Thursday, May 01, 2008
Are EKG's always neccessary in ADHD patients

By Dr. Anthony Policastro

On April 22, 2008 the American Heart Association (AHA) announced that all children on stimulant medication for ADHD should receive EKG's. The announcement sounded like there was new research to suggest this. That was not the case. The decision was based upon the input from a pediatric cardiologist in Philadelphia. The American Heart Association simply followed his lead. We are now treating more adults with ADHD. Adults have more heart problems than children. When I start a child on stimulant medication for ADHD, I tell the parents about the side effects. One of the side effects is an effect on heart rhythm. This is much more common in adults than it is in children. That is what I tell the parents. What the research has actually shown is that there is a possibility of a serious heart rate abnormality in 1 out of a million children who take these drugs. That is true if we look at all the patients who take the medication. However, if we do some screening of patients before starting medication, the rate is much lower. That is the approach that is currently used. The American Academy of Pediatrics (AAP) and the American Association of Child and Adolescent Psychiatrists (AACAP) treat patients with ADHD all the time. Pediatric cardiologists do not ever treat these children. I have been treating ADHD with stimulants for 35 years. I have never had a cardiac complication. The current recommendations from the AAP and AACAP are to ask two questions. One of them is whether there has been anyone in the family with a history of heart disease under age 3. The second is whether the child has had any heart problems. I ask all my new patients these questions. If you can answer yes to either question, then an EKG is indicated. I do a fair number of EKG's because of that. If the EKG is normal, then medication can be prescribed. If the EKG is not normal, I refer the patient to a cardiologist. I have had to refer two patients to the pediatric cardiologist over the last year. Both were deemed completely normal. If you ask these questions then you will find those patients at higher risk. That means for the rest of the children, the risk will be much lower than the overall 1 in a million risk. We will need to wait until the AHA, AAP and AACAP settle their differences. In the meantime we will be doing more EKG's. My plan is to do them on my patients the next time I see them. Since I see them every three months, I should have them all done by the end of August. When we do the EKG's we will send them all to the pediatric cardiologists to be read. Almost 100% of them will likely be normal. Even if they are not normal, it does not mean that the child will have a problem. It only increases the risk. The pediatric cardiologist will then get paid for reading the normal EKG on the normal patient. For those with abnormal EKG's the pediatric cardiologist will get to see the patient. They will likely find that everything is normal. That was what happened with the two patients I sent to the pediatric cardiologist. The pediatric cardiologists indicate that all this increased business did not motivate their decision at all. What is likely to happen is that we will be doing a lot of normal EKG's for the next few years. Then we will realize that it is a big waste of time. We will then go back to doing it exactly the way we have been doing it for years.

Four reasons that Lymphedema should not be left untreated

By Sheila Brant CMLD/T, OTR/MS

Lymphedema is a chronic disease characterized by swollen arms, legs, face, scrotum or abdomen. There are four reasons to seek treatment for lymphedema: pain, difficulty walking or performing daily activities, appearance, and/or prevention of future problems. Excessive swelling can cause nerve endings to be compressed resulting in pain at the site of the swelling. Walking can become difficult when swelling is present (especially in the legs) because the excess fluid causes weight gain. Excessive swelling in a body part can result in disfigurement or changes in appearance. Lastly, if swelling is left untreated, infection can occur as well as irreversible changes in the tissue secondary to stretching. After making the educated decision to seek help for swelling, take the following steps: 1. Find a lymphedema specialist. Nanticoke Outpatient Therapy Services at Mears has two certified therapists who specialize in treatment of lymphedema and various edema related diagnosis. 2. Exercise lightly. Regular exercise can improve circulation and fluid drainage. Exercise should not be strenuous on the affected limb. Ask your physician before starting an exercise program. 3. Be aware of any changes to the extremity involved. Watch for any swelling, inflammation or a feeling of heaviness while performing activity with the extremity affected. If you feel any changes stop the activity and speak with your doctor. 4. Pay close attention to cuts and scrapes. Infection may occur more easily. Clean cuts well and use an antibiotic ointment. Keep them covered until they heal. 5. Get a lymph massage. Specially trained therapists can perform a massage to increase lymphatic drainage. 6. Wear a compression garment. They compress the affected limb, which helps fluid drain out. The garment must fit properly to be effective. Ask your doctor for a referral to the Nanticoke Lymphedema Clinic at Nanticoke Mears Center and make a decision to be in control of your health. Contact Nanticoke Health Services at Herring Run at 629-6224 for more information.

Hospital gift shop holds sale "Pamper Your Body and Your Spirit" with luxurious products at the Bath and Beauty Collection Sale sponsored by the Look-In Glass Shoppe of Nanticoke Hospital. The sale will be held in the lobby of Nanticoke Memorial Hospital on Thursday, May 1 and Friday, May 2. Products for women, men and children available. All proceeds from the Look-In Glass Shoppe benefit Nanticoke Health Services.

