DEAR DR. DONOHUE: I have a herniated disk that is causing me pain and forcing me to walk with a cane. For long distances I have to use a wheelchair. I am 69. What are my options besides surgery, which I am not even considering? – J.R.

ANSWER: One option is physical therapy. Has a therapist outlined a program for you to keep your back muscles limber and to strengthen them? The therapist will also instruct you in applying heat and cold, which can go a long way toward easing the muscle spasms that are secondary to irritation caused by a herniated disk.

Pain control is another important aspect of treatment. The pain of a herniated disk does not come entirely from the disk pressing on spinal nerves. It also comes from pain-inciting substances generated by the bulging disk, and from muscle spasms. A muscle relaxant like cyclobenzaprine, along with pain relievers, can make many back sufferers more mobile.

Has anyone suggested to you epidural steroids? “Steroids” in this situation refers to cortisone drugs. When they are injected into the epidural space – a region above the spinal cord – they soothe inflamed nerves and tissues and often bring relief to people suffering back pain from a herniated disk.

Although not yet widely used, Botox – botulinum toxin – can untwist the contorted back muscles caused by a disk pressing on back nerves. Whether this treatment gains approval, only time will tell.

Don’t rule out surgery completely. In addition to standard surgical operations, there are newer techniques employing small incisions through which the bulging disk can be removed piecemeal with the help of a scope and special instruments. One such procedure is called a microdiskectomy. You have several options.

The back-pain booklet gives a lengthy exposition of this common problem and its treatments. 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 $4.75 U.S./6.75 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I went to the doctor, and he said I have cataracts. I would like to know if cataracts would go away by themselves, or do they always progress? What are they? – M.

ANSWER: Every person alive at this very moment will develop a cataract if he or she lives long enough. About half of all adults between the ages of 53 and 64 have the beginnings of one, and most of those over 75 have one. In spite of such facts, few of these people will ever need cataract surgery.

Cataracts are a clouding of the eye lens, which is behind the pupil and which focuses light on the retina. With age, proteins seep into the eye lens. The process continues throughout life, but it is a slow process, and it often does not interfere with vision.

Only when a cataract makes things look so fuzzy that it’s hard to read, drive a car or watch TV does the clouded lens need to be removed. There are no alternatives to surgery.

Wearing sunglasses won’t make a cataract go away, but it can slow the process. Ultraviolet light plays a major role in cataract formation. You can’t buy just any old pair of sunglasses. You must get the kind that filters out ultraviolet light. That should be stated on the glasses.

DEAR DR. DONOHUE: I have had a sore on my left buttock for several years. I have enclosed a copy of the biopsy taken from the sore. What is it? Is there any treatment? – M.C.

ANSWER: The biopsy says the sore is lichen simplex and chronicus, a skin condition that itches terribly. Part of the cure involves a firm resistance against scratching. Cortisone creams and ointments can often dull the itch so scratching can come to an end. Have you tried a cortisone product called Cordran tape? It’s put over the sore. It delivers the medicine and serves as a protective barrier should the itch return and you automatically begin to scratch.

DEAR DR. DONOHUE: Could you explain what happens to a person in her 70s who might have water on the brain? I have never heard of someone that age as having it. I though it happened only in newborns. What causes it? Could her children get it? – I.H.

ANSWER: Adult water on the brain is called normal pressure hydrocephalus. It happens mostly to people over 70 and results from a block in the reabsorption pathway of cerebrospinal fluid, the fluid that bathes the brain and spinal cord and circulates within the hollow brain caverns. The increased fluid volume compresses brain tissue and leads to three prominent symptoms: dementia, ataxia and urinary incontinence.

Dementia is a fall-off in mental function and memory. Ataxia is uncoordinated walking. People shuffle and stumble. They have a hard time lifting their feet off the ground. Urinary incontinence is the loss of bladder control.

The condition can result from a prior brain infection or from a blow to the head, or can arise without any identifiable cause.

Shunting of fluid from the brain to the abdomen though a very small-bore tube brings a reversal of symptoms to many.

DEAR DR. DONOHUE: Do people without a gallbladder produce bile? – G.S.

ANSWER: The gallbladder is the storage tank for bile made by the liver. People without a gallbladder still make bile. Instead of being stored in the gallbladder, which empties after a fatty meal, bile drips into the digestive tract from the liver on a constant basis. Bile aids in fat digestion. Without a gallbladder, people still digest fat.

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. Readers may also order health newsletters from www.rbmamall.com.