DEAR DR. DONOHUE: My sister-in-law fell and broke her hip. She had a successful surgical repair. She was transferred to a nursing home for rehab. She was there for three weeks and began vomiting and had severe diarrhea. Finally, she was transferred back to the hospital, and it was found that she had C. diff. The hospital did all it could, but she passed away. Not much is mentioned about C. diff. I am scheduled for knee surgery. How do I keep from getting this infection? — B.G.

ANSWER: C. difficile is aptly named; it is a difficult bacterium. It’s the cause of antibiotic-associated colitis, an infection and inflammation of the colon. The typical story goes like this: A hospitalized patient is given antibiotics for an infection. The antibiotics kill that person’s good colon bacteria. That gives the C. diff organism a chance to multiply. The C. diff population explodes because the good bacteria — the ones that kept C. diff in check — are gone. It’s something that the military would call collateral damage, unintended destruction of innocent people (the good bacteria) from an antibiotic.

This organism produces two toxins (poisons) that bring on diarrhea and abdominal pain. Not everyone comes down with symptoms, and some are so mildly affected that they are only mildly ill. Others, however, become gravely sick, and some die.

You can’t do a whole lot to prevent this infection. The burden is on the hospital. Only recently it has been discovered that this germ can be spread through airborne particles, a surprise to everyone. C. diff infections also can be acquired in the community, but the chief place where transmission takes place is the hospital and facilities like nursing homes.

Treatment consists in stopping the antibiotics. If that doesn’t put a halt to diarrhea, then metronidazole or vancomycin, two drugs that most people don’t recognize, often can bring matters to an end.

Don’t fear hospitalization or antibiotics. Your chances of coming down with this infection are small.

DEAR DR. DONOHUE: I read all the time about the risks of having a heart attack. I never see anything said about the risks for having a stroke. What are they? I fear a stroke more than I do a heart attack. — P.S.

ANSWER: The risks for both are similar. They include uncontrolled high blood pressure, cigarette smoking, diabetes, high cholesterol, too little exercise, a large waist, excessive alcohol consumption and a high ratio of Apo B to Apo A-1. This last item needs an explanation. Apo B is similar to LDL cholesterol — the bad kind of cholesterol, the kind that clogs arteries. Apo A-1 is more like HDL cholesterol — good cholesterol, the kind that keeps arteries clean. I have to admit that these tests are not usually ordered.

This subject is complicated by the fact that there are two different kinds of stroke. The more-common variety comes from obstruction of blood flow to a part of the brain from a plugged artery, like the plugged heart artery of a heart attack. The less-common variety comes from the breaking of a brain artery, something called a hemorrhagic stroke.

The two require different treatments and different approaches to prevention.

P.S. is like most people who live in greater fear of a stroke than a heart attack. The booklet on strokes explains the kinds of strokes and what can be done to prevent and treat them. Readers can obtain a copy by writing: Dr. Donohue — No. 902, Box 536475, Orlando, FL 32853-6475. 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.

DEAR DR. DONOHUE: I have heard that doctors say not to eat red tomatoes. They make your blood pressure go up. I love to eat them. I thought they brought blood pressure down. — J.H.

ANSWER: I haven’t heard of any connection between red tomatoes and high blood pressure. I’ve looked and can’t find any support for that idea. Salting tomatoes isn’t a great idea, since salt contributes to blood pressure rise. Evidence does exist that supports the link between tomatoes and lowering blood pressure.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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