Thursday, November 09, 2017
Joint Camp patient climbs mountain Less than five months after two partial knee replacements, Jeff King, a former patient of Nanticoke Health Services Joint Camp, spent a week pushing his body to extreme limits as he climbed Mt. Kiliman.jaro, the highest mountain in Africa. King, formerly of Hartley and now residing in Saratoga Springs, Utah, com.pleted the hike this past September. The journey took seven days and King reached the top elevation of 19,341 feet at Uhuru Peak, Tanzania, Africas highest peak. If it was not for the help of Dr. Law.rence Piccioni, orthopedic surgeon, and the team at Nanticoke Health Services, King might not have been able to make this climb at least not without a lot of pain. After an attempt at the climb last year (he was one day from the summit when a person he was with became ill), he was in a lot of pain. His knees were very sore and they got progressively worse. Walking short distances hurt, sitting for too long hurt, and he had trouble sleeping because of the constant pain in his knees. This past winter, the pain prompted him to see a specialist in Utah. The told him he was too young for knee replacement surgery and he recommended an expensive brace to help reduce the pain and pressure on his knees. King did some research and even spoke to someone who had the brace. This person told King the brace could cause more pain and bruising and told King it probably was not the right solution for someone who was as active as King. After that, he made an appointment with his former physician, Dr. Lawrence Piccioni, to get a second opinion. In March, King flew to Delaware and met with Dr. Piccioni who said he was a perfect candidate for a partial knee re.placement. In April, he had this surgery on his right knee. Just two weeks later he had a partial left knee replacement. I was so bow-legged from my joints dropping that I gained an inch in height after surgery, recalls King. I had family members say it was an amazing differ.ence between my first and second surgery. My knee with the procedure was straight and the knee waiting for surgery was still crooked. I didnt realize how much pain I was in until after the first surgery. My knee felt so much better. I was walking two hours after surgery and felt great. I was doing laps around the unit. The knee that didnt have surgery was hurting so much more than the one that just had surgery. Everybody at the hospital the anesthesi.ologists, nurses, doctors, and therapists were all awesome. When I went through Nanticokes Joint Camp, I saw models of exactly what would be put in my knees. King flew home to Utah right after surgery. It was a four hour long plane ride and he walked to the terminal by himself with no problems. His girlfriend, Karen, was ready to meet him at the airport with a wheelchair, but he happily said he would walk instead. At age of 57, King enjoys a very active life. He is retired from the City of Dover Police Department after 20 years and cur.rently works as a federal police officer with the Department of Defense in Utah. King enjoys getting outdoors and the picturesque mountains of his new hometown of Saratoga Springs. I like to hike, I like to bike, I like to keep moving, King said. I would not be able to do these things without pain if it was not for Dr. Piccioni and the team at Nanticoke. To learn more about Nanticokes Joint Camp program, call 629-6611, ext. 5105 or visit

By Dr. Anthony Policastro Sir William Osler is a name few people know, however, he is credited with being the father of modern medicine. Osler was one of the four founding professors of Johns Hopkins Hospital. He created the first residency program for specialty training for physicians and was the first to bring medical students out of the lecture halls and to the patients bedside. One of Oslers famous quotes is: One of the first duties of the physician is to educate the masses not to take medicine. The point he is making is that we treat many diseases that go away on their own. For example, we know that ear infections do not kill patients. As a matter of fact, 85% of ear infections get better on their own. The other 15% do not get better and go on to cause chronic infections. So, we end up treating 100% of patients with ear infections just to get 15% better. Another example is strep throat. Strep throat symptoms usually last 72 hours and they go away. If we use antibiotics, the patient gets better in 24 hours. So, at best we are only cutting symptoms off by 48 hours. Many people do not realize that the reason to treat strep throat is not to make it better, but to prevent rheumatic fever - a rare complication of strep infections. I spent eight years teaching interns and residents at Andrews AFB. One of my favorite comments to the residents was: If you wait long enough, it will go away, because most pediatric illnesses are self limiting. Unfortunately, patients and their parents do not always think that way. I have seen many patients over the years with viral infections. There is not much to do for these infections other than to wait for them to resolve. As a result I have faced many angry parents who brought their child to the doctor for one reason. They did not want a diagnosis or my expertise. They also did not want an explanation of the course of their childs illness. The reason they came in was to get medication. When they did not receive it they voiced their concern that they had brought their child in for nothing. I took a history. I did a physical exam and I made a diagnosis. None of that was relevant. Since I did not prescribe medication they felt it was a useless visit. Sometimes I had parents call on the phone and ask for an antibiotic. I offered to see the child but they did not want the child seen. They wanted an antibiotic called in to the pharmacy. I often wondered, if the parents are so smart, why dont they call in the antibiotic? They clearly know better than I do so what do they need me for? The pharmaceutical companies do not help much. They want to sell their medications. You cannot watch a television show without seeing an ad for a drug you have to have. Over 100 years ago, Sir William Osler knew very well that medication is not always the answer. Doctors need to know when medication is the right answer and when it isnt. Unfortunately, doctors are not always respected for their decision.

