Kristen Mauk

I had always heard that kidney stones were the closest thing to labor pain and childbirth that a man could experience, but being a woman who had been through labor four times, I didn’t quite believe it or understand the comparison. That is, until the other day…

I was sitting at the computer writing and felt a pain like a muscle cramp in my right side. But, since I couldn’t recall having done anything strenuous the day before, I just figured I had been sitting too long in one spot. Moving around helped for a brief time until the pain returned, more intense and radiating from the right flank around my side and down to my groin. Hmmm….being a nurse I wondered what this could be so I tried the usual techniques as the pain intensified: Tylenol, the massage chair, walking, lying down, sitting up, and having the kids rub my back. Yikes, the pain that can only be described as an unrelenting, constant hurt of the greatest magnitude, a 12 on the pain scale of 1 – 10, which no positioning or over the counter pain medication can touch had me rolling on the floor and telling the kids to call Dad to come home from work now.

Yes, that was just the beginning of my kidney stone experience. In trying to explain the pain to my husband on the phone, he said I sounded so short of breath that he thought I was having a heart attack and called EMS. When they arrived, the pain had subsided and I was left to diagnose myself with a kidney stone, with which the paramedics agreed. But since the pain was completely gone, did I really need to go to the hospital and in an ambulance no less? On their recommendation, the answer was yes.

In the ER, the IV was started and a CAT scan done to confirm our suspicions. Having no history of kidney stones, I was surprised at this painful attack that came on with no warning at all.

The ER doctor came in to see us and said in a thick accent, “Well, you were right. In 5 – 7 days you will have a special delivery!” he laughed.

I glanced at my husband who had turned white and later told me he thought for a second, “you mean she’s having a baby?!” (which at 53 surely would have been some sort of miracle). My first thought was “5 – 7 days of this pain? Are you kidding me?” How will I survive?

Another painful bout came as I lay on the gurney, and four strong IV medications didn’t completely take away the pain. We were told the pain comes from the spasms of the ureter as the stone blocks the flow of urine and irritates the inflamed tissues. Who could imagine that a 2 mm stone the size of a grain of sand could cause so much discomfort? The word intractable pain had new meaning for me now and I wished I had been more sympathetic to people and patients with kidney stones.

They sent us home with a urine strainer and prescriptions for Flomax and a combination of anti-inflammatories and pain medications. Another attack in the car and all I could do was writhe in pain and pray for relief. My husband kept repeating, “I hope I never get one of those”. It is the type of pain that one would do almost anything to stop but that nothing relieves short of passing the stone.

As I took my pain pills, strained my urine, and drank copious amounts of water to help the delivery along, I had time to reflect on the age old debate of kidney stone pain being akin to labor and childbirth. Having some experience in the childbirth area, I still found no way to compare the two in terms of what hurts more, but here were my reflections:

Labor pains were more predictable and increased with intensity as you moved towards the goal of delivery. Kidney stone pain, on the other hand, was unpredictable and had the most intense pain with every bout.

Doctors can predict when the baby will be delivered by closeness of contractions, and examining cervical dilation and effacement. Kidney stone delivery is much less predictable.
If your baby is too big to be delivered vaginally or there are complications, a C-section can be performed. And if your kidney stone is too big to pass, you may have laser treatment to break up the stones or major surgery to retrieve them. Both can mean painful recoveries.

There are medications they can give you for labor and delivery. You can even get an epidural, which I never had, but am told they can make the experience much less painful. But the kidney stone pain didn’t seem to be completely obliterated by anything short of passing it.

In comparing types of pain, I guess I can see where men would say they come close to labor pain with a kidney stone, but 10 hours of back labor was equally as bad, and having your OB doctor turn your baby internally prior to a natural birth still rates as the #1 pain I have ever had (but at least it was over quickly).

