Dear Dr. Roach: Golf-ball-sized hydrocele doesn’t require any treatment

Keith Roach, M.D., syndicated columnist

Dear DR. ROACH: I am a 77-year-old man, and I had an ultrasound done because I noticed my left testicle seemed swollen. The result showed a large fluid collection (5 x 5 x 3 cm) superior to the left testicle. My doctor said to leave it as is, but if it bothered me, he could operate and remove it. Should it be removed? Will not removing it lead to other problems in the future? — B.K.

ANSWER: A hydrocele is the name for a fluid collection in the testicle resulting from excess fluid production or reduced fluid reabsorption. They range in size from relatively small to massive. They can cause discomfort and skin irritation when they are large.

Most of the time, they do not need any treatment. Unless it really is bothering you, I wouldn’t generally recommend surgical treatment. You can certainly wait and get it done at any time, since the hydrocele does not put you at risk for any dangerous complications.

DEAR DR. ROACH: On vacation, or when swimming in a chlorinated pool, the question often arises: How does a quick shower compare to a half hour of swimming in a properly chlorinated private pool, which leaves you cleaner? I understand that soap and physically scrubbing your body could affect your cleanliness. — R.H.

ANSWER: Chlorine in a swimming pool is added to keep you safe from germs in water. The amount of chlorine is just a bit less than the chlorine in drinking water. This is a surprise to people who have found that pool water hurts their eyes. The reason is that skin cells (and sweat, lotions and, yes, urine from swimmers) react with the chlorine in the pool to form substances called chloramines. These are what cause the irritation and cause you to have that chlorine odor when you get out of the pool.

I recommend a quick shower before you get into a pool to reduce contamination of the pool, and a thorough scrub with shampoo and soap when you get out, to wash off the chloramines.

DEAR DR. ROACH: Is it possible to ever permanently recover from C. diff? I just had a second relapse and am taking vancomycin for several weeks, as I did the last two times. — E.G.

ANSWER: Clostridium difficile, known as C. diff, is a stubborn bacteria that may normally live in the colon, but can overgrow the healthy bacteria to cause symptoms of watery diarrhea, often with fever and cramping.

Treatment with oral vancomycin has long been the usual first-line treatment, and it is usually effective. However, a newer antibiotic, fidaxomicin, has been proven more effective and would be a better choice for you, having failed a course of vancomycin.

Unfortunately, some people can even fail with fidaxomicin. There are other options, including a monoclonal antibody to the C. difficile toxin, bezlotoxumab, which can be given along with antibiotic treatment.

The best approach for C. diff is not to get 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 truly necessary. Long-term use of proton pump inhibitors, like omeprazole, also predispose people to developing C. diff, which is one reason I try to minimize use of these drugs.

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Editors note:

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 send mail to 628 Virginia Dr., Orlando, FL 32803.


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