DEAR DR. GOTT: I follow your column in our local paper religiously, and your "No Flour-No Sugar" plan has made a big difference in the hypoglycemia condition that I seem to be prone to. Sadly, I don't stick to it nearly often enough.

More specifically, I am 65 and probably an alcoholic — the result of a lifetime of bad choices and a couple of bad marriages. I live (by choice) in a fairly remote part of Michigan's Upper Peninsula, where medical advice is hard to come by. I also have a history of oral cancer, despite not having smoked for more than 20 years. The only ENT doc available to me has decided that the "cut it out and biopsy it" approach every three months or so is the proper one.

While I quite understand that his approach is the most conservative one, I am barely healed up by the time I need to go see him again. A second opinion is not available to me up here, and I am truly miserable for the time it takes for my mouth to heal. Do you have any suggestions on an alternative approach?

DEAR READER: I was immediately struck by your straightforward, no-nonsense summation. It is both healthful and refreshing. Let's take things a step at a time. My approach to weight loss expects that you might falter. That's the beauty of it. If you choose to go out for a great pasta dinner, do it. There shouldn't be any guilt involved, but simply a wish to diversify briefly. You can get back on track and take up where your diet left off. Unfortunately, pounds have a way of creeping back on rather quickly, so it's important you don't splurge too often.

If you think you "may be" an alcoholic, you probably are. People often feel they are stuck in a rut. It becomes quite easy to pick up a drink in an attempt to pass the day rather than think of taking a walk, sketching in a book, going bowling or playing a game of solitaire. However, even in remote areas of the country, there are AA meetings and support groups available if you are truly motivated.

Oral cancer can form in any part of the mouth. The risk of acquiring it increases with tobacco use, the consumption of alcohol, in males over the age of 40, for those with a family history; for those with HIV and those exposed to radiation.

A dentist may choose to perform a painless oral brush biopsy that involves taking a sample of tissue for analysis. If the tissue remains suspicious, a scalpel biopsy may be performed under local anesthesia that can be performed by a dentist or specialist. A surgeon may believe the best method of control is through surgery, such as you have had, perhaps followed by radiation, chemotherapy or a combination thereof.

Present these options to your surgeon or dentist for his or her review. If you disagree with what you are told, locate the nearest teaching hospital, make an appointment, get a second opinion and carry on from there. You've made it clear this will be an imposition because of your location, but you owe it to yourself.