And last, but most significantly, with labor and childbirth you expect and usually earn a wonderful, lasting, happy surprise at the end of the process, where you hold your newborn in your arms and experience the glory of motherhood, quickly forgetting the pain that was endured to have your bundle of joy. Whereas, at the end of your kidney stone passing, you collect a little grain of something that goes into a plastic container for the urologist to later analyze and you can’t believe how much that little devil hurt to get out. You may experience relief and joy at the passing, but there are lifestyle modifications to make to try to avoid it ever happening again, and still without the assurance that it can be prevented, so unlike the conception process. Who, having had one kidney stone, would ever make plans to have another?

Fortunately, my stone did not take 7 days to pass and was gleefully collected in a matter of hours.

So, my answer to the question of which is more painful, a kidney stone or labor and delivery, is a simple one: they cannot be compared. It’s like apples and oranges. Different types of pain, but both extremely intense, though the kidney stone is much more unpleasant because the outcome is not a lasting joy for the rest of your life. Since every person experiences pain differently, no one could really answer this question anyway because pain is a subjective experience.

For me, given the choice between labor and a kidney stone, I pick labor. Childbirth is definitely more fun and with rewards that last a lifetime.

What is assisted living (AL)?
A Scandinavian model for senior care, now known as assisted living, made its way into America’s care system in the 1980’s. According to a 2012 report by AARP, there is no standard definition for assisted living (AL). Although individual states and residential facilities can give their own definition of AL, the term most often means that help is provided with meals, social support, medications, dressing and/or bathing and the like with 24-hour per day supervision. The Assisted Living Federation of America (ALFA) (2013) defines assisted living as “a long-term care option that combines housing, support services and health care, as needed”. The focus of AL is on maintaining dignity, respect, and independence of older residents.

In 2010, there were more than 51,000 licensed residential care settings (including assisted living) that reported more than 1.2 million beds (AARP, 2012). A study published by the National Center for Assisted Living (NCAL) cited 31,100 assisted living facilities serving 733,400 persons in 2010.

What is the typical assisted living resident like?
The average age of those in assisted living facilities is 86.4 years (MetLife, 2012). According to the National Center for Assisted Living (2013), the typical resident needs help with at least one activity of daily living (ADL), and most are over the age of 85. More females (76%) live in assisted living settings than males (26%). Thirty-seven percent of persons in AL receive help with more than three ADLs (NCAL, 2012). More than half of persons in AL facilities have some type of cognitive impairment (Alzheimer’s Association, 2009). A growing percentage of persons in AL facilities have Alzheimer’s disease.

What types of services are provided?
Some of the usual services provided in a licensed AL include:
• Assistance with eating, dressing, bathing, toileting
• Access to health services
• Medication management
• Dining services
• 24 hour staffing and security
• Emergency call systems
• Exercise and wellness facilities
• Social and recreational activities
• Housekeeping and laundry
• Transportation
• Access to banking
• Chaplain or religious services
• Memory care

How do I know if I need assisted living?
There are a variety of reasons why persons might choose an assisted living setting. Some people move to AL because they want more socialization than living alone, they want to be nearer to their adult children but do not reside with them, or because they can no longer manage at home. The person in an assisted living facility generally needs some help with activities of daily living, but does not need skilled nursing care. So, AL might be right for you if you wouldn’t be able live at home any longer without help, but you still don’t need to be in a nursing home or need the help of a nurse around the clock. You may be able to do many things on your own but maybe you have difficulty with dressing, meal preparation, or managing your pills.

How do I decide which senior living community to choose?
There are a variety of senior living options, of which assisted living is but one. Often, family members will help you decide which option is best for you, but you should look at all your choices. You should pick a place that offers the services that you need. Cost and location are additional considerations. It is also good to ask about the staffing ratios, what nursing care is available, and what happens if you later need a higher level of care than the AL provides. ALFA provides a Guide to Choosing an Assisted Living Community. This includes a helpful checklist that can be downloaded from their website.