Nanticoke Memorial Hospital offers childbirth classes Nanticoke Memorial Hospital will hold childbirth classes on Tuesdays this month from 6:30 p.m. to 8:30 p.m. in the ground floor conference room. The class will meet each Tuesday for a total of five weeks four weeks related to childbirth education and the fifth week will be a breastfeeding class. The 2017 dates are: Nov. 14, 21, 28 and Dec. 5, and 12. The maternity education classes are designed to offer information, counseling, support, and hands-on experience to help prepare for a new family member. They will cover pregnancy in general, information to prepare the expectant mother for labor and delivery, and will include a tour of Nanticokes Mother & Baby Care Center. A refresher course is also available for those who have previously taken childbirth classes. The refresher class covers breathing techniques, signs, symptoms, and stages of labor, birthing options, and a tour of Nanticokes Mother and Baby Care Center. The cost of the childbirth course is $50, and the cost for the refresher course is $25. Mothers are encouraged to bring their partner or support person for all courses. Pre-registration is required for either class. To register or for more information, contact Nanticokes Maternal Child Health Clinical Educator at 302-629-6611, extension 2540. To learn more about womens health services provided by Nanticoke, visit

By Jonathan Souder Do you like to get down on the floor on your back with your knees bent and place your hands behind your head and then proceed to sit up? And sit up? And sit up? Sounds like were talking about sit-ups, right? Sit-ups were not fun for me as a child. Maybe thats why I dont like them as an adult. I do like strengthening the core and have learned various ways to do that instead of doing sit-ups. What is the core on the body? Most people think of the abdominals and six-pack abs as the core. According to the American Council on Exercise (ACE), our core is a three-dimensional cylindrical unit where muscles run in more than one direction. These muscles are the transverse abdominus, obliques, rectus abdominus and erector spinae with the diaphragm muscle at the top of the cylinder and the pelvic floor muscles at the bottom. Its important to keep these muscles strong so they can support the spine and keep our back healthy. Heres three effective core exercises (ACE) that I like to do. The wood chop. This helps to build core rotational strength. If using a resistance band, place band end on the ground and stand on it with both feet. Hold the other end with both hands and tighten your abdominals. Squat down with your weight in your heels and your spine aligned. Stand up and rotate your arms out in front of your body, twisting at the ribcage with your hips squared to the front. Keep your knees slightly bent at the top of your movement (dont lock out your knees). The bird dog. This helps to build three-dimensional (three-dimensional is rotational, side-to-side and forward-backward movement) core stability strength. You dont need any equipment for this exercise. Just the floor and maybe a yoga mat for cushion if you prefer. Lower your body onto all fours (on your hands and knees). Tighten your abdominals. Extend one arm out in front while the opposite leg extends back. Hold for a count of 8-10 seconds and repeat on the other side. The prone plank. Like the bird dog, this will build three-dimensional core stability strength. You can do this on the floor on your hands and up on your toes. If you have wrist pain, you can lower yourself to your forearms. You can also make this easier by having your knees on the floor instead of your toes. Tighten your abdominals and hold for a count of 15 30 seconds. Your body should be positioned like a straight board or a plank. Keep your core muscles strong with these exercises. Heres to your great back health. About the author Jonathan Souder is the fitness director at Manor House, an Acts Retirement-Life Community in Seaford, Email your thoughts to

