DEAR DR. DONOHUE: I am an 83-year-old woman with a very bad cholesterol problem. When I take statin medicines, my arm and leg muscles ache. I tried Zetia, but it did nothing for me. I am also a heart patient. Is there any other medication that might help? Is it true that Metamucil might do some good? – R.E.

ANSWER: The statin medicines – Mevacor, Zocor, Pravachol, Lescol, Lipitor and Crestor – are the most potent cholesterol-lowering medicines available. If you cannot tolerate them, there are other ways of nudging cholesterol downward – maybe not as dramatically as the statins do, but any lowering is helpful. Niacin brings down LDL cholesterol and triglycerides. So do medicines like Questran, Colestid and WelChol.

Fiber lowers cholesterol. Metamucil and Perdiem contain the fiber psyllium. They not only help control cholesterol, but they keep you regular. Soluble fiber – the kind of fiber found in oats, barley, beans, citrus fruits and apples – brings cholesterol numbers down.

Regardless of the kind of cholesterol problem you have, diet almost always influences cholesterol. Limit the amount of saturated fat you eat. Saturated fat is the kind of fat that is solid at room temperature. The fat that surrounds and runs through cuts of meat is saturated fat. Dairy products like butter have saturated fat. You have to also watch trans fats. If a product’s label doesn’t state how much trans fat is in it but you see “hydrogenated oils,” you know you are dealing with trans fats. They’re used in many commercially prepared foods, including baked goods.

Your diet should be one with plenty of vegetables, fruits, whole grains and beans.

Is 83 too old to be concerned about cholesterol? It is if the 83-year-old has no great risk of heart disease. You say you are a heart patient, so you are at risk, and you still have to pay attention to your cholesterol level.

DEAR DR. DONOHUE: I have been on Fosamax since January. Should this alter the amount of calcium that I take each day? I take 700 mg a day. I eat a cup of plain yogurt every day too. – L.V.

ANSWER: Fosamax is an osteoporosis medicine that works by slowing down the daily destruction of bone that accelerates in osteoporosis. Taking it doesn’t change calcium requirements.

Adults should be taking 1,200 to 1,500 mg of calcium a day. One cup of plain yogurt has about 250 mg of calcium, so you are close to the 1,000 mark with your supplement and yogurt.

Don’t forget vitamin D, needed for calcium absorption. Those between the ages of 51 and 70 need 400 IU daily, and those older, 600 IU. Some experts feel that even these recommended doses are too low.

DEAR DR. DONOHUE: I am 84 years old and have been diagnosed with iron-deficiency anemia. My doctor requested that I have upper- and lower-GI X-rays. He says I am losing blood, since my blood count is low.

My question: Why can’t they treat me for the iron deficiency with iron first to see if it helps before putting me through these tests? – L.M.

ANSWER: No anemia should be treated without finding its cause. Blood is the principal source of body iron. Continuing to lose blood defeats iron supplementation. Even when you put more iron into the body, more than normal is coming out of it.

Furthermore, bleeding can be a sign of some very dangerous conditions. I don’t like to bring up such things, but you cannot ignore the possibility of a cancer that is bleeding.

Have the tests. They aren’t that difficult, and they could save your life.

DEAR DR. DONOHUE: For almost two years I had red blood cells in my urine. I had a scope exam of the bladder six months ago, and the doctor removed two benign tumors. However, the last urine test I had showed three red cells per HPF – whatever that means. Should I be concerned? – P.D.

ANSWER: The tech who examined your urine saw three red blood cells per high power field (HPF), the highest magnification on the microscope. The normal number is two or less. Whether that one extra cell is significant, your urologist is going to have to decide. He or she might want to do another scope exam of your bladder.

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.