DEAR DR. DONOHUE: Will you please address the pros and cons of these two weight-loss methods: the Lap-Band and the over-the-counter fat-blocking pill orlistat, sold under the name Alli? – G.P.

ANSWER: Lap-Band is short for laparoscopic adjustable gastric banding. It’s an operation. Through small incisions in the abdomen, a surgeon inserts a viewing scope (laparoscope) and instruments with which he or she can encircle the top of the stomach with an adjustable band. That creates a small pouch for a stomach. People cannot eat large quantities of food. They fill up quickly. They lose weight.

The “pros” of this operation include a considerable weight loss, which brings protection against diabetes, high blood pressure and arthritic knees and hips. Cholesterol almost always drops.

The “cons” are the fact it is an operation, and all operations have the potential for complications. It requires anesthesia, another possible risk. The band might need readjusting down the road. There’s always a threat of infection from any surgical procedure.

Orlistat has been around for some time and is sold as the prescription drug Xenical. Alli can be obtained without a prescription. It contains a smaller dose of orlistat. This medicine inhibits the intestinal enzyme lipase, which breaks up fat so that it can be digested. Less fat is absorbed. Weight is lost. A major “pro” for Alli is not having to undergo surgery. Some “cons” are possible loose stools, an increase in gas and a decreased absorption of vitamins A, D, E and K, which require fat to pass into the blood. That can be remedied by taking those vitamins in pill form.

I cannot find a comparison between weight loss achieved with the Lap-Band and orlistat. It’s reasonable to assume that surgery is the winner.

Before considering either, people ought to make a concerted effort to lose weight through diet and exercise. Only if that combination fails should thoughts turn to an operation or a pill.

DEAR DR. DONOHUE: I am in my 80s and in good physical and mental health. On occasion, I run into “senior moments” – forgetting a name or a date. I mentioned this to my doctor and he, without any discussion, prescribed Aricept, which costs a great deal prior to an insurance discount. I found out that this medicine is for people with Alzheimer’s. I have no indication of that problem. If I take this medicine, will I develop a dependence on it and, should I stop taking it, will I end up with Alzheimer’s? – A.L.

ANSWER: Aricept doesn’t create dependence and it won’t lead to Alzheimer’s disease if you start taking it and then stop.

If you don’t need a medicine – any medicine – there’s no reason to commit to it. It sounds like your doctor made a rush to judgment. Why not let him know you’re not going to take it?

The Alzheimer’s pamphlet discusses the signs of and treatment for this disease. Readers can order a copy by writing: Dr. Donohue – No. 903, 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 am a 36-year-old male, and I have an umbilical hernia the size of a baseball. In addition, I am in the early stages of cirrhosis. Local doctors have declined to perform an operation because of a high risk of infection. Is there anything I can do at this time? – M.M.

ANSWER: Cirrhosis at any stage might slightly increase the risk of surgical infection, but not to the degree that necessary surgery can’t be done. Cirrhosis might also increase the risk of bleeding during surgery. You realize that livers are transplanted in patients who have advanced cirrhosis. Cirrhosis, therefore, doesn’t prohibit an operation.

You’re not a far drive from your state’s capital, where there is an excellent medical school. Contact its surgery department and make an appointment. I’m sure you’ll find a surgeon willing to correct your hernia.

DEAR DR. DONOHUE: Several months ago, I fell. X-rays indicate that I have arthritis in my left hip. When I resumed my exercise program, I had pain on raising my left leg about 12 inches off the ground. Do I increase or decrease my exercise? Is there a painkiller or vitamin I should take? – B.W.

ANSWER: Pain is a signal to stop doing whatever it is that causes it. Perhaps arthritis is the cause. A cause has to be found before continuing any exercise that brings it on. Don’t blunt the pain with medicines until you find the cause. Vitamins will not help.

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