Intrathecal Baclofen Therapy, or, Meet Dr. Vascello.

Join us now on a journey through time and space... to the legend of the Mighty Creech...

So, yesterday I had an appointment with this really cool anesthesiologist doctor named Luis Vascello. Luis was first trained at the Universidad de Buenos Ares, which is a nice enough place if you are Argentinian and in need of a med school. Since then, he has published several studies and articles about the baclofen pump, which we will discuss at length in a moment; suffice to say, homebody has his credentials. My crippleologist, Dr. Salles, swears by this guy. Anyhow, so I went to see him to talk about the baclofen pump, and for those of you who are interested, I will now explain in exhaustive detail everything you could ever need to know about intrathecal baclofen pump therapy. If that sounds boring to you, go read someone else's blog. If you want to skip ahead to the **'s below, that is where we get back to what is going on.

Okay then. What is baclofen? Baclofen, for starters, is a muscle relaxer. It is used extensively in patients with high levels of spacticity because it inhibits the way neurological signals can travel in the body. The way that this stuff works is that it gets into the fluid that surrounds the spinal cord (inside of your spine) and sorta makes your nerves behave.

Wait, so what's a spacticity? Spacticity is caused (at least in spinal cord injuries) when a nerve message gets totally mixed up. Example time!

Okay, a nerve, say one on your skin that feels for hot temperatures, decides to send a message. Okay, so Ryan's hot leg nerve sends a signal to Ryan's brain to tell Ryan not to worry, that it isn't particularly hot on this part of the leg at the moment, and thus we are probably not of fire. Your nerves do this billions of times a day, and there is usually not an issue, unless in fact you are on fire. Anyhow, the brain sends a signal back, thanks nerve, keep me in the loop. Ryan's hot nerve, however, doesn't go all the way to the top. It gets to his spinal cord just fine, but then the connection that used to go to the brain isn't there anymore. Since Ryan's nerve doesn't get the all clear from Ryan's brain, he gets a little worried. "Maybe we're not on fire because we are drowning underwater!", Ryan's little nerve thinks to itself. He tells all his nerve buddies around him that Ryan is drowning, when in fact, Ryan is typing on his blog (like that ever happens). The nerves get all panicky, and the muscles start firing, trying to get away from the drowning, or maybe run from the cold, or possibly shiver; you gotta understand, nobody has a clue down there in Ryan's leg! So, Ryan's leg starts getting all twitchy; that's a spasm.

Fun days in Ryan's body, right? So, muscle relaxers like baclofen reduce the amount of crazy going on in the nerves by limiting how much they are allowed to gossip with other nerve neighbors. Less Housewives, more... The 'burbs? Anyone remember that movie?

Now, right now, Ryan takes this wonderful baclofen (actually, he takes a different drug at the moment, but we can pretend). Think of those neighbor blockers as little tiny picket fences. Ryan takes about 600 fences a day. those fences go all over his body, and get in the way of everything; the fences stop his brain from braining, making him tired, they stop his arms from arming, etc. What they don't do is slow down the nerve gossip because they never made it to the spinal fluid. Of the 600 fences that go in to Ryan's body every day, about 3 fences make it into their very important places while the other 597 fences cause problems.

A baclofen pump works by pumping fences from a fence barn in Ryan's belly (aka, the pump) through a tube directly into the spinal fluid. What does this mean? It means that if Ryan needs, say, 4 fences a day, the doctors can feed him only 4, because they are going exactly where they need to be. This means all those other fences and their mean, mean side effects go away. Ryan is now alive, alert, awake, and enthusiastic, and his muscle spasms are still controlled in exactly the same way.

**That's what a baclofen pump is and how it works; now on to how that affects Ryan.

The baclofen therapy is a process that begins with a baclofen trial. Before the doctor's implant the pump, they want to be sure this thing is going to work. What happens is that Ryan goes in for an appointment (February the 8th). The doctor will stick a needle into Ryan's spinal cord and then hook that needle up to a big ol' box-o-baclofen. A physical therapist and the doctor will monitor Ryan over the next 3 days as the baclofen is slowly pumped through him to see if and how he reacts. Assuming the fences (see the explanation above) are strong enough and going where they are needed, Ryan should have much less spacticity. Once we find this to be the case, out comes the needle and Ryan can go home. We know now the pump will work, so in about 2 weeks, it's surgery time!

Dr. Vascello will perform the surgery on a Monday morning. First, he'll take a drill and drill a hole in Ryan's spine. Then, he'll put a tube in there that will alow medicine to be pumped in. Next, hell install the pump, which is about the size and shape of one of those round metal IceBreakers tins, in Ryan's belly. Finally, he'll connect the tube to the pump, and get those meds a'flowin'.

That night, Ryan will go to Cardinal Hill Hospital. He'll be wearing a metal brace that keeps him from twisting, bending, or otherwise pulling on his internal tube. For about a week, he will be learning how to dress and bathe himself in the brace (which he has to wear for 4-6 weeks) while the doctors monitor his spacticity and adjust the amount of medicine the pump is pumping. At the end of the week, he'll head home and rely on everyone he knows to take care of him while he plays Lego StarWars on the Wii and sleeps a lot.

Once the brace is off, Ryan will be all back to normal. He'll do all the things he used to do, plus have a couple more really cool scars to tell his grandkids about someday. About once a month or so, he'll go to a doctor, who will stick a big long needle into the pump to refill it. After 10 years or so, Ryan will go back under the knife, when the doc will take out the pump and put in a new one, with fresh batteries and whatnot. The same tube stays in though, mostly forever.

So, that is the baclofen pump. I will take questions and comments on my blog, my facebook, or through my email at creechwebdesign@gmail.com.