How much does it cost to live in an AL facility?
The cost of AL depends on where you live. Keep in mind that most assisted living is paid for privately, meaning out-of-pocket, and not by insurance. According to MetLife’s Market Survey of Long-term Care Costs (2012), the national average base rate for assisted living was $3,550 per month. This means that a person who lives in an assisted living facility can expect to pay an average of $42,600 per year. Of course this also varies depending on the number of extent of services with which the resident needs help. The base rate generally includes specific services, but each additional service beyond that may add an extra monthly fee. Compare this to an average nursing home rate for a shared room at nearly $84,000 per year for a person needing Alzheimer’s care (MetLife, 2012) or a national median cost of $270 per day in a nursing home that provides 24-hour per day nursing care (Genworth Cost of Care Survey, 2013).

Are there alternatives to assisted living facilities?
So, are there other options besides going to an assisted living facility if you are an older adult who needs a little help? The answer is yes. Adult day services are one community option. Also, many home care agencies offer companions, homemaker aides, or nursing assistants to help people age in place at home. Most of the time, getting these services means a minimum number of hours per day must be paid for. The national average hourly rate for home health aides was $21 in 2012. Homemaker or companions who provide “hands-off” care such as running errands, shopping, housekeeping made a median of $19-20 the same year (Genworth, 2013).

This is where unique options for assisted living services at home are needed and can save consumers money. Senior Care Central offers persons needing assisted living in the home the opportunity to have more control over their care situation at a much lower cost while getting professional, quality care. Imagine that you could set the hours that you want to have a caregiver in the home, and that caregiver could be a nursing student who has a higher level of education than most home health aides. This care option may cost you half the price charged by a home health care agency. SCC’s model promotes aging in place on your own terms and lets you link with caregivers online, browse profiles to choose caregivers you want to contact, and make your care arrangements directly with them.

Background

Although gastroesophageal reflux disease (GERD) is common among older adults, the true prevalence is not known. Many patients with GERD-related symptoms never discuss their problems with their primary care provider. GERD is thought to occur in 5–7% of the world’s population, with 21 million Americans affected (International Foundations for Functional Gastrointestinal Disorders, 2008). It is found in both men and women.

Signs and symptoms

Pathophysiological changes that occur in the esophagus, hiatal hernia, and certain medications and foods increase the risk for GERD. Obesity (Corely , Kubo, Levin et al., 2007) and activities that increase intra-abdominal pressure such as wearing tight clothes, bending over, or heavy lifting have also been linked to GERD (MedlinePlus, 2005a). The cardinal symptom of GERD is heartburn; however, older adults may not report this, but rather complain of other symptoms such as pulmonary conditions (bronchial asthma, chronic cough, or chronic bronchitis), a hoarse voice, pain when swallowing foods, chronic laryngitis, or non-cardiac chest pain (Pilotto & Franceschi, 2009). The chronic backflow of acid into the esophagus can lead to abnormal cell development (Barrett esophagus) that increases the risk for esophageal cancer.

Diagnosis

Older adults often have atypical symptoms, making the diagnosis of GERD very challenging. As people age, the severity of heartburn can diminish, while the complications, such as erosive esophagitis, become more frequent. Therefore, endoscopy should be considered as one of the initial diagnostic tests in older adults who are suspected of having GERD (Pilotto & Franceschi, 2009). Examination of the esophagus, stomach, and duodenum through a fiber-optic scope (endoscopy) while the person receives conscious sedation, allows the gastroenterologist to visualize the entire area, identify suspicious areas, and obtain biopsies as needed. Helicobacter pylori (H. pylori), a chronic bacterial infection in humans, is a common cause of GERD, affecting about 30% to 40% of the U.S. population. Testing for H. pylori can be done during the endoscopy or by other tests (Ferri, 2011).

