It appears you have not yet Signed Up with our community. To Sign Up for free, please click here....



Pain Management Message Board
Post New Thread   Closed Thread
LinkBack Thread Tools
Old 01-31-2011, 10:47 AM   #1
Newbie
(female)
 
Join Date: Jan 2011
Location: Tyler,tx USA
Posts: 3
rantan35 HB User
Unhappy Medtronic implantable system

Hi, I posted last week regarding the pain pump I am getting on the 10th of this month. I spent almost all of yesterday reading old posts and getting lots of information from this site. I am 42, I have 3 grandkids and 3 grown kids as well. I have been married for almost 24 yrs and I have a wonderful husband, BUT.......
He has been to hell and back with me and my illnesses. I had a cervical fusion in 2003, I literally went through every pain medicine and just about every Dr. in the town I live in because this all started with migraine headaches that started in 1986 after a car wreck I was in. I didn't put two and two together until 2003 and the pain management Dr. I was seeing at the time received a letter from my insurance company wanting to know why no tests had been run other than injections,drug therapy,and burning the nerves in my neck. Finally I was referred to a neuro surgeon who did an MRI and saw that I had two bulging discs in my neck causing the headaches. By this time I had such a prescription drug addiction it was scary. So the new doc did surgery he fused 2 levels in my neck and sent me home on my same meds. At this point it was Phentenal patch 100's, hydrocodone10/with dextromorphine that I had to buy from a compounding pharmacy and a bunch of other stuff that I took from my psychiatrist. After my 6 week check up I went to a 3 week rehab where I went mon-fri 8am-3pm. I lost my job with all those great benefits that allowed me to see who I wanted to when I wanted to and had a very small copay on everything. Needless to say rehab did not help because I was not ready. So I got a new job,with great benefits and the cycle started again. This time I knew what I was doing,I knew what to say to get the prescriptions and somehow I still preformed my job tasks. In 2006 my family fell apart. My husband went on interferon,my 15 yr old daughter started cutting herself,and my 16 yr old son got his 26 yr old mgr at the burger joint he worked at pregnant. No wonder I finally hit bottom. Well this time I went to a 10 day detox program and a 30 day intreatment program in Stephanville Tx. I am happy to say that I have not abused any medicine since. In 2009 I was coming home from my parents home in Waco Tx. there was a wreck on I-H 35 so traffic was stopped. I came to a stop and looked in my rear view mirror and saw a black pickup going very fast coming up behind me, I had time to say "Oh God" and then it felt like an explosion went off. My 2003 Dodge Caravan was totaled and the person who hit me ended up hitting 3 other vehicles. Thank God we are all alive. The only one hurt other than the driver of the black truck was me. My neck and back were hurting so bad I thought I was gonna die. Obviously I did not. I went to the ER in Waco, my husband came down from Tyler to take me home and I saw my Dr. on Monday in Tyler. I was immediately sent to a PM dr and I told him my history with pain meds. He prescribed vicidin 5/500 4 times a day and flexerill 10mg 3x daily. He did an xray to make sure my neck was ok and thank God all hardware was still intact. So I started Physical therapy for 2 weeks on the neck and then we moved to pt on the back. The back was in such bad shape that the exercises that the physical therapist tried sent me to the ER. So I kept going to the pain mgmt Dr. and he did SI joint injections,a epideral,and the whole nine yards. Finally my back did not get any better and my pain mgmt dr said he would understand if I wanted a 2nd opinion. So I called my attorney and ask him what to do. He recommended a great pain management Dr. He did a MRI with contrast and he did a test on all the nerves in my back at all levels and when he did the pressure test, it showed that 4 levels were so painful that I almost came off the table. The insurance company paid the maximum that he was insured for and my underinsured pd what I had. There is not a surgeon around that will touch my back. I have degenerative disc disease that I did not know I had. My doctor says I probably would not have had any problems until I was much much older. So my pm recommended either the neurostimulator or the pain pump. I have a tens unit that I use for my neck and it works great but does not even touch the pain in my back. So I did the trial for the morphine pump and got 100% relief. I am scheduled to have the pump put in on 2/10. Right now I am on Hydrcodone 10/500 4xday, morphine sulfate 30mg 2xday,flexerill 10mg 3xday, and flector patch every 12 hours. I am in so much pain all the time I can't wait to get this pump put in. My husband has seen me and lived with me through all of the above he keeps my pain meds and makes sure that I stay on the right track. I am just so afraid that this pump is going to be more than HE can handle. I stay at a 8-9 on a pain scale of 1 to 10. I was put on the morphine about 2 months ago to get me ready for the pump. To see how my body reacts to it. Then the dose was increased last week because of the constant pain. I love my husband so much, but he does not understand what its like to live with this kind of pain and to still be expected to perform all of the duties I have as a stay at home MIMI. My son lives with me and my husband and the children's mother works 60-70 hr work weeks, so they are here all the time. I want my family to understand what I am going through without them making me feel like I am whining and complaining. Maybe that is what I am doing. Does anyone feel my pain, does anyone have any suggestions? Please forgive the long post I think I just needed to get it all out.

