Thursday, March 12, 2015
Doctor's Perspective
There is more to the story regarding resistant bacteria

By Dr. Anthony Policastro
Recently, there were concerns about an antibiotic resistant bacteria that caused infections after endoscopic procedures. Much of what I initially heard about it was based upon people who had read the headlines. As is usually the case there is more to the story. The bacteria in question are called carbepenem resistant enterobacteriacae (CRE). In Latin the prefix entero" stands for intestine. Thus the bacteria that we are talking about are normal inhabitants of the intestine. Everyone carries them. They include E-coli. Some types of E. coli have been known to cause intestinal symptoms. They include a group called Klebsiella. We all have them in our intestine. Bacteria have been developing resistance to antibiotics for years. In many cases this is due to patient behavior. Some resistance develops because people demand antibiotics when they do not need them. Some of it occurs because patients do not complete their prescribed course of antibiotics. This resistance is closely related to evolution. It is called survival of the fittest. When you use an antibiotic, you kill many bacteria. The only ones that can survive are those resistant to that antibiotic. In most cases, non-resistant bacteria will later grow back and so the resistant ones remain small in number. However, if we keep overusing antibiotics, the result is that only the resistant ones will survive. Carbepenem is a relatively new class of antibiotics. They are powerful. Of course, the main reason they are powerful is because they are new. Bacteria have not been exposed to them that much so resistant bacteria have not had the chance to develop. That has clearly changed. The recent outbreak involved a device called a duodenoscope. This scope goes in from the mouth, down the esophagus, into the stomach, past the stomach and into the duodenum. The outbreak did not involve colonoscopes. Therefore, people scheduled for colonoscopies should not be concerned. Like most procedures, there are a certain number of patients who will have a complication from the procedure. Infection with CRE is one such complication. More than 500,000 duodenoscopies are performed in this country per year. About 100 - one in every 5,000 procedures - result in infections. There are a lot of good results from duodenoscopies. For that reason, we need to continue doing them. We also need to address cleaning the instrument which is difficult to clean because it has many small moving parts. Using a small brush like a toothbrush is an important part of the cleaning process. We need to be careful about throwing out the baby with the bath water. It is important to realize that every procedure is associated with some risk. It is also important to not blow that out of proportion. Colonoscopies had nothing to do with the recent outbreak so there is no reason to continue spreading that untruth.

Sun safety tips for winter sports Winter sports enthusiasts spend ample time outdoors, often hitting the slopes for skiing and snowboarding. Despite cold temperatures, clouds and dreary weather, winter sports lovers are still at risk for sun damage and skin cancer. About 86 percent of melanomas and 90 percent of nonmelanoma skin cancers are associated with exposure to the sun's ultraviolet (UV) rays. In addition, the sun's UV rays are also responsible for 90 percent of the visible changes commonly attributed to skin aging including wrinkles, leathery skin and brown spots. Snow reflects up to 80 percent of the sun's ultraviolet (UV) rays. As a result, the same rays can reach the skin twice. Additionally, up to 80 percent of UV rays burn right through the clouds. Skiers and snowboarders are at an even greater risk, as these sports take place at a higher altitude, where the thinner atmosphere absorbs less UV radiation. Sun exposure increases four to five percent with every 1,000 feet above sea level. Frostbite and windburn are common concerns during the winter, and people often don't realize that the sun's UV rays can be just as damaging on the slopes as they are on the beach," said Perry Robins, MD, president of The Skin Cancer Foundation.

That's why it's so important to practice proper sun protection year-round, even in cold or cloudy weather." The Skin Cancer Foundation recommends the following tips to stay sun-safe during outdoor winter sports:
  • Use a broad spectrum (UBA/UVB) sunscreen with an SPF of 30 or higher whenever spending extended time outdoors. Apply sunscreen to all exposed areas, and reapply every two hours or after excessive sweating.
  • Don't forget the often-missed spots: This includes the ears, around the eyes, the neck, the underside of the chin and hands.
  • Use a moisturizing sunscreen with ingredients like lanolin or glycerin. Winter conditions can be particularly harsh on the skin.
  • Protect the lips by wearing a lip balm with an SPF 30 or higher.
  • Cover up with clothing: Look for sunglasses or goggles that offer 99 percent or greater UV protection and have wraparound or large frames, which will protect your eyes, eyelids and the sensitive skin around your eyes - all common sites for skin cancer. In addition, consider a ski mask for even more protection.

'Binge Eating' lecture Binge Eating Disorder" will be the topic of Delaware Hospice's Lunch Bunch Lecture with Dr. Judy Pierson on Friday, March 13 from 12:30 to 1:30 p.m at the Delaware Hospice Center in Milford. This event was rescheduled from Friday, March 6. Binge eating disorder is the most common eating disorder in America. The notion that people can just stop" only fuels the problem by triggering self-destructive shame. Fortunately treatments, medications, and support are available. Registration is required as seating capacity is limited. Lunch (noon to 12:30 p.m.) is $5 per person and the presentation is free. Register by Thursday, March 5, by contacting Michele August at 302-746-4503 or email

Hospice Grief Support Group Delaware Hospice will offer a six-week support group, Healing after the Loss of a Loved One." The group will be held on Mondays, March 23-April 27, from 5-6:30 p.m., at the Cancer Support Community Delaware, 18947 John J. Williams Hwy., Ste. 312, Rehoboth Beach. This free group is open to any adult who is grieving the loss of a loved one. Each week a topic will be presented and discussed to help those in mourning cope with their loss. To register, contact Midge DiNatale, bereavement counselor, at 856-7717, ext. 4120 or ,

Caring for someone with Alzheimer's A free workshop will be held at the Easter Seals Tunnell Center in Georgetown from 10:30 a.m. to noon on Wednesday, March 25, that will provide caregivers with important information about preparing and caring for an individual with Alzheimer's Disease during an emergency or disaster. Presentations will be conducted by representatives of the Alzheimer's Association Delaware Valley Chapter and Delaware Assistive Technology Initiative at the University of Delaware's Center for Disabilities Studies. The workshops will address:
  • Communicating with people with Alzheimer's Disease
  • Wandering – triggers and prevention
  • Safety issues and interventions at home and while traveling
  • Assistive technology for caregivers and individuals with Alzheimer's Disease
Register online at For more information, contact Phyllis Guinivan at