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Dear Dr. Roach: Three weeks ago, I had a comprehensive exam. , I am a 53-year-old man and in good health. I have no complaints. I am quite active and able to hold my own in basketball games with my 16-year-old son and his friends.

Nothing was found on the exam. My lab tests were good, except for a high blood calcium. The doctor thinks it might be my parathyroid glands. I know nothing about them or what they do. Will I need surgery?

J.M.

Dear J.M.: The parathyroid glands are four small glands plastered to the back of the thyroid gland in the lower neck. Their job is regulating blood calcium. If calcium dips, these glands release parathyroid hormone, which removes calcium from bone to restore the blood calcium level.

A rise in blood calcium is an indication one of these glands is making too much parathyroid hormone. Since the calcium is taken from bones, one of the signs of an overactive gland — hyperparathyroidism — is bone weakening. A second complication is kidney stones. Weakness and fatigue are other symptoms.

Like most people who have a high blood calcium you have no symptoms. Close to 80 percent of those with hyperparathyroidism in its early stages have none .

Surgery is the ultimate answer for this condition. All those with signs of high calcium need surgery. Doctors recommend surgery for all those younger than 50. If the calcium is 1 mg/dl (0.25 mmol/L) higher than normal, surgery is advised. If hyperparathyroidism is harming the kidneys or bones, that’s another indication for surgery.

For those older with no symptoms, surgery can be deferred. Your doctor will follow you to see if your calcium level is rising or if you are developing symptoms; you might never do so. You can keep things from worsening by staying active and drinking lots of fluids. Fluids prevent kidney-stone formation.

Dear Dr. Roach: I am 77 and in good health. My resting heart rate has been 28 to 34 for many years. My family doctor seemed unconcerned. He retired, and his replacement has tried to get me to see a heart doctor.

A few weeks ago, my heart rate rose to the 60 to 70 range. The only thing that has changed is some of my eating habits. I drink in excess of 10 cups of coffee a day. Any thoughts?

J.S.

Dear J.S.: You take in a lot of caffeine. It can increase the heart rate, but the effect is usually transient. I side with your new doctor. Your former rate was incredibly low, far lower than that of highly conditioned athletes. I believe you should consult a heart doctor. The rise might be only a temporary thing. Something might be wrong in the way your natural pacemaker functions.

Email questions to ToYourGoodHealth@med.cornell.edu.

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