Thursday, April 05, 2012
Body chemistry affects medication

By Dr. Anthony Policastro

One of the things that I see when prescribing medications is that the expectations of patients do not always match the way medications work. When a medicine is taken, it is absorbed into the body. There are several different things that can happen with the way the medication acts at that point. One of those is that the medication can work quickly. A good example of this is medication used to treat fever. When you take this kind of medication, it works within about 20 minutes. The fever goes down at that point. The fever will stay down until the medication wears off. That usually is four to six hours later. At that point another dose is needed to make the fever go down again. That pattern will be followed until the cause of the fever is gone. I sometimes will receive a call from patients' parents. The complaint is that they gave the child a dose of medication for the fever. Then a few hours later the fever returned. This is what we expect. However, their expectation is that one dose will make the fever disappear permanently. These medications do not work that way. A second thing that can happen is that a few doses of medication are necessary in order to provide the treatment that is necessary. This is fairly typical for the way antibiotics work. Antibiotics do not clear infections after only one dose. It takes several doses in order to kill off the cause of the infection. I will often tell parents that even after one dose, an infection might continue to get a little worse. By the second dose, it usually will stop getting worse. By the third dose we will see it get better. Patients do not always understand this type of action. They expect an instant improvement after the first dose. When that does not occur, they are surprised. In addition, since it takes several doses for the medication to work, it also takes more doses for it to completely cure the infection. That is why antibiotics are continued after the infection seems better. If you stop them too quickly, the infection might return. A third thing that can happen is that medication can build up slowly in the body. This is typical of medications that we take over a long period of time. Blood pressure medication is like this. Cholesterol medication is like this. Thyroid medication is like this. In these conditions, it might take days or weeks before an effect is noticed. The same thing is true when the medication is stopped. It might take days or weeks for the effects to go away. It might take days or weeks for any side effects to disappear. The problems with medications like this are related to the expectation that there will be a rapid improvement in the symptoms for which the medication is being taken. That is not true. For these medications, it is important to know what to do if a dose is missed. Since they build up over such a long period of time, it is usually advisable to take the dose later in the day when you realize that you missed it. One dose that is off schedule is not likely to create any long term issues. Treatment of asthma is a good example of how all these things come into play. There are some asthma medications that are used for quick relief. Certain inhalers or nebulizers are like this. There are other medications that are used for brief periods of time to provide a decrease in inflammation over a few days. Oral steroids fall into this category. There are other medications that are taken every day to prevent asthma attacks in the first place. Some of those are oral and some are inhaled. These work more slowly over time. The bottom line is that the way the body reacts to medication is very different. If you do not know for sure how your particular medication works, you should have that discussion with your doctor. Do not assume that you know the answer. If you do, as is often the case with assumptions, you are likely to be wrong.

New depression support groups If you have been diagnosed with depression, are currently receiving treatment and need extra support, join the Mental Health Association in Delaware's newest depression support groups. The support groups provide a safe and comfortable environment for adults who may be struggling with depression to find others who may be going through similar experiences, learn coping skills and take back control of their life by being proactive. A support group meets in Seaford every Wednesday from 6 to 7:30 p.m. The location of the meeting is provided only to registered members. To register, contact the Mental Health Association in Delaware at 302-654-6833 or 800-287-6423. These new groups are made possible due to a grant received from Blue Cross Blue Shield of Delaware's BluePrints for the Community program.

Autism awareness in April Autism Delaware is taking part in a range of efforts designed to help raise awareness throughout the month of April. "Autism Awareness Month is the perfect time to explain the needs–across the lifespan–of the people living with autism spectrum disorders and their families," notes Theda Ellis, M.B.A., M.Ed., Autism Delaware's executive director. The Walk for Autism steps off April 21 at Bellevue State Park in Wilmington and April 22 at Cape Henlopen State Park in Lewes. This year's goal is to raise $200,000 for the services and supports needed by the growing number of people and families affected by autism throughout the state. Autism Delaware is also supporting the Autism Speaks worldwide initiative to Light It Up Blue on World Autism Awareness Day, April 2. A bright, blue light will be shone on landmarks wanting to show support for autism awareness. For more information about Autism Delaware's statewide efforts, visit

Brain injury awareness competition The Brain Injury Association of Delaware (BIAD) is hosting a competition for Delaware's high school seniors. The organization will be accepting short video submissions spreading awareness about brain injury with a deadline of April 30. After submission to BIAD, videos will be posted to BIAD's YouTube channel - and the senior who receives the most "Likes" by May 31, will win a $150 college book voucher, donated by members of BIAD's Board of Directors. Any Delaware high school senior may enter the competition, and BIAD encourages competitors to get creative with the video - students may document their own awareness activities or tell a story with their video. BIAD reserves the right to reject inappropriate submissions. Competition guidelines are available on BIAD's website at

