Latest news with #Penthrox
Yahoo
26-03-2025
- Health
- Yahoo
IUD insertions can be extremely painful, and in Yukon there's no standard to deal with it
Brenna Symanski vividly remembers the pain of having her intrauterine device (IUD) changed. "For a split second, it felt like every cell in my body was on fire," she recalled. An IUD insertion is a procedure involving a tiny T-shaped device being inserted through the vagina and cervix and into the uterus to provide years of highly effective contraception. But the experience of the procedure, and how painful it is, can vary widely between women — highlighting the fact that there is no standard approach to pain management when it comes to IUD insertions. Symanski grew up in the Yukon and lives in Whitehorse. The first time she had an IUD inserted she was 16. She says that time the experience was fine. She was given lidocaine, a topical gel anesthesia used to numb the uterus. She assumed getting the IUD changed would be a similar experience. It wasn't. "I screamed so loud," recalled Symanski. She says the nurse did not seem sympathetic, and told her "to imagine how much worse having a baby would be." "And meanwhile, I'm trying not to pass out," Symanski said. After the procedure, she says she couldn't walk on her own and her partner had to help her to her car. She feels that there was a dismissive approach to her pain during the procedure. "It's just really sad that women's pain is just written off… I felt like I was annoying the nurses, by being in pain." Megan Manion, also in Whitehorse, says she was nervous about getting her IUD because she'd had painful experiences in the past. She asked at the clinic if there was anything they could give her ahead of time for the pain and says the nurse told her it would only be a little pinch. She says that was not her experience. "Like, I have a pretty high pain tolerance, but I was in tears I was in so much pain," said Manion. Megan Manion of Whitehorse said she 'was in tears I was in so much pain,' when she had her IUD inserted. (Submitted by Megan Manion) She says the female doctor told her not to be such a baby about it. Experiences can vary based on provider There are several places in Whitehorse that provide IUD insertions, and experiences can vary depending where people go. Only one place — the Yukon Sexual Health Clinic — offers Penthrox, an inhaled anesthetic that patients breath in and out during insertion. Michelle McCulloch, a nurse practitioner who helps run the clinic, says Penthrox "essentially blocks the sensation of pain." Penthrox has only been available at the clinic since November, and patients who opt to have it are charged around $100. The clinic has been donated some funds to cover the cost for people who can't afford it. CBC News spoke to several other women in Yukon who had IUDs inserted at other clinics. They said they were offered lidocaine, or were told to take ibuprofen or acetaminophen before or after. Some felt their pain and anxiety were not taken seriously. Justine Fair is a Yukon-based physician who specializes in women's health. She was instrumental in bringing Penthrox to Whitehorse. "I've thought for a long time there's no other procedure that we do as family physicians that has this amount of pain without putting people to sleep," said Fair. "I've been inserting IUDs for more than a decade, and I know that it causes pain, and it's always been frustrating that we didn't have anything better." Fair argues that women's experience of pain is "probably underappreciated and/or underreported." Inserting an intrauterine device (IUD) can be extremely painful for some women, and in Yukon the experience can vary depending on where it's done and what sort of pain-management options are available. (Ben Nelms/CBC) At the Yukon Sexual Health Clinic, patients seeking an IUD have a consultation so the health care provider can understand their past experiences with IUD insertions. "Whether or not they've had pregnancies and deliveries, past traumas, anxiety levels, and whether or not they've been sexually active," said McCulloch. Those conversations help determine what pain or anxiety medications are recommended for the patient. In rare cases, women are offered the option of being sedated at the hospital. Alethea Stobbe, is the territory's director of integrated health which oversees the Whitehorse walk-in clinic, the Dawson City Medical Clinic, and the Yukon midwifery program. She says there is no policy dictating a pain-management regiment for IUD insertions, but says it's standard to consult with the patient before a procedure about the options. She cites ibuprofen, acetaminophen, and lidocaine as options. "I think the majority of us are working to provide evidence-based care. But I also know there is some variation depending on where you're accessing," said Stobbe. Research indicates mixed results According to Fair, part of the issue is that there is no proven best option for managing women's pain. She says some studies indicate success with certain medications, while others recommend alternatives. "In my experience, different physicians use what they either research themselves or what they have found works the best for the patient population that they're serving," said Fair. The Society of Obstetricians and Gynaecologists of Canada also says the research into what works best is so far inconclusive. It has a list of medication recommendations for IUD procedures, including lidocaine, ketoprofen, ketorolac, naproxen (Aleve), and tramadol. The society also says Penthrox, or methoxyflurane, is an effective option though there is no data specifically on using it during IUD insertions. There is also no national standard for pain management with IUDs. Health Canada says provinces and territories are better suited to mandate any such guidelines. The Society of Obstetricians and Gynaecologists of Canada says the health-care provider and patient should work together to develop an appropriate pain management plan. That can leave people who are looking to access an IUD in the somewhat vulnerable position of having to advocate for themselves. McCulloch says it's important for people to know what their options are. "If they are talking to a provider and they don't feel like they're being offered pain control, or management of anxiety, they should advocate for themselves to look for other options," said McCulloch. McCulloch also says she's been getting good feedback recently from patients at the Yukon Sexual Health Clinic, who are reporting "the best experience they've had with a painful procedure." "[That's] because of the knowledge they have and the medications that are offered," she said.
