Information was received from a patient who was receiving some kind of morphine (unknown dose and concentration) via an implantable pump for non-malignant pain.The patient was on high dose of oral pain medication (hydromorphone/dilaudid) and stated being on oral pain medication is so horrible and was affecting her that she got the pump implanted, but was removed due to a confirmed infection that begun on an unknown date.Her neurosurgeon scared her and gave her no hope stating the pain pump was just as bad as pills because the medication can still get into her brain and she can still be addicted to medication, patient¿s back was such a mess from her neurosurgeons since 2008, and she was trying to get to use the pain pump.When she had her pump trial and pump implant, she didn't take one pill.Patient was at the kitchen sink and there was fluid dripping down the legs, this happened maybe 2 weeks post implant, she went to the emergency room and they transferred her to a different hospital where the pump was put in, they took cultures and the cultures showed a bad infection and also showed it was not spinal fluid patient also experienced drainage.Patient was in the hospital for 2 weeks because of a bad infection and the pump was removed, no further complications were reported.
|
Additional information was received from the healthcare professional.It was reported that on (b)(6) 2017 the patient had serratia.The pump was removed on (b)(6) 2017.The patient's chief complaint was low back and leg pain secondary to failed back syndrome.She had a back surgery with laminectomy in 2008.The patient had a significant increase in pain.She had multiple injections and had aqua therapy, however she was unable to do a lot of aqua therapy.A pain management physician performed radiofrequency ablation which was not very beneficial.The patient had been having an increasing amount of pain and as a result had stopped driving.The patient had undergone fusion with multiple back levels.She had gone to rehabilitation, with which she was not very pleased.She had a fractured vertebra and needed another surgery after that.At the time of this report the patient was having pain in her back radiating into both legs.She had significant increased pain with bending and stairs were quite a problem.She indicated reduced pain with lying down.The patient had some weakness of the leg and she had tingling.The patient indicated having constipation as a result of medication.She indicated that her sleep had been disturbed.She maintained her height and weight.The patient's bowel movements had been a problem.She had not taken any prescription pain medications or xanax.This resulted in her having some difficulty with sleeping.She also indicated that she had a rash on both of her legs.It appeared to be more on the right side than on the left.On (b)(6) 2017 the patient had recently undergone placement of an intrathecal catheter and pump.Inspection indicated that the wound had healed quite well.The patient had continued to take large doses of opioids.She was having some concerns about symptoms in her legs.On (b)(6) 2017 the patient came to the office urgently.She indicated that since the day before there had been a lot of swelling in the posterior incision.Her husband indicated that there was a lot of fluid.She had been feeling a little malaise but had not headache; she did not have a temperature.On (b)(6) 2017 the patient had recently been in a medical center for about 4 days.At that time the patient had mattress sutures placed and it appeared that the "lead" had stopped.Aspiration of the anterior pocket was done.Initial cultures were essentially negative but a more recent culture indicated that the patient had serratia.On (b)(6) 2017 the patient had recently undergone removal of the catheter and pump as a result of an infection.The patient had received intravenous and oral antibiotics for some time, and since then the antibiotics had stopped.The patient continued to have swelling on the anterior abdominal wall on the right side and had been having a lot of increased pain "weighing" up and down the stairs.She had been evaluated by the spinal surgeon who was not very keen to consider replacing the pump.On (b)(6) 2017 the patient came to the office to discuss the possibility of replacing the pump.She indicated that she had not been doing too well since the pump was removed.She was not taking any antibiotics at that time.She had been having increasing pain in her right leg, which was not a problem before the catheter was removed.The patient would avoid cigarette smoke, continue home remedies, continue the present treatment plan and continue with a home exercise program as tolerated.The patient was to continue with current medications, and would follow up in 2 months for a fluoroscopy procedure and pump refill.The hcp was not satisfied with the current pain management as it appeared that the combination of medications was not working out very well for the patient.The patient needed to stay active and to continue to exercise on a regular basis, and have good posture and weight control.When the patient had the trial and had the pump she had stopped taking all her pain medications.She was a lot better before the pump got infected.The hcp would discuss the matter with the physicians concerned before making up her mind about replacing the catheter and pump and reviewed that there was always a significant risk of repeat infection.Upon review of the patient's blood work her white cell count was back to normal.There was some fluid leaking from the patient's posterior incision.Inspection indicated that there was swelling in that area and it appeared to be slightly tender.Some clear fluid was noted.The hcp suggested that it would be appropriate to apply pressure in that area and suggested that the patient apply her abdominal binder again, and that she must call the hcp with an update in 2 days.If the situation was not getting better, the hcp suggested that it would be appropriate to set her up for an epidural blood patch and that if the blood patch was not adequate, it may be necessary for the surgeon to explore the wound.The patient appeared to be leaking spinal fluid but had no symptoms related to low pressure headache.The hcp gave the patient cefadroxil to cover for any possible infection; she would receive 500 mg every 6 hours for 10 days.The patient indicated that she had been very constipated.The hcp gave her some samples of movantik and explained that she needed to make an effort to have regular bowel movements.The hcp instructed the patient to call the office in 2 weeks with an update and was due for a refill in (b)(6) 2017.The patient¿s medical history included medication allergies: citracal "other reaction, max-d;" keflex unspecified; lactose unspecified; latex "other reaction, tape;" myocin "other reaction, all myocins;" vitamin c unspecified; vitamin d "other reaction, max-d and 3000." non-medication allergies: baker's yeast, iodine, latex, tape.The patient was a former smoker.The patient's pain scale with activity was a 10.The patient had a 5 cm long surgical scar at the midline of the thoracic spine centered at the level of t8 (thoracic), t9 and a 15 cm long surgical scar at the midline of the lumbar spine oriented vertically from l2 (lumbar) to l5, and a 5 cm long surgical scar to the right of the midline oriented horizontally.Past health history included breast cancer and squamous cell skin cancer the patient currently had invertebral disc degeneration in the lumbar region, low back pain, spondylosis without myelopathy or radiculopathy in the lumbar region, and postlaminectomy syndrome.The patient¿s concomitant medications included: alprazolam tab 0.25 mg for 15 days (quantity: 1 not specified), subs ok, start date (b)(6) 2014 ; cefadroxil 500 mg capsule, 1 capsule by mouth for 10 days (quantity: 40 capsule), subs ok, start date (b)(6) 2017 ; escitalopram tab 20 mg for 30 days (quantity: 1 not specified), subs ok, start date (b)(6) 2014 ; "hydrochlorot" tab 25 mg for 90 days (quantity: 1 not specified), subs ok, start date (b)(6) 2014 ; hydromorphon tab 4 mg for 20 days (quantity: 1 not specified), subs ok, start date (b)(6) 2014 ; pump syringe dilaudid 5 mg/ml, clonidine 75 mcg/ml, 1 syringe intrathecally (quantity 22 ml) (chronic intractable pain - daily dose 1 mg/day - deliver (b)(6) 2017 , surgery (b)(6) 2017 ), subs ok, start date (b)(6) 2017 ; qvar (beclomethasone dipropionate unspecified) (quantity: 1 not specified), subs ok, start date (b)(6) 2014 ; simvastatin 40 mg tablet (quantity: 1 not specified), subs ok, start date (b)(6) 2014 ; tobra/dexame sus 0.3-0.1% for 25 days (quantity: 1 not specified), subs ok, start date (b)(6) 2014 ; trazodone tab 100 mg for 30 days (quantity: 1 not specified), subs ok, start date (b)(6) 2014.No further complications were reported.
|