NMH offers CPR classes Nanticoke Memorial Hospital will offer community CPR classes to anyone interested in learning CPR at the Nanticoke Training Center located on Water Street in Seaford. Participants will learn how to perform the basic skills of CPR on adults, children, and infants and how to help an adult, child, or infant who is choking and use of the AED. This classroom-based, video, and instructor-led CPR course offers families, friends, and community members the opportunity to learn CPR and need a course completion card. Classes are open to participants ages 12 and up. This program is specifically designed for those who prefer to learn in a group environment with feedback from an instructor. The target audience is those who have a duty to respond to a cardiac emergency because of job responsibilities or regulatory requirements. Cost is $40. Payment and registration is required by no later than five business days prior to the class. Late registrations may be accepted if seating is available. To register and to obtain a listing of class dates/times, contact the Nanticoke Memorial Hospital's Training Center office at 629-6611, ext. 8919. Pre-registration is required.

Fresh food for less fortunate As backyard vegetable gardeners and farmers begin to prepare for the spring planting season, the Food Bank of Delaware encourages individuals to consider planting a few extra seeds for hungry Delawareans. With one in four Delawareans depending on the food bank's network of hunger-relief partners, the need for getting fresh produce into the community is needed now more than ever, especially as low-income Delawareans struggle with obesity issues. Last year more than one million pounds of produce were donated to the food bank. This year the food bank hopes to exceed that amount. Produce donations that are most-needed include: potatoes, tomatoes, watermelon, eggplant, peppers, corn, green beans, cantaloupe, greens, cucumbers, squash and carrots. Individuals and farmers interested in donating surplus produce to the Food Bank of Delaware may contact Jim Weir, operations director, by emailing or calling 302-444-8073. For more information about fresh produce donations, visit

First aid classes at NMH Nanticoke Memorial Hospital will offer community First Aid classes to anyone interested in learning first aid on Tuesday, April 17 from 6:30 to 9:30 p.m., at the Nanticoke Training Center on Water Street in Seaford. Participants will learn basic first aid that will enable them to administer help during the first few moments until emergency responders arrive. Classes are open to participants ages 13 and up. The course covers cognitive learning, role-playing, and skill practice. Cost is $30. Payment and registration is required by no later than five business days before the class. Late registrations (if seating is available) will be an additional $5 fee.

To register, or for more information, contact Nanticoke Memorial Hospital's Training Center office at 629-6611, ext. 8919. Pre-registration is required.

Bill targets HIV testing Testing for HIV would be part of a blood test, in much the same way as cholesterol and other screenings are, under legislation that cleared the Senate recently. On a 20-0 vote, Senate Majority Leader Patricia Blevins' bill was OK'd and now heads to the House for consideration. Under current law, people who want to be checked for HIV have to request a blood test. Blevins' measure gets rid of that requirement and gives patients the option of not being tested. Currently, Delaware and Massachusetts are the only states that require patients to request a separate screening for HIV, the virus that causes AIDS. Supporters of the bill say they think making it easier to get tested will encourage more people to get checked. "We need this because there's a certain stigma that attaches itself, if you have to ask for the test," said Joe Scarborough of the Delaware HIV Consortium. "What this does is normalize HIV testing, making it a part of health care like cholesterol or blood sugar screenings, which we hope will lead to more people getting tested."

Immunizations keep baby safe From bordetella pertussis to Rotavirus A, a wide variety of bacteria and viruses could potentially sicken your baby, but a comprehensive vaccination schedule should keep your child out of the danger zone. That's the message from a pediatrics expert during Infant Immunization Week, April 23 - 29. "There are many different strains of different pathogens which are constantly evolving over time. That's why it's vital for parents to bring their children to the pediatrician regularly so their immunizations are updated," said Bayhealth Milford Memorial Hospital Assistant Chair of Pediatrics Lowell Scott, M.D. According to Dr. Scott, major immunizations for your child include:
  • The pertussis vaccine. Pertussis, or whooping cough, is a highly contagious bacterial disease caused by bordetella pertussis. Immunizations for your child should be updated at two months, four months, six months, 15 months, five years and 11 years.
  • The pneumococcus vaccine. Diligent vaccination can greatly reduce the likelihood of ear infections and pneumonia. Make sure your child is updated at two months, four months, six months and 15 months.
  • The rotavirus vaccine. Rotaviruses are the leading cause of severe diarrhea and dehydration among infants and young children.
To stay updated on the latest vaccines for your kids, see your pediatrician.

New Parkinson's Support Group A new Parkinson's Support Group will be starting in Western Sussex County. The first meeting will be held at the Nanticoke Senior Center in Seaford on Monday, April 16 from 10 to 11:30 a.m. The meeting will be led by Dennis Leebel, leader of the 150-member Rehoboth Beach/Lewes Parkinson Education and Support Group. If you or anyone you know has Parkinson's, a support group can be a great help. You will learn more about the disease, treatments, and all the resources available to help you. Free literature about Parkinson's will also be available for you to take home. Caregivers are strongly encouraged to attend. There is no fee to register for the meeting, but you must sign up by calling the Nanticoke Senior Center at 629-4939.

