Thursday, August 02, 2018
Doctor’s Perspective
A thorough exam is always important

By Dr. Anthony Policastro
When I was in medical school, we spent a lot of time learning how to do thorough physical exams. Since then technology has become more sophisticated. For that reason we tend to lean more on technology and less on physical exams. I used to teach pediatrics to family practice residents. One of the things I did with each group of residents was take them to the newborn nursery. When we got there the infants were wrapped in blankets and the only thing showing was their head and neck. I would then spend the next hour asking the residents to observe all the things they could about the exposed area. We would talk about how many different diagnoses could be made by seeing only the head of a newborn. We were all taught in medical school how to examine the lungs, heart and abdomen. There were four steps to the process. The first is inspection which meant to visually look at the area. It did not mean a casual glance but to observe carefully. Over time one would develop a sense of what appeared to be out of the ordinary which would allow a more focused exam of that area. The second is palpation which refers to placing hands on the patient and feeling for things that are not normal. This is important in many areas of the body but especially the abdomen. We can palpate the size of the liver, see if the spleen is enlarged and see if a mass is present. We can also palpate to see if there is a throbbing abdominal aortic aneurysm. There are other types of palpation. I once saw a 15-year-old obese girl who had a fever for two weeks. She was seen three different times during that period. One of the old rules for palpation is that every patient with a prolonged fever needed a rectal exam. Because of her age, sex and weight, that had not been done. The rectal exam showed an easily palpable large mass which turned out to be an appendiceal abscess. The third is percussion. In this instance the physician places one hand on the body. That hand is then tapped with a finger from the other hand which allows for sound waves to tell how hollow the area below is. For example, the lungs are hollow, however, when they are filled with fluid, they sound solid. The fourth is auscultation which is the use of the stethoscope. We usually think of the stethoscope as being used for the heart and lungs, however, there are other uses for it as well. Listening to the neck can tell about narrowing of the carotid artery. Listening to the abdomen can be very useful in someone with abdominal pain. All of these things are still valuable, however, technology has made them seem outdated. When I do an exam, I have a goal in mind. I like to tell the patient up front what I predict the technology will show. The more times I am right, the more times I become convinced that physical examination is as valuable as it was when they taught it to us in medical school.

Lymphedema Support Group Nanticoke Rehabilitation Services hosts lymphedema support groups on the third Thursday of each month from 1:30 to 3 p.m. at the Seaford Library and Cultural Center. This month's meeting is Thursday, Aug. 16. This free support group is open to anyone affected by lymphedema including patients, caregivers, and relatives. Meetings will consist of a lecture by health care professionals and medical equipment providers followed by refreshments and an open question and answer session or discussion among participants. Registration is not required. For more information about this support group or to learn more about services provided by Nanticoke Rehabilitation Services, call 302-629-6224 or visit

Parkinson's Support Group Nanticoke Health Services, in conjunction with CHEER and Care DE and the Manor House, will hold a Parkinson's education and support group on Thursday, Aug. 16 from 9:30 to 11 a.m. at the Manor House in Seaford. This support group is free and open to the public.

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. Studies show that the information, training, and counseling that participants receive at support groups 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, Delaware. For more information, contact Tara at 302-629-6611, ext. 3838.

Novak named director Nanticoke Health Services is proud to announce that Kelly Novak has been promoted to director of volunteer programs. In this position, Novak oversees all volunteer programs within Nanticoke Health Services including at Nanticoke Memorial Hospital, the Allen Cancer Center, and the Nanticoke Health Pavilion Seaford. Novak started her career at Nanticoke in March 2015 as a support specialist for the Nanticoke Health Foundation to assist with the capital campaign and special events. In June 2016, she was selected to lead and expand Nanticoke's Volunteer Services program while continuing her duties with the foundation. Novak received her bachelor of science in communication from Fitchburg State College in Fitchburg, Mass. and her master of science in secondary education from Pensacola Christian College in Pensacola, Fla. Additionally, she has 30 years of management-level experience in various industries including healthcare, private education and the food service industry. Novak also currently serves as vice president of the Delaware Association of Volunteer Administrators (DAVA). Novak resides in Seaford and is actively involved at Crossroad Community Church. In her free time, she enjoys making pet visits with her certified therapy dog.

FHR to affiliate with Elwyn Elwyn, a nonprofit human services organization supporting individuals with intellectual and developmental disabilities (IDD) and behavioral health needs in California, Delaware, New Jersey, and Pennsylvania, and Fellowship Health Resources, Inc. (FHR), a nonprofit behavioral healthcare organization with services spanning seven states, has announced that the organizations have signed an affiliation agreement. Working together, the organizations are now uniquely poised to provide a coast-to-coast continuum of care and enhanced services to meet a wide range of IDD and behavioral health support for individuals and families of all ages. Upon consummation of the affiliation, Elwyn will become the sole member of FHR. "By merging our service offerings, FHR and Elwyn will have the ability to better treat individuals as a whole, instead of requiring those in our care to seek treatment from multiple organizations to service their needs," said Debra M. Paul, FHR president & CEO. Paul will continue to serve as CEO of FHR, and the current FHR programs will remain under the name Fellowship Health Resources, Inc.

Diabetes prevention class Nanticoke Memorial Hospital will host a two-session Diabetes Prevention Class on Monday, Aug. 27 from 5:30-6:30 p.m. in Meeting Room 1. This course is designed for individuals age 18 and over who have been diagnosed with prediabetes. Prediabetes is a condition where blood glucose levels are higher than normal, but not high enough to be classified as diabetes. Utilizing resources developed by the National Diabetes Education Program (NDEP), this course provides individuals with basic tools to help them make appropriate lifestyle changes and reduce their risk for developing diabetes. Cost is $20 per person and a physician referral is required for registration. For more information or to register, contact Nanticoke's Diabetes Education Department at 302-629-6611, ext. 2288. To learn more about diabetes services at Nanticoke, visit