Dr. Roach: How to prevent and protect yourself from C. diff

Dear Dr. Roach: I have an immunoglobulion A (IgA) deficiency and have had to take many antibiotics over the years. But I have never contracted Clostridioides difficile (C. diff) until I took clindamycin recently. It was horrible!

What could I have done to prevent this? And is disinfecting the bathroom with bleach enough to keep my family safe after my recovery? I obviously can’t use bleach everywhere.

— R.L.

Dear R.L.: C. diff is horrible, even life-threatening. Antibiotic use, especially clindamycin, is strongly associated with the development of this infection. Having an IgA deficiency puts people at a higher risk for mortality from this infection. Prevention is best achieved by avoiding the use of antibiotics. (So, readers, please don’t insist on antibiotics for a viral infection.)

Some people have asked me about the use of probiotics to treat or prevent C. diff, but there are not good data to support the use of probiotics for either treatment or prevention of C. diff, even though the theory is sound.

As far as protecting the family, everybody should wash their hands with soap and water (not alcohol sanitizers) frequently while the person is sick, especially before and after seeing or caring for the person, after using the bathroom, and before eating.

If possible, the person with C. diff should use one toilet that nobody else uses. Frequently cleaning the bathroom surfaces, doorknobs, toilets and faucet handles is important. Bleach (9:1 dilution) or an industrial cleanser specifically made for C. diff is recommended.

Dear Dr. Roach: I’m a 77-year-old male in good physical health. I experience numbness while sleeping, mostly in my right shoulder and arm, but the numbness extends to my right thumb. This has affected my sleep, and it’s hard to get circulation back.

— F.N.

Dear F.N.: Numbness upon awakening is almost always an issue with a nerve being compressed — not a circulation problem at all. (Circulation problems in an extremity typically present themselves as muscle aches with exercise and are more likely in the legs than the arms.)

The thumb gets its nerve supply from the median nerve. Compression of this nerve occurs most commonly in the wrist within a structure of bone and connective tissue called the carpal tunnel. However, carpal tunnel pain and numbness typically extends from the elbow down, usually not all the way up to the shoulder.

Numbness in the shoulder and down is most commonly caused by compression of the nerve root in the neck, specifically the sixth cervical root (which runs above the sixth cervical vertebra). Problems with the disk or with arthritis in the neck can lead to arm, hand and thumb numbness.

Finally, in between the nerve root and the median nerve are nerve structures called the superior trunk and lateral cord, which are part of the brachial plexus, from the lower neck up to high in the armpit. It’s unusual but possible to develop nerve compression there.

A careful physical exam can help, but you may need a nerve study like an electromyograph (EMG) to find which nerve might be getting compressed. Once you know, then you can learn about the possible treatments.

Readers may email questions to ToYourGoodHealth@med.cornell.edu.