Friday, July 16, 2010

Weapon of Choice

    What can I say?  I called it wrong.  A week ago I was ready to jump all over one pump system and run with it.

    By the advice of our CDEs and my own conscience, we invited two of the three reps to spend some time with us and review their particular products.  As it turned out, the number I had for the Accu-Check rep had two digits reversed.  I looked on-line at the Spirit and was not at all impressed after seeing what Animas and Medtronic had to offer.  No disrespect to Roche, but it just seems to be a very out dated system and not user friendly (which was the number one complaint I found on user groups).  And with that it came down to one decision: Ping or Paradigm.  What made the final decision so tough for us is that both systems are so great.  They both fulfill the basic functions of an insulin pump.  They are both popular and have established track records.  And... they both have advantages over the other.

    After meeting with the two reps and doing hours of internet and soul searching, we finally picked our new weapon in Jonathan's fight: Medtronic Paradigm 522

    So, why did I change my tune?  Why did I go for the pump that he can't wear swimming?  Why did I go for the pump that I'm going to have to dig for to bolus in the middle of the night?  Why did I opt out of the pretty colour screen?  Why did I walk away from all the neat things that Ping can do?  In a word... Perspective.  I guess you could say I had a paradigm shift.

    I gave up waterproof.  Medtronic used to promote their pumps as waterproof.  The 511 and 512 models developed stress cracks over time, many of which were not easily visible and went un-noticed.  Some of the pumps took on water and shut down.  Even Animas pump casings have been known to crack.  Animas has reinforced some areas of their pump that were prone to cracking, but is it a 100% guarantee that water will never get in? No.  The guarantee is, that if water does affect them the company will replace it.  Also, while wearing the pump, you may be able to lounge in the pool, or lake (God forbid your $7000 pump fall off in the lake!), or maybe even do laps.... Jonathan likes to do cannon-balls, one after another....  I just don't think that's great for any pump - besides, with the way he goes, we'd probably have to suspend basil anyway.

    I gave up remote.  The Ping remote does two big jobs that the Contour Link doesn't: 1) Has the Calorie King (after a year though we know Jonathan's diet inside and out and what we can't get off a package we probably have to weigh on his dietary scale anyway.  2) It controls the pump, the same way the key pad on the pump does.  The only time that the remote control bolus would come in really handy is in the middle of the night which at present we bolus on average about once a week (some weeks more, some weeks none).  Another reason I gave up the remote is you only get one, and only one can be linked to the pump, which means to use it when we're not with him is to give it to him (at $250 each to replace), while the Medtronic can accept BGs from multiple remotes, we get three to start, and if we need another it's only $60.

    I gave up smaller increments.  This was a tough one for me to gauge and I really needed the clinic's help in determining this capability's importance to Jonathan.  Does he really need 0.05 increments for bolus and 0.025 increments for basil?  Animas' increments are half of Medtronic's.  The wonderful ladies at the clinic went to great lengths throughout this process to ensure they did not sway our decision, and their answer to this question was no exception: "We have children over the age of 3 on the Medtronic insulin pump -- and have not had a problem up to now needing to have the .025 unit shifts in basal.  Our little ones under 3 have chosen Animas for this feature."  A respectably impartial statement if I do say so myself, as well as in line with at least one very experienced family.

    What did I get in return?  Well, I got three linkable meters to replace the meters currently at home, school, and latchkey (hmmmm 3 for 3... that was a nice coincidence).  Also, I got CGM capable.  We had initially dismissed the CGM because we can't get it covered and the sensors are $50 for 3 days (although we know some stretch that to 6).  While the transmitter is OMG expensive ($700), we can get a loaner from the clinic from time to time when we need to get a better look inside Jonathan to help straighten things out, and Medtronic also has deals occasionally where you can get a pack of 8 sensors and a transmitter for $500 and they will send you the sensors as you need them.

    Beyond the meters and ability to CGM on and off at will (I would full time if it was covered or we win the $50 million in tonight's lotto), we got a few bonuses that didn't really factor in to the decision but did sweeten the deal.  1) Medtronic has (at least here) an automated supply service... I fill out a standing order form (that I can change when necessary) and they ship us product every three months (which is also the frequency of the government coverage checks).  I also ordered an extra months supply right up front because I want to always be at least 3 weeks ahead.  2) As much as this shouldn't be about the money, the supplies were more cost competitive.  One other bonus that factored in was that of COT (Continuation of Therapy).  The government only shells out for a replacement pump after 5 years.... manufacturers warranties are 4 years (go figure)... Animas offered a $500 extended warranty program... Medtronic supplies a "loaner" if there is a failure in the 5th year to carry Jonathan through.

    The other thing I should touch upon is the software.  Both pumps are capable of downloading their memories onto a computer (Animas even supports Mac - but we don't have one).  The huge difference for us and the team though is that Animas' system generates a PDF file of numbers and basic graphs where as Medtronic's is a web based system that allows for a far more analytical review of the data as well as access by anyone you want to give it to.  Animas is "getting new software" eventually; "it's on it's way".

    Both pumps showed very well and both reps were very knowledgeable about their products and were wonderful to talk with, but in the end the Paradigm just ended up being a better fit.

Pump arrival: First week of August.
Tons of reading and button pushing and going to on-line "Pump School": Rest of August.
Official training and start of saline trials: September 2nd.

PUMP START: September 7th 2010 (Day 374 ADx)

Monday, July 12, 2010

One Down, One To Go - It is Like Buying a Car, Just Nicer Sales People

   I'll admit it, if you couldn't tell from the last post, Ping was a foregone conclusion.  Um... well... yeah......  Turns out I have a more long and hard thinking to do that I thought I did.

   I knew that picking a pump, like any major decision, was best done after taking a long hard look at the each of the finalists.  Although Animas really caught my attention, I knew that not talking to Medtronics would be a huge disservice to Jonathan (and us).  So tonight, the very nice and very knowledgeable Medtronics rep made the 2 hour drive to see us and spent about an hour and a half with the family.  Bringing pumps for everyone to play with as well as a number of infusion sets and other accessories he was able to speak to every point we threw at him (I think he's been through this before).

   Tomorrow we meet with the Animas rep.  I've met her before, super-nice lady, and has a daughter on the Ping.  I thought Steve had his work cut out for him and felt bad at first about making him drive all that way, but now I'm not so sure it's not April that has to do some real selling.

   If anything though at least I feel a little more at east about this being a more even match-up.