Saturday, May 14, 2011

New Body Parts Installed or Been a Long Time Since I Posted


I can summarize my life pretty quickly since my last post in September of 2010.

Lots of back pain. Trying to work, sleep, live with lots of pain. I pretty much stunk at everything, work, relationships, life in general.

Last summer (2010) I did the trial for a "neurostimulator" or more simply, spinal cord stimulator, or what is basically a TENS unit where the electrodes that zap you are inserted in your back close to the spinal cord. This device is effective for some, but in me, they could never get the device to "buzz" in the areas where I hurt, lower back and outside left leg/butt. There are electrodes for the final two inches or so, and it's this section of the electrical cord which is implanted along the inside of the vertebrae close to the spinal cord. The Here's a brief run-down of these devices on Spine-Health.com, one of my most frequently visited sites (http://www.spine-health.com/treatment/back-surgery/spinal-cord-stimulation-chronic-pain).

So for me, the spinal cord stimulator trial was a failure, and my Pain Management Doctor and I started talking about one of the final tricks he had up his sleeve.

Intrathecal Pain Pump. Or just Pain Pump to many. Similar idea to the spinal cord stimulator, but with a pain pump, a catheter is inserted into the intrathecal space of the spine. This is the same protective sack where the spinal cord lies and in which our spinal fluid flows slowly from lower back, up to and around the brain, and back down the spine.

The idea is to deliver minute amounts of pain medication directly into the spinal fluid, allowing it to flow up and down with the spinal fluid and delivering some of the most powerful pain relief that can be given these days.

All along this path, work really sucked. I just hurt too much to be a great engineer, and I couldn't really take high enough doses of pain medicine to really cut the pain without drastically cutting my brain power, which is essential in the engineering world.

I've been on disability since earlier this year, and I have slowly gone through the process with my Pain Doctor to have a pain pump trial (it was deemed successful in me), visit a neurosurgeon he referred me to, get all the pre-surgery health checks done, and to have surgery to have the pain pump and catheter installed permanently.

First, the pain pump trial. in February, I went into a day-surgery center and Pain Doctor and crew sedated me a bit, and then using a fluoroscope, which is basically a live-action x-ray machine, gave me a tiny shot of morphine straight into the intrathecal space in my spine.

I've had so many shots and surgeries in my back that from the middle of my back down to almost my rear end is mostly scar tissue. But one of the beauties of the pain pump and the flow of spinal fluid up and down is that they can inject the medicine in any place along the spine and the medicine will flow with the spinal fluid, hopefully delivering sweet pain relief along the way.

I stayed at the surgery center for several hours for them to make sure that I wasn't having serious side effects from the bolus of morphine in my spine and during that time felt my pain levels really decrease. They sent me home and I was to keep a journal of sorts and to stay off oral pain meds as long as I could.

I lasted about 36 hours, but I left it too long before starting my oral medications again.

I got a good bit of pain relief for the first 24 hours and then the pain slowly started increasing again. When I took my first oral meds at the 36 hour mark I didn't know it, but the pain pendulum was swinging back to serious pain really, really fast.

It took me a couple of days to carefully dole out to myself doses of oral pain meds until the pain was back to where I could even sleep.

But the initial pain relief of the directly applied morphine was what they wanted to see, and after weeks of doctors visits and pre-surgery checks had my pain pump installed in late April at Sebastian River Medical Center in Sebastian, Florida. That's near the neurosurgeon's office and about 15-20 miles south of where we live in Palm Bay.

I had an incision along my spine for the surgeon to put the catheter tip into the intrathecal space push it up in there a couple of inches along my spinal cord.

Then they "tunneled" around my side to create a path for the flexible catheter to reach around to my front left side where another incision was made to implant the actual pain pump filled with morphine.

They also had to make a small incision on my left side to help continue the tunneling for the catheter to reach around from my back to my front.

Total, 3 incisions to heal from. Though I was able to get up easier than after my previous surgeries since they hadn't actually worked on or ground away bone, I've had a heckuva time with three incisions healing.

I'm still a week away from my first visit with Pain Doctor since my surgery, but the surgery incisions have healed enough that I can feel the pain pump having a little bit of positive effect on my pain level.

The surgeon filled the pain pump, but only set it at a super-low release rate, enough to make the pump work until Pain Doctor could see me and I had healed enough to start ramping up the the delivery rate of the pain pump.

As of today, I'm slow moving, but doing pretty well. The incisions have been slow to heal and are still pretty sore, even three weeks on.

I'm basically still in the same pain situation as before the surgery, but the fact that I can now feel the light effects of the pain pump helping gives me hope that in the coming months we can get the device adjusted to where I don't have to take much oral meds.

The initial goal is to stop taking my long acting pain meds and then only have to occasionally take a quick acting pain medicine for "breakthrough" pain as needed. Getting off the long acting stuff will be a big relief to my liver and kidneys from the years of daily oral pain medications.

The pain pump can possibly give as good relief as long acting oral pain medications, but at the rate of only 1/200 or so of what I would take orally.

In other words, you have to take a pretty big dose of oral pain medicine to help lower serious pain levels, but with the pain pump's direct delivery to the spinal fluid, many patients get the same pain relief with 1/200th of what they were taking orally.

Just tiny, tiny amounts are delivered by the pain pump in a 24 hour period but with the same effect as hefty doses of oral pain medications.

Anyway, if anyone is still out there, and you've read this far, I'll throw you a bone and stop here.

I'm still not out of the woods yet, but the pain pump system is successfully implanted in me. It seems to be giving a bit of help to my pain levels, and should help more and more as I resume visits with Pain Doctor who will fill the pump and adjust the release rate of it's medicines from here on out.

If you are interested, follow this link for a short video on the pain pump (http://www.spine-health.com/video/intrathecal-pump-implant-video). Just click on the "Play animation without narration" link in the frame, and then start clicking the "Next Step" button to continue the very short animated views of how the pain pump system is installed. It's only about a minute long. A picture will make all that I wrote here come clear with just a glance as to how the pieces are placed.

I seriously hope to resume blogging, I miss it very much. It's a great release valve for me.

Until next time...God bless you.

4 comments:

imac said...

1st its great to see you back John.
Thats certainly some wow factor info there.
Good luck my friend, fingers crossed that it all works out well for you, and see you back here soon.

Carina said...

I was just thinking about you the other day as I was cleaning out my old blog links. I decided not to give up on you yet, and I'm glad I didn't!

I hope and pray that this pain pump makes your life livable again!!

Gilberto Shneider said...

Did you ever feel any back ache because of the pump? Actually, I'm just curious of how people can manage using the pain pump. Anyway, I hope you fine now. Stand straight amidst life's difficulties!


Gilberto Shneider

Blogger said...

Did you know you can create short urls with BCVC and receive money for every visitor to your short links.