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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Page 32 of 51

32 SEPTEMBER 2018 | EMSWORLD.com PROFILES IN EMS Others grew large enough to threaten her life; an ovarian cyst the size of a grape- fruit sent her to emergency surger y. "Unit 1, respond, syncopal episode." In 2003 it was suggested that perhaps an implanted s acral ner ve stimulator might help alleviate her pain and bladder symptoms. One devastating catch: They could not use it until she was sure she was done having children. That wasn't a possibility just yet. A New Challenge "Unit 1, respond, vaginal bleeding, possible miscarriage." Anne's pregnancy ended with a mis- carriage at 11 weeks. If she were going to have any other children, it would have to be soon. She star ted Clomid injections again within weeks of her miscarriage. When she became pregnant again, the challenges were enormous. She had been on a methadone regimen for pain con- trol for months. The doctors in Vail didn't know how to deal with a mother and baby on methadone so were reluctant to see her. She couldn't have a pelvic exam due to her histor y. She became hyperemetic in the first trimester, vomiting so much she was placed on a Zofran pump. She lost 25 pounds, a frightening amount dur- ing pregnancy. She eventually gained it back, with only an additional 6 pounds. Her pump became infected, requiring IV antibiotics for treatment. She ended up on bed rest for the last trimester, which is its own special version of hell. "Unit 1, respond, female vomiting, 14 weeks pregnant." Anne's husband and acquaintances grew more estranged and of fered little empathy or support, especially when she remained on her pain-control regimen. Throughout her journey she did ever y- thing she was told to do by her health- care providers. She did her due diligence, consulted experts, and researched ever y avenue. When the doctors in Vail could not manage her case, she traveled back to Denver and worked out a bir th plan. C-section was out of the question; the trauma from the surger y would majorly irritate all the structures in Anne's abdo- men, triggering a response and putting her at extreme risk for cysts, adhesions, and worse. The 35-week roller-coaster came to a stop with the arrival of a beau- tiful baby boy—who also happened to be on methadone. A n n e's p e r inat al te am d e ci d e d to maintain the methadone. She planned to breastfeed, so they kept her dosing the same as it had been throughout the pregnancy. The stigma associated with opioid use in general, accompanied with the idea of a mother "tainting" her breast m ilk , s h ove s a s o ci e t y- d r i ve n s t ake through some ver y sound clinical think- ing. By maintaining her dose they were preventing her son from suffering addi- tional stress and markedly reducing, if not eliminating, the chance that he might suffer neonatal abstinence syndrome. "Unit 1, respond, sick baby." For more than a decade, the recom- mendation from pediatricians and neo- natologists has been to allow mothers to remain on their methadone regimen while breastfeeding. 1 The amount of metha- done that makes its way to breast milk is low, and the benefits of breastfeed- ing far outweigh the unproven effects of exposure from this route. Breastfeeding also helped calm Anne's cysts. Af ter 14 months her son weaned himself without symptoms and with no long-term ill effects. Managing the Mischief Despite the lull in her surgical history, the cystitis remained. With the baby weaned, she returned to the University of Colorado to have a sacral nerve stimulator implanted. Before they would do it, Anne had to have a ps ychological profile done. They wanted to assure themselves she really was experiencing pain and not just addicted to her pain regimen. Once more she had to prove to someone that her symptoms were real. She met with the inter view panel and answered each of their questions. Even now, with years behind her of being treat- ed by a host of specialists, she still had to prove she was legitimately experiencing symptoms that impacted her daily life. After an exhaustive batter y of inter views and tests, they came back to her with her results. "Anne, you're not craz y." The stimulator helped a great deal. Even though Anne was not "cured," she began to enjoy more normalcy in her life. In 2006 she under went a partial hyster- ec tomy. Even though her ovaries had caused her agony for years and she was finished having children, her physicians felt that, due to her being just barely in her 30s, to take them would represent a larger problem. The pain continued to improve, and although it took over a year, she wa s able to wean of f the methadone and antidepressant Effexor. For a brief period it seemed as if the mischief was man- aged. She became interested in working with patient safety and quality measures, taking a job with the county public health department. Then in 2008 the stimulator began malfunctioning. Anne was referred to a new urologist who was well-versed with the device and immediately spotted the problem: "They did this all wrong." Once again Anne wa s thrust onto a fier y roller-coaster that hurtled her from specialist to specialist, tests and read- justments as her pain levels once again escalated. By now Anne had been deal- ing with this for close to a decade. While it impacted ever y facet of her personal and professional lives, Anne's attitude remained positive. "Stress and pain can feed of f each other," she says. "I became really under- Upon moving to Colorado, Montera changed careers from nursing to perinatal education.

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