CBC
26-03-2025
- Health
- CBC
IUD insertions can be extremely painful, and in Yukon there's no standard to deal with it
Brenna Symanski vividly remembers the pain of having her intrauterine device (IUD) changed. "For a split second, it felt like every cell in my body was on fire," she recalled. An IUD insertion is a procedure involving a tiny T-shaped device being inserted through the vagina and cervix and into the uterus to provide years of highly effective contraception. But the experience of the procedure, and how painful it is, can vary widely between women — highlighting the fact that there is no standard approach to pain management when it comes to IUD insertions. Symanski grew up in the Yukon and lives in Whitehorse. The first time she had an IUD inserted she was 16. She says that time the experience was fine. She was given lidocaine, a topical gel anesthesia used to numb the uterus. She assumed getting the IUD changed would be a similar experience. It wasn't. "I screamed so loud," recalled Symanski. She says the nurse did not seem sympathetic, and told her "to imagine how much worse having a baby would be." "And meanwhile, I'm trying not to pass out," Symanski said. After the procedure, she says she couldn't walk on her own and her partner had to help her to her car. She feels that there was a dismissive approach to her pain during the procedure. "It's just really sad that women's pain is just written off… I felt like I was annoying the nurses, by being in pain." Megan Manion, also in Whitehorse, says she was nervous about getting her IUD because she'd had painful experiences in the past. She asked at the clinic if there was anything they could give her ahead of time for the pain and says the nurse told her it would only be a little pinch. She says that was not her experience. "Like, I have a pretty high pain tolerance, but I was in tears I was in so much pain," said Manion. She says the female doctor told her not to be such a baby about it. Experiences can vary based on provider There are several places in Whitehorse that provide IUD insertions, and experiences can vary depending where people go. Only one place — the Yukon Sexual Health Clinic — offers Penthrox, an inhaled anesthetic that patients breath in and out during insertion. Michelle McCulloch, a nurse practitioner who helps run the clinic, says Penthrox "essentially blocks the sensation of pain." Penthrox has only been available at the clinic since November, and patients who opt to have it are charged around $100. The clinic has been donated some funds to cover the cost for people who can't afford it. CBC News spoke to several other women in Yukon who had IUDs inserted at other clinics. They said they were offered lidocaine, or were told to take ibuprofen or acetaminophen before or after. Some felt their pain and anxiety were not taken seriously. Justine Fair is a Yukon-based physician who specializes in women's health. She was instrumental in bringing Penthrox to Whitehorse. "I've thought for a long time there's no other procedure that we do as family physicians that has this amount of pain without putting people to sleep," said Fair. "I've been inserting IUDs for more than a decade, and I know that it causes pain, and it's always been frustrating that we didn't have anything better." Fair argues that women's experience of pain is "probably underappreciated and/or underreported." At the Yukon Sexual Health Clinic, patients seeking an IUD have a consultation so the health care provider can understand their past experiences with IUD insertions. "Whether or not they've had pregnancies and deliveries, past traumas, anxiety levels, and whether or not they've been sexually active," said McCulloch. Those conversations help determine what pain or anxiety medications are recommended for the patient. In rare cases, women are offered the option of being sedated at the hospital. Alethea Stobbe, is the territory's director of integrated health which oversees the Whitehorse walk-in clinic, the Dawson City Medical Clinic, and the Yukon midwifery program. She says there is no policy dictating a pain-management regiment for IUD insertions, but says it's standard to consult with the patient before a procedure about the options. She cites ibuprofen, acetaminophen, and lidocaine as options. "I think the majority of us are working to provide evidence-based care. But I also know there is some variation depending on where you're accessing," said Stobbe. Research indicates mixed results According to Fair, part of the issue is that there is no proven best option for managing women's pain. She says some studies indicate success with certain medications, while others recommend alternatives. "In my experience, different physicians use what they either research themselves or what they have found works the best for the patient population that they're serving," said Fair. The Society of Obstetricians and Gynaecologists of Canada also says the research into what works best is so far inconclusive. It has a list of medication recommendations for IUD procedures, including lidocaine, ketoprofen, ketorolac, naproxen (Aleve), and tramadol. The society also says Penthrox, or methoxyflurane, is an effective option though there is no data specifically on using it during IUD insertions. There is also no national standard for pain management with IUDs. Health Canada says provinces and territories are better suited to mandate any such guidelines. The Society of Obstetricians and Gynaecologists of Canada says the health-care provider and patient should work together to develop an appropriate pain management plan. That can leave people who are looking to access an IUD in the somewhat vulnerable position of having to advocate for themselves. McCulloch says it's important for people to know what their options are. "If they are talking to a provider and they don't feel like they're being offered pain control, or management of anxiety, they should advocate for themselves to look for other options," said McCulloch. McCulloch also says she's been getting good feedback recently from patients at the Yukon Sexual Health Clinic, who are reporting "the best experience they've had with a painful procedure."