Sixteenth Annual Diabetes Wellness Expo is Nov. 14 Nearly 80,000 Delawareans have diabetes and an additional 84,600 people have been diagnosed with pre-diabetes. Diabetes is the leading cause of kidney failure, adult blindness, lower-limb amputations, heart disease and stroke. The disease requires extensive medical monitoring and costly, lifelong treatment. However, the health impacts of the disease can be managed through healthier lifestyle choices and self-management of medications so people can enjoy a higher quality of life. More than 50 exhibitors and screeners will showcase health services, supplies and programs to Delawareans with diabetes at the 16th Annual Diabetes Wellness Expo, to be held Tuesday, Nov. 14 from 9 a.m. 3 p.m. at the Dover Downs Conference Center. The free event, organized by the Delaware Diabetes Coalition (DDC), the Division of Public Health (DPH) and other partners, will bring together health care facilities, diabetes-related organizations and businesses to promote self-management and healthier lifestyles for people with diabetes and prediabetes. The Expo includes educational presentations on: diabetes/prediabetes management, medication adherence, eating healthy, A1C control and the benefits of exercise. Blood sugar, blood pressure, foot care, eye exams and other screenings and tests are available. Free flu shots will also be provided at the Expo. A box lunch including a gourmet sandwich, fruit and beverage will be provided on a first come, first-served basis. Overweight and obesity are major contributing factorsfor developing diabetes. In Delaware,20.8 percentof adults who report being obese have been diagnosed with diabetes, compared with3 percentof adults who report normal weights. People with pre-diabetes are at risk for developing type 2 (often called adult onset) diabetes, but they can significantlyreduce that risk by increasing physical activity and eating a healthier diet. The National Diabetes Information Clearinghouse estimates that between 90 percent and 95 percent of people with diabetes have type 2. The 2016 Delaware Behavioral Risk Factor Survey (BRFS) provides information about compliance with recommendations for people with diabetes: 57 percentsay they check their blood glucose (sugar) levels one or more times per day. The recommended frequency is three times a day for most diabetic adults; 33 percentsee their doctor four or more times a year.An additional 35 percent say they see their doctor two or three times a year; 75 percentof people with diabetes had an eye exam in which their pupils were dilated during the past year; 77 percentsaid a health professional had checked their feet for sores or irritations one or more times in the past year; Nearly half (47.2 percent) of all adults diagnosed with diabetes say they have taken a course or class in how to manage diabetes. For more information, please call the Delaware Diabetes Coalition at 302-388-9728 or Delawares Division of Public Healths Diabetes and Heart Disease Prevention and Control Program at 302-744-1020. You can also learn more about diabetes programs and resources at

DPH confirms first Sussex County influenza case for 2017-18 season The Delaware Division of Public Health (DPH) is reporting the states first laboratory-confirmed cases of influenza in Sussex County, for the 2017-2018 flu season.

The Sussex County case involves a 65-year old female. This brings the total number of flu cases this season to seven. The other six were announced last week. Three are from Kent County and three are from New Castle County. There are two main types of influenza (flu) virus - types A and B - that routinely spread in people and are responsible for seasonal flu outbreaks each year. All seven cases of the lab-confirmed influenza cases are type A. DPH urges all Delawareans six months of age and older to get vaccinated soon if they have not yet done so. The flu is easy to transmit and you can get it even from seemingly healthy, but unvaccinated, children and adults. Since it takes about two weeks after vaccination for antibodies to develop in the body that protect against influenza virus infection, it is important to get the flu shot as early as possible to give your body time to build immunity.The intranasal vaccine (flu mist) is not being recommendedthis year based on the Centers for Disease Control and Preventions analysis, which showed the intramuscular vaccine was better at protecting against certain strains of influenza. Vaccinations not only prevent people from getting the flu, but they can reducethe severity of flu illness and prevent visits to the doctor, clinic, emergency room, hospitalizations, and serious consequences (including death) from influenza. Vaccinated people have less chance of missing family, school and work events due to influenza illness. Getting a flu vaccination is easy.Theyare offered through physician offices, many pharmacies and some grocery stores. DPH is also offering flu vaccines at its Public Health clinics in several State Service Centersincluding some with evening hours.For more information about the flu and where to get vaccinated, visit, call 1-800-282-8672, or Google CDC flu finder and enter a ZIP code. Last flu season, Delaware had4,590confirmed flu cases, 15 of which were fatal. Delawareans can prevent the spread of the flu and other respiratory illness with good hygiene: Wash hands frequently with soap and water or use alcohol-based hand sanitizers, cover coughs and sneezes with a tissue, and dispose of tissues immediately. If a tissue is not available, cough or sneeze into your inner elbow. Droplets from a sneeze can travel up to six feet. Also avoid touching your eyes, nose, or mouth. Flu symptoms come on suddenly, and include fever, cough, sore throat, runny or stuffy nose, headaches and body aches, chills, and fatigue. Some people get complications including pneumonia, bronchitis, and sinus and ear infections. Those sick with the flu should stay home from work, school, and other gatherings and not return until they have been free of fever with temperature less than 100 degrees F (37.8 degrees C), without the use of fever-reducing medications for at least 24 hours. They should avoid close contact with well people in the household, stay well-hydrated by drinking plenty of water and other clear liquids. Over the counter medicines can provide symptom relief but if you suspect you have influenza, call your doctor as they may decide to provide antiviral medications to help hasten recovery and prevent serious complications. This is particularly important for those who feel very sick, are pregnant, or have chronic medical conditions. A person who is deaf, hard-of-hearing, deaf-blind or speech-disabled can call the DPH phone number above by using TTY services. Dial 7-1-1 or 800-232-5460 to type your conversation to a relay operator, who reads your conversation to a hearing person at DPH. The relay operator types the hearing persons spoken words back to the TTY user. To learn more about TTY availability in Delaware, visit

