Ryan has a baclofen pump surgically implanted in his abdomen. It’s roughly the size of a hockey puck. From there, a catheter runs around his torso to his spinal column. Medicine (baclofen) is delivered directly in the spinal column, thus eliminating the common issue of a drugs ineffectiveness of passing through the blood-brain barrier — since it carried directly to the brain via the spinal fluid.
This drug, in most cases, relaxes the skeletal muscles. In turn, it reduces the frequency of “posturing” (stiffening of the body, like the stupid new craze called “planking”) and spasms. Currently, Ryan receives 400 mcg per day at a continuous rate (or 16.7 mcg/hour). Early on, he was receiving well over 1,500 mcg. The last reductions was in January (while he was in the hospital) from 425 mcg to 400 mcg.
As helpful as it is, it can cause people to become flaccid. So relaxed that they simple cannot move easily. An obvious objective is to avoid this, but overshooting can cause bigger issues. So, it’s always a judgement call to lower the dosage. Clearly, we take this risk and will again today. It’s a calculated trade-off, but the fear is he will start “storming” again. Usually within 24 hours.
A nurse technician will make a home visit this afternoon to refill and reprogram the pump. After refilling the reservoir Ryan will be reduced to 375 mcg per day at a continuous infusion rate (15.6 mcg/hour). I know this doesn’t sound like a huge reduction, but it is. Baclofen, in this form, is extremely powerful stuff. Think about it… it’s measured in micrograms, one-millionth of a gram… the smallest commonly used measurement of mass. Protocol never allows reducing it by more than 10% for risk of withdrawal.
Oh, yes, the next twenty-four hours will be tense indeed. I hope, for Ryan’s sake, my instincts are right.