 
The following user gives a hug of support to rantan35:
Pegala (01-31-2011)
Sponsors Lightbulb
   
Old 01-31-2011, 01:39 PM   #2
Senior Veteran
(female)
 
Join Date: Jul 2010
Location: Missouri
Posts: 755
maltluver HB Usermaltluver HB Usermaltluver HB Usermaltluver HB Usermaltluver HB Usermaltluver HB Usermaltluver HB Usermaltluver HB Usermaltluver HB Usermaltluver HB Usermaltluver HB User
Re: Medtronic implantable system

Hi, and welcome to the board. I must say I think you are a very brave lady to tell your story as you did and I congratulate you for working so hard and beating your addiction.

I wanted to tell you that I have the morphine pump and have had it for about 10 years. I cannot imagine doing without it! My pm has dilaudid in it and it just does wonders for me. I was without my pump for almost a year after my spine surgeon sliced the catheter and no one knew it. After gradually increasing pain we finally did another MRI and that's when the spliced catheter was seen! It was several more months before I got a new one as I was recuperating from another spinal surgery and my pm wanted to be sure that I suffered no ill effects from the dilaudid that had been coursing through my body. People asked me how I could chance having another one and I can only say that life without it was miserable. My surgeon was just sure I was going to sue him, but gosh, I can understand how it happened. I've had 2 more surgeries since then and now I just remind him about the pump catheter right before the surgery. You might want to keep this in mind after you get your pump, if you should ever need more surgery.

I hope you have great success with it as I have had. I still require some oral meds for breakthrough pain but have learned to pace myself so I don't require them too often....maybe 2 or 3 times a week.

Hopefully, your pain will be diminished a great deal and you will be more able to cope with the turmoil around you. I do wish you great, good luck.

Carol
__________________
Lumbar surgery x 7 over the last 30 years.
cervical fusion...2 levels
medtronic pain pump implanted
Last surgery Oct, 2010, 3 levels

 
Old 01-31-2011, 04:09 PM   #3
Newbie
(female)
 
Join Date: Jan 2011
Location: Tyler,tx USA
Posts: 3
rantan35 HB User
Re: Medtronic implantable system

Thanks for the reply. I find that throwing it all out there regarding my past gets the good the bad and the ugly out of the way. I hope the morphine works. I had surgery the first of January on a unrelated manor and was given dilaudid for pain for my back also for the pain in my ear (the unrelated problem). I really would like to skip the morphine and just have the dilaudid. It didnt make me swimmy headed and it really helped. Maybe I will be able to talk to my pm before the 10th. Once again thanks so much. I really would like to read more stories from yall that have the pain pump.

 
Old 01-31-2011, 04:30 PM   #4
Senior Veteran
(female)
 
Join Date: Jul 2009
Location: Maryland
Posts: 694
Pegala HB UserPegala HB UserPegala HB UserPegala HB UserPegala HB UserPegala HB UserPegala HB User
Re: Medtronic implantable system

Hello Friends,
Rantan I don't have a Medtronic pump, so I can't give advice, but I just wanted to let you know how impressed with I am with you. You've been through so much, and you keep going. Hang in there. It sounds like relief is just around the corner. Please know that you are in my thoughts and prayers.
Peggy

 
Old 02-01-2011, 08:59 AM   #5
Senior Veteran
(female)
 
