EMS World

AUG 2018

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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Page 40 of 51

40 AUGUST 2018 | EMSWORLD.com PROFILES IN EMS men who had undergone the same pro- cedures. 3 Half, for having their sternum sawed open. This isn't the promotion of politic s but simple biology. It is not a reach to consider that the internal structure and anatomy dif fers ba sed on gender. We adapt dosing and treatment to age and weight; why is considering gender such a stretch? "Women have hormonal cycles, small- er organs, higher body fat composition— all of which are thought to play a role in how drugs af fect our bodies," noted health and science writer Laurie Edwards. "We also have basic differences in gene expression, which can make dif ferenc- es in the way we metabolize drugs. For example, men metabolize caffeine more quickly, while women metabolize certain antibiotics and anxiety medications more quickly. In some cases drugs work less ef fec tively depending on sex; women are less responsive to anesthesia and ibuprofen, for instance. In other cases women are at more risk for adverse— even lethal—side effects." 4 A Nurse's Story Anne Montera is an animated, articulate woman with a cheerful voice and bright personality. The cadence of her speech is ardent, sincere, and optimistic. When you have her attention, there is no doubt she is listening to you. It makes her story difficult to hear, because for a long time nobody was truly listening to her, and it almost killed her. Those who work in healthcare are fre- quently the least likely to seek its help. Not so in Anne's case: A newly graduated nurse, fresh from college, her introduc- tion into adulthood came with crippling pain. She b egan to exp erience "hard periods," episodes of extensive pain that would twist her into knots and impact her ever yday life. Active in sports, she'd had or thopedic surgeries on a knee and an ankle, and even being cut open was noth- ing compared to what her insides would do to her ever y few weeks. Her doctors began looking for causes, and when they scoped her gallbladder, they discovered she had significant endometriosis. She was full of scarring already. They moved her case quickly from GI over to gynecology, and just five months before she was to marr y, she was told that the scarring wa s so bad that she probably would not be able to conceive. T his wa s n ot acce pt ab le to Mo n - tera, but sometimes the medicine can be wor se than the illnes s . She spent months receiving shots and taking fer- tility treatments, medications that trig- gered crippling migraines like clockwork. Though she closely followed all her doc- tor's instructions, ver y little was done to address her pain or help her manage what she was physically experiencing. Through all of this Montera kept work- ing as a nurse, coming up with ways to cope that would still allow her to func- tion. While this tenacity is not limited to gender, it is consistent with women and chronic pain. One of the major facets of pain management comes from learning how to assess and measure it. One of the many gender differences discovered was how men and women perceive their pain. In the frequently cited study "The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain," researchers pointed out that "Psychological factors influencing the pain response include cognitive appraisal of pain (i.e., meaning- making), behavioral coping mechanisms, and cultural influences." 2 This means women and men v iew the experience of pain from perspec- tives unique to their gender experience. Women describe pain with context, with a primar y concern of how it impacts their relationships and abilit y to function in their cultural roles (like child care). Men relate pain to loss, a threat to their liveli- hood. When pain impacts their ability to physically work, they will more aggres- sively complain about it. Montera continued to work and push through a daily routine because to reach her professional goals, or personal ones like childbirth, she simply had to. Pain al so catches men by surprise. Women have a range of "normal" pain that comes from just being biologically a woman, menses being the best example. So they sort any other pain differently, on an alternative scale and with a range of what is bearable vs. not. Men generally do not have to sort it, just react to it. Not in Their Heads After the birth of her first child, Montera's body rebelled even harder, and she refers to her experience with her "daily dose of pain." Though she knew this was not normal, her doctors fell back on the simplest answer: They told her she had ovarian cysts and rec- ommended more rounds of hormone treat- ments. Yes, she had ovarian pain, but there was more—and it was impacting her daily life. Sharp, shooting pains in her pelvic floor made it difficult to stand, walk, or drive. Her pelvic bones would ache; she could identify her anatomy just based on the pain. Doctors did not pursue any other avenues. Studies demonstrate that physicians generally have difficulty accurately diag- nosing or treating women with complex gynecological issues. Women with acute abdomen complaints are often assumed to have g ynecological issues instead, making for delays in proper testing. Additionally, when it comes to chronic pain, 70% of the people it impacts are women. "And yet, 80% of pain studies are conducted on male mice or human men," found feminist writer Laura Kiesel. "One of the few studies to research gender dif- ferences in the experience of pain found that women tend to feel it more of the time and more intensely than men." 3 Biol- ogy and hormones are thought to play a Montera at nursing school graduation with her parents. (Photos: Anne Montera)

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