DEAR DRS. DONOHUE AND ROACH: What is the best way to get rid of tonsil stones, besides sticking my finger down my throat as far as I can and trying to dislodge the smelly things? More importantly, what is the way to prevent tonsil stones? I never had them until a year or so ago. — S.M.

ANSWER: Tonsil stones, or tonsilloliths, are the not uncommon (one study reported them in 7 percent of young adults) but seldom discussed clusters of calcified material that lodge in the tonsils. Your tonsils, those oval-shaped swellings on the sides of the back of your throat, are important for the cells of the immune system.

Tonsilloliths form in the crypts (deep valleys) of the tonsil, and sometimes are visible as white or yellow spots when looking in the mirror. They become bothersome if they are large enough to cause discomfort or difficulty swallowing, but often they are noticed because of their unpleasant odor. Tonsilloliths often spontaneously come out of the tonsils; they usually are described as waxy or hard, with a peculiar odor.

I don’t recommend sticking your finger in the back of your throat. The gag reflex can be very strong, and the tonsils have a very good blood supply, so damaging them can be very bloody. Some authorities recommend removal using the tongue attachment of a Waterpik (or similar device), but I have had general success with saltwater gargles. Very large or recurrent tonsilloliths are an indication for a visit to the ENT doctor.

DEAR DRS. DONOHUE AND ROACH: I am writing to see if the medicine I get in the United States is the same that I get from India. I took Evista by Eli Lilly, who says there is no generic; however, my supplier from India says there is a generic. — A.O.

ANSWER: India has no patent protection of medications, so many Indian companies make versions of U.S. pharmacologic drugs at greatly reduced cost. Some of the companies are exceedingly reputable, and the drugs are identical. However, you don’t have the guarantee of purity that comes with government regulation of pharmaceuticals in the United States and Canada. While I understand wanting to save money on an expensive medication, you’re taking a risk.

TO READERS: Questions about breast cancer and its treatment are found in the booklet on that subject. To obtain a copy, write: Dr. Donohue — No. 1101, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DRS. DONOHUE AND ROACH: I came down with a bout of Bell’s palsy a few years ago. My problem is that it didn’t totally leave. So I’m left with very limited movement on the right side of my face. I do facial exercises daily in hopes of regaining the lost movement. I use a portable stimulator on my face. Yet I have a partially paralyzed face. I would like to know if there’s something else I could do to correct this. And I’d like to know if acupuncture would help. — L.M.

ANSWER: Bell’s palsy is, as you have described, the loss of the ability to move the muscles on one side of the face. It can be caused by a virus, but the exact cause is not certain.

Treatment works if it is begun promptly, but most people with Bell’s palsy recover within a year. For those people who, like you, have not recovered within a year, I don’t know of any treatment that is effective in improving function. Acupuncture has not had beneficial effect. Since Bell’s palsy can affect the eyelid, a visit with an ophthalmologist is a good idea for people with persistent facial weakness, in order to protect the eye.

Drs. Donohue and Roach regret that they are unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may write the doctors or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers also may order health newsletters from www.rbmamall.com.

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