Join Date: Jul 2010
Location: Missouri
Posts: 755
maltluver HB Usermaltluver HB Usermaltluver HB Usermaltluver HB Usermaltluver HB Usermaltluver HB Usermaltluver HB Usermaltluver HB Usermaltluver HB Usermaltluver HB Usermaltluver HB User
Re: Medtronic implantable system

Quote:
Originally Posted by rantan35 View Post
Thanks for the reply. I find that throwing it all out there regarding my past gets the good the bad and the ugly out of the way. I hope the morphine works. I had surgery the first of January on a unrelated manor and was given dilaudid for pain for my back also for the pain in my ear (the unrelated problem). I really would like to skip the morphine and just have the dilaudid. It didnt make me swimmy headed and it really helped. Maybe I will be able to talk to my pm before the 10th. Once again thanks so much. I really would like to read more stories from yall that have the pain pump.
Rantan, with the pump, you won't get that swimmy headed feeling, so the morphine might handle your pain very well. Dripping into the spinal canal as it does, it is much more powerful than taking oral meds. You really want to have the least powerful drug that will handle your pain so that there is room to titer it up if necessary. I started with morphine which worked quite well for a long time; my pm switched me to dilaudid after a couple more surgeries and increased pain.

Wishing you great luck....please stay in touch.

Carol
__________________
Lumbar surgery x 7 over the last 30 years.
cervical fusion...2 levels
medtronic pain pump implanted
Last surgery Oct, 2010, 3 levels

 
Old 03-03-2011, 07:03 PM   #6
Junior Member
(male)
 
gncrzy's Avatar
 
Join Date: Jun 2010
Location: MIDWEST IOWA
Posts: 17
gncrzy HB User
Re: Medtronic implantable system

Hi
I would like to ask how often does this pump have to be filled??? I have had 2 back surgery's then ended up with right leg & foot pain so my surgeon suggested that I get A SCS so in October I did get A SCS it works great for the leg and foot pain.But my back pain is very bad. My PM DOC has me on Oxycontin but I have been on it for A long time I want to get off the pain meds and get A pain pump.I would like to be able to drive my self some were instead of depending on my boys to take me places and get my life back.

 
Old 03-04-2011, 09:47 AM   #7
Senior Veteran
(female)
 
Join Date: Jul 2010
Location: Missouri
Posts: 755
maltluver HB Usermaltluver HB Usermaltluver HB Usermaltluver HB Usermaltluver HB Usermaltluver HB Usermaltluver HB Usermaltluver HB Usermaltluver HB Usermaltluver HB Usermaltluver HB User
Re: Medtronic implantable system

Quote:
Originally Posted by gncrzy View Post
Hi
I would like to ask how often does this pump have to be filled??? I have had 2 back surgery's then ended up with right leg & foot pain so my surgeon suggested that I get A SCS so in October I did get A SCS it works great for the leg and foot pain.But my back pain is very bad. My PM DOC has me on Oxycontin but I have been on it for A long time I want to get off the pain meds and get A pain pump.I would like to be able to drive my self some were instead of depending on my boys to take me places and get my life back.
Hi. My pump is filled every 11 weeks or so. There are smaller pumps that require being filled every 6-7 weeks and that choice will be up to you and your doctor. You can find a lot of information on the net about the pump. Have you talked to your pm about it and is he willing to do a trial?

The pump isn't for everyone, but you have already demonstrated that having a foreign object implanted isn't a problem for you, so you should be a good candidate.

I wish you the best of luck and hope you will post again and let us know how things are going for you.

Carol
__________________
Lumbar surgery x 7 over the last 30 years.
cervical fusion...2 levels
medtronic pain pump implanted
Last surgery Oct, 2010, 3 levels

 
Old 03-14-2011, 12:46 AM   #8
Newbie
(male)
 
Join Date: Feb 2011
Location: Plainfield, Illinois, United States
Posts: 2
laughhammer HB User
Re: Medtronic implantable system