Telegraph
21-03-2025
- Sport
- Telegraph
Andy Onyeama-Christie suffered one of worst injuries in rugby history – now he is back
Andy Onyeama-Christie thought he was familiar with the concept of pain. He had already broken an arm twice, requiring four operations, once when a screw holding two plates together pushed through his skin. But all that paled in comparison when on Oct 13 last year Onyeama-Christie fractured and dislocated his left ankle playing for Saracens against Harlequins. 'Genuinely, if you said to me, 'I'll break your arm every day the next 100 days', or you do that one more time, I'll take the arm, no question,' Onyeama-Christie says. 'I have played hurt, but it's just pain. Pain I can cope with. That was otherworldly.' Even a hardened observer such as Saracens director of rugby Mark McCall was taken aback by the severity of the injury, and especially the effect it had on the other players on the pitch. 'There are lots of occasions when bad injuries occur but it was the first time I had seen something like that,' McCall says. 'It was just the effect it had on the people on the pitch who were almost in shock. It was almost like a horror movie. Players just couldn't look.' Here, Scotland flanker Onyeama-Christie takes Telegraph Sport through the gruesome nature of the injury and the step-by-step rehabilitation that has put him in position to make his Premiership comeback in the showdown against Harlequins at the Tottenham Hotspur Stadium on Saturday. The injury In the warm-up at the Twickenham Stoop, Onyeama-Christie is unusually nervous. Sweat is pouring off him even though it is not especially warm. Yet as soon as the whistle blows, the butterflies vanish and Onyeama-Christie is in his element. Seven minutes in, Saracens run a set play. The last thought that goes through his head is that he has an opportunity to step Cadan Murley. But he is caught by hooker Jack Walker in what is termed a hip-drop tackle. Then comes a crunching noise that sounds like fabric being ripped, only it is Onyeama-Christie's skin and bone. At this point, Onyeama-Christie knows he has broken something but buries his head in the floor, trying to disengage from reality for as long as possible while Saracens team-mate Nick Tompkins is frantically waving to the referee to stop play. That pretence is brutally shattered when Harlequins second row Stephan Lewies attempts to clear out Tompkins, only to kick Onyeama-Christie's fractured ankle. 'That's where I had the worst pain imaginable,' Onyeama-Christie says. 'I've turned to grab my leg like that and I have seen my foot facing the wrong way. Every day of your life for 26 years, you see your feet every single day pointing the exact same way. There are certain things in life that are just a given, that you take for granted. Then you have that kind of shock of being like, 'Wait, what?' Everything I've ever known is changed and I looked down, it's pointing off to the left. That's when I kind of panicked.' The pain is so intense that he does not think that the Penthrox, an emergency pain relief inhaler administered by the Saracens doctor, is working. 'I said to him, 'Doc, this isn't doing anything'. He's like, 'Oh, really?' and he's gone and taken a little suck and says, 'It's definitely working'.' While Onyeama-Christie receives a more potent form of pain relief, the doctors inspecting his ankle cannot find a pulse in his foot so they have to physically realign his ankle on the pitch. As the painkiller finally takes effect, his mind starts drifting into dark places. 'I don't feel like I'm this kind of person, but in my head I just kept saying, 'This is so unfair',' Onyeama-Christie says. 'I have had a few injuries with my arm and the timings of it have meant missing the Premiership final and the World Cup. So, at that moment, everything flooded into my head: 'I'm not going to play my 100th match for Sarries, I'm not going to play in the autumn for Scotland, I'm not going to play in the Six Nations.' It just seemed like an absolute disaster and that my whole world came crashing down. I kept saying I'm not going to cry, I'm not going to kick off, I'm going to wait.' Wishing Andy Onyeama-Christie a speedy recovery🤞 #GallagherPrem | #HARvSAR — Rugby on TNT Sports (@rugbyontnt) October 13, 2024 It takes 30 minutes to transport Christie from the Stoop to Paddington hospital and all the time his mind is racing. 'I was seeing tweets saying, 'His career is done', and being tagged in things like that,' Onyeama-Christie says. 