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Aging baby boomers want to live active lives, require innovations in medical treatment

Published: Monday, Aug. 3 2015 11:39 p.m. MDT

Jim Dickson recovers from shoulder reconstruction surgery at Lakeview Hospital in Bountiful on Thursday, April 11, 2013. Dickson had peripheral nerve blocks applied before the surgery to help with the pain. (Kristin Murphy, Deseret News) Jim Dickson recovers from shoulder reconstruction surgery at Lakeview Hospital in Bountiful on Thursday, April 11, 2013. Dickson had peripheral nerve blocks applied before the surgery to help with the pain. (Kristin Murphy, Deseret News)

BOUNTIFUL — The baby boomer generation is aging, and a large portion of the growing 65-and-older population isn't going quietly into a sedentary retirement.

Many are requiring joint replacement surgery, as they intend to remain active until the bitter end, according to Dr. John Edwards, an orthopedic surgeon who specializes in knee and shoulder replacement surgeries at MountainStar Healthcare's Lakeview Hospital.

"People are more active and they're more active for longer," Edwards said, "and as a result, they don't want to have pain associated with their joints."

With the population of retirement-age people in the state expected to increase by 126,700, or 51 percent, between 2010 and 2020, doctors are applying procedures such as the peripheral nerve block prior to joint replacement surgeries to reduce pain and recovery time.

Utah has the sixth fastest growth rate in the nation for people age 65 and older, according to a Utah Department of Human Services report. Doctors expect the number of surgeries to continue to climb with the aging population.

Occupational therapy assistant Terilynn Conner shows Jim Dickson how to put on a sling as he recovers from shoulder reconstruction surgery at Lakeview Hospital in Bountiful on Thursday, April 11, 2013. Dickson had peripheral nerve blocks applied before the surgery to help with the pain. (Kristin Murphy, Deseret News) Occupational therapy assistant Terilynn Conner shows Jim Dickson how to put on a sling as he recovers from shoulder reconstruction surgery at Lakeview Hospital in Bountiful on Thursday, April 11, 2013. Dickson had peripheral nerve blocks applied before the surgery to help with the pain. (Kristin Murphy, Deseret News)

Edwards said hip, knee and shoulder joints can wear out with age, resulting in sometimes debilitating pain and the inability to move as once was possible, which can be frustrating for someone wanting to remain active.

With available medical technologies, as well as the desire of more people to be active and healthy throughout life, Edwards said many are turning to surgery to replace these aching joints.

And those seniors considering orthopedic surgery are now told that their pain level during surgery and recovery can be dulled with the help of a presurgical procedure practiced by most major hospitals and some smaller community facilities in the state, according to Lakeview anesthesiologist Dr. Tory Hinkle.

"We really use them every day," Hinkle said.

Lakeview Hospital has been ranked first in the state for the number of orthopedic surgeries it offers as well as the quality of service provided for the past three years, and it is among America's 100 Best Hospitals for orthopedic surgery, according to a Healthgrades annual report.

Registered nurse Jonathan Fox applies a fresh bandage to Jim Dickson as he recovers from shoulder reconstruction surgery at Lakeview Hospital in Bountiful on Thursday, April 11, 2013. Dickson had peripheral nerve blocks applied before the surgery to help with the pain. (Kristin Murphy, Deseret News) Registered nurse Jonathan Fox applies a fresh bandage to Jim Dickson as he recovers from shoulder reconstruction surgery at Lakeview Hospital in Bountiful on Thursday, April 11, 2013. Dickson had peripheral nerve blocks applied before the surgery to help with the pain. (Kristin Murphy, Deseret News)

It is procedures like the peripheral nerve block that makes them a desirable option for the population needing surgery.

Peripheral nerve blocks, Hinkle said, can reduce the time patients spend in the hospital following a joint replacement surgery, provide a pain-free sleep during the typical post-surgery stay, and enhance their recovery process. It's not necessarily new treatment, but it has advanced over time.

"We've been doing this for years," Hinkle said. "The new part is the ultrasound technology that we are using has come a long, long way. We can see the nerves on the screen; see where the needle comes into the body. We can avoid any kind of blood vessels."

The procedure, he said, used to involve a cumbersome table and computer that provided a sometimes indecipherable image, which made correct placement of the anesthetic more difficult.

Occupational therapy assistant Terilynn Conner helps Jim Dickson do physical therapy as he recovers from shoulder reconstruction surgery at Lakeview Hospital in Bountiful on Thursday, April 11, 2013. Dickson had peripheral nerve blocks applied before the surgery to help with the pain. (Kristin Murphy, Deseret News) Occupational therapy assistant Terilynn Conner helps Jim Dickson do physical therapy as he recovers from shoulder reconstruction surgery at Lakeview Hospital in Bountiful on Thursday, April 11, 2013. Dickson had peripheral nerve blocks applied before the surgery to help with the pain. (Kristin Murphy, Deseret News)

A nerve block involves numbing the nerves nearest to the surgical site with a local anesthetic to last during the most intense pain period, which typically covers the entire first 24 hours after surgery, allowing the body to focus on healing rather than the pain. It provides an alternative to general anesthesia.

