FREQUENTLY ASKED QUESTIONS:

• Will it work? (test dose will answer that - try before you buy).
• How is dose determined? (depending upon response and duration of response to trial: the start dose with pump implant is determined; the trial is typically 50, 75 or 100ug bolus determined by physician after reviewing clinical status).
• Length of stay for trial? (typically go home same day).
• Length of stay for implant procedure? (average 3-5 days).
• What is the SynchroMed Infusion System? (pump & catheter system).
• What does the pump do? (allows programmed precise controlled amount of drug to be delivered right into the spinal fluid).
• Why is intrathecal baclofen more effective than oral baclofen? (a much higher dose can be obtained directly at spinal cord receptor sites of action, lower dose needed by injection into spinal fluid than can be achieved or tolerated by mouth).
• If a higher dose is delivered to the spinal cord for increased effectiveness, will I have more side effects? (definitely not).
• Is ITB therapy effective for leg spasticity and spasms? (definitely yes and yes).
• Is ITB therapy effective for upper extremity spasticity? (yes).
• Do people the pump become tolerant to ITB and need increasingly higher doses? (rarely, infrequently, once the therapeutic dose is achieved it is uncommon to find the need to keep on increasing the dose, <5% become refractory to increasing doses of medication long term, a drug holiday is often effective for this in any case).
• What is pump made of? (titanium).
• How much does pump weigh? (very light, pick one up and see for yourself - 6 oz).
• How big is pump? (about size of hockey puck - regulation puck size; 3inches wide, 1inch thick).
• Is there only one size pump? (no, adult size noted above holds 18cc medication, pediatric size which is ~17% smaller holds 10cc medication).
• Can you get pump in different designer colors? (no - it does not matter, it is implanted inside where no one can see).
• What does pump have inside it? (computer chip, battery, motor, antenna, reservoir for drug, internal catheter).
• What type of battery is inside? (lithium).
• Where and how will the pump be implanted? (surgically implanted in lower abdomen, catheter tunneled around the back).
• What is the catheter made of? (small diameter silicone rubber tube).
• Timing of implant post-trial: - When? -- (elective).
• Physical Therapy follow-up post-implant: home, in-patient, how long? (depends upon particular situation and needs and of course insurance allowance).
• How often will the pump need to be refilled? (depends upon pump rate required for optimal response and concentration of drug used).
• Who refills it? (physician or nurse).
• Where does refill occur? (office, home, wherever needed).
• How is my pump reprogrammed? (by telemetry wand and laptop computer).
• Is refill procedure painful? (no - should not be).
• How long does refill take? (15-30 minutes).
• Can the pump be reprogrammed/readjusted without being refilled? (yes).
• How long does it typically take to adjust pump dose for indiviual optimal effect? (depends, - you knew that, be patient).
• What if I change my mind? (can be reversed, removed or turned off).
• Does the body reject the pump? (no).
• Can I ever have an MRI again? (yes, depends, pump has to be turned off temporarily or possibly emptied and turned off - refilled and/or turned on immediately after MRI, discuss with physician, be aware that not all MRI facilities have computer to turn pump off and on).
• How long does the battery last? (average 3-7 years).
• Will my pump need to be replaced? (only with malfunction or battery replacement).
• What if I hear beeping sounds? (pump alarm indicating low reservoir, or less likely battery reserve low or pump malfunction - no you did not break it).
• What are my responsibilites? (know medication, rate, refill date, notify physician for change in status).
• What are the potential risks? (see web site for detailed information about potential complications, withdrawal, overdose, infection).
• What daily activities will affect my pump? (electrical devices probably not, extreme temperature and pressure - probably yes; diathermy & lithotripsy - yes; avoid: hot tubes, sauna, scuba diving, non-pressurized aircraft).
• Will my daily routine change? (hopefully with better control of spasticity you will gain independence).
• Will I be able to stop taking other oral spasticity medication? (yes).
• If there is a problem with the pump can I use oral spasticity medication temporarily? (yes).
• Will this effect other medications I take? (discuss with physician).
• Can this therapy be used with other implantable medical devices? (depends:- pacemakers - yes; ventriculo-peritoneal shunts - yes; gastrostomy tubes - yes; spinal cord stimulators - probably yes, check with physician; vagal nerve stimulators - probably yes; others - ask).
• Is epilepsy a contraindication to ITB therapy? (no).
• Can this therapy be used during pregnancy? (no definite information available - discuss with physician).
• Can I breast feed? (oral baclofen is transmitted through breast milk, no information is available about intrathecal baclofen).
• Can I take hot baths & showers? (yes).
• Can I engage in sexual relations? (if you want).
• Will ITB Therapy make me sterile? (no).
• Can I travel? (yes - coordinate with refill dates, also medtronic website - www.medtronic can advise of physicians trained to help in an emergency throughout the united states).
• Will my pump set off metal detector at airport? (it might - carry implanted device identification card).
• When I die can I be cremated with an implanted pump? (NO - the freon gas that drives the compressor will explode, - yes you can take them with you; no this is not a problem with sunbathing); check refill date if patient expired, to avoid embarassment of pump alarm at wake or burial.
• Will my insurance cover cost of pump implant and medication refills? (discuss with physician - yes, most do without any problems; some require pre-authorization).

---

---