Centenary hosts health screening Life Line Screening will be at Centenary United Methodist Church in Laurel on Friday, May 16 conducting stroke, vascular disease and heart rhythm screenings. Appointments will begin at 10 a.m. Recommended baseline screenings include stroke/carotid artery, atrial fibrillation, abdominal aortic aneurysm and peripheral arterial disease. The carotid artery screening uses ultrasound to identify blockages in the arteries in your neck, a leading cause of stroke. The atrial fibrillation screening checks for an irregular heart beat and the abdominal aortic aneurysm screening looks for a ballooning of the largest artery in the body. Screening for peripheral arterial disease checks for blockages in the arteries of the arms and legs, a condition that leaves the individual at four to five times higher risk of heart disease. Additional screenings can be added for a more comprehensive risk assessment and include C-reactive protein, a blood marker for vascular disease and diabetes; complete lipid panel including HDL/LDL and total cholesterol; glucose, a measure of blood sugar level which can determine your risk for diabetes; and an ultrasound screening for osteoporosis. Pick any four screenings for $140 and all eight screenings are $199. For more information, visit To schedule your screenings at Centenary United Methodist Church, call 877-754-9631. Pre-registration is required.

State improves immunization rates The Division of Public Health's (DPH) immunization program was recently recognized by the Centers for Disease Control and Prevention as the fourth most improved state in tracking the basic immunization series from 2003-2006. The National Immunization Survey reports that Delaware's childhood immunization rates increased by 21.4 percent, between 2003 and 2006. The state's rate of 80.3 percent in 2006 was above the national target rate of 80 percent and much higher than the recorded national rate of 77.1 percent. The increased rates are the result of more young children in Delaware receiving complete vaccinations, which include four doses of diphtheria-tetanus-pertussis, three doses for polio, one dose for measles, three for Haemophilus influenza type b, three for hepatitis B, and one for chickenpox. Through outreach, education and advertising to providers and caregivers, DPH's immunization program ensures that vaccines are accessible by removing barriers for children who are uninsured, under-insured or on Medicaid. The program used its registry to connect parents and providers to immunization records, ensuring that vaccines are given on time. For more information about infant immunizations, contact DPH's immunization program at 800-282-8672.

Nanticoke honors nurses On Tuesday, May 6, Nurses Day, the Pastoral Care Department of Nanticoke Health Services will be offering the first annual Blessing of the Hands to all professional nurses. This is an opportunity for all nurses in the local community - no matter where you work or what you do - to come and receive an acknowledgement of your indispensable role in patient care. The ceremony is free of charge, takes less than five minutes to complete and will be offered at two locations - beginning in the morning from 8 to 8:30 a.m. at Life Care at Lofland Park located at 715 E. King Street and again from noon to 6 p.m. in Stevens Classroom at Nanticoke Memorial Hospital, 801 Middleford Road. Touch is an integral part of the work of nurses and a Blessing of the Hands service is a way to honor and affirm the work of nurses. The ceremony includes a blessing and anointing of oil. Because hospitals are places where people of many faiths work, the blessing includes language appropriate to an interfaith setting. A quiet area will be provided for those nurses who choose to sit awhile and reflect after the blessing. For more information about the Blessing of the Hands service being offered at Nanticoke Health Services, contact Rebecca Rollins at 629-6611, ext. 2630 or

Gift shop offers Mother's Day sale Don't forget that special person in your life on Mother's Day, which is Sunday, May 11. Shop the Mother's Day Sale at the Look-In Glass Shoppe in the lobby of Nanticoke Memorial Hospital on Thursday, May 9. All proceeds from the Look-In Glass Shoppe benefit Nanticoke Health Services.

Golf tournament planned The fourth annual Wellness Community Golf Tournament will be held on Monday, June 9 at Kings Creek Country Club in Rehoboth Beach. Enjoy prizes, a continental breakfast and barbeque luncheon celebration. Golfers may register to play for $125 per person, including green fees and cart. The event begins at 7:30 a.m. with registration followed by a shot gun start at 9 a.m. There will be guaranteed prizes awarded for the longest drive, closest to pin and low score. The tournament closes with the first 100 paid registrants. The golf tournament helps raise public awareness about cancer. To be a sponsor or donate items for the raffle, contact Marcia Esposito at 302-645-9150 or For more information, visit

Alzheimer's offers courses The Alzheimer's Association Delaware Valley Chapter is offering professional training programs at the Georgetown office. These programs include CEU credit for social workers, nurses and nursing home administrators. Certificates of completion are also available. Courses include "About Dementia" on Tuesday, May 6 from 9 a.m. to noon (three credits); "Making Connections" on Tuesday, May 13 from 10 a.m. to noon (two credits); and "Understanding Wandering" on Friday, May 23 from 10 a.m. to noon (two credits). The cost of each session including CEU credit is $49 or a certificate of completion is $29 per registrant. Pre-registration is required by e-mailing Jamie Magee at or by calling 302-854-9788.

Stroke support group Nanticoke Memorial Hospital will offer free monthly Stroke Support Group meetings designed for individuals who have survived a stroke and their families and caregivers. Meetings are held the third Thursday of each month at Nanticoke Cancer Care Center, from 1:30 - 3:30 p.m. The meetings will consist of guest speakers and breakaway sessions, in which caregivers and survivors will meet in two groups to discuss concerns, provide support and networking. Refreshments will be provided. Sheila Brant and Joan Burditt, occupational therapists at Nanticoke Memorial Hospital, will facilitate the support group meetings. Pre-registration not required. For more information, call 629-6611, ext. 5121.

Depression support group The Mental health Association in Delaware will be sponsoring a Depression Support Group in Laurel on the second and fourth Thursdays of each month. The meetings begin at 7 p.m. The MHA encourages anyone dealing with a depressive disorder to attend. Register in advance by calling 1-800-287-6423. Peer support groups sponsored by Mental Health Association of Delaware are not intended to replace professional mental health treatment. MHA does not publish support group locations; locations are provided with registration.