Thursday, February 14, 2008
It is important to be aware of drug interactions

By Anthony Policastro, M.D

There have been a lot of reports about the death of actor Heath Ledger the last few weeks. The story about a multiple-drug overdose may sound unusual but it is not. We heard the same thing about Elvis Presley years ago. It is likely that the same thing happened to Marilyn Monroe. What many people do not realize is that the side effects of some drugs add together. We see this in the hospital frequently. Patients may be on several drugs. The drugs may have similar side effects. We then see those side effects add up. They cause the side effect to be more obvious. The best example of this is related to depressed breathing. There are many drugs that slow down breathing. When taken in combination, they can actually cause breathing to stop. When we have people in the hospital taking morphine for pain, we have to carefully watch their breathing. The main cause of death from heroin overdose is stoppage of breathing. Thus opiate pain medication interferes with breathing. It does so in a significant way. Heath Ledger had taken two of these pain relievers. One of them had a brand name of oxycontin. The other brand name was Vicodin. Both are commonly prescribed pain medications. A second group of drugs that cause breathing to be depressed are tranquilizers. There are two groups of tranquilizers. The major tranquilizers are usually only used on psychiatric patients. They are given by injection. The minor tranquilizers are commonly prescribed. They include drugs like Valium and Xanax. Heath Ledger had taken both of those drugs. A third group of drugs is used to promote sleep. Patients with insomnia take them. One of the more common drugs for this is called Restoril. Heath Ledger had taken this medication for sleep. Another group of drugs that can depress respiration is the ones used for muscle relaxation. Many patients in pain have tight muscles. Thus muscle relaxants are often taken with pain medication. Heath Ledger had no evidence of muscle relaxants in his blood stream. Some people take antihistamines to help them sleep. The most common example of this is Benadryl. Another example is a drug called Unisom. Heath Ledger had taken Unisom. While these drugs do not usually cause much depression of breathing, the effects still add up. The bottom line is that there were six drugs in Heath Ledger's system that could cause breathing problems. In his case, he probably took the drug to help him sleep. Once he went to sleep his breathing stopped. All of the drugs except Unisom were prescribed drugs. Unisom is an over the counter preparation. We should all be aware of the fact that even if drugs are in different categories, they can still have similar side effects. Before we mix drugs, we should make sure we know how they interact. I often have patients ask me if there is a problem taking Ritalin with other drugs. There is usually no interaction, but it is a good question to ask. Asking about drug interactions can never be a bad thing. We should all be conscious of the need to do so.

Quarantine lifted on horse farms
Dr. Sara Busch, state veterinarian, announces that the state imposed quarantine of the six horse farms in Delaware was officially lifted following a recent inspection of the farms. The release of these quarantines is a result of no new or suspect cases during the 21 day quarantine period on any of the farms involved.

Cholesterol screenings planned
Nanticoke Memorial Hospital will be offering cholesterol screenings on February 14, 16 and 21, from 7:30 to 10 a.m. at the Seaford Golf & Country Club, located at 1001 W. Locust St., Seaford. The lipid profile test requires a 12-hour fasting and reads the HDL and LDL blood levels. Cost for the lipid profile is $15. No pre-registration is required. In addition to the cholesterol screening free blood pressure checks will be offered as well as information on Nanticoke's Cardiac Rehabilitation services and Cancer Care services. Results from the cholesterol screening will be mailed approximately two weeks after the test is performed. For more information, call 629-6611 ext. 2404.

CPR classes offered at Del Tech
Cardiopulmonary resuscitation (CPR) basic classes for the general public and refresher courses designed for health care professionals are available at Delaware Technical & Community College, Owens Campus. Parents, teachers, coaches and babysitters are just a few of the people who can benefit from these classes. Healthcare providers whose jobs require CPR certification can take the refresher course to meet continuing licensure requirements. Two separate sessions of CPR Heartsaver courses are offered: one teaches adult (one-rescuer) and the other infant and child techniques. Participants may sign up for either or both. For complete information about these and other prevention and wellness courses, contact Corporate and Community Programs at 854-6966.

