Question: Please give me some advice. I am a healthy, athletic 24-year-old woman who gets recurrent tonsillitis. My tonsils swell and become painful. This happens five or six times each year. I have been advised to have my tonsils out. I am a little leery about having my tonsils removed. Should I be? What causes tonsillitis?

- A.P.

Answer: Last question first. Tonsils are lymph tissue, very much like that in the network of lymph nodes throughout the body. Lymph tissue is our defense against infections, filtering out germs as they appear. In action, such tissue becomes enlarged. That's normal. It goes on all the time.

Now, should tonsil tissue encounter an overwhelming assault by an organism, then it not only enlarges but becomes inflamed and painful, often covered with pus. That's tonsillitis.

Different germs can cause tonsillitis, but let's stick with the common one - streptococcus. With strep, the objective criteria for recommending tonsillectomy are: a history of seven infections in one year, five in each of two consecutive years or three in each of three consecutive years.

Such objective guidelines do not exhaust the criteria for removal. Severe infections that interfere with normal lifestyle can also justify removal.

We're speaking here of the well-known but nebulous phrase used so often in medicine: quality of life. It's a factor only you and your doctor can evaluate.

Although most tonsillectomies have been performed on children, age is usually no barrier to the procedure when it's deemed necessary. Readers often express this concern.

Question: Just what does smoking have to do with ulcers? I am always confused when you mention that in your column. My doctor believes smoking causes ulcers, too.

- T.O.J.

Answer: Smoking reduces the amount of bicarbonate your body produces, so its acid-neutralizing effect is lost. I'd bet you didn't know your body makes bicarbonate.

The long-term effect of smoking on ulcer patients, though, is that it hinders ulcer healing and makes relapse more likely.

The reading material you asked for is on the way. Other readers can order a copy of my ulcer pamphlet by writing: Dr. Donohue - No. 25, P.O. Box 5539, Riverton, NJ 08077-5539. Enclose $3 and a self-addressed, stamped (52 cents) No. 10 envelope.

Question: I have been warned about my longtime use of nasal decongestant sprays. I am afraid of the well-known rebound effect once you quit. I am a classic case, I guess, damned if I do and damned if I don't. How could I ever quit?

- I.H.

Answer: It can be done, even in the most severe cases of decongestant spray abuse. You will need a doctor to help, but you can begin by trying to substitute a simple saline solution spray.

When you check in with your doctor, he might prescribe an oral medicine such as pseudoephedrine and possibly a steroid nasal spray.

Even so, it can take some time to get the nasal tissue safely back to a normal function.

You saved my readers from my annual sermon against misuse of nasal sprays. I hope your letter has a warning effect.

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Question: Should a person testing for blood sugar at home avoid vitamin C. Does it throw the reading off?

- Mrs. H.I.

Answer: Vitamin C will not interfere with a proper blood sugar reading.

You might be referring to urine testing, in which case large amounts of C can produce a false result. But so long as you are dealing with the blood test, you have nothing to worry about.

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