DEAR DR. DONOHUE: I am an 81-year-old woman diagnosed with a torn rotator cuff. They’re talking about surgery, but I heard that it sometimes leaves you worse off. That makes me totally afraid of it. What can I do to avoid it? The pain is not too bad during the day, but when I go to bed, it hurts a lot. – N.L.

ANSWER: The rotator cuff consists of four tendons coming from back muscles. They loop around the top part of the upper arm bone, which has a ball shape. The ball fits into a hollow depression in the shoulder, and the rotator cuff keeps the ball in the shoulder depression. It does look like a shirt cuff encircling the wrist. (The rotator cuff is unbuttoned.)

Tears of the rotator cuff come from shoulder injuries or from age-related wear. They are very common and account for millions of doctor visits annually.

If the tear is small, nonsurgical treatments can be considered. For the night pain that comes with such shoulder injuries, propping up the shoulder with a pillow when you sleep on your back often eliminates the pain. Physical therapy keeps the shoulder limber. Gentle stretching and strengthening exercises can rehabilitate the shoulder. These are done under the supervision of a physical medicine doctor or a physical therapist. Anti-inflammatory medicines – Advil, Ibuprofen, Aleve – also diminish pain.

For large tears or for pain that persists, you shouldn’t hesitate to seek a surgical solution. Surgery is much more often a success than a failure. Sometimes it can be done through a small incision and with a scope.

Take the nonsurgical route for a while and see what happens.

DEAR DR. DONOHUE: My mother has advanced cancer and isn’t expected to live much longer. She knows this and is prepared for it.

She is in constant pain even when she takes narcotic painkillers. Her doctor has suggested massage therapy. Does that make sense to you? – B.K.

ANSWER: Yes, it does. Massage has given pain relief to many who are in a situation like your mother’s. The doctor has to be in contact with the therapist so massage techniques can be modified if the cancer has spread to bone or if the patient has osteoporosis. Since the doctor suggested it, I say it’s worth a trial.

DEAR DR. DONOHUE: In reference to a drug whose generic name is ximelagatran and whose brand name is Exanta, can you say when it will be on the market? I look for its appearance. – E.G.

ANSWER: Exanta was developed to take the place of the blood thinner Coumadin. Coumadin is not a convenient drug to take. Users have to have frequent blood tests. No tests are required of Exanta users.

For the present, Exanta has been put on a back shelf because in trials it caused liver injury in some. If that obstacle can be overcome, it will be a boon for those who must be on blood-thinning medicine.

DEAR DR. DONOHUE: Every time I hear chalk squeak on a blackboard, I get chills down my arms. Why? – K.L.

ANSWER: It’s a common reaction, and I don’t know why it happens. Perhaps the noise is similar to a noise made by animals in our ancestors’ era, and it was a signal for them to take flight. (I made that up.)

DEAR DR. DONOHUE: My daughter and her husband have tried to have children and have gone through the usual fertility tests.

Can infertility be inherited? It seems to run in our family. – J.M.

ANSWER: Between 10 percent and 15 percent of couples face a fertility problem. In some instances, infertility might be influenced by heritable factors, but they’re not the primary cause for most cases.

Infertility is defined as one full year of trying to have a child without success.

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.

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