- Disabilities & the Disabled
SCI: Spinal Cord Injury -Inthrathecal Baclofen Pump Experience Part 3
DOCTOR VISIT TO FILL BACLOFEN PUMP
The last step of my initial Baclofen Pump experience was to:
- Extract the saline from the initially implanted pump
- Refill the pump with Baclofen and set the dosage.
My pump was implanted in my left upper butt cheek slightly below the sacral bone. The doctor chose to place the pump there because it would be easier to refill, more comfortable, and less intrusive. The latter is because typically they are implanted in the stomach where that requires the doctor to thread the catheter from the stomach implant site around the side, and up thru the spine. By having it implanted on the backside, there is less tubing and chances of problems.
After the staples were removed, and the area begins to heal, it is not extremely noticible. You can feel it when you lay down, or sit in certain positions, however because of the location you do not sit on the pump. Therefore it does not provide the feeling of sitting on your wallet. Rather, it feels more like having a device slightly bigger than a skoal tobacco container slightly below the 'love handle' area.
Having the pump refilled was surprisingly simple. When I arrived, the doctor asked me to lay on my stomach, and then he placed a small Velveta Cheese sized device over my pump and it read wirelessly data from the pump including:
- Function and current device status
- Battery status
- Current dosage drip statistics
And many others..
There are no local site sensations of discomfort or irritation during this process.
After the doctor verifies the pump is working correctly he follows the procedure outlined in the above screen shots so he may extract the saline from the initial pump install, and refill it with baclofen.
During this process the doctor:
- Places a plastic template the exact size and shape of the baclofen pump over your implant site so he can determine the location of the needle hole. The pump has a circular hole directly in the center that allows one-way passage of a needle into the device. This template is not glued or stuck to your body. Once the location is found it is easy to determine the exact match.
- He injects a needle directly into the center of the template marked for the needle and it goes directly into the pump.
- He extracts all the saline (about 18ml), then re-injects the pump with concentrated Baclofen.
During this process there was virtually no pain or discomfort. I barely felt the needle go in and there were no additional feelings after it was in place. Could be due to the thicker backside??
The extraction and subsequent re-injection of Baclofen was extremely quick, and the whole process took less than 2 minutes.
After the doctor was finished, he removed the needle (once again no pain) and then he replaced the Velveta Cheese size device over the pump to read the statistics. He then set the pump to the highest setting to allow the remaining saline in the tube to be flushed out. During this process he places his ear over the pump to verify he can hear it on the high setting. Once verified he asks you to continue laying down for 15 minutes. When the time is up, he places the wireless device over the pump and lowers the settings back to the specified drip rate.
From then on, the pump will continue to constantly drip baclofen into the spinal canal. I was initially concerned about the possibility of clotting around the end of the pump tubing, and the doctor assured me this is an extremely rare occurrence. The tubing is implanted in the spinal canal (directly next to the spinal cord) where the spinal fluid is free-flowing. Therefore the constant motion of csf fluid in addition to the fact that clotting cells are not within the canal is what minimizes the chances for clotting.
The initial setting is typically the same amount given during the baclofen pump trial over a constant 24hr period of time.
There are no initial feelings of pain, or weakness after the baclofen is injected. I noticed a difference about 30 minutes after the refill which continued to quickly improve.
The doctors should inform you that the process of determining the proper dosage and concentration of baclofen may take 2-3 months or so. They incrementally increase the dosage upon your request to ensure there are no complications or loss of movement. I did not experience any residual spinal headaches after the refill, or any other local site discomfort.
Overall, the experience has been extremely positive and my abdominal and back spasms have been greatly reduced. I will be returning to increase the dosage for my leg spasms, however I can clearly see a difference.
I would still highly recommend the procedure to anyone considering an intrathecal baclofen pump for spasticity. I will continue to update my progress over the months, but so far so good.