Alzheimer's Support Group Nanticoke Memorial Hospital's next Alzheimer's Support Group meeting is at 1:30 p.m. on Tuesday, April 10, at LifeCare at Lofland Park's first floor Resident Lounge, 715 E. King St., Seaford. This group provides support and information about Alzheimer's and dementia to families, caregivers and anyone who is affected by this disease. Refreshments will be provided. Pre-registration is not required for this free support group. For more information, contact LifeCare at Lofland Park at 628-3000, ext. 8302.

MHA offers LifeLines program The Mental Health Association in Delaware is offering LifeLines, A Suicide Prevention Program to Delaware's private middle schools made possible by a grant from the State Division of Prevention and Behavioral Health Services. LifeLines is a comprehensive suicide awareness program for middle schools providing a whole-school program made up of three unique components: LifeLines: Prevention, LifeLines: Intervention, and LifeLines: Postvention. This trilogy of programs is the only existing model of its kind available for schools. The complete LifeLines Trilogy is based on over 20 years of suicide-in-youth research that indicates an informed community can help to prevent vulnerable teens from ending their lives. Schools may contact Emily Vera, suicide prevention project director to obtain more information at 302-654-6833. For more information about mental health or MHA in Delaware, call 302-654-6833 or 800-287-6423 or visit their website at

National Volunteer Week Nanticoke Health Services joins communities across the nation in celebrating National Volunteer Week, April 15 - April 21. According to Jean Baldwin, director of Volunteer Services, "Nanticoke Health Services will show their appreciation to the hundreds of community members who actively volunteer their time and talents and spread their kindness to the patients, visitors, and staff of Nanticoke Health Services each and every day." The highlight of Volunteer Week will be the Volunteer Appreciation and Recognition Banquet on April 19, at 5 p.m. held at Heritage Shores Club in Bridgeville where many of Nanticoke's volunteers will be recognized for their dedication and commitment. The theme for this year is Nanticoke Health Services Volunteers: Touching Lives, Lifting Spirits. The extremely dedicated volunteers of Nanticoke Health Services gave over 42,000 hours of service during 2011. To learn more about becoming a Nanticoke Health Services volunteer, call 629-6611, ext. 2475.

'Understanding Hoarding' lecture Delaware Hospice's Family Support Center will hold a Lunch Bunch Lecture on "Understanding Hoarding," with Dr. Angela D'Antonio, on Friday, April 13, at the Delaware Hospice Center, 100 Patriots Way, Milford, from noon to 1:30 p.m. Those who hoard have limited insight into the seriousness of their living situation, experience extreme anxiety when asked to part with their possessions, and are strongly resistant to getting help. Judging those with this crippling disease is never helpful. Understanding what drives this behavior is the first step in being able to address it. This workshop will explore the causes of this compulsive behavior, ways families can intervene, the resources available and therapeutic approaches generally used to treat hoarding. Lunch Bunch Lectures are organized by Delaware Hospice's Family Support Center and are open to the public. Registration is required as seating capacity is limited, and the cost of lunch is $5 per person. Register by Wednesday, April 11, by contacting Vicki Costa, associate director of the Family Support Center, at 856-7717, ext. 1129, or

Breast cancer support group Delaware Breast Cancer Coalition, Inc. (DBCC) has expanded its Beginning Your Pink Ribbon Journey, a program for women newly-diagnosed with breast cancer, by partnering with Nanticoke Memorial Hospital Cancer Center in Seaford. The free, monthly program is offered at the Cancer Center located at 801 Middleford Road, Seaford, the third Thursday of each month from 3 to 4 p.m. To learn more, call Lois Wilkinson at 672-6435. Registration is required and light refreshments and small gifts are provided.

Bereavement luncheons Delaware Hospice's "New Beginnings" bereavement luncheons are an informal way to meet and talk with others, who have had similar loss experiences. Lunch begins at noon and is followed by a brief program. The location rotates each week of the month throughout Sussex County. "New Beginnings" luncheons are open to the public. Registration is not required. There is no fee except the cost of your lunch. For more information, call Midge Dinatale or Paul Ganster at 856-7717.

NAR-ANON support group "Take Heart, Be Strong" is a support group available to those family members and friends who are concerned about the drug/alcohol addiction of a loved one. We find people in NAR-ANON who understand what we are going through and are ready to share their experience, strength and hope to help us. This group meets at 7 p.m. every Thursday in the Youth Room at Crossroad Community Church, 20684 State Forest Rd., Georgetown. If you are interested or know someone who might be, call Beth at 302-745-0466. This is an anonymous program and there are no obligations. Attendance is welcome with no prior arrangements. For more information and other meeting locations, visit