I have to say anyone that lives with spine problems that it is a tough road to travel. I had a C3-C5 fusion. The disks were so intertwined with the nerves that damage was certainly going to happen. I have a Medtronic SCS and it is working wonderfully. I got about 20 days before the battery needs to recharge, and I have no problems like burning pain when I recharge the battery. I did everything my doctor told me to do after the surgery. I will tell you my wife has been a saint or godsend through all of this. In 2001 I herniated the disks. I lived with the pain until a neuro exam came up with a negative babinsky test. My doc's office was right across the parking lot from the hospital. He called an ambulance to take me to the hospital on a Friday. They kept me so drugged up and relaxed that I don't remember taking an ambulance ride to their other hospital 9 miles away. and anything else that was done until I woke up from fusion surgery on Tuesday morning. I had the surgery on Dec 19th and 50 days later I was back to work running my construction company cutting a monster sized roof. Then in October of 2006 I took a couple of my guys to work with another company to help them on a huge job. Then one day we lifted a 20 foot wide by two stories wall that was framed with 2x8 studs and all sheathed with plywood exterior. The wall got dropped on my and herniated 3 more discs, broke 4 ribs, dislocated my knee, wrecked my hip socket and hip bone, and trying to slow the wall down and get out before it smashed me, I tore the rotator cuff, labrum, and bicep tendon. Almost 4 years later I got a Medtronic SDS for neck and arm pain. I have great relief from the neck and arm pain. Sometimes the battery area seems to get achey. For the biggest majority of the time I get relief. I get enough to work as a carpenter although I no longer lift walls or roof rafters. As a boss and owner I make my employees do the heavy stuff. My wife though thought that I was just trying to avoid helping her and avoiding things like cutting the grass or hanging out with my son. Then she read some message boards about people who have fusions, and the damage caused bythem. MY WIFE HAS BEEN NOTHING SHORT OF FANTASTIC!! She even got my mother in law to understand what I'm going through. People thought I was faking until my wife told them what she read.

 
Old 04-28-2011, 01:42 AM   #9
Newbie
(female)
 
Join Date: Apr 2011
Location: Eugene, OR, United States
Posts: 2
jeriah HB User
Thumbs up Re: Medtronic implantable system

