Richard L. Bruno is chairperson of the International Post-Polio Task Force and director of The Post-Polio Institute at Englewood Hospital and Medical Center. Please e-mail questions directly to him at ppsforum@newmobility.com.

Note: This column is for information purposes only and is not intended as a substitute for professional medical advice.

Q: I have high cholesterol and my doctor wants me to take a cholesterol lowering drug, Lipitor. I said no because of the reports I have read that cholesterol lowering drugs cause muscle weakness in polio survivors. Should polio survivors take cholesterol lowering drugs?

A: The issue of cholesterol lowering drugs hurting polio survivors has been blown way out of proportion. The buzz in the post-polio community is that muscles break down in polio survivors taking cholesterol lowering drugs. But there have been no specific studies of the effects of these drugs on polio survivors. Only about one-half of 1 percent of everyone who takes a statin cholesterol lowering drug, such as Lipitor, get rhabdomyelisis, a condition where muscles do indeed break down. Muscle breakdown appears to be no more frequent in polio survivors but would obviously do them more harm.

If you are on a statin drug and you feel any muscle pain, especially in your calf muscles, stop the drug immediately and call your doctor. If you are worried about taking statin drugs, ask you doctor if you can use slow-acting niacin or a bile acid sequestrant drug to lower your cholesterol.

But there is more to managing high cholesterol than taking a pill. In May 2001 new federal guidelines were issued to lower cholesterol and prevent heart attack and stroke. The guidelines include measuring cholesterol every five years, increasing HDL "good" cholesterol while lowering both LDL "bad" cholesterol and triglycerides, treating high blood pressure, stopping cigarette smoking as well as getting more people on cholesterol-lowering medications.

Weight control and physical activity are also recommended. But while weight control both lowers the "bad" cholesterol and raises the "good," increasing physical activity--which also increases PPS symptoms-often only raises the "good" cholesterol. The guidelines suggest reducing saturated fat and dietary cholesterol while eating more foods high in soluble fiber, such as cereal grains, beans, peas, legumes, and fruits and vegetables. So following the Post-Polio Institute protein diet--consuming more protein (especially at breakfast), eating smaller portions, reducing carbohydrates and fats--plus eating more fruits and vegetables, is good for your neurons and your cholesterol. And it will help you lose weight even if your are less physically active.

Click here for the Post-Polio Institute diet.

Q: I had polio at age 11, was paralyzed from the neck down and recovered almost completely. I am 54 now and still able to go about as before. But for 10 years I have felt a tremor all over my body when I do too many things or even have to make too many decisions. Nowadays I feel the tremor more often. You have written about the resemblance of some PPS brain fatigue symptoms to Parkinson's disease. Am I developing Parkinson's or is my tremor a part of the PPS?

A: From research done 50 years ago we know that the poliovirus damaged the brain neurons that produce dopamine, the neurotransmitter that controls movement and activates the brain. Damage to dopamine neurons underlies Parkinson's disease as well, causing muscle rigidity and tremor as well as fatigue, difficulty in finding words, and trouble focusing attention--symptoms almost identical to those in polio survivors with "brain fatigue."

However, after 19 years of studying and treating PPS, we have found no higher rate of Parkinson's disease in polio survivors. Why? Because at least 70 percent of the dopamine neurons in the brain must be damaged for there to be tremor and rigidity, and almost all polio survivors lost fewer than 70 percent of their neurons and therefore do not have tremor later. But the combination of poliovirus damage and aging can produce an additional, smaller loss of dopamine neurons and cause brain fatigue symptoms in some polio survivors.

The whole-body tremor you describe is likely a symptom of overuse abuse--your muscles trembling because you are doing too much and tiring out your polio-damaged, overworked neurons. Our PPS patients also report trembling in muscles that are overused when they get emotionally or physically exhausted, and sometimes when they don't eat. So eat, pace your activities and rest before you start to shake and rattle.