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Medical pumps ease discomfort Attached to the body, they dispense drugs gradually for greater freedom By BILL KETTLER Mail Tribune Freedom is Matthew Comer's best Christmas present this year. Freedom from fatigue that swept over him when his blood sugar plummeted. Freedom from daily insulin injections to regulate his metabolism. Freedom to be an ordinary 9-year-old boy. Last Christmas, the Medford boy had just been diagnosed with diabetes, and he was learning how to manage his disease. He felt droopy when his blood sugar fell too low. He was learning to count carbo-hydrates to keep his metabo-lism in line. He had to eat on a strict schedule and have an insulin shot every time he ate. "When he was on that schedule, he felt like he was a slave to it," said his mother, Diane Comer. "He's real spontaneous. When he wants to do something, he wants to do it right now." Matthew's life is better this year because he has an insulin pump to regulate his blood sugar. Scarcely bigger than a deck of cards, the pump fits on his belt and dispenses minute amounts of insulin into his body through a spaghetti-thin tube connected to a needle in his abdomen. When he eats, he can use the pump to get enough insulin to digest his food. "I think the pump's a lot better," Matthew said last week during a skating party for his diabetes support group. "Mainly because I can do everything. If I want to take a shower, I can disconnect it." Miniature medical pumps aren't new, but physicians continue to find new ways to use them. The pumps' strength lies in their ability to provide regular doses of medicine at prescribed intervals or a continuous low-level dose. That makes them useful for a wide range of medical conditions - from dispensing insulin to fighting cancer. "Pumps have changed the ways that therapies are done," said Sue Kilbourne, nurse supervisor for infusion services at Rogue Valley Medical Center. "People don't need to spend days in the hospital for treatment." Some cancer patients, for example, go on with their weekly routine while a pump feeds them drugs that kill cancer cells. Pumps loaded with pain killers provide relief for people who have chronic back problems. Doctors prescribe a pump loaded with antibiotics for people who can't shake a stubborn infection. "Instead of being in a hospital and getting antibiotics three times a day we can put several days' worth of drugs in a pump," Kilbourne said. "The pumps can be programmed to dispense drugs every four, or six or eight hours, or whatever." Pumps can also be used to feed people who have chronic bowel disease or have lost the ability to digest food. Patients can be fed intravenously by pumps loaded with a combination of glucose and amino acids known as TPN, or "total parenteral nutrition." ("Parenteral" is a medical term applied to any substance that enters the body in a manner other than through the digestive canal.) Kilbourne said pumps excel at providing uninterrupted pain relief for cancer patients by continuously dispensing tiny amounts of narcotics. "Pain is never controlled as well with a shot," she said, noting that injections produce peaks and valleys of pain relief. The amount of pain killer in the bloodstream peaks soon after an injection. The drug (typically morphine) gradually fades - and may disappear entirely - before the next scheduled injection. "If you give them a continuous infusion they don't have those peaks and valleys," she said. "And once you're in pain, it takes more medicine to get you out of pain than to keep you pain free." Pumps may cost as much $6,000, so most people rent one from a hospital if they plan to use it only for a short time. Medical insurance typically covers just a percentage of the cost of a pump, and diabetics who use a pump must also procure insulin (several bottles per month at about $45 per bottle) and test strips (about 70 cents each) to monitor blood sugar four to eight times a day. "We figure it costs us about what a car payment would cost," Matthew's mother said. People who can easily follow a rigid schedule can manage their diabetes adequately with regular insulin injections, but insulin pumps have proven their worth for diabetics who can't live by the clock. Sue Amidon, a registered nurse who has diabetes, got a pump years ago because her work often prevented her from eating at the right time to maintain her blood sugar. "I was working in a fast-paced office, and I couldn't do some procedures without worrying about low blood sugar," she said. "You never knew when you were going to get lunch," said Amidon, a certified diabetes educator who now works at Rogue Valley Medical Center helping other diabetics learn to manage their disease. "I got a pump because I wanted really good diabetic control. I didn't want to have to worry about whether people could rely on me." Amidon said insulin pumps can be money-savers despite their high cost. "If a pump saves one hospital visit, you've saved a lot of money. It costs $4,000 to $5,000 for an uncontrolled blood-sugar episode." For young Matthew's parents, his insulin pump provides reassurance that he can manage his metabolism pretty well on his own. "Most of the time with the pump he's right on target," his mother said. "We're not chasing those highs and lows anymore." Reach reporter Bill Kettler at 776-4492, or e-mail [email protected] Mail Tribune Home | Ottaway Newspapers, Inc. | Dow Jones & Co., Inc. | Privacy | Contact Us Copyright � 2001 Mail Tribune, Inc.