DEAR DR. DONOHUE: Please help. I am a 55-year-old female diagnosed with C. diff infection in September of last year. I feel my nurse practitioner is a little too nonchalant for me. Since the diagnosis, I have asked questions that my practitioner cannot answer. For instance, can a person be a carrier without having symptoms? And is there an antibiotic other than Flagyl for treatment? I have taken Flagyl twice without luck. I was also diagnosed with diverticular disease five years ago.

An important point: I was not on antibiotics prior to the diagnosis. I am considering a specialist. — N.G.

ANSWER: Not so long ago, Clostridium (klos-TRID-ee-um) was a germ (bacterium) known only to medical people. Now everyone has heard about it, or should have.

Almost exclusively, but not always, it happens to invade people taking antibiotics. The antibiotics kill normal bacteria in the colon, and the C. diff bacterium takes over to cause diarrhea. The germ is widely spread in nature. It produces spores, the equivalent of eggs. Spores can last a long time on inanimate objects. People pick up the spores on their hands and transfer them to the mouth. This happens in communities, but it happens most often in hospitals and nursing homes.

Yes, people can carry the bacterium and have no symptoms — asymptomatic carriers. In fact, 50 percent of infants for the first six months of life are asymptomatic carriers. Those people and infants don’t need treatment. Sickness, when it develops, is diarrhea. Initial treatment is stopping any antibiotic. If the person is quite sick, then Flagyl (metronidazole) is given. Oral vancomycin is used for Flagyl failure and for severe diarrhea. A new drug, fidaxomicin (Dificid) is now an available alternative, but it is expensive. There are other treatments. Diagnosing the infection involves 1. Finding the toxins produced by the germ in stools; or 2. Finding the bacterium in stools; or 3. Seeing peculiar membrane on the surface of the colon, scope exam required. All of these also require a patient having digestive-tract signs — diarrhea, for example.

You need the intervention of a specialist in infectious diseases. You have one of the world’s most famous medical institutions not that far from where you live. Make an appointment there to clear up this issue.

DEAR DR. DONOHUE: I received a notice from the Veteran’s Affairs Department that said, “Persons age 65 should take the pneumonia shot.” I asked for the shot, but they told me that people get pneumonia only twice in their lives, once when very young and once when old. They said I had a shot four years ago when I was 65 and didn’t need another. I told them my spleen had been removed and asked if that made a difference. I didn’t get an answer. — R.R.

ANSWER: The pneumonia shot is for one kind of pneumonia, pneumococcal (NEW-moe-KOK-ul) pneumonia, a pneumonia that can be caught at any age, but one that is most dangerous for the very young and the elderly.

For most adults, the shot is a one-time affair at age 65. For people without a spleen, a second dose of the vaccine needs to be given five years later. You deserve a second shot when the five-year period has elapsed. Not having a spleen puts you in a high-risk category should you be infected.

DEAR DR. DONOHUE: What are the dangers of smokeless tobacco? What’s the best way to quit using it? — S.M.

ANSWER: Chewing tobacco and snuff are examples of smokeless tobacco. They promote mouth cancers and, if swallowed, cancer of the esophagus.

They cause dental decay, gum inflammation and leukoplakia, white patches in the mouth that can evolve into cancer.

The best way to quit is just to stop. If a person finds the cravings for nicotine distracting and disturbing, then nicotine gum can help the body to function well without getting nicotine in its usual way. Follow the directions for tapering gum use.

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.