Stiff as a board

Hello once again. Well, time is winding down now. The scramble for me to get those last 70+ surveys is on. I have definitely learned a thing or two about public opinion based things. Additionally I have learned a thing or two about follow-up. It is not enough to trust that someone is doing what you asked them to do; you must follow-up and make sure that it has been done or is getting done. Also I need to stress the fact that multiple surveys are OK, in fact they are encouraged.
Overall though this has been a good experience, I am glad I did this thing.

So, on to the 'DotW' feature. Last night I sat with an adolescent male who needed constant attention - actually he was pretty stable, I sat and watched TV and studied organic chem for 12 hours - so that he would not yank out his g-tube. A g-tube or gastric tube is a tube that is placed in the stomach from the outside and held in it's location via an inflatable balloon. G-tubes are placed so that a patient who is not eating, or is at high risk for aspiration - putting fluid into your lungs by not swallowing properly - can still get the nutrition they need via a fortified liquid. Early yesterday it seems that he was able to completely yank the thing out on his own, that must HURT! It is also very surprising to me that he was able to pull the thing out because I have been on this watch assignment before, a lot in fact, and have yet to see one come all the way out despite the amount of times it gets yanked on.
Anyway, long story short, this kid was in the hospital this time for placement of a Baclofen pump.

This has got me thinking, and today's feature drug shall be: Baclofen!
Like always we will begin by looking at the organic molecule:

I think this is the first instance of where I have used the generic name first. The brand name of Baclofen is Lioresal. Baclofen is used to treat muscle spasticity and is basically a muscle relaxer. It is generally available as a white pill, but sometimes a pump is placed in the patient and a catheter is inserted into the spinal column, or intrathecal space.
(http://www.drugs.com/baclofen.html)

Personally I have seen both the oral dose and the pump version. The cool thing about the pump version is that because the drug is being delivered at the nerve site it can be administered in terms of micrograms instead of milligrams. The nurse who works in the clinic at my hospital is a friend of mine and she has explained all of this stuff to me. I have also held one of the pumps, they are solid metal - about the size and shape of a hockey puck - with a silicon part in the middle - sort of about where the hole of a donut might be - and one side there is a triangle shaped silicone piece that holds the catheter in place.
Here is a picture of one:
This webpage is full of interesting information about Baclofen pumps. They call them ITBs or intrathecal baclofen therapy.
Here is another picture showing the pump once inserted into a patient:
This particular picture is oriented so that the pump is slightly above the right hip of the patient.

The second image is an animation of how the pump is positioned in the body

There is a bump - once again about the size of a hockey puck - that is visible under the skin of the patient. Clicking on the color picture will show the curious person the actual procedural pictures of a spinal fusion and insertion of a baclofen pump. I think it's pretty cool, but the more squeamish should be spared my medical curiosity.
Baclofen is a very effective medication at treating spasticity or spasms. After severe head trauma or when a person has decreased neurological function is when I have typically seen these inserted. The reason why spasticity is an issue after trauma or with decreased function was explained to me this way; the muscles in the body want to be contracted all of the time; the brain basically blocks out those signals and filters them so they can be controlled for autonomous muscle use. When the brain is impaired it no longer is able to filter out those signals like it once did. Baclofen therapy is also useful for persons who are suffering from MS. My wife's cousin is suffering from complications of MS and is really hoping to get a pump inserted to help with her spasticity and spasm issues.

According to: http://www.southshoreneurologic.com/clinical/itb/itb-results1.html there is a statistical significance in the amount of persons on baclofen and a decrease in their spasticity and spasm levels. On one of the tables they state that 168 patients were included in the study and spasticity was abolished 97% of the time; muscle spasms were abolished 98% of the time; bladder function was restored or improved 78% of the time and overall function was improved 70% of the time.


In addition to it's use as a muscle relaxer it seems that baclofen can be used to block the addictive effects of cocaine usage; at least in female rat populations. This is interesting though because it might have future benefit in therapy as an agent to help individuals who are struggling with addiction. (http://www.drugabuse.gov/NIDA_notes/NNVol17N6/Animal.html)

I am sorry for the brevity of this post. Once again I have bit off a bit more than I can chew with this feature drug. I would love to discuss all of the information I have found and the incredible resources I have by knowing the staff who maintain and install these devices, but time is forever against me. If you are interested in learning more any of the links provided should be more than sufficient.
Personally I think this drug is unbelievably helpful in the lives of people who are dealing with anything from complications of severe head trauma to MS.