Dear Dr. Gott: I went to an orthopaedic doctor for severe back pain and leg pain. After having tried physical therapy for eight weeks and all kinds of medications, he sent me to have an MRI. The finding was a herniated disc in the lumbar region. I began steroid injections and have had two so far. I was told they try three injections, and if this does not work, they recommend back surgery. They said the disc is pressing on my sciatic nerve and that is why the pain is so severe. I am 74 years old, and I want to know if I can keep getting injections without having surgery on my back.

Reply:>Three cortisone injections is usually the limit. If they are ineffective, you have exhausted your non-surgical options. To give you related information, I am sending you a copy of my Health Report "Managing Chronic Pain". Other readers who would like a copy of should send a long, self-addressed, stamped envelope and $2 to Newsletter, PO Box 167, Wickliffe, Ohio 44092. Be sure to mention the title.Dear Dr. GottB>My husband has a pilonidal cyst near his anus, which is quite painful. His doctor has offered suggestions such as warm soaks and rubbing it gently. When my husband mentions to his doctor it is still bothering him a lot, the doctor just says he could have it cut out, but he doesn't seem to take any interest in my husband's problem anymore. Any suggestions?

ReplPilonidal cysts are hairy lumps at the base of the spine. They usually are related to an opening on the skin's surface, leading to infection. If they cause no pain, they can be ignored. If there is discomfort or drainage, however, surgery would be appropriate. I believe surgery is your husband's best option at this point. I recommend that he seek the advice of a general surgeon.

To give you related information, I am sending you a copy of my Health Report "An Informed Approach to Surgery". Be sure to mention the title. Dear Dr. Go You recommended that a reader with chest pains go to the emergency room. Please go to the library and get the Ladies' Home Journal. They are encouraging ALL their readers to protest and write to them because 1.) ERs are closing nationwide and 2.) ERs are turning people and ambulances away. Please check it out. Re: Chest pain can reflect an acute coronary syndrome or a heart attack that needs to be addressed as an emergency in a hospital setting. With all due respect to the Ladies' Home Journal, they are treading on thin ice. Although it's true that ERs are being overutilised (in large part because of patients with trivial complaints such as colds), chest pain is a valid reason to seek ER attention.

Dr. Gott is a retired physician and the author of the new book "Dr. Gott's No Flour, No Sugar Diet". Contact him c/o United Media, 200 Madison Avenue, fourth floor., New York, New York 16.