Strep throat infections that are chronic — lasting more than three months — or recurrent are indications for tonsillectomy in adults. However, this is an uncommon surgery in adults, and there isn’t a lot of published data on the effectiveness of treatment.

Some data show that tonsillectomy does reduce incidence of infection, as would be expected. Other data show improved quality of life and fewer missed work days.

My own experience is limited to a handful of patients: All have had significant improvement in the number and severity of infections. On the other hand, the surgery itself is unpleasant, and that’s putting it mildly.

There is a significant risk of major complications — perhaps around 3%. One patient told me that the first two weeks after surgery were horrendous, but gradually improved over time.

As always, it’s a balance between benefits and risks of surgery. But it’s a difficult enough surgery that you are wise to be apprehensive, and I would recommend surgical consultation only if your symptoms were severe enough and significantly impact your life.

Three years ago, my mother was prescribed 50,000 IU of vitamin D per week. I read that this dose can lead to serious complications if continued for more than a month or two. How common is it for someone to be on such a high dose for three years? Should my mother insist that her doctor take her off this medication?

Fifty thousand units a week is frequently given for eight to 12 weeks in people with significant deficiency in vitamin D, and people often then are switched to a daily dose of 1,000 to 2,000 IU. However, some people prefer a weekly dose, and 10,000 to 20,000 would be the usual dose.

Perhaps 10% to 20% of the time, in my experience, people do need higher doses, and 50,000 is not unheard of. Some people have a genetic condition requiring high doses.

However, this dosing should be guided by blood levels, and I certainly would feel better knowing that your mother has had her level measured if continuing this high dose.

My daughter gives her 3-year-old daughter fizzy water daily. All her water bottles and sippy cups are filled with some kind of carbonated water. My granddaughter’s appetite seems to have decreased. Could this be caused by the fizzy water? Is it harmful to her stomach?

I don’t recommend carbonated water for babies or small children. The dissolved gas in the water can distend the stomach, causing cramps, and that gas has to come out, meaning burps or flatulence.

The sense of distention in the stomach might be causing her to eat less, as well. Stick to tap or bottled water in reasonable amounts.

Dr. Keith Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. © 2019 North America Synd., Inc.

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