EMS World

SEP 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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EMSWORLD.com | SEPTEMBER 2018 31 P ain is a four-letter word. It's a deceptively simple syllable that can confound the art of medicine and resonate through a person's life. Care providers know everything and nothing about it. It is the reason people call us, the trail marker we follow toward our dif- ferential diagnosis, and the combatant we seek to defeat in the arena of palliative care. We also cannot say for certain that you have it, what it means, and how bad it really is. We must take your word for it and go with what the exam tells us. What we know now is that not all pain is equal. Chronic pain conditions are not just angr y ner ve endings but indicators of inflamma- tion and serious dysfunction. Pain is also not just a simple biological response but a glowing neon indicator of a potentially complicated and deva stating medical histor y—one we might miss if we assume the nature of the call is not serious. Anne Montera's relationship with pain is a long and intimate one. By 2002 the young nurse had struggled for years to balance her personal and professional lives while negotiating devastating pelvic pain. It would take three years of perse- verance before she would meet the one physician who was willing to listen and knew what was happening to her. He gave her monster a name: interstitial cystitis. A Daily War However, identifying the enemy and defeat- ing it are two different things. An exploratory surgery found her entire pelvis loaded with adhesions to her bladder and intestines. Then there were the ovarian cysts that had to be routinely dealt with. Anne's lower abdomen waged a daily war with her. "Unit 1, respond, 30-year-old female with abdominal pain." Her medication regime became a deli- cate balancing act in constant pursuit of relief. When that was unsuccessful the next assault on her symptoms came at the point of needle: a three-hour drive to Denver, followed by a ruthless series of trigger-point injections, ever y four weeks like clockwork. She wa s put on methadone for it s ease of regulation and longer half-life. Clomid injections for the endometriosis were wreaking havoc with her ovaries. Throughout this Anne had to juggle car- ing for her young daughter, her work, and shifts. The family moved to Vail, Colorado. She changed jobs, moving into perinatal education. Her husband at the time grew increasingly distant. He would routinely be unavailable to help whenever the time came for more treatment or even caring for the household. There is frequently a sense of myster y when it comes to the female reproductive system. Where Anne's pain was coming from wasn't a myster y; her entire pelvic floor roiled with lava on a regular basis. Ever y time they would go in, they would tr y to make it better, scraping out what adventitious tissue they could. Some- times cysts would rupture, and the fluid would drain and irritate her pelvic floor. By Tracey Loscar, BA, NRP, FP-C Last month we explored how women experience pain diff erently (https://www.emsworld.com/article/220933) and began sharing the unusual journey of nurse Anne Montera. Her story continues here. Catch Anne as the featured keynote speaker at EMS World Expo, Oct. 29–Nov. 2 in Nashville. NOT IN HER HEAD: PART 2: THE BATTLE WITHIN It took nurse Anne Montera years to get her pain accurately diagnosed—but that wasn't the end of the story Photos courtesy Anne Montera Featured speaker at EMS World Expo, Oct. 29-Nov. 2, 2018, Nashville, TN emsworldexpo.com

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