PHC lowers readmission rates atients discharged from the hospital is readmitted within 30 days. Peninsula Home Care at Nanticoke is taking steps to reduce the rate of readmissions by working closely with hospitals to improve discharge planning and providing quality transitional care for individuals to continue recovering in the home. Medication management is at the core of advanced discharge planning and transitional care. Medication adherence can be improved by changing the patients perception of cost, concerns and benefits in addition to responding to behavioral factors such as the perceived burden of taking medication, concern about side effects and failure to understand why the medication is necessary.

Types of non-adherence Medication non-adherence is divided into four major categories: primary (when a patient does not fill an initial prescription), secondary (when a patient does not fill a prescription on time), unintentional (when a patient forgets to take a medication or is careless in some way as to miss a scheduled dose) and intentional (a decision not to take the medication). Unfortunately, up to 80% of non-adherence may be intentional.

Care takes collaboration Physicians play an important role in improving medication adherence but cant do it alone. Support and collaboration is necessary from all members of a multidisciplinary health care team including home care nurses, case managers, clinicians and caregivers. These team members can help increase the number of touch points for patients, offering repeated checks as they move through their plan of care. One of the most important members of this team is the patient themselves, said Nancy Bagwell, area director of operations, Peninsula Home Care. Patient engagement and education is necessary for the individual to manage their disease or condition and understand the important role medication has during recovery. For more information, visit

Saraco appointed to committee Karen Saracco, director of health information management (medical records) at Nanticoke Memorial Hospital, has received a three-year appointment to the Hospital Discharge Technical Advisory Committee within the Delaware Department of Health and Social Services (DHSS). As a member of this committee, Saracco will study issues related to the collection, compilation, dissemination and confidentiality of hospital discharge data reporting as it relates to the improvement of healthcare for Delawareans.

Nanticoke Rehabilitation Services to hold Lymphedema Support Group Nanticoke Rehabilitation Services hosts lymphedema support groups on the third Thursday of each month at the Seaford Library and Cultural Center from 1:30 pm to 3:00 pm. This months meeting will be held on Thursday, Nov. 16. This free support group is open to anyone affected by lymphedema including patients, caregivers, and relatives. Meetings will consist of a lecture by healthcare professionals and medical equipment providers followed by refreshments and an open question and answer session or discussion amongparticipants. Registration is required. Lymphedema is an abnormal collection of high-protein fluid just beneath the skin that occurs most commonly in the limbs. The condition can be caused by a variety of factors including family history, damaged lymph vessels, lymph node removal, infection, or radiation therapy. Lymphedema causes swelling which may create movement limitation, and leaves patients at higher risks for wounds and infections. Lymphedema is a chronic condition with specific manual treatments, skin care, compression pumps, wraps, and exercises. For more information or to register, contact Robert Donati, PT, CLT at 302-629-6224. To learn more about services provided by Nanticoke Rehabilitation Services, visit

