To Your Good Health
DEAR DR. ROACH: After a patient has had megadoses of IV and oral antibiotics, is there anything they should do to restore the balance in their bodies, such as eating probiotics or yogurt, or is that just all nonsense? — N.W.
ANSWER: The idea makes perfect sense: Antibiotics not only kill the bad bacteria that is infecting us, they also kill many of the healthy bacteria that help us with digestion and other functions. (The whole suite of healthy bacteria living in our gut is termed the “microbiome.”) Why not help the gut return to normal by giving it some healthy bacteria, such as those found in yogurt with live cultures, or specific probiotics, which are just the healthy bacteria?
The answer is that it has been very hard to prove that there is any benefit in doing so. In people with no symptoms after finishing an antibiotic course, there probably aren’t any benefits. At least one study showed what researchers called a “very severe disturbance” in the person’s microbiome and actually slowed the return to a person’s normal microbiome, which they had prior to antibiotics.
Worse still, very rarely, infections have been transmitted through probiotics. Symptoms after antibiotic therapy, especially diarrhea and fever, could indicate a very severe infection called Closteroides dificile (“C. diff”), which does not respond to probiotics and usually needs powerful antibiotics to treat. Probiotics have also not been found to prevent C. diff.
DEAR DR. ROACH: Why are older patients always asked, “Have you ever fallen?” It is annoying, and I wish you would stop asking. — L.M.B.
ANSWER: Falls in older adults are a major cause of disability. Falls can lead to fractures, and fractures lead to poor movement, and sometimes to a progressive decline. A history of a fall is a major risk for future falls, so any person with a history of indoor falls should undergo a pretty comprehensive evaluation as to why they fell and to see what can be done to prevent future falls.
This includes, of course, managing any chronic illness, but also correcting vision as much as possible; evaluating the home for risks such as poor lighting and area rugs; and evaluating gait and balance, with a referral to a physical therapist for exercises to improve these and for assistive devices, if necessary.
Falls may also be the first indication of a significant medical or neurological condition that may benefit from treatment. I’m sorry you find it annoying, but it’s an important question.
DEAR DR. ROACH: My wife developed COVID with symptoms starting eight days ago. Yesterday was her sixth day of testing positive, while I have been negative throughout (go figure). We are planning to test ourselves again tomorrow. We are supposed to visit family in a few days, but two family members (in their 70s) each have one kidney due to cancer, while another (late 30s) is a colon cancer survivor. What is your opinion regarding transmission and risk in this situation? — A.B.
ANSWER: Your wife would be considered noninfectious on day 10, but the most conservative recommendation is to discontinue isolation only after a person has tested negative (ideally, two negative tests taken 48 hours apart) after day 5. The downside to this strategy is that it is clearly documented that some people can continue to be positive weeks (even months) after a COVID infection, but are very minimally, or not at all, infectious. People with severe immune system diseases (transplant recipients on active chemotherapy, for example) or who have had severe infections (hospitalized for a prolonged period or requiring intubation) should consult an expert to be sure. If you both continue to have no symptoms and you have a negative test, I would say you are very unlikely to pose a risk to your family members.