DEAR DR. DONOHUE: I am between a rock and a hard place. I have a bulging (ruptured) disk in my lower back. I have been very active, running marathons, playing tennis and skiing. My orthopedic doctor suggests a spine operation that entails fusion of the backbones. My family doctor feels surgery won’t allow me to live a normal life. What should I do? – D.E.

ANSWER: Disks are shock-absorbing devices sandwiched between adjacent backbones. They have a tough, outer ring and a soft, gelatinous core. A “bulging or ruptured” disk is one whose inner core protrudes through the outer ring, and it might impinge on nerves emerging from the spinal cord. The result can be no pain, back pain, or pain in the back, buttocks and legs.

Not every bulging disk needs an operation. Quite a few fix themselves, given time.

Indications for surgery include progressive back-muscle weakness; disturbed control of the urinary bladder or the bowels; incapacitating pain that does not respond to four weeks of conservative treatment; or pain that goes away but comes back again, and more severe.

The choice of operation depends on how large the protrusion is, how many nerves are involved and how stable or unstable the spine is. One standard operation consists of removing only a fragment of a vertebra along with the protruding part of the disk. Such an operation heals rather quickly and does not impose great limitations on most of those who have it.

Fusion entails locking adjacent vertebrae together to form a single unit. That’s done to provide stability to the back. Only the doctor who performs the operation is the one who has to set activity limits after such surgery. Not all people who have had fused backs have to greatly limit their lifestyle.

You need a second opinion – not from me, but from a surgeon who can examine you. Bringing in a second mind is bringing in a fresh breath of air, and no one’s feelings will be hurt by doing so.

The back booklet outlines the causes and treatments of many back ailments. Readers can obtain a copy by writing: Dr. Donohue – No. 303, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.50 U.S./$6.50 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I went in with my husband, who is 80 years of age, to see his doctor. I told the doctor that my husband stops breathing for up to 17 seconds at a time during the night. He then starts breathing again.

He was checked for sleep apnea, and he has it.

My husband says he doesn’t have it and refuses to take the treatment. Please tell me what I can expect from this. He tires easily now. – M.B.

ANSWER: Sleep apnea is periods of no breathing that last 10 seconds or more during sleep. Usually the involved person is a snorer whose snoring grows louder and louder up to the point when breathing stops, and then the music of the night suddenly ceases. Breathing resumes with a grunt.

Sleep apnea can lead to heart problems. It can raise blood pressure. It can also cause a rise in the lungs’ blood pressure, a matter quite different from ordinary high blood pressure and one that causes many serious complications.

It also disturbs normal sleep. Even though your husband might not know what is happening while he’s asleep, apnea fragments his sleep and leaves him tired during the day.

Treatment is not terribly onerous. It consists of wearing a mask that delivers pressurized air to the lungs during sleep.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.