'I'd see these things and then start sobbing. I am like, 'My career is done at 25. What the f--- am I going to do? I don't have a degree. I'm not ready for this'. I would hand my phone to the physio, suck some gas and air, get bored and ask for my phone back.' There are no beds available when he arrives at hospital so, for a while, he is in the hallway watching the remainder of the Saracens' match on his brother's phone. Andy Onyeama-Christie, on morphine, watching the rest of the Quins Sarries game yesterday in hospital. Priorities! #GallagherPrem — Tight Five Rugby (@TightFive_Rugby) October 14, 2024 Onyeama-Christie spends nine hours in hospital as surgeons realign his foot twice before it is stable. That night is Maro Itoje's 30th birthday party but the England captain comes to the hospital immediately after the game to visit Onyeama-Christie. 'That meant a lot to me,' Onyeama-Christie says. 'Apparently, loads of boys had asked if they could come see me, but the physio said I don't think a hospital is going to allow 30 rugby players to just rock up.' The aftermath That evening, Onyeama-Christie's partner Tash Soodeen is at a modelling shoot when she sees on a website commentary that her boyfriend has suffered a serious injury. They had been together for only four months, with Soodeen recently returning from Los Angeles to move in with Christie in his flat in north London as they looked for a place together. 'When I was sat in a hospital bed, still in my full match kit, probably stinking, 'You're about to see the absolute worst of me over the next few months',' Onyeama-Christie says. 'To be honest, she probably did with the mood swings and being, like, depressed, feeling sorry for myself or just waking up in a s--- mood or being angry. This is not to mention the fact that I can't walk, I can't cook for myself, and I can't even carry a bowl of cereal from the side by the sink to the table without spilling it. For the first week, I could not even wash myself. Some of the compromising situations and positions she saw me in that time removed any kind of red tape in the relationship.' Over the next week, Onyeama-Christie receives a steady stream of visitors from Saracens as he awaits surgery. 'I think pretty much every day someone was coming over after training or on a day off,' Onyeama-Christie says. 'Ben Earl came over a fair few times and brought me a cross with a few prayers on it, which meant a lot. We both believe in God and I still have it on my bedside table. That really meant so much and really took the edge off because otherwise I'm in basically a dark room along with my thoughts.' Pain, however, was a constant, unwelcome companion in the first month following the operation. Onyeama-Christie struggles to recall what he did in this period without looking at his phone, as the days blurred into one and other. 'Everyone was saying to me, 'Oh, you've had like a month off – have you been into any series, read any good books, watched any movies?' I would be like, 'No, I've done literally nothing. All I've been doing is sleeping and eating and taking meds'. 'Honestly, I'd wake up and I was in so much pain – pain that makes you want to scream the minute I woke up – so I just had all the painkillers I could. That would knock me out for three hours. That was my life. Fentanyl was the highlight of the injuries, the fact that I get these small windows of bliss. I don't think I have a particularly addictive personality, but I can see how dangerous that could be for some people.' The rehab On Nov 4, Onyeama-Christie has his cast removed. The scar left by the surgery looks like he has been the victim of a shark attack, but the following week he is back at Saracens to begin his rehabilitation. The surgeon has told him the best scenario is a six-month recovery. Like any athlete, Onyeama-Christie is already thinking, 'Can I make it four months?'. Yet in the early stages, there are no shortcuts to take. The first exercise Saracens physio Joel Teiger makes him do is simply wiggling his toes and then lifting his big toe without lifting the others. From there, he progresses to being in a sliding chair he can rock with his ankle and then some banded work to increase his range of movement. After two weeks, Onyeama-Christie starts walking again and using an anti-gravity treadmill. Yet, during this period, Onyeama-Christie makes the decision to separate himself from the rest of the Saracens squad. 'I wasn't ready to be involved in anything rugby related,' he says. 'I'd go in doing my rehab and the gym session and leave. I didn't want to hear about our attacking shape for the weekend. I wanted to be disconnected from it. I needed to take a break from rugby because I want to come back feeling refreshed and having missed rugby. It was quite traumatising so I need to refind the love for it.' He tries to find other outlets. Working as a player ambassador for Saracens Foundation and the Sporting Roots project, Onyeama-Christie helps organise football matches at the StoneX Stadium for refugee and asylum seeker communities in north London. 