 Once discharged
from hospital the process of titration of the dose of ITB
begins to find the ideal dosage for the patient and perhaps
the best timing during the day to deliver that dose. This
dose titration process can take a few months involving
outpatient visits to ensure the best management of the
patient's spasticity. Not all spasticity is unwanted, some
patients may require a certain small degree of spasticity
to help ambulate and transfer. The balance is to eliminate
unwanted hindering spasticity while maintaining some spasticity
that maybe beneficial. The programmable capabilities of
the SynchroMed II pump allow for accurate adjustments in
very small doses to achieve this optimum balance.
The typical follow-up
visit will involve a pump refill if needed, an assessment
of the clinical effects of the current dosage, an interrogation
of the pump using a physician programmer to check the pump
function and a battery status check of the pump battery.
It is during these follow-up visits that alterations to
the dosage are made using the physician programmer. Dependent
on the reservoir size, the stability of the drug, the concentration
of the ITB and the daily dose programmed, the refill interval
is usually anywhere between 2-6 months. Refill is achieved
by injection of fresh baclofen using a syringe and injecting
through the skin directly into the pump reservoir via a
refill port (opening controlled by a valve). This refill
procedure lasts a few minutes and is usually well tolerated
by the patient, sometimes an anaesthetic cream is used
to numb the skin where the injection is made.
It is important
for the patient to inform any other doctor about the presence
of the implanted pump and that it is filled with ITB prior
to any other medical or surgical treatments since it may
alter other treatment decisions, including informing the
patient's dentist. If you are planning to travel on holiday,
it is also recommended that the patient informs the medical
team so that the contact details of a nearby medical team
experienced in this therapy can be provided if necessary.
It will also allow the medical team to determine whether
the pump will need to be refilled prior to traveling. In
addition the patient should carry an ID card, if provided
by the medical team, that gives brief details of the therapy
and the medication. |
