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Removal Of Baclofen Pump

baclofen pump removal immune response to baclofen



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#1 Apparelyzed

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Posted 20 September 2012 - 12:54 PM

Removal of Baclofen Pump

As many of you know, I've had ongoing issues with my Medtronic Syncho baclofen pump since it was replaced in March 2011.

I've had a baclofen pump of various makes on the right side of my abdomen since 1992.

The initial issue was in the anchor points breaking free after my 4th pump was replaced due to excessive scar tissue. This led to a haematoma and breakdown of scar tissue. The pump was then revised, and the pouch was redone, which seemed ok until March 2012, when the pump started to slip downwards which resulted in skin breakdown.

In March 2012 the pump was re-sited to the left side of my abdomen, along with re-threading of the spinal catheter. There was a collection of serous fluid around the pump which, even following aspiration would not completely clear up. The pump was working fine, and spasms were very well controlled.

In late July the scar tissue began to breakdown, overnight there appeared to be a blister effect forming on the scar on my abdomen. The breakdown was excised and sutured.

In August the scar tissue again broke down, and the pouch was revised, cleaned out, and stapled, and different sutures used for internal fixation and closure. Full bloods were taken for growth factors, infection. All bloods returned clear.

2nd September 2012, breakdown occurred once again, 2 weeks following the pouch revision, see photo 1. The only option was to remove the pump, let everything heal, and look at implanting another baclofen pump at a later date. The pump was turned down to it's minimum dosage of 60µg/ml and oral baclofen of 30mg x 4pd was started. After 10 days of bed rest in hospital, the breakdown had expanded, and fluid had again collected around the pump, see photo 2.

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Wound 1.

IMG_0796.jpg
Wound 2.

The pump was removed, and so far the spasticity has been manageable, less severe than when the pump ran out or was faulty. it's now 10 days post op, and I have reduced my oral baclofen to 20mg x 3pd, and 30mg at bedtime. I still have all my staples in, and am wearing an elasticated binder to minimise any CSF loss whilst the entrance wound to the intrathecal space fully heals. I am anticipating that the spasticity will further reduce as the staples are removed, and inflamation subsides.

All blood results have come back negative for infection, inflamation markers etc. We are still awaiting the immunology results.

This has been an extremely rare reaction to the pump, and is the only case my consultants have come accross combined with my negative blood results.

If needed, would I have another baclofen pump? Yes, it has given me a quality of life I couldn't of dreamed of if oral medication was my only method of management. I was on very high doses of baclofen, dantrium and diazapam before the pump, something which was not a long term solution.

I would still recommend the pump for people with severe spasticity, as it can make a huge improvement to your quality of life.

Simon.

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#2 easttnmarine

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Posted 20 September 2012 - 04:10 PM

I SINCERELY hope things resolve for you soon. You obviously know this better than anyone else, but that is one nasty looking spot you're dealing with. I was injured in Iraq in Jan '04 & had a pump put in the left side of my abdomen in Aug '05. Although I've had a couple of issues, they have been very minor compared to what you've been through these last few months. Like you, I think getting the pump put in was one of the best things (medically), I've ever done, as it made a dramatic difference in my spasticity & quality of life.

Best Wishes,
Louis

#3 brockit79

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Posted 20 September 2012 - 07:01 PM

wow, i too hope that things improve and you can have your quality of life back soon Simon. we need da boss back on form to keep the unruly ones in check ;)
Neek me chawa, wermo, mo killie ma klounkee!

#4 Tetracyclone

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Posted 20 September 2012 - 11:24 PM

Well, Happy Birthday Simon :sarcasm_on:
At least you feel well enough to post. May it happen that your body behaves differently this time and that reasonable oral doses make life manageable because it seems you have the equivalent of an "allergy" to what is being put inside of you. Maybe it has decided it simply does not like anything artificial inside. We do change over time.

And congratulations on keeping your wits about you. It isn't easy when we aree sick.

#5 bobm

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Posted 21 September 2012 - 05:54 PM

Very best wishes, Simon. Brilliant that you are posting through these difficulties.

Time for medical science to look harder at the spasticity issues shared by sci and ms people? There are an awful lot of us, particularly if you add in the numerous older men who have [largely] undiagnosed cervical myelopathy.
Bob

#6 Tetracyclone

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Posted 21 September 2012 - 07:26 PM

Very best wishes, Simon. Brilliant that you are posting through these difficulties.

Time for medical science to look harder at the spasticity issues shared by sci and ms people? There are an awful lot of us, particularly if you add in the numerous older men who have [largely] undiagnosed cervical myelopathy.


Yes!

#7 davebahm

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Posted 29 October 2012 - 01:14 AM

Best wishes to you, Simon. Your inflammation looks kind of like what mine was. It is odd that blood tests have all returned as negative for infection, though that's good as infection is no fun.

But your spasticity is reducing as you reduce the dosage of oral baclofen? That sounds great, so why take the risk of getting another pump? I'm going to do everything I can to avoid getting another one.

Dave

Edited by davebahm, 29 October 2012 - 01:15 AM.



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