Quote:
Originally Posted by rantan35 View Post
Hi, I posted last week regarding the pain pump I am getting on the 10th of this month. I spent almost all of yesterday reading old posts and getting lots of information from this site. I am 42, I have 3 grandkids and 3 grown kids as well. I have been married for almost 24 yrs and I have a wonderful husband, BUT.......
He has been to hell and back with me and my illnesses. I had a cervical fusion in 2003, I literally went through every pain medicine and just about every Dr. in the town I live in because this all started with migraine headaches that started in 1986 after a car wreck I was in. I didn't put two and two together until 2003 and the pain management Dr. I was seeing at the time received a letter from my insurance company wanting to know why no tests had been run other than injections,drug therapy,and burning the nerves in my neck. Finally I was referred to a neuro surgeon who did an MRI and saw that I had two bulging discs in my neck causing the headaches. By this time I had such a prescription drug addiction it was scary. So the new doc did surgery he fused 2 levels in my neck and sent me home on my same meds. At this point it was Phentenal patch 100's, hydrocodone10/with dextromorphine that I had to buy from a compounding pharmacy and a bunch of other stuff that I took from my psychiatrist. After my 6 week check up I went to a 3 week rehab where I went mon-fri 8am-3pm. I lost my job with all those great benefits that allowed me to see who I wanted to when I wanted to and had a very small copay on everything. Needless to say rehab did not help because I was not ready. So I got a new job,with great benefits and the cycle started again. This time I knew what I was doing,I knew what to say to get the prescriptions and somehow I still preformed my job tasks. In 2006 my family fell apart. My husband went on interferon,my 15 yr old daughter started cutting herself,and my 16 yr old son got his 26 yr old mgr at the burger joint he worked at pregnant. No wonder I finally hit bottom. Well this time I went to a 10 day detox program and a 30 day intreatment program in Stephanville Tx. I am happy to say that I have not abused any medicine since. In 2009 I was coming home from my parents home in Waco Tx. there was a wreck on I-H 35 so traffic was stopped. I came to a stop and looked in my rear view mirror and saw a black pickup going very fast coming up behind me, I had time to say "Oh God" and then it felt like an explosion went off. My 2003 Dodge Caravan was totaled and the person who hit me ended up hitting 3 other vehicles. Thank God we are all alive. The only one hurt other than the driver of the black truck was me. My neck and back were hurting so bad I thought I was gonna die. Obviously I did not. I went to the ER in Waco, my husband came down from Tyler to take me home and I saw my Dr. on Monday in Tyler. I was immediately sent to a PM dr and I told him my history with pain meds. He prescribed vicidin 5/500 4 times a day and flexerill 10mg 3x daily. He did an xray to make sure my neck was ok and thank God all hardware was still intact. So I started Physical therapy for 2 weeks on the neck and then we moved to pt on the back. The back was in such bad shape that the exercises that the physical therapist tried sent me to the ER. So I kept going to the pain mgmt Dr. and he did SI joint injections,a epideral,and the whole nine yards. Finally my back did not get any better and my pain mgmt dr said he would understand if I wanted a 2nd opinion. So I called my attorney and ask him what to do. He recommended a great pain management Dr. He did a MRI with contrast and he did a test on all the nerves in my back at all levels and when he did the pressure test, it showed that 4 levels were so painful that I almost came off the table. The insurance company paid the maximum that he was insured for and my underinsured pd what I had. There is not a surgeon around that will touch my back. I have degenerative disc disease that I did not know I had. My doctor says I probably would not have had any problems until I was much much older. So my pm recommended either the neurostimulator or the pain pump. I have a tens unit that I use for my neck and it works great but does not even touch the pain in my back. So I did the trial for the morphine pump and got 100% relief. I am scheduled to have the pump put in on 2/10. Right now I am on Hydrcodone 10/500 4xday, morphine sulfate 30mg 2xday,flexerill 10mg 3xday, and flector patch every 12 hours. I am in so much pain all the time I can't wait to get this pump put in. My husband has seen me and lived with me through all of the above he keeps my pain meds and makes sure that I stay on the right track. I am just so afraid that this pump is going to be more than HE can handle. I stay at a 8-9 on a pain scale of 1 to 10. I was put on the morphine about 2 months ago to get me ready for the pump. To see how my body reacts to it. Then the dose was increased last week because of the constant pain. I love my husband so much, but he does not understand what its like to live with this kind of pain and to still be expected to perform all of the duties I have as a stay at home MIMI. My son lives with me and my husband and the children's mother works 60-70 hr work weeks, so they are here all the time. I want my family to understand what I am going through without them making me feel like I am whining and complaining. Maybe that is what I am doing. Does anyone feel my pain, does anyone have any suggestions? Please forgive the long post I think I just needed to get it all out.
I know just what you are going through! I have a different problem, I began having symptoms of Multiple Sclerosis when I was 18, had more severe symptoms in 1995 and just dismissed them, than was hit wiht severe pain, numbness and muscle spasms in both arms...this went on for weeks and I still didn't go to the doctor. In the year 2000 I found I couldn't speak at work, everytime I tried to talk, different words came out, I went home and called the doctor. I finally looked up information on my symptoms in 2000 and all matched M.S perfectly, I knew I had it. So, I went through 2 neurologists and kept up the persuit of a diagonosis until I was diagnosed in 2001. Pain, and severe muscle spasms have always been my main symptoms! I now take 300mg of mscontin=morphin a day, 3000mg robaxin a day, 30mg flexerial, valium for muscle spasms that don't stop... and now my doctor is wanting me to go on the pain pump! I developed an allergy to baclofen, that worked pretty well on my back, but I had to stop taking it because I was having episodes were I couldn't breath well, or like I couldn't get enough air. Anyway. the pain pump, while it sounds good and all, if you do the research, has been on a class 1 recall with the FDA for the last few years!! It appears that the morphin, which is acidic, causes grandulomas to form in the area where the tube is implanted in the spinal cord bones. the cartilige around the bones swell up and can close the tube, stopping the flow of medication and causing withdrawl and pain. The tubing than has to be moved again, causing alot of pain.....So, they now recommend only using baclofen in the pump or non-acidic approved meds to prevent problems.
My way of thinking is to wait until they figure out how to prevent the problems and make the implant more worthwhile. Having a tube implanted into my body and into my spinal canal doesn't sound safe to me. I will only go that path when I have no choice and the meds I am taking are affecting me to such a level that I can't function at all. I am close to that right now!!!

So....I have to decide, do I have it implanted or not? I will continue to do more research before I make that decision.

As for needing to tell others about your suffering and pain, you are human!! when someone is going through such experiences we feel a need to have others understand how much pain we are going through, so they can have an understanding of what you are feeling every day. A close friend or husband/wife, needs to listen so they can share there loved ones experiences and understand their needs and grief. It is in a way a grieving process, isn't it?

