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    No Breakthrough Pain for Medtronic's Morphine Pump.
    Anon_236648 posted:
    I have posted this before, yet it was way too long; I have had a Medtronic's infused morphine pump for the past twelve years and during this time; I have always been provided with breakthrough pain relief medication. In addition, I have had a bad time with my diabetes as I have been in a diabetic coma, on both sides of the spectrum, once my blood sugar was over 1000, and my stepson found me, and took me to the hospital, where I spent six days in the I.C.U. The other time, my blood sugar dropped to almost 0, and I was full renal failure. This accident caused me to hit my neighbor's fence, and I ended up in the ICU for one week. I was able to back my car into my driveway, and had my stepson take me to the hospital; yet this time I committed a serious crime, leaving the scene of a motor vehicle accident. I guess I was supposed to call the police first, make out an accident report, then go to the hospital. Therefore, the police had my car towed from my personal driveway, and took it to an impound lot. My car keys were in the car, along with the keys to my house. When I finally got home from the hospital, I went to search for my breakthrough medication, but it was nowhere to be found. I searched the entire weekend, and after I could not find it, I knew I had to make a police report, which I did. Then I informed my doctor of the theft, (this was the first time in twelve years, that I had ever had any medication missing, or ever come up short. My doctor had my take a urine test for drugs, which came back negative; except for the medication I was taken. They also did a drug screening on my while in the hospital for my diabetes's, and it came back negative for everything, including Xanax and Dexedrine, two drugs which I take on a daily basis. So I don't trust those test very much. This was about the seventh time I was required to take a drug test from my pain doctor, and they all came back negative for any illegal drugs, or any alcohol. Yet from that point on, my doctor refused to give me any more breakthrough pain medication, He told me he wants to use my morphine pump to control my breakthrough pain. So when it feels like a knife is stabbing me in the liver (I have stage four ((end stage)) cirrhosis of the liver), I have to call his office, make an appointment, which takes two weeks, then have him increase the flow rate of my pump. I do not like the feeling of being out in left field, which he is trying to put me in; I used to go 40 days before I had my pump refilled, now it is at 22 days, and I won't let him increase the flow rate any more. This makes me suffer needlessly when I over do things or I have Sharpe pain in my liver. I would like to know form any other persons who have a Medtronic's implanted morphine pump, and see if they would like to have their breakthrough pain treated this way. In addition, I just found out from Medtronic's, that my new pump that was just implanted, is capable of allowing me to give myself up to four booster shots, for my breakthrough pain. This was never told to me by my doctor. The Veterans Administration, pays for my bills pain management, as I contacted hepatitis-C while I was in the navy, after going through four operations, and there was no such thing as a disposable syringe back then. Thank you for your input.

    Take the Poll

    For anyone who uses a Medtronic's inmplanted morphine pump, and how their breakthrough pain is treated.
    • Agree with the way the doctor wants to treat it
    • Disagree with the way the dotor treates it
    • Ask him why I was never my pump could give me an extra amount
    • Almost impossable to find a new pain doctor
    View Poll Results
    cweinbl responded:
    With many chronic patients, doctors will prescribe a chemically different drug for breakthrough pain. For example, the long-acting drug could be Fentanyl Transdermal and the BT drug Oxycodone. Or, the LA drug might be Kadian with the BT med Hydrocodone.

    Have you discussed with your doctor the possibility of tolerance? Have you been using the same drug in your pump for 12 years? In most cases, after several years and the same medication, you will experience significant tolerance. When you reach the maximum safe dosage, you should rotate to a different medication for a month or two. After that, you can often return to the original drug with improved efficacy. There are many medications that you can use with the IT pump, including one that is only available for IT pumps — Prialt.

