DEAR DR. DONOHUE: I am a 69-year-old woman and take simvastatin and alendronate. I was feeling really tired. My muscles and joints hurt. I told my doctor, and he cut the dose of simvastatin. I was still tired and hurting, so I stopped all meds. I now feel a lot better. My doctor says I need to stay on simvastatin because of family history. What would you suggest? — M.V.

ANSWER: My first suggestion is to try to come to peace terms with your doctor. He prescribed simvastatin (Zocor) because your cholesterol is high and because members of your family have had heart attacks. The goal of cholesterol control is a total cholesterol of less than 200 mg/dL (5.19 mmol/L). Your LDL cholesterol — bad cholesterol, the kind that does the most artery-clogging — is considered optimal when it’s less than 100 mg/dL (2.58 mmol/L). Lowering cholesterol and LDL cholesterol is made possible with weight loss, daily exercise, decreasing saturated fats (red meats, whole-fat dairy products) and adopting a diet emphasizing vegetables, fruits, olive oil, whole grains and two fish meals a week. Whole grains are grains that haven’t been refined; they retain all their parts, including their outer coat, the bran. Exercise is 30 minutes on most days of the week. Walking is acceptable.

If, on this program, your cholesterol and LDL cholesterol rise, then you have to consider medicines. Simvastatin is one of seven related medicines. You might be able to tolerate one of the other six better than simvastatin. And if that doesn’t pan out, cholesterol-lowering drugs completely unrelated to simvastatin might bring your numbers down. Those medicines include Questran, Colestid, Welchol and Zetia.

The doctor put you on alendronate (Fosamax) for osteoporosis. If you stopped alendronate, it, too, belongs to a large family of drugs, and you might benefit from one of those medicines. Or you might tolerate unrelated osteoporosis medicines like Prolia or Forteo. Be sure to get enough calcium — 1,000 to 1,200 mg a day, along with vitamin D, 600 to 800 IU a day. Exercise is as important for osteoporosis as it is for heart health.

Coronary artery disease due partly to high cholesterol is the No. 1 health problem in this part of the world. The booklet on it describes how it comes about and how it’s treated. To obtain a copy, write: Dr. Donohue — No. 101, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: My doctor told me I had E. coli, and that it’s something women get. What is it? What causes it? — M.M.

ANSWER: E. coli isn’t an illness; it’s a bacterium, a germ. Its full name is Escherichia (ESH-uh-REEK-ee-uh) coli. But let’s keep it E. coli.

It’s a common cause of urinary-tract infections. Women are particularly susceptible to such infections because their urethra, the tube that drains the urinary bladder, is much shorter than men’s. Bacteria can ascend into the bladder much more easily in women than in men. Signs of bladder infection are pain on urinating and frequent urination.

E. coli causes other illnesses, too. Diarrhea and food poisoning are two other E. coli infections.

And it can live harmlessly in the colon. As long as it stays there, all is well. If it finds its way to other body sites, it brings trouble.

DEAR DR. DONOHUE: I take many pills. My thought is that if you take all of these pills at one time, they mix together. How are you getting benefits from them if they are mixing in your stomach? Should I take one pill at different times? — C.H.

ANSWER: Some medicines are incompatible with each other, not so much because they mix but because one can block the action of the other. Unless your doctor or pharmacist tells you to take your medicines at different times, you can take them at the same time. If you have any doubts, check with your doctor. If you had to take each pill at a different time, your whole day would be devoted to pill swallowing.

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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