I hope I have helped a little? I feel your pain and suffering!!! And, I do know what pain feels like to that extream degree! Sometimes it feels like it is impossible the human body can feel such pain and still be alive? It's when we feel such pain, that we become like animals! We want to go in a corner and hide, and be left alone. any talking or interactions are impossible, the pain is so severe!!!! And yet, all the medication I take, at times don't even touch the pain giving me relief! Thats why I'm thinking of going on the pump anyway. than I can be given very high doses, that are very small internally, making it safer to take the morphin, able to take much higher amounts to treat the pain, and less side effects, like being stoned out on meds so that all you can do is sit and zombie out on the tv.

I hope you find what you need to treat your pain! do what you need to do. Ask for understanding from your loved ones, Sounds like you have a wonderful husband.....tell him that often!! As for your kids, love them, and hug them. Ask them for help, and expect them to, it will help them understand and feel important, like they are needed...which they are..by you!
Take care......jeriah*

 
Old 04-28-2011, 06:53 AM   #10
Junior Member
(male)
 
gncrzy's Avatar
 
Join Date: Jun 2010
Location: MIDWEST IOWA
Posts: 17
gncrzy HB User
Re: Medtronic implantable system

Well I don't know what to do now I went to the doc and ask him about the pain pump and he flat out told me that he will not put one in because I already have the stimulator implant. He told me I cant have 2 systems implanted at the same time. So now what do I do
__________________
WAY2FAST4U

 
Old 04-29-2011, 11:52 PM   #11
Newbie
(female)
 
Join Date: Apr 2011
Location: Eugene, OR, United States
Posts: 2
jeriah HB User
Thumbs up Re: Medtronic implantable system

Remember one thing first and formost A DOCTOR IS NOT A GOD OR ALL KNOWABLE, THEY MAKE MISSTAKES! They work FOR YOU! YOU IN FACT HIRE THEM TO HELP YOU WITH YOUR HEALTH, you can also fire them if they do not help you the way they should.

If the device you have now does NOT WORK GOOD ENOUGH OF YOUR PAIN, and does no better than taking drugs by mouth, than have it removed!

If after much study, you decide you want to try the other device (which is on a class 1 recall with the FDA , so check that problem before deciding) than that is your decision. Get a second opinion!

Remember, you are the boss, they work for you! Just find one who will work for you and treat you with respect and care!

Sorry, sometimes it takes alot of looking to find the right doctor.

Hang in their!

 
The Following User Says Thank You to jeriah For This Useful Post:
gncrzy (04-30-2011)
Closed Thread

Similar Threads
Thread Thread Starter Board Replies Last Post
Looking into Medtronic Pain Pump brianpain33 Pain Management 8 07-08-2012 01:59 PM
Pain Meds and the Immune System(Boils) Brosiah Pain Management 10 07-02-2009 06:55 AM
Amitriptyline to leave the system. Xanath283 Pain Management 6 06-30-2008 04:52 PM
Medtronic Morphine Pain Pump Problems MollyGirlUSA Pain Management 5 04-20-2007 03:10 AM
Medtronic- Psychiatric Evaluation, Why? Beulah E. Pain Management 5 10-26-2006 10:35 PM




Thread Tools

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is Off
HTML code is Off
Trackbacks are Off
Pingbacks are Off
Refbacks are Off




Join Our Newsletter

Stay healthy through tips curated by our health experts.

Whoops,

There was a problem adding your email Try again

Thank You

Your email has been added








TOP THANKED CONTRIBUTORS



tortoisegirl (159), gmak (155), Shoreline (149), BB07 (91), backhurtz (84), katlin09 (69), Ilovemycutedog (53), galalena (50), jonnstar (35), Isotope (34)

Site Wide Totals

teteri66 (1180), MSJayhawk (1006), Apollo123 (906), Titchou (850), janewhite1 (823), Gabriel (759), ladybud (755), midwest1 (669), sammy64 (668), BlueSkies14 (607)



All times are GMT -7. The time now is 02:54 PM.



Site owned and operated by HealthBoards.comô
Terms of Use © 1998-2014 HealthBoards.comô All rights reserved.
Do not copy or redistribute in any form!