Daffodil Days through Feb. 20
For 35 years the American Cancer Society has been sharing hope for a world free of cancer with Daffodil Days, its longstanding program to help raise funds and awareness to fight cancer. This year's Daffodil Days are up and running thru Feb. 20. For a donation of $10, local residents will receive a bouquet of fresh-cut daffodils or a pot of miniature daffodils to support the fight against cancer. In addition to cut and potted daffodils, the American Cancer Society will offer Gea R. Hope, the third in a series of special Boyd's Bears designed exclusively for the American Cancer Society's Daffodil Days Bear in a Pot or Bear and a Bunch that can be ordered for a donation of $15. To place an order, or to get involved with the program contact Mary Catherine Hopkins at 875-7308.

Activity and diet are important for heart health

Active Living
Daily physical activity should be a lifelong habit. An increasing body of evidence points to this step as one of the most important factors for maintaining health and extending life. Anything that gets kids up and moving is good. Activities that leave them "breathless" are better. Kids need a total of at least 60 minutes of activity each day, half of which should be moderate to vigorous activity. Moderate activities include walking, vacuuming, cleaning one's room, raking the leaves and gardening chores. Vigorous activities include most sports, dancing, skating, jogging, swimming, and cycling. The more activity kids get, especially of the "breathless" variety, the stronger their hearts will become. Other benefits: Exercise gives kids energy, helps with concentration and is a natural mood lifter. Regular physical activity can help kids sleep better. Some studies suggest that kids who are physically fit perform better on standardized tests in both reading and math. More time spent being active helps kids to achieve or maintain a healthy weight. If the weather is good, kids can: Head to a nearby park or playground. Swing a little, or "hang-out" on the monkey bars. Ride a bike, roller blade or play old favorites like freeze tag or capture the flag. Play catch with a frisbee or a football. See how many consecutive catches the child can make. Play hopscotch or jump rope. See who can get to one hundred the fastest. A fun way to keep track of activity is to use a pedometer. About 2000 steps equal a mile. If the skies are gray, kids can: Play a game of charades or Twister. Put on an exercise video with an up-to-date vibe that will encourage kids to participate. Have a dance party - blast the stereo and burn some calories.

Healthy Eating
The effects of poor dietary habits are showing up in children at younger and younger ages. These effects include the early precursors of heart disease. Eating five or more servings of fruits and vegetables daily is good offense. Most fruits and vegetables have no cholesterol, few calories and lots of fiber. Eating patterns are established early in life, so offer a variety of fruits and vegetables to young children on a regular basis. And if at first you don't succeed, try, try again. It may take up to 10 tries for children to accept a new food.

How to get five servings?
Add fruit - peaches, bananas, blueberries, strawberries - to breakfast cereal and oatmeal. 100% fruit juice is good for kids, but should be limited to about four ounces daily. Whip up fruit smoothies using fresh or frozen fruit, fat-free yogurt and a dash of milk or juice. For lunch, pack carrot sticks, cherry tomatoes, grapes, apple slices or mandarin oranges and include low fat dip - most kids love "dippables." Add lettuce, tomato and sprouts to sandwiches and wraps. At least half the dinner plate should consist of fruit and vegetable dishes. (French fries don't count.) Go for color and variety. Eat at home and at the dinner table. Kids thrive on routine and regular family meals are a great opportunity for sharing food and conversation. It takes some planning to have the right ingredients on hand for preparing healthy balanced, meals (so you're not tempted to opt for processed food or take-out). Limit your purchases of packaged, ready-to-eat snacks, such as chips and cookies, which are often high in fat and calories and low in nutrients. Have a good laugh. Laughter provides physical and emotional release, relieves anger and stress, and relaxes the muscles. Some studies have even suggested that laughter strengthens the immune system. More good reasons to lighten up! Be a good role model. Let children see you enjoying fruits, vegetables and other healthy foods. Take family walks, play active games as a family, go grocery shopping and cook together. Take care of your heart, too!

From Nemours Health and Prevention Services
Nemours Health and Prevention Services (NHPS), a non-profit organization based in Newark, Delaware, works with families and communities to help children grow up healthy. Its goal is to develop programs and contribute knowledge that will enhance child health promotion efforts in Delaware and will eventually have value for children nationally. More at