Preventing the spread of C. diff requires routine hygiene

BY KEITH ROACH, M.D.

Dear Dr. Roach: We have a close family friend who was hospitalized with C. diff several months ago after working at an assisted-living facility. How do we minimize the risk to our family when this person visits our home? If he has another episode, will he know if he is contagious? — Anon.

Answer: If your friend has been out of the hospital for several months, it is likely that he is no longer contagious if he is not having symptoms. It is possible to still have the bacteria without having diarrhea, the major symptom. A person who has Clostridium difficile (“C. diff”) and no symptoms is called a “carrier.” Both carriers and those who are symptomatic are potentially contagious (the route of infection is fecal-oral). However, C. diff can cause serious illness, and is worth being concerned about.

Fortunately, no more than routine hygiene is necessary to protect your family. The spores of Clostridium are difficult to eradicate, so washing them away is the best option. Your friend should wash his hands with soap and hot water, as should your family, especially before eating and after using the bathroom. Person-to-person spread between family, work or social contacts is rare.

Dear Dr. Roach: A couple of days ago, your column contained a letter about side effects from drugs for alleviating the symptoms of benign prostatic hyperplasia. You did not mention the use of daily low-dose (2.5 mg) Cialis. I could not stand the side effects of Flomax, but find that daily low-dose Cialis has no side effects and cuts my urination frequency in half. — A.M.

Answer: Tadalafil (Cialis) is best known as a treatment for erectile dysfunction, but a 2012 study showed that it is about as effective as tamsulosin (Flomax) for treatment of prostate enlargement.

While I am glad you have had no side effects, there is no medication that will be free from side effects in everybody. With tadalafil, some people will notice a significant drop in blood pressure, as can happen with tamsulosin. The combination of the two can produce even greater drops in blood pressure in some men. Tadalafil cannot be used with nitrates. Visual symptoms also are possible, but uncommon.

Daily tadalafil is a reasonable alternative for men who have intolerable side effects to medications like tamsulosin, although it is expensive. It also treats erectile dysfunction, which is common in older men, the ones who are likely to have BPH.

Dr. Roach writes: A recent column on low female libido continues to generate additional letters. I received two letters from women who were treated with testosterone (sometimes with female hormones), and both of these women reported excellent results, which they wanted me to share. A gynecologist, Dr. Kathy Maupin, sent me her book on testosterone treatment in women, along with her observation that 95 percent of her patients fully recover their libido when treated. The published studies on testosterone treatment in women have mostly shown benefit, though not to the remarkable degree that Dr. Maupin reports. Further, the Food and Drug Administration has not approved any testosterone product for women. Nonetheless, testosterone replacement remains an option for treatment of low libido in women.

Readers: The booklet on sodium, potassium chloride and bicarbonate explain the functions of these body chemicals and how low or high readings are corrected. To obtain a copy, write:

Dr. Roach

Book No. 202

628 Virginia Dr.

Orlando, FL 32803

Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may

email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall.com.