    Finally, I would not remain with a physician who treated me in this way. I know that it can be difficult changing physicians when they know you are using narcotics. But there are still compassionate physicians out there.
    NavalVeteran replied to cweinbl's response:
    Hi, thank you for your response. My doctor did change my medication to Dilaudid, but the side effects were miserable, so after about two months, he put me back on morphine, yet he refuses to provide breakthrough pain medication to me; choosing to increasing the flow rate of my pump instead. I have asked him on several occasions, why he will not provide me with breakthrough medication, and the only thing he says is "We have been through this before, and I am not going to talk about it again". The only thing that I admitted to, was to his nurse, because while on the Dilaudid, I lost any type of appetite I had, and was unable to sleep. I had just got out of the hospital, due to the VA having me on the wrong medications for my diabetes, which kept building up in my body, until my blood sugar finally did crash. So I told my doctor's nurse that I tried taking a puff or two of marijuana. Yet when my doctor had me drug tested, it came out negative. Trying to find a new pain management doctor is almost impossible. It seems like he has black listed me, as his office will always call me, knowing that I have yet found a doctor, and making an appointment for me to have my pump to be re-filled. I called Medtronic's, and asked them for a list of doctors who are able to manage a morphine pump where I live (St. Louis, MO.) and the list was very short, and almost all the doctors that I have called, I am told they are not excepting new patients. So it looks like I am stuck between a rock and a hard place. More so, after Medtronic's told me my new pump is capable of hooking up some type of thing that would allow myself to give me an extra bolus amount of medication, from my pump, up to four times a day, yet my doctor never said a word about it.
    annette030 replied to NavalVeteran's response:
    Your doctor has made it very clear what he is willing to do. Some doctors do not believe in breakthrough meds at all, they always want to increase the long acting meds instead.

    I think you are stuck with his way of doing things until you find another doctor willing to accept you as a patient.

    Telling his nurse that you used an illegal drug may have led to not getting breakthrough meds, but he may have decided to do that anyway.

    This is one of the problems with using a medication pump, you are at the mercy of whatever doctors use them, and are willing to accept you as a patient.

    Take care, Annette
    NavalVeteran replied to annette030's response:
    What gets me, is after I had my forth pump implanted last year, I asked my doctor if the pump I now have is capable of giving me an extra bolus amount of medication, just for breakthrough pain, and he told me no. Yet when I was on the phone last week with Medtronic's, the woman looked up which pump was implanted in me, and told me that, yes, I do have the type of pump that can give me an extra dosage of medication, for the times I am really hurting. Who cares what the cost is, as the VA is paying for all my office visits, as it is service connected (I contacted hepatitis-C while in the navy, back in the 10970's, before they used disposable syringes, yet now it has progressed to stage four (end stage) cirrhosis of the liver. My hepatologist, who is one of the top five in the US, as he was the one who treated Naomi Judd, and Pamela Anderson, stated that end stage cirrhosis can cause severe arthralgia and arthritis in almost all my joints, and that I suffer form it on a daily basis. Yet my pain doctor just does not pay attention. This doctor will not even write you a note, so you could use is for back up ammo, when fighting with the VA, and it is not just me, he does not write notes for any of his other people he treats, as I guess he makes better money writing books about chronic back pain, as he has wrote two of the so far. If you ask me, he is the one who is starting to become the big pain. I am going to just tell the VA to find me a new doctor to take over my pump; yet do not send me to the one and only doctor that doctor was so arrogant, that my alarm was going off, which meant the my pump was about to run out of morphine. This doctor refused to turn my alarm of told me I would be better off getting myself drug tested, and then go to a methadone clinic. It was a good thing that my wife was with me, otherwise, I might have hauled off, and cold cocked that dam doctor for even suggesting something like that.
    cristiano99 replied to NavalVeteran's response:
    I have been dealing with long term pain from a bad horse accident-then broken fusion-then bad surgery for the last 11 years. I am 58 and trying my best to stay active. Could you tell me why you have gone through 4 pumps? I live outside a city with only a few pain mgt. docs and cannot find one who will treat me (long story), but am being encouraged by family to get a pump (which I am leery of). Just taking oral meds now. Methadone & oxycodone. Thanks for the input, and I will pray for you and the tough spot you are dealing with. (Not a religious kook...just one who has had help along that line.) All the best.
    NavalVeteran replied to cristiano99's response:
    No problem, my first pump only had a battery life of two years, then once that one ran out; I had to have it replaced. My doctor replaced the pump, but the location that he first chooses was a bad location was on my back flank, and I sleep on my back. This caused the new pump not to heal, so I finally told my doctor (this was the good doctor that I had), to please re-position my pump to my front, and sleeping with the thing in my back, was like sleeping with a hockey pump lying under you. So he changed it like I asked to my front, and boy did he bitch, at my catheter had become attached to my insides; and he had to free it all up, so he could move it to my front. It took him about seven hours to do. That pump lasted for six years, as they have a new battery that last longer now. Six years later, the computer said my batteries were about to go out, so it was time to have a new one implanted in me, There are some pumps out there, but not made by Medtronic's that have a much longer life to them, but they have a lot of restrictions to them. One of them is absolutely no S.C.U.B.A. diving. With my Medtronic's pump, I can still dive, but only shallow water dives, which is better than not diving at all. So the average life span of a Medtronic's pump is about 6-7 years, depending upon how often it has to dose you. FYI- Prior to getting a pump, they will test you out with a temporary type pump, with an IV in you. That way you can see if it helps very much. As for me, it was a wise decision, as with a pump, the medication does not go through your liver or stomach, where about 60% of your oral medication gets lost. With the pump, it goes straight from the pump to your pain control central (i.e. your spinal region). It does a great job in controlling your pain, but there are those times when pain will just break through your normal threshold, and you need something extra. Being provided with breakthrough pain medication for my entire time, then to have this guy pull the plug on it was a low blow; and I refuse to allow him to increase the flow rate, because that will have me sitting up on cloud nine, a feeling I hate. Prior to my pump, I was taking eight 80mgs. of Oxycottin, three times daily. That is the same as taking 384 Percodan's a day. So you can see why I switched. Not to mention I have stage four (end stage) cirrhosis of the liver, so I would most likely be dead, had I stayed on oral medication, I contacted hepatitis-C while I was in the navy, back in the 1070's, and back then, there was no such thing as a disposable syringe; they reused the syringes and needles over and over. To sterilize them, they put them in an incubator, but unknown to them, heat does not kill the hepatitis-C virus. Good Luck, Lee
    annette030 replied to NavalVeteran's response:
    I was a RN in the 1970s and there were disposable syringes back then. I have never used the old fashioned kind. My great aunt did, she was also an RN from 1916 until the late 1960s, she was the person who sharpened the reusable needles and wrapped the glass/metal syringes for sterilizing. It was not an "incubator", but an autoclave that heated and "sterilized" instruments and syringes back in those days.