'When you are doing something like that it reminds you that you are incredibly lucky and you can get bogged down in your own stress,' Onyeama-Christie says. 'I am very grateful for what it has done for me, so I am happy to give back when I can.' On Jan 29, Onyeama-Christie starts running again, although it is 'clunky and awkward' as his ankle collapses as he runs. While off the painkillers, his ankle remains highly uncomfortable and he needs a further bone-graft operation. 'My perception of pain is probably incredibly skewed,' Onyeama-Christie says. 'I described it more as discomfort, but it is a necessary one. It doesn't feel good. When I compare it to how it felt the morning before Quins, it feels horrendous. But when you move the goalposts to the worst point, it feels amazing. 'I kind of had to learn to be more honest with myself in terms of actually reflecting on how I feel. Even now, when I wake up in the mornings, I'm hobbling and then I have to warm up and do exercises when I get in and see physio, and then I start getting a bit more out of it. I don't know if it will ever feel normal, I doubt it'll ever be the same, but my main concern is will I be able to get what I need out of it? My job is to be explosive, I need to be able to step off it, I need to jump off it, I need to be able to sprint off it. I'm not prepared to start losing metres per second off my top speed and start losing height off my best jumps. I'm not OK with it. I'm not going to tolerate that. So that's my main concern, making sure I get back to the level at least I was at before.' On Feb 27, Onyeama-Christie begins team training again. On March 14, he comes off the bench for 20 minutes in a friendly against Edinburgh. At one point, he makes a line break after stepping off the same left foot as he had done against Quins. 'That was just what I needed,' Onyeama-Christie says. 'There are a lot of things you can do in a game that you can't really replicate in training. You can't really hit someone properly. Stepping off my left foot and accelerating was great for my confidence.' The comeback From the moment that his surgeon, James Calder, had told him his estimated recovery time, Onyeama-Christie had fixated on playing in the Harlequins match at the Tottenham Hotspur Stadium. It is the biggest fixture in Saracens' season, is against the team he injured himself against and happens to fall on his 26th birthday. 'There's a certain poetry there, I can't deny,' Onyeama-Christie says. As gruelling as the physical rehabilitation was, Onyeama-Christie also had to work equally hard to recover mentally from the injury. For the first few weeks in his recovery, Onyeama-Christie would have flashbacks of the moment Lewies kicked his ankle. Then he decided to watch the injury, which was too graphic for TNT Sports to broadcast a replay, on a loop. 'Part of it is for closure and to sort of normalise it,' Onyeama-Christie says. 'It's something that happened. If I don't acknowledge it, then how can I play rugby again? The amount of pain I went through, how could I be able to go and put myself at risk of that happening again without seeing exactly what happened, understanding how it happened, understanding that it was a freak accident and chances are it shouldn't happen again?' Onyeama-Christie is clear that he could not have got back to this position without the support of many people, from Teiger, who himself was recovering from an ACL injury, to McCall, for giving him the dispensation not to be around the rest of the squad. His family will be at the Tottenham Hotspur Stadium as well as Soodeen, whose support he was dependent upon in those first few weeks. 'In that first month, she gave me all the grace in the world,' Onyeama-Christie says. 'She doesn't give it to me anymore. That grace period is definitely over.' Yet sport does not always provide fairy-tale finishes. There is no guarantee of Onyeama-Christie making a stirring contribution from the bench nor of Saracens winning. Perhaps the biggest hurdle of all is accepting that he is putting himself back in harm's way the moment he steps back on the pitch. 'People say, 'You have had your fair share of injuries now',' he says 'You just have to understand that the world doesn't work on the basis of what you deserve and what you don't deserve. It is not a case of you've had a fair share of something so you're not going to have it happen again. 'I think my faith has made me more capable of accepting that that's not the truth and being OK with that. If I do come back and get injured in my next game, then I'm OK with it. I think that is what has guided me through this. I'm not coming back expecting to be the best player in the world. I'm not coming back to be better than I was before, but I'm just coming back excited to play rugby again.'
