DEAR DR. ROACH: I’m a healthy female in my mid-70s. I’ve taken the recommended calcium citrate with vitamin D for years, until about three months ago, when test results showed I have slightly higher than normal calcium levels. I stopped the calcium, but testing results were the same three months later. Since women have been advised to take calcium, especially as we age, this is quite a surprise. — M.T.

ANSWER: Most of the calcium in the body is locked away in the bones. The body has several systems to carefully regulate the calcium level in the blood. The two most powerful of these are vitamin D and parathyroid hormone. Abnormalities in either of these can cause problems in blood calcium levels, which is very dangerous, because it can affect the muscles. A very low blood calcium level causes tetany, severe cramping and inability to move muscles normally (tetanus is an infectious disease that causes muscle cramps via an entirely different pathway).

With low calcium intake, blood calcium remains normal or near normal, but the calcium in the bones is depleted. That’s why adequate calcium intake is important in the prevention and treatment of osteoporosis. Calcium through the diet is preferred to calcium via supplements, because supplements increase the risk of kidney stones and may increase the risk of heart disease.

High levels of blood calcium are more likely to be due to excess parathyroid hormone than high vitamin D (which is very uncommon). With the body systems working normally, excess dietary calcium is simply excreted by the kidneys.

Since the most likely cause for high calcium is an excess of parathyroid hormone, often made by a benign tumor of the parathyroid gland, your doctor should test your parathyroid hormone level.

The osteoporosis pamphlet furnishes details on calcium intake and how it affects bones. Readers can obtain a copy by writing:

Dr. Roach

Book No. 1104

628 Virginia Dr.

Orlando, FL 32803

Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name address. Please allow four weeks for delivery.

DEAR DR. ROACH: In December 2014 and again this fall, my stool specimens have shown blood. I’ve had a colonoscopy and endoscopy both times. Results show no abnormalities or bleeding. I do drink an energy drink in the morning and have non-troubling hemorrhoids. Could either cause a false report?

I enjoy your column and am always delighted when I’m not the subject. — M.T.

ANSWER: A stool test is looking for evidence of blood in the stool. Hemorrhoids can cause a stool test to be positive. But even though it’s a true positive (it IS showing blood), it is not the kind of positive we dread: colon cancer, nor a polyp, which is how colon cancer usually begins.

A false-positive means that there is no actual blood, and the test mistakenly states that there is. Eating raw vegetables before taking the stool sample is the most common cause of a false-positive test. I looked up the ingredients in your energy drink, and do not think it should cause a false-positive.

Experienced clinicians have learned not to accept a history of hemorrhoids (or even seeing hemorrhoids on physical exam) as the sole cause of a positive stool blood test, because people can have both hemorrhoids and colon polyps or colon cancer. A thorough evaluation, such as a colonoscopy, it still called for in people with stool testing positive for blood, even in those with a history of hemorrhoids.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall.com.

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