Dear Dr. ROACH: I am a 77 year old male and had an ultrasound because I noticed that my left testicle looked swollen. The result showed a large fluid collection (5 x 5 x 3 cm) superior to the left testicle. My doctor told me to leave it as it is, but if it bothered me he could operate on it and remove it. Should it be deleted? Will deleting it cause other problems in the future? —BK
ANSWER: A hydrocele is the name for an accumulation of fluid in the testicle resulting from excessive fluid production or reduced fluid reabsorption. Their size varies from relatively small to massive. They can cause discomfort and skin irritation when large.
Most of the time, they do not require any treatment. Unless it really bothers you, I would generally not recommend surgical treatment. You can certainly wait and do it at any time, because the hydrocele does not put you at risk of dangerous complications.
DEAR DR. ROACH: On vacation, or swimming in a chlorinated pool, the question often arises: how does a quick shower compare to half an hour of swimming in a properly chlorinated private pool, which leaves you cleaner? I understand that soap and the physical rubbing of your body can affect your cleanliness. — HR
ANSWER: Chlorine in a swimming pool is added to protect you from germs in the water. The amount of chlorine is just a little less than the chlorine in drinking water. This is a surprise for people who have found that the pool water hurts their eyes. The reason for this is that skin cells (and sweat, lotions and, yes, swimmers’ urine) react with pool chlorine to form substances called chloramines. They are the ones that cause the irritation and make you smell that chlorine smell when you get out of the pool.
I recommend a quick shower before entering a pool to reduce pool contamination, and a thorough scrub with shampoo and soap when you get out, to remove chloramines.
DEAR DR. ROACH: Is it possible to recover from C. diff permanently? I just had a second relapse and have been on vancomycin for several weeks as I have the last two times. – FOR EXAMPLE
ANSWER: Clostridium difficile, known as C. difficile, is a stubborn bacteria that can normally live in the colon, but can invade healthy bacteria and cause symptoms of watery diarrhea, often accompanied by fever and cramps.
Treatment with oral vancomycin has long been the usual first-line therapy and is generally effective. However, a newer antibiotic, fidaxomicin, has been shown to be more effective and may be a better choice for you after vancomycin treatment has failed.
Unfortunately, some people may even fail with fidaxomicin. There are other options, including a monoclonal antibody against the C. difficile toxin, bezlotoxumab, which can be given along with antibiotic treatment.
The best approach for C. diff is not to catch it in the first place, which is a good time to remind people not to ask for antibiotics – and for my colleagues not to prescribe them unless they are really necessary. Long term use of proton pump inhibitors like omeprazole also predisposes people to developing C. diff which is one of the reasons I try to minimize the use of these medications.
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Dr Roach regrets that he cannot respond to individual letters, but will incorporate them into the column whenever possible. Readers can email questions to [email protected] or send mail to 628 Virginia Dr., Orlando, FL 32803.