"These blocks make it great on the patient," Hinkle said. "It's a lot easier, takes away a lot of stress to the body, so you don't feel that pain. … Also, they don't have to take as much anesthetic so they feel much better."

The nerve block also reduces the need for potentially addicting narcotic pain medications during and throughout the surgery, recovery and rehabilitation periods, which both doctors said is a tremendous advantage, given the growing number of prescription drug-related problems in Utah.

And the outcomes are also better.

Registered nurse Jonathan Fox applies a fresh bandage to Jim Dickson as he recovers from shoulder reconstruction surgery at Lakeview Hospital in Bountiful on Thursday, April 11, 2013. Dickson had peripheral nerve blocks applied before the surgery to help with the pain. (Kristin Murphy, Deseret News) Registered nurse Jonathan Fox applies a fresh bandage to Jim Dickson as he recovers from shoulder reconstruction surgery at Lakeview Hospital in Bountiful on Thursday, April 11, 2013. Dickson had peripheral nerve blocks applied before the surgery to help with the pain. (Kristin Murphy, Deseret News)

"Joint replacements are very successful," Edwards said, adding that 90 percent of people are happy with the results, and the remainder likely have underlying or other medical issues that can exacerbate their joint problems. "It's still an artificial joint and is subject to wearing out, but they're lasting longer than ever with the materials being used now."

The surgeries, he said, help to take away the pain and increase levels of activity more quickly for patients.

That's exactly what Jim Dickson, of Kaysville, is hoping for following complete shoulder reconstruction at Lakeview on Wednesday.

The retired Davis High School football coach and driver's education teacher said he had been enduring problems with his rotator cuff for some time. The group of tendons and muscles in his shoulder that make it function correctly had worn down, but after a somewhat painful fall in December, he needed additional medical attention.

Occupational therapy assistant Terilynn Conner shows Jim Dickson how to put on a sling as he recovers from shoulder reconstruction surgery at Lakeview Hospital in Bountiful on Thursday, April 11, 2013. Dickson had peripheral nerve blocks applied before the surgery to help with the pain. (Kristin Murphy, Deseret News) Occupational therapy assistant Terilynn Conner shows Jim Dickson how to put on a sling as he recovers from shoulder reconstruction surgery at Lakeview Hospital in Bountiful on Thursday, April 11, 2013. Dickson had peripheral nerve blocks applied before the surgery to help with the pain. (Kristin Murphy, Deseret News)

When arthroscopic surgery failed to fix it earlier this year, Edwards moved to reconstruct the whole joint.

A peripheral nerve block, to deaden the pain during and after surgery, Dickson said, made the process more feasible. The 63-year-old has had both knees replaced as well, but he got through those without the added pain management of a nerve block during surgery.

"It's definitely a plus" to not feel the pain," he said. Just hours out of surgery, Dickson said he felt very little discomfort and was just dealing with numbness in his hand. He hopes to get back out on the golf course as soon as possible, as it is one of his favorite pastimes.

"I'm hoping I can get out there and keep going," Dickson said.

Doctors have told him he has about six to eight months of recuperation before he can try out his swing. Only about eight weeks of that is expected to include intense physical therapy, but Dickson expects to be "good as new, if not better," he said.

Occupational therapy assistant Terilynn Conner, center, shows Debbie Dickson and Jim Dickson how to put on Jim's sling as he recovers from shoulder reconstruction surgery at Lakeview Hospital in Bountiful on Thursday, April 11, 2013. He had peripheral nerve blocks applied before the surgery to help with the pain. (Kristin Murphy, Deseret News) Occupational therapy assistant Terilynn Conner, center, shows Debbie Dickson and Jim Dickson how to put on Jim's sling as he recovers from shoulder reconstruction surgery at Lakeview Hospital in Bountiful on Thursday, April 11, 2013. He had peripheral nerve blocks applied before the surgery to help with the pain. (Kristin Murphy, Deseret News)

Hinkle said Dickson will need pain medications for a couple days, but "the first day is the worst. You're in a lot of pain after surgery, typically."

He said patients heading under the knife for major joint replacements and other arthroscopic surgeries are encouraged to ask about the nerve block procedure. It's a more practical approach to a sometimes very painful situation, Hinkle said.

"The more education people have about these things, the better," he said. "It leads to better patient satisfaction."

E-mail: wleonard@deseretnews.com, Twitter: wendyleonards

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