Welcome to Healing Well. I too, have a pump and understand very well your expectations and such. Yes, I do believe that you did become tolerant to Morphine. Our bodies are such complex pieces of machinery. I have one that just does not tolerate most medications regardless what they are for. Dealing with me as a patient is a real challenge for all of my drs.
I do not understand why your dr is leaving Morphine in the pump if he believes you have become tolerant, that makes absolutely no sense what so ever. Personally, if it were me I would request a different combination of drugs and have the Morphine taken out. Although, these pumps were designed for Morphine there are many drug combinations that can be used off label in the pumps safely. I could not tolerate Morphine orally and for some reason my goofy dr put Morphine in the pump when it was put in. I am like what the hell were you thinking here dr. I was livid. Well, long story short, out came the Morphine. I have Dilaudid, Clonodine, Sufentanil & Bupivacaine.
I do have a new PM dr since mine stopped practicing PM boy, was that a blessing in disguise. My concerntration level of Dialudid is 37.5, Clonodine 150mcg/ml, Sufentanil 15mcg/ml and Bupivacaine7.3 mg/ml. I receive 8.7 mg in 24 hours and this works very well for me at the moment. My first PM did not have enough knowledge of drugs or pumps to properly handle a pump patient. That left me high and dry with very low doses in my pump and me not feeling well at all. I went from 15mg concentration level to 35.7 in one visit and I felt like a human being again, first time in a long time. He kept telling me I was at my max dosage and I was far from being there and still am. Its all boils down to the drs being educated enough to handle these pumps. The only thing that ever changed in my pump on the readings has been the Dilaudid due to increases. My dr is exrtremely knowledgable in these pumps and has over a decade of experience with them. She is extremely well versed in drugs and does her own mixing right there in the office, she does not use an outside pharmacy. She leaves it totally up to me on when I need an increase. If one is needed then I call a couple of days before the appt and tell her nurse, the dr ok's it and it increased at my refill. I go every six weeks for a refill. I have a 90 pump which mine is an older model, it was implanted in June of 1995. My dr. says the pumps should be refilled every 6 weeks because the drugs lose their potency sitting there in these pumps, this was new to me too.
Do you have a PTM with your pump? That seems to be the new thing on the horizon, but to me its no different than the pumps that could be programmed to give a bolus at certain times of day. But, many people love the PTM.
I do hope you can get this straightened out with your dr. Please keep us posted on how you are doing.
Post Edited (Marleigh) : 9/15/2009 9:34:49 AM (GMT-6)
Oh no, you are so right-you need to be seeing your dr for sure and insist that your appts be with him. If he ever questions you about seeing the other, tell him what happened. Thats BS, you have been a patient there far too long to have to put up with crap from some assistant in my opinion.
I would go ahead and get scheduled with him to get the Morphine out no sense in leaving something in there that is not working. I truly do not see how he thought adding Clonodine would help or even make a difference, all so wrong. I do hope he does right by you on this. There is a saying about pain pumps that is so true "your dr can either make your pump a success or a failure",. I have been on both sides of that coin and let me tell you, my new dr. is definetly making my pump a success.
The first year of my pump I truly thought I had made a mistake in having it put in. While titrating a pump the increases are usually done at 20%, well due to severe swelling of the legs and and feet my pm dr did not want to add to that problem by overloading me with pain meds and only did 10% increases which was nothing. I was in the very same pain I started with. After a year of that nonsense I finally told him a mistake had been made and all the crap he had told me on how much better my pain would be controlled was nothing but a lie and I had relied on him to tell me the truth about the pump. He was really surprised to hear that from me because I was not a complainer and I sure did not make waves and always went with the flow. But, I figured after all I went thru having the surgery, which was done as an out patient and that should never happen, I was tired of being Miss Nice Patient. I backed him in a corner and he knew I meant every word I said. As of right then I got a 20% increase and went back weekly instead of bi-weekly for increases until I got some relief. Don't get me wrong, I just loved this guy as a dr but I soon found out he wasn't worth a wooden nickel when it came to pain mgt and pumps and medications. He was just too green around the gills and he needed educating terribly. This is typical with many of the anesthesiologist turned PM drs. They just do not have the education and experience they need. They tell me generally speaking it takes almost 6 months to get you where you need to be with your pump. Naturally we are always started at the very lowest settings and most of the time the concentration level is the lowest as well.
After getting a new PM dr, my neighbor who is a nurse saw me outside one day. He commented that I sure did seem to be feeling alot better. I told what all had happened. He said well, I was really surprised that you were on such a low dose in your pump considering how long you had, had it. Like he said, someone could go to ER and get a shot of Dilaudid that was alot more than I was getting in my pump in 24 hrs. lol.
Its like my new PM dr tells me the pain will always come back and it will always be there. We will become tolerant to our settings over time. We will need increases and there is no set rule on when and how many it will take. She assures me on every visit that I am still considered a "low dose" and I have a very long way to go before ever maxing out on Dilaudid. She says even if Dilaudid maxed out or stopped working there are so many different drug combos that can used in the pumps safely. Knowing this is a great relief for me. She says she has one patient that has 7 medications in his pump and thats what it takes to keep this person mobile and able to have a life.
I do hope you get all this taken care of soon. Just hang in there and keep insisting that you see your actual dr.