    Who knows when the military started using more modern equipment. They had what they had, medicine is an evolving field, they learn more every day. They didn't even know Hep C existed back in 1970, or HIV/AIDS.

    A temporary pump is used with an intrathecal line into the intrathecal area of the spine, not an IV. An IV is an intravenous line that goes into your vein. Just minor adjustments, but important to be as accurate as possible.

    Take care, Annette
    fenton04 replied to annette030's response:
    I have been working in labs since the 70's. Back then it was called hepatitis non a non b. I know sure when it got indentified.
    annette030 replied to fenton04's response:
    What kind of lab work did you do?

    When I was in nursing school in 1968-1970 there was hep A and hep B, shortly after that there was the non-A and B that you mentioned. Now there is hep A, B, C, D, E, G, and non- "all of the above" hepatitis, I suspect with research they will find even more. What happened with hep F? Do you know?

    Take care, Annette
    fenton04 replied to annette030's response:
    Hospital lab work and yes we test for A B C D E G hepatitis. Do not know about F. We just stay busy doing A,B, and C. OBTW I started working in labs in 1977. Used to do amylase testing that took 8 hours. Same test today 15 minutes. Back then we did a lot of wet testing. Today its all automated. Faster and a lot more accurate. Lab turned out to be a good career choice.
    annette030 replied to fenton04's response:
    I am a retired RN who worked mostly in hospitals also. Lab folk are wonderful resources in my opinion. Things are always evolving.

    Take care, Annette
    NavalVeteran replied to annette030's response:
    I guess I lucked out, as I had to have my pump refilled, and by pure luck, there was a rep. from Medtronic's at his office. That is when I nailed my doctor, by asking him why he told me my new pump is not capable of setting me up, so it can give me a bolus amount, up to four times a day of morphine, for breakthrough pain. He talked with the Medtronic's rep. and he confirmed that it was indeed possible. So not I have to lie this on the VA, and have to get them to agree to allow for this to be done, as it is not cheap. Yet am sure they will agree to pay for it. So I caught my doctor in a plain lie, and he could not back out of it, with a Medtronic's rep. in his office. Always did say, there are more than one way to skin a cat.
    nirvanas replied to NavalVeteran's response:
    It seems that not matter we are from, we are all on the same boat. I am from Puerto Rico and the treatment of the pain with the pump is great compare with Miami, where I live know! I thought that I was the only one with each and the same problems that you have and I was wrong. Have you think of getting toguether somehow and take some action like a sue? I talked and talked with medtronic this week twice, telling them what is going on and how does this affect all of us and the ones that we don't know. Eventhough they say that they are only in charge of selling the pump and the kit, if this comes out in the news or to the court they will be in problem because it's the image of medtronic and now, that they know, even more because they are in complicity with those cruel actions from the doctors.

    This is only an idea because I am thinking of having the pump remove!
    Sorry for my English but spanish is my first language.

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