Open enrollment on With the open enrollment period for Delawares Health Insurance Marketplace cut to six weeks, Delawarean seeking coverage for 2018 are urged to sign up early, beginning Nov. 1, in order to avoid any last-minute rush before the Dec. 15 deadline. Early enrollment is also important because the federal government has announced planned maintenance shutdowns of on most Sundays during open enrollment. Coverage for enrollees who sign up by Dec. 15 and pay their first months premium will be effective Jan. 1. Delaware currently has more than 27,000 people enrolled for coverage through its Health Insurance Marketplace, including 73 percent who re-enrolled for 2017 and 27 percent who were new enrollees. Earlier this year, Aetna announced it would not sell plans on Delawares Health Insurance Marketplace for 2018. Enrollees with Aetna plans for 2017 must choose one of seven Highmark Blue Cross Blue Shield of Delaware plans that are available for purchase in 2018 or they will be automatically enrolled in a similar plan offered by Highmark. Enrollees who currently have coverage through Aetna Health or Aetna Life will be notified in writing as to what steps to take to obtain an alternate plan. In October, Insurance Commissioner Trinidad Navarro announced that the Department of Insurance had approved an average rate increase of 25 percent for 2018. With the premium increase, Delaware is making an extra effort this enrollment season to make sure residents who do not have employer-sponsored health insurance or who are not eligible for public programs such as Medicare, Medicaid, and the Childrens Health Insurance Program are aware of the federal tax credits available when they buy private plans through the Health Insurance Marketplace. The tax credits can help reduce the cost of their monthly premiums. Consumers can go to to check out their options for 2018. Individuals who need help enrolling in coverage will have access to free in-person assistance from federally funded and trained specialists at several Delaware organizations including La Red Health Center. State-licensed insurance agents and brokers are also available to help individuals re-enroll and to help employers update their coverage, at no extra charge. For more information, go to You can enroll in marketplace coverage at or by calling 1-800-318-2596 (TTY - 1-855-889-4325). In addition to the Health Insurance Marketplace, some residents might be eligible for coverage though Delawares expanded Medicaid program, which is open year-round. To be screened for or to apply for Medicaid benefits, go to Delaware ASSIST.

Nanticoke to host Parkinsons education and support group Nanticoke Health Services, in conjunction with CHEER and Care DE and the Manor House, will hold a Parkinsons education and support group on Thursday, Nov. 16 from 9:30-11 a.m. at the Manor House located at 1001 Middleford Road in Seaford. This support group is FREE and open to the public. Parkinsons disease (PD) is a progressive neurological disease that affects the part of the brain that controls muscle movement. A Parkinsons disease diagnosis can bring out many difficult emotions fear, anger, resentment, hopelessness, and more. It is a challenge to learn how to cope with these feelings along with the stress of diagnosis and treatment. Participating in education/support groups is essential for coping with an illness such as PD or other disorders that impair bodily movement. This support group is not only helpful for the individual diagnosed with PD, but also for caregivers, friends and family. Group members welcome guest speakers on a variety of subjects related to PD and provide support to each other through other small group discussions. Each individual may experience different symptoms, such as tremors, rigidity, poor balance, and a list of others. Studies show that the information, training, and counseling that participants receive while attending support group sessions enhances the quality of life, help to alleviate stress, and may even boost the immune system. Tara Trout, LPN at Nanticoke Memorial Hospital, co-facilitates the group with Kathy Landis, Caregiver Resource Coordinator at CHEER in Sussex County. For more information, contact Tara at 302-629-6611, extension 3838.

SUPPLIES FOR PUERTO RICO - In October, the medical staff of Nanticoke Memorial Hospital collected medical supplies for the people of Puerto Rico who were devastated by recent hurricanes. Through the generosity of local providers, donations collected amounted to more than 30 boxes full of supplies including medications, glucometers, insulin, wound care supplies and other items needed to provide medical care. The supplies were donated to the Delaware branch of the American Volunteer Emergency Response Team (A.V.E.R.T.), which provides relief to areas of devastation. Drs. Sandra Mancilla and Arvind Gireesh were a part of the collection efforts along with several of their colleagues. Several of the medical staff at Nanticoke have family and friends living in Puerto Rico. Dr. Mancilla is accepting new patients at Nanticoke Primary Care Laurel and will continue seeing her patients at Nanticoke Primary Care Delmar in 2018. Dr. Arvind Gireesh is part of the Nanticoke Vein Center.