DEAR DR. GOTT: I am an active 50-year-old man with chronic shoulder pain. My doctor, a sports-medicine surgeon, wants to remove the bursa sac and maintains that the sac is not necessary. Because I would like to remain active — especially in the gym — I am skeptical.

DEAR READER: A bursa is defined as a small, fluid-filled sac whose purpose is to reduce friction between bodily tissues. There are 160 bursae throughout the body, all of which are located in areas of large joints, such as the knees, elbows, hips and shoulders. The main symptom of bursitis of the shoulder is severe pain, primarily on movement. Causes include arthritis, infection, injury to the site or, most likely in your case, overuse.

Symptoms are commonly treated by resting the affected joint, and with cold packs, anti-inflammatory over-the-counter medications, heat once any swelling disappears and antibiotic therapy for infection. Some cases don't respond to simple treatment and require aspiration of the bursa fluid. This procedure is commonly performed in a physician's office and may be followed by a cortisone injection into the affected area.

When inflammation in the subacromial bursa adds to pain experienced, the lubricating sack is often removed by a surgeon in a procedure known as bursectomy or debridement. Generally speaking, recovery is rapid, because range-of-motion exercises are begun soon after surgery in an attempt to accelerate rehabilitation.

Now comes the difficult part. You need to sit down with your specialist and explain that you want to remain physically active. Determine how long you might anticipate the recovery period to last and whether there will likely be any unwanted side effects. Your surgeon knows your case and should be able to predict the outcome based on your general health. Ask whether he plans to do arthroscopy, which will be less invasive and require less recuperation rather than make a larger incision, which will take longer to heal. You might also feel more comfortable requesting a second opinion.

To provide related information, I am sending you a copy of my Health Report "An Informed Approach to Surgery." Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

DEAR DR. GOTT: I have been on your No Flour, No Sugar diet since last July, and so far have lost 40 pounds. I recently found a millet and flax bread. It is made with millet flour and brown-rice flour. Is it acceptable on your diet? If not, that's OK because I don't crave bread anymore. This is the easiest diet I have ever been on.

DEAR READER: If a product contains flour, then it isn't acceptable. I recommend sprouted grain or organic sprouted whole grain and seed breads that don't contain flour.

Millet flour is a gluten-free product made from grain. It resembles wheat but is superior in terms of content. A single serving has 15 percent of the RDA of iron, and is high in potassium, magnesium and B vitamins.

Brown-rice flour is gluten-free 100 percent ground-rice grain. The "flour" is ground from un-hulled rice kernels and is used as a flour substitute in many recipes. Because of the natural fats and oils in the grain, it has a tendency to turn rancid rather rapidly, so small amounts are commonly purchased to avoid spoilage.