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For decades, Patti Trongard worked in real estate, buying and selling property in her native Minnesota. She then got into property management after relocating to Florida eight years ago.
“It became my dream to work on Sanibel Island,” Patti shares. “When I sought employment on the island, I just sort of landed in property management.”
The role of a property manager is to oversee all operations related to a property on behalf of the owner. Tasks include supervising the maintenance and repair of the property as well as dealing with tenant issues.
“The job involves a lot of communication,” Patti adds. “I report to a board of directors, and I also work with owners associations. I manage everything from accounts payable to vendor contracts to owner concerns. I also take care of the property’s exterior to protect the owners’ investment.”
Patti notes that her responsibilities shifted significantly after Hurricane Ian hit the area in September 2022. The hurricane decimated swaths of Southwest Florida, especially coastal Lee County and communities such as Fort Myers Beach and Sanibel Island.
“After the hurricane, my job centered mainly on managing construction, the rebuilding of damaged properties and dealing with insurance adjusters,” she expounds. “It’s been very interesting work, but also very difficult and very sad because of all the destruction.
“I’m now semi-retired. Just recently, I stopped working full time and started doing property management on a part-time basis. I was managing 17 properties when I was working full time. Today, I manage only one.”
For fun, Patti embraces artistic endeavors. She’s an accomplished painter who displays her artwork at various community art fairs in her free time.
Sometimes, however, debilitating migraine headache pain kept her away from her hobby for days.
“I’ve suffered from headaches for 40-plus years,” Patti laments. “I’ve lived my life with migraines since I was 18 years old, and for years, nothing I tried took them away. The headaches caused blinding pain, nausea and vomiting. It was an extreme pain that would go on sometimes for two or three days.
“The migraines made me sensitive to sound and light, particularly fast-moving light like you see at a movie theater when things are flashing all around you. That kind of light could also trigger a migraine. I got headaches just about every day. Sometimes, they were so bad that I had to go to the emergency room.”
A migraine isn’t just a bad headache. It’s a disabling neurological disease with different symptoms and remedy approaches compared to other headache disorders, such as tension or cluster headaches.
Over the years, Patti tried numerous treatments, including narcotic pain relievers and chiropractic adjustments. The narcotics dulled her migraine pain for a few hours, but nothing brought long-term relief. Then she saw a sign that gave her hope.
“I drove past Orthopedic Center of Florida, and there was a sign out front advertising its pain management services,” Patti remembers. “I went home and researched its pain management staff and was impressed, so I made an appointment. It was the best thing I’ve ever done for myself.”
Lo and Behold
At Orthopedic Center of Florida, Patti met with Laura Kent-White, ARNP-C, a nurse practitioner who specializes in pain management and has expertise in the treatment of migraine headaches.
“Often, people have migraine headaches that they don’t identify as migraines,” Laura notes. “A migraine may only be diagnosed after the patient has suffered for years with what they think are recurring sinus headaches or stress headaches. But lo and behold, they’re actually migraines.
-Laura Kent-White, ARNP-C
“There are many things that can trigger a migraine, and we’re getting better at identifying those triggers. We’re also broadening our understanding of the potential causes of migraine. And with that knowledge comes newer treatments.”
Amino acids are organic compounds that serve as the building blocks of proteins. Neuropeptides are amino acids released by cells in the central nervous system, including the brain and spinal cord, that act as chemical messengers. These amino acids play a crucial role in hormone secretion, which can lead to various outcomes, such as head pain.
Research has shown that a neuropeptide called calcitonin, which is picked up by certain receptors in the body, may be a trigger for a migraine headache. Neuropeptides have also been shown to promote progression of an existing migraine headache.
“There are newer medications called CGRP (calcitonin gene-related peptide) inhibitors that are designed to block the receptors from picking up calcitonin, which prevents inflammation of the membranes surrounding the brain that may lead to migraines,” Laura asserts. “It’s good news for migraine sufferers that there are new medications available that may provide them with better pain relief.
