While I was out . . .

[Guest guest]

.. . . I was in the hospital having surgery. Not spinal, thank God. As many of you know, I have had some problems with morphine infusion pumps. The first pump had to be replaced completely last January. The second pump somehow got into a bad position in my abdomen. It was eroding out, getting very close to my epidermis, and highly vulnerable to infection or worse.. In addition, it could not be refilled at all because it was turned inside my body -- and as of last Sunday, it was giving me hourly alarms indicating that it had run completely dry. Consequently I was trying to handle acute intrathecal morphine withdrawal at home with oral medications which were not equivalent. This is a tricky proposition and is nearly impossible in my experience. The benefit of intrathecal morphine, infused by one of these pumps, is that the medication can be given in smaller doses which affect the brain very little at all -- rather, most of the medicine goes to pain

receptors in your spine. Also, the medicine can be infused continuously, day and night -- so, no more waking up in agony and waiting for your pills to work before you even venture out of bed. I am considered a particularly good candidate for an infusion pump like the ones I have had, since I have long- standing narcolepsy. Oral and transdermal pain meds aggravate my narcolepsy, causing me to have sudden and dangerous sleep attacks regardless of where I am or what I am doing. The pump causes me no such problems. So, all in all, the pump has been a godsend -- but any malfunction or difficulty with such a pump can be pretty bad news.My neurosurgeon finally saw me - and my irritated purple abodomen over the pump -- last Tuesday. As I expected he would, he admitted me to the hospital immediately and operated the following day. By the time I went into surgery, though, I already felt considerably better. I am normally a pretty independent old cuss, but this

time I was glad to let the hospital staff set up an IV morphine infusion, as well as an external PCA pump which allowed me to give myself a bolus every 15 minutes, pending the restoration of my internal pump. With this arrangement, I was much more comfortable than I had been for some time -- apparently the pump slows its flow rate befpre it runs out, so I had been in some discomfort for some time, while unable to obtain proper follow-up from several medical professionals. I was also surprised to find that a few days in a hospital bed, doing little more than visiting with friends and family and reading good books, did wonders for my back and my overall well-being. I had been so mobile with the pump while it was working that I had been running around overdoing things like crazy. The benefits of a few days of rest amazed me. The pump revision on Wednesday took about four hours -- I still don't know why, but they said something about taking a while to position

me. I woke up feeling as if I had been tossed around like a sack of potatoes, then had had my innards rooted into and carved up considerably -- which is exactly what my surgeon confirmd he had done, digging and cutting out lots of injured or necrotic tissue below the visible level. Fortunately I seem to have barely avoided an infection by having the surgery when I did. There was also some danger that the pump was going to come right through my outer skin and out of my body.They did put a very large surgical drape on me, front to back, I presume in case they had to made any adjustment in the intrathecal catheter, that is, the long tube leading from the pump on the righthand side in front, passing around my right side, then entering my spinal canal in the back. But fortunately all the tubing was apparently patent and problem-free. They also ran the usual tests on the pump to make sure it was functioning properly.I am gettting used to the

manufacturer's reps poppping up at the doctor's office for trickier reprogramming sessions or gowning up for the OR. In fact, when I regained consciousness for just a moment in the operating room, it was to see from Medtronic approaching me with his handheld programmer hear him asking me, ", may I interrogate your pumpj?" While dubious at first, I am now glad these extremely knowledgeable people are available to doctors at every stage, from implantation through refilling through any malfunctioning necessitating tests or surgery. This particular company's representatives, at least, are outstanding -- tremendously instructive to medical professionals and patients alike, in my experience.Two days post-op, I started spiking a low-grade fever and my oxygen sturation dropped the second night, so the staff was concerned. I am severely allergic to a growing list of antibiotics, so they were also alarmed when I broke out in a rash, and they decided not

to d/c my final doses of I.V. clindamycin and gentamicin. I was hoping to get sprung the next morning, but the nurse practitioner in charge of the unit came in and told me she would really feel better if I got an allergy consult first. This was a good idea, since the allergists determined that I was actually experiencing contact dermatitis from something called IO tape, which comes incorporated in the type of surgical drape that had been used on my body. I have been dutifully using a prescription steroid cream four times a day, and the rash seems to be getting better. At any rate, the whole experience -- starting with several weeks of discomfort and difficulty before I ever got seen by a physician -- has been surprisingly affecting and exhausting. Since the pump revision,. I have just not bounced back as quickly or satisfactorily as I expect to do after a "minor procedure." So I trust our members will bear with me if I am not quite up to speed here at the

group. It's good to be back. As ever,