Aches & Pains
The aches and pains of old age aren’t just physical. When it comes to leaving a beloved home for a nursing facility, or watching a loved one decline, there can be plenty of heartache as well. Growing old comes with unique challenges that more of us are facing because of increasing longevity. But doctors say there is help out there for both physical and emotional stressors.
According to the Arthritis Foundation, there are more than 100 different types of arthritis and more than 50 million adults suffer with it. It is most common among women and occurs more frequently as people get older. Degenerative osteoarthritis is the most common form and occurs when cartilage, the ‘cushion’ on the ends of bones, wears away, causing pain, swelling and stiffness.
why we get it
Risk factors include excess weight, family history, repetitive motion, age and previous injury. “As we age, our joints are like hinges that become rusty and creaky,” says Dr. Steven W. Baak, director of Arthritis Center. Osteoarthritis, he says, occurs at varying rates depending on your physical makeup and family history, and it’s distinctly different from rheumatoid arthritis, which is a long-term autoimmune disease.
RA affects one in 100 people and occurs when the body’s immune system attacks the joints, leading to pain and deformity. It can appear quite suddenly. “When life has been lived in a predictable fashion, a person can feel very betrayed by his or her body,” Baak says. “But it’s an exciting time to be in rheumatology because there are so many different treatment options available.” While there’s no cure for the disease, medications can be effective at restoring function, and today many are being administered intravenously. These infusions work by interrupting the immune system, reducing swelling and pain. On average, infusions are given monthly. Baak describes Arthritis Center’s infusion clinic as a ‘comfortable home’ where patients can recharge in a nurturing environment. While some infusions take a few hours (long enough to watch a movie, he notes), others are complete in under an hour.
“Our goal is to return patients to normal existence with the understanding that an ongoing regimen of treatment is necessary to keep the arthritis at bay,” Baak explains, adding that after three months of treatments, he has seen people who once needed wheelchairs walk out on their own.
At The Inner Connection in Webster Groves, physical therapist Sharon Hepburn offers alternative therapy to reduce and eliminate the chronic pain associated with both osteoarthritis and rheumatoid arthritis. It’s true, Hepburn says, that the population is living longer and therefore is more susceptible to conditions like arthritis, but she’s quick to point out that diets these days tend to be full of highly-processed foods. “The very first thing we do is tell patients to get off all sugars. Arthritis is an inflammatory process and sugar is highly inflammatory. So that means no beer, no wine and no desserts,” she says. If that doesn’t improve symptoms, she suggests an elimination diet, weeding out gluten, dairy and nightshade vegetables (potatoes, eggplant, peppers, etc.), which might be causing sensitivity. “The inflammation response is different in different people,” Hepburn explains.
Also a massage therapist, Hepburn says joint manipulation and massage can be hugely beneficial for arthritis patients. “It’s important to get blood flowing to the affected areas,” she says. She stresses that movement and stretching are extremely important, even though a patient experiencing pain may not feel like exercising. As for ways to help prevent osteoarthritis from occurring, Hepburn says it’s best to start early. “Rather than waiting until problems occur to change your behavior, begin in your 30s and 40s by watching your diet and maintaining a good level of mobility,” she advises.
For obvious reasons, knees are a common site for developing osteoarthritis. “They work very hard for us,” says Dr. Robert Sciortino, orthopedic surgeon at St. Luke’s Hospital. In mild cases, general wear and tear can result in the thinning of cartilage between the femur and tibia. When the pain is severe, Sciortino says it may be due to bone rubbing on bone because the cartilage has worn away completely. A simple X-ray can determine the degree of debility.
Sciortino says there are different lines of attack, but he always tries to treat patients conservatively. Initially, he recommends modifying activity levels, using a cane or losing weight to reduce stress on the knee, as well as nonsteroidal anti-inflammatory drugs like Aleve (naproxen) or Advil (ibuprofen). But he cautions that these should be taken under the supervision of a physician because of the risk to heart and kidneys, and—in light of the trend in opioid use and abuse—he doesn’t support the use of regular painkillers for chronic conditions.