“For those who experience chronic migraines, BOTOX® injections, another newer treatment, may be recommended. BOTOX was discovered as a treatment for migraines when people receiving BOTOX Cosmetic injections to soften their fine lines and wrinkles realized their migraines also improved.”
It is believed that BOTOX interferes with the transmission of pain signals from the brain to the muscles of the face and head, thereby preventing headaches.
The cause of migraine is unclear, but researchers have identified risk factors. For example, migraine is more common in women and often starts between ages 10 to 40. Many women find migraine headaches get better or go away after age 50. Migraine also runs in families and is more common in people with depression, anxiety, bipolar disorder or epilepsy.
It’s also known that certain factors can elicit a migraine episode. Common triggers include hormonal changes; stress; foods and drinks such as aged cheese, chocolate, alcohol and caffeine; changes in the weather; physical activity; loud noises; bright lights; strong smells; and too little or too much sleep.
Laura works with migraine patients to try to uncover what triggers their episodes. Once identified, patients can then avoid them to help prevent migraines from starting or progressing.
“Some people who suffer from migraine, about 30 percent, develop symptoms several hours to up to three days before the headache starts; this is called a prodrome,” Laura describes. “Prodromes are often not identified by patients until their providers begin asking questions. Prodrome symptoms may include food cravings, low energy, irritability and a stiff neck.
“In some cases, migraine sufferers get a warning sign, called an aura, that a headache is imminent. With an aura, people can become nauseated or feel like they’re outside of their body. An aura can also present as watery eyes or visual disturbances, such as seeing black dots, wavy lines or flashes of light.”
Migraine is a very common condition, affecting 39 million Americans and 1 billion people worldwide. The financial cost of migraine in the US, in terms of sick days used and lost productivity, is estimated at $78 billion annually.
JORDAN PYSZ / iFoundMyDoctor.com
For fun, Patti enjoys painting, and she often displays her work at community art fairs. In the past, migraines kept her away from her hobby for days, but that’s not the case anymore.
Life-Changing Treatment
The first thing Laura did in addressing Patti’s condition was perform a thorough evaluation with testing to rule out any underlying brain pathology as the cause of migraines. When the test results came back negative, Laura prescribed several medications before finding a treatment plan that worked for Patti.
“Patti is a long-time migraine sufferer who came to us with a known diagnosis,” Laura recalls. “When I first saw her, she was taking an old migraine medication called FIORICET®, which wasn’t entirely effective.”
FIORICET is a brand-name drug that combines butalbital, acetaminophen and caffeine.
“Over time, we treated Patti with a wide variety of medications, including various blood pressure medications and BOTOX,” the doctor notes. “Ultimately, she responded to the BOTOX injections and a CGRP inhibitor. That combination provided excellent results. It cut down her number of migraine days tremendously.”
Patti was relieved by her treatment in more ways than one.
“I was relieved that Laura took my situation seriously,” Patti says. “She didn’t brush me off and lead me to believe there were no options, that I had to live with the migraines. She explored old treatments and new treatments until we landed on the combination that worked for me.
“I now receive BOTOX injections every three months in my forehead, head, upper neck and shoulders to relieve tension in those areas, and it works wonderfully. She also prescribed a newer medication called QULIPTA® (atogepant).
“The combination of BOTOX injections and QULIPTA has pretty much eliminated my headaches. It totally changed my life. My migraines are a thing of the past.”
Over the years, Patti has visited multiple providers trying to find an answer to her migraine problem. She greatly appreciates Laura’s expertise because it led to relief.
“Laura is extremely knowledgeable, and she keeps up on all the new medications and treatments,” Patti raves. “On top of that, she really listens to you and explores options with you. She tries to determine the source of your migraines and works with you until the problem is resolved.
“I referred my sister to Laura for treatment of her migraines. My sister lives in Minnesota but has a home in Florida. She’s going to fly down every three months to work with Laura. That’s how good she is.”
