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Posted December 18, 1996

This week's questions:

• Is it beneficial (and safe) to get my tonsils removed?

• I have constant intestinal gas. Could I be lactose intolerant?

• If you get pregnant after using a condom, will the fetus be affected by nonoxynol-9?

I have problems with my tonsils. Every one to two months my tonsils become bigger and when I go to see the doctor they give me an antibiotic. This has been happening since 1995 and the latest episode was last week. My questions: Is it possible to remove my tonsils? And what are the effects of removing them?
-- NK

The situation you describe is common, and one that resulted in many tonsillectomies in years past. But what is tonsillitis? And are tonsillectomies useful?

The tonsils are aggregates of lymphoid tissue that stand like sentries at the gate, guarding the throat and upper respiratory tract from an invasion of hostile microorganisms. The term lymphoid tissue simply refers to a large collection of immune cells contained within the nodular structure of a tonsil. Tonsils are similar to lymph nodes that you might feel in your neck or under your arm.

Any time there is an upper respiratory infection, the tonsils are called upon to help fight off the intruder, be it a virus, a strep bacteria, or other types of microorganisms. When you look in the throat, the tonsils may be enlarged, and white spots -- which are actually small aggregations of pus -- will often appear on the surface of the tonsils. These changes are not specific for any particular type of throat infection, although it is slightly more common with a strep throat.

The only reason to use antibiotics for a sore throat is to treat a strep infection. That's it. No enlargement of the tonsils, fever, nor the intensity of the throat soreness, nor even the appearance of white spots on the tonsils, are indications by themselves to use antibiotics. Either a rapid strep test or throat culture should be done, or there should be reasons to have a high suspicion of strep (such as culture-confirmed sore throats in the immediate family) before antibiotics are used.

Therefore, in response to your question, unless throat cultures have been done, it may be that the many antibiotic prescriptions you have received have been unnecessary. But if, in fact, recurrent strep infections have been documented, make sure you are taking the full prescription that has been given to you (10 days is normal), or consider alternate antibiotics (rarely necessary).

Tonsillectomy, or surgical removal of the tonsils, is rarely done any longer. At one time it was thought that removing the tonsils (and small auxiliary lymph aggregates called the "adenoids") would prevent recurrent sore throats. However, after many years of overly-aggressive interventions, it was found to be more helpful to the ENT specialist's pocketbook than it was to the patient. Now, tonsillectomies are reserved for patients who have very frequent sore throats (more than six per year, for example) or who have obstructive airway symptoms from the size of the tonsils.

There is a rare risk of serious bleeding from the tonsillectomy procedure, and there is the usual small risk of complications from general anesthesia. However, there are no significant adverse consequences to having the tonsils removed.

-- R. Jandl,12/16/96, Category: common ailments

I have over the last several years had constant intestinal gas, which is both uncomfortable and embarrassing enough to start keeping me from going out in public as I used to. I am wondering if, in my 40s, I could have developed lactose intolerance, and if that could be the cause of my problem. It doesn't seem to matter at all whether I avoid the foods commonly said to cause gas.

Although not usually a chosen topic of discussion at cocktail parties, questions about excess gas abound in the doctor's office. Many people, it seems, experience problems with rumbling gas discomfort, excess belching, or, as we say in the business, flatus.

Well, people are different. Some are gassier than others. Also, what one person feels is normal, may be upsetting to another. But if we exclude foods such as broccoli, cucumbers, beans, and other well known gas-generating vegetables, what about the possibility of lactose intolerance?

Lactose intolerance is a very common disorder which often appears in middle age. It is especially common among Blacks and Asians. Lactose is the dominant sugar in cows' milk. In order for the body to be able to digest it, an enzyme called lactase must be present on the lining of the small intestine. If it is deficient, as it may be congenitally, or after a bad case of acute gastroenteritis, the lactose sugar remains in the bowel undigested. Bacteria love that. Bacteria are always looking for sugars to feed on, and when exposed to the lactose will gobble it up, generating gas as a by-product of metabolism. The lactase-deficient person will experience various combinations of excess gas, bloating, diarrhea, and abdominal discomfort within an hour or so of a meal containing milk or other dairy products (cheese, yogurt, etc.).

If this fits your situation, go on a diet free of all dairy products for a week or two. Your intestines should quickly resume normal function. If lactose intolerance is, indeed, present, then you will have to adjust your diet to exclude cows' milk, or use milk products that are pre-treated with Lactaid -- the same enzyme that you are missing.

-- R. Jandl, 12/7/96, Category: common ailments

What are the side effects to the fetus if a woman becomes pregnant even after her partner uses a condom with a spermicidal lubricant on it (which has not gone past the expiration date)? In other words, are there any side effects of nonoxynol-9 spermicide on the sperm that still mates with the female egg (like the sperm not being able to carry the genes or the chromosomes due to its reaction to the spermicidal chemical nonoxynol-9)?

In cases of condom and spermicide failure, at least one sperm has overcome overwhelming odds to reach and fertilize the egg. Without the use of contraception, he had one shot in millions to be the lucky suitor. Having outflanked the condom, and swum through a toxic sea of spermicide, what is left of him? Might the spermicide have damaged him to the extent that an abnormal fetus results?

Happily, this does not seem to be the case. Having survived intact enough to reach and penetrate the egg, the sperm seems to have all the components necessary to co-produce a normal, healthy child.

-- R. Jandl, 12/7/96, Category: sexuality & sexual health