DEAR DR. DONOHUE: Recently my doctor referred me to an ENT doctor because my calcium was elevated and so was my parathyroid hormone. The ENT doctor ordered a 24-hour urine test and found elevated calcium there, too. The doctors think I have a slow-growing tumor of one of my parathyroid glands. I have a sestamibi test yet to take and have tentative surgery scheduled. I read that lots of people don’t know that they have this condition and that it can be watched for years if you’re without symptoms. Would you recommend surgery? I’m in my 50s. — R.

ANSWER: The parathyroid glands are four small glands (about .24 inches long, .12 inches wide and .08 inches thick), located in the neck behind the thyroid gland. Parathyroid hormone, the hormone they make, regulates the blood level of calcium. It keeps it in a fairly narrow range.

When one (or possibly more) of the glands overproduces its hormone, calcium levels rise and complications can occur. Among those complications are kidney stones, stomach and duodenal ulcers, and osteoporosis. Osteoporosis occurs because parathyroid hormone takes calcium from bones.

Removal of the overproducing gland cures the condition.

However, it is true that a number of people with hyperparathyroidism have no symptoms. If these symptomless people are older and are suffering no complications, they can be watched.

A person’s age (younger people are advised to have surgery, and 50 is considered young), the blood level of calcium, the level of parathyroid hormone and the appearance of any of the complications of too much calcium are major considerations for surgical treatment. In some hospitals, the gland is removed through minimally invasive surgery.

A sestamibi scan spotlights which of the four glands is acting up.

For you, I would recommend surgery.

DEAR DR. DONOHUE: I have restless leg syndrome. Is there anything I can do to ease these episodes that happen almost always at night? I’d appreciate your thoughts on the subject. — M.F.

ANSWER: You and almost one-fifth of the elderly population contend with restless leg syndrome. It’s a sensation of pins and needles or of a creepy-crawly feeling in the legs. It comes on mostly in the evening when sitting or when lying in bed. The feeling also can be achy, burning or stabbing sensations.

Restless legs make a person get up and move about. Movement temporarily suppresses the discomfort the syndrome brings. People can be wakened from sleep by restless legs.

Cut back on the use of caffeine and alcohol. A warm bath followed by a leg massage in the evening sometimes can keep restless legs at bay. Medicines such as Mirapex, Requip, Neurontin and Horizant are effective for some patients.

DEAR DR. DONOHUE: I am an 82-year-old male with type 2 diabetes. I take metformin, which keeps my sugar well regulated but causes severe bowel upset. Is there any medicine that can replace metformin? My doctor said he knows of no replacement. — L.R.

ANSWER: Metformin (Glucophage) is only one of many oral medicines used for control of type 2 diabetes. Glucotrol, Amaryl, DiaBeta and Glyset are some of the other oral type 2 diabetes medicines.

Maybe your doctor said that metformin has done such a splendid job for you that he didn’t want to mess up your blood sugar control by switching you to another drug. Did the doctor ever suggest supplying you with a medicine that could take care of the intestinal upset?

I guess all this depends on just how great your gastrointestinal distress is. If it is truly unbearable, then a trial of another medicine definitely is in order.

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.