pain from the spasticity is bad enough that I am also on Vicoden.   

My test dose was administered in the recovery room of the day surgery unit at the hospital. I was ushered into a small private room, with the help of my hubby I changed into the surgical patient uniform- the johnny. My nurse inserted an IV, drew blood, checked my oxygen levels and blood pressure.  All good.

Finally Dr. Calm (of course not his real name), the neurosurgeon, entered. Reassuringly, he numbed my back then administered the Baclofen via the lumbar puncture.  Within a few minutes the procedure was complete.  As with all LP’s I was ordered to lay flat for an hour or so.

Here is the great part.  By the end of the hour I felt some effects.  My legs bent without pushing, without pain.  But the real test was in my hips and torso.  As one doc put it, I “lost my wiggle”.  My torso is so tight I cannot reach over my head. Again, my hubby helps my dress and undress.  He, my son and a trusty grabber all help me reach into cabinets, cupboards, and even pick things up off the floor.

When I was able to get up, I was able to get up.  I was able to get off the bed without help, without pain, without having to adjust myself just so.  I shot my husband a look but he was two steps ahead with a smile.  During the next few hours I took the short walk, long one if you have trouble walking like I do, to the bathroom. This was a beautiful moment.  For the first time in two years, I felt as if I was walking, really walking.  Not just dragging the two dead cement columns attached to my waist around.  My hips moved, my wiggle wiggled.  

Hubby escorted me to the bathroom, but returned to the recovery room.  Coming out of the bathroom without forearm cructches and walking, really walking, was a feat worthy of Olympic Gold. As I turned the corner I saw the face of my husband.  The face of the man I married.  Not the face of the man I have looked into for the past three years, the one distorted with stress, worry, and fear. But the happy smiling face of the man I married fifteen years ago.  

When I got back to the room I stretched like a bear waking from hibernation, a two year hibernation. It felt GREAT!  But the best part of the day was seeing the smiling face of my husband.  I don’t worry about the future because I know that he worries enough for the both of us.  I have learned that life is what you make of it.  No one is given a life without obstacles, we all suffer.  That is the great equalizer, that is what unites us.  Whenever I look into another’s eyes, I can’t help but see suffering like mine. In this way, I have learned to take what I have because all we ever have in now, this moment, and it IS precious. 

So, now I wait for a few weeks until Dr. Calm surgically implants a Baclofen pump, ITB Therapy, into my body.