What about dietary supplements like glucosamine and chondroitin sulfate? “There’s some controversy about these,” Sciortino says. “Some say they are no better than a placebo. So I don’t make any promises.”
Other nonsurgical options are cortisone injections and a treatment called viscosupplementation. This is an injection of a substance, which—like motor oil—keeps the joints moving smoothly. Sciortino says it mimics the synovial fluid that ordinarily lubricates the joints and reduces friction. Viscosupplementation is a series of three or five injections given over a period of three or five weeks.
the ABCs of surgery
Dr. Mark Sucher of Mid County Orthopaedic Surgery & Sports Medicine says knee replacement surgery isn’t as painful as it sounds. “We do a pretty good job of controlling pain these days,” he says, adding that some surgeries even can be performed as outpatient procedures if the patient is robust enough. A local anesthetic is injected by an anesthesiologist into a peripheral nerve, and anti-anxiety medication is given if necessary.
If the replacement is partial rather than full, only one of the three knee compartments is replaced, usually the medial (inside) one. A full replacement involves the kneecap and outside compartment as well. Sucher explains that during the procedure, any remaining cartilage is shaved from the ends of the bones and replaced with metal, and a piece of plastic is placed between the metal inserts. “This acts like new bone, articulating metal on plastic instead of cartilage on cartilage,” he says.
Usually, a knee replacement requires one to three days in the hospital and three months for a full recovery, during which time a physical therapy regimen should be followed. Sucher says there really isn’t an age limit. “As long as the patient is considered strong enough for surgery, it can be done on 80- and 90-year-olds,” he notes.
Registered nurse Jacque Phillips says the main home healthcare trend these days is to address the whole person. Where once the focus was solely on meeting physical needs, now addressing the emotional and spiritual needs of a patient is just as important. Phillips founded AccuCare Home Health Care of St. Louis in 1994 after recognizing gaps in care after people were sent home from the hospital. “They were always being readmitted,” Phillips remembers, “because they did not have the tools to fare well at home.”
the comforts of home
Her goal for AccuCare, consequently, was to fill those gaps and help clients lead the fullest lives possible in their home environments. With a staff of 130, the private, in-home agency provides anywhere from one hour of care—which might mean walking a dog or driving a client to a hair appointment—to 24/7 nursing. “Our aim is to have clients maintain their independence as long as they possibly can,” Phillips says. AccuCare’s staff is made up of RNs, certified nurses’ aides and caregivers, but they also seek the counsel of outside certified care managers. These are patient advocates, she explains, who look at each case from all angles and help AccuCare develop an individualized package of services.
it takes a village
Care Choice Care Management (CCCM) is one of these go-between agencies. “We deal in every aspect of aging,” says Maria Miskovic, owner and principal care manager. “We address physical infirmity, failing memory, even legal and financial planning.” CCCM has seven managers on staff, many of whom are social workers and gerontologists with hospital backgrounds or experience with long-term care. “The hardest thing when it comes to aging is that people tend to be fiercely independent and want to hold on to that independence desperately,” Miskovic says. “They avoid the services they need because they are proud and don’t want to appear weak.” CCCM’s goal, she says, is to honor that sense of independence but enlighten people before an emergency happens.
“As a person’s needs change, we are there to guide them through the maze of healthcare options, to connect them with services and resources, and to provide strategies and solutions to make informed decisions about their care,” says Miskovic, who also is a licensed clinical social worker. She adds that if it’s apparent that a care facility is the best option, CCCM also can work with a family to find the best possible situation. Sometimes, an initial two- to three-hour assessment is all that’s needed, but often CCCM works with a client through the end of life. “Needs change as we age,” she says. “And we are there through the ups and downs, anticipating problems before they happen and making sure all services are running smoothly.”