Treatments

The objectives of treatment for GERD include: (1) relief of symptoms, (2) healing of esophagitis, (3) prevention of further occurrences, and (4) prevention of complications (Pilotto & Francheschi, 2009). Lifestyle and dietary modifications are important aspects of care. It is widely recommended that persons with GERD should stop smoking, limit or avoid alcohol, and limit chocolate, coffee, and fatty or citrus foods. Medications should be reviewed and offending medications modified, since certain medications decrease the lower esophageal sphincter (LES) tone, allowing acid to backflow into the esophagus. These include anticholinergic drugs, some hormones, calcium channel blockers, and theophylline. Avoidance of food or beverages 3–-4 hours prior to bedtime, weight loss, and elevation of the head of the bed on 6-to-8 inch blocks are some other interventions that may help alleviate symptoms. Pharmacological treatments with antacids in conjunction with histamine 2 (H2) -blockers (Tagmet, Zantac, Axid, and Pepcid) are used for mild GERD. If these are ineffective in controlling symptoms, then the proton pump inhibitors (PPIs) are the next drugs of choice. These include medications like Nexium and Dexilant. With lifestyle modifications and appropriate medications, older adults can manage their GERD symptoms so that quality of life is maintained.

Adapted from Mauk, K. L., Hanson, P., & Hain, D. (2014). Review of the management of common illnesses, diseases, or health conditions. In K. L. Mauk’s (Ed.) Gerontological Nursing: Competencies for Care. Burlington, MA: Jones and Bartlett Publishers. Used with permission.

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Most of us have New Year’s resolutions. One of my new goals for 2020 is to age better. Andrew Weil, MD, in his bestseller Healthy Aging: A Lifelong Guide to Your Well-Being (2005) said, “to age gracefully requires that we stop denying the fact of aging and learn and practice what we have to do to keep our bodies and minds in good working order through all the phases of life” (p. 7). You may well ask, “how does one do that”? For me, it means actually practicing what I preach. We are fortunate today to have so much research and information on aging that we can pinpoint some specific areas that are common to successful aging. I have taught these to numerous students and groups of older adults, but it wasn’t until I joined the over 50 age group that this knowledge seemed more personally applicable. So, let me share with you five keys that both scientists and the oldest old persons in our society have found contribute to healthy aging.

Have a positive attitude towards life. This includes having good coping skills and being able to deal with grief and loss appropriately.  Most centenarians will say that you should always having something to look forward to. Make a list of places you want to travel this year, vacations to take, people you need to visit, or things that need to be fixed around the house. Then start to cross them out as you do them, and bask in your accomplishments.

Maintain key relationships. These include having a stable marriage and/or being involved in a religious or social community. In George Vaillant’s book Aging Well (2002), he reported the results of the Harvard Study of Adult Development. Generativity, or selfless investment in others (including the next generation), was found to be the best predictor of a long and happy marriage. Likewise, studies show that older persons who affiliate with a religious organization, such as attending church regularly, report better health and better social support systems, and tend to remain independent longer.

Maintain a healthy weight through proper nutrition. Eat a diet with plenty of fiber, fruits, vegetables and water. Limit saturated fats, salt, processed foods, and less useful calories from alcohol or sugary drinks.

Stay active. Physically, do some moderate exercise on most days of the week. For persons who are older and unable to do strenuous activity, remember that regular daily chores that include continuous motion such as doing laundry, gardening, or cleaning house can count as exercise and can also be spread throughout the day to accumulate the recommended 30 minutes of activity. If able, brisk walking is highly recommended. Keep your mind active as well. Resolve to take up a new hobby such as a craft, learning to play an instrument, or studying a foreign language. Working puzzles, playing cards, and reading are also good ways to stimulate your brain function and keep your memory sharp.

Avoid negative behaviors such as overeating or drinking too much alcohol.  Adopt an attitude of “everything in moderation”. Don’t smoke, and if you do smoke, stop. Sadie Delany (1994) at over 100 years of age wrote in her book Having Our Say, “so you want to live to be 100. Well, start with this: No smoking, no drinking, no chewing” (p. 11).

Resolve with me to age more gracefully during 2020 and let’s see how we do. Do you have any secrets of healthy aging that have worked for you or your parents/grandparents? Please share them with us.