A Childhood Desire
From the time Sharon* was a child, she desired to help people. She wanted to be a teacher or a nurse and ultimately became a licensed practical nurse.
“Originally, I wanted to work in pediatrics, but then I changed my mind,” Sharon discloses. “I worked in primary care for six years, and I’ve been in orthopedics for about five years. “
Sharon has been a nurse at Orthopedic Center of Florida for about a year after initially coming onboard to assist a physician who recently joined the staff as well.
“I work specifically for Dr. Scott Thompson, who is one of the orthopedic surgeons at Orthopedic Center of Florida,” Sharon elaborates. “Before joining the practice, I worked with Dr. Thompson at Naples Community Hospital. I’ve been with him for five years.
“As his nurse, I’m the initial point of contact with his patients. I check them in and obtain their intake information. If the patients are receiving injections, I draw up the medication and get the injections ready for the doctor. I also administer medications, order MRIs and schedule patients for surgery. About the only thing I don’t do is go into the operating room with Dr. Thompson.”
Like Patti, Sharon began suffering from recurrent headaches as a child. Sharon suspected they were migraines because the headaches were debilitating. But it wasn’t until years later that she was officially diagnosed with the disorder.
“I got headaches at least five times a week,” she reveals. “I knew when they were coming on because I got blurry vision and a slight headache. Usually within an hour, I would start to become nauseated and wouldn’t really be able to see. The headaches eventually got so bad that I had to go into a quiet room, turn off the lights and lie down with ice packs.
“Light often made my headaches worse, and looking at the computer, my phone or anything like that aggravated them. The headaches could last anywhere from an hour to four hours, and I couldn’t do anything while I was having one.
“There wasn’t anything specific that would bring on the headaches. I could be watching TV, playing with the kids or just doing dishes, and suddenly I would know a migraine was coming on. Once I realized that, I took Excedrin® Migraine and went to my room to sleep for a couple of hours, hoping that when I woke up the headache would be gone.”
Excellent Results
Not long after going to work at Orthopedic Center of Florida, Sharon was reviewing Laura’s schedule one day and noticed that a patient was coming in for a migraine workup. That prompted Sharon to ask Laura about her own headaches and before long she was seeing Laura regularly for treatment.
“Sharon missed a day of work, and when she came back, she said, I had the worst headache,” Laura recalls. “After that happened a second time, I recommended we do a migraine workup on her.”
Sharon tells a similar story.
“When Laura and I started talking about my headaches, she asked how often I get them, and I told her at least five times a week,” Sharon relates. “I also told her that I never leave the house without essential oils and Excedrin Migraine, and that’s solely because I don’t want to get stuck somewhere and not have anything to treat a headache if one starts.”
After that conversation, Laura performed tests and determined that Sharon’s headaches were indeed, migraines. To alleviate them, Laura prescribe a CGRP inhibitor that Sharon responded well to. Sharon hasn’t missed a day of work due to a migraine since.
Laura later informed Sharon that she was a good candidate for BOTOX injections. There’s just one problem with that solution: Sharon is terrified of needles.
“I watched Laura inject BOTOX into patients a couple of times and told her, I don’t know if I can do that,” Sharon describes. “Then she told me about a newer drug that came on the market. So in May, I started on QULIPTA, and it’s been life-changing.
“Now, instead of getting headaches five times a week, I may get one or two a month, if that. Even my husband says, Who are you now? Because I’m not incapacitated with headaches all the time.”
Like Patti, Sharon is grateful for the nurse practitioner’s help with eliminating her frequent headaches.
“Laura is very knowledgeable,” Sharon raves. “She’s a great nurse practitioner, very thoughtful and caring, and she really enjoys helping people. If anybody tells me they have migraines, I encourage them to see Laura and ask about QULIPTA and BOTOX injections. I tell them it will change their life.”
*Patient’s name changed at their request.
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