DEAR DR. DONOHUE: I am a 68-year-old man who has had a high blood calcium level for a number of years. The last reading was 11.1 mg/dL (2.8 mmol/L). My doc thinks I might need parathyroid-gland surgery. What’s this all about? What is the parathyroid? Why can’t I just cut back on calcium? – R.F.

ANSWER: Grab the lower part of your neck as though you were going to choke yourself. You have your hands around your thyroid gland. Behind the thyroid gland and stuck to its backside are four parathyroid glands – small glands that regulate the blood calcium level. The normal blood calcium level lies between 9.0 and 10.5 (2.2-2.6). Yours is a bit high.

Parathyroid-gland hormone coaxes calcium out of bone and into the blood. It also increases the absorption of calcium from the digestive tract and slows its disposal into the urine.

Prolonged high levels of calcium can lead to fatigue and weakness and might cause memory problems. They often lead to osteoporosis. They can cause kidney stones. They can also damage the kidneys by encasing them in a calcium shell.

The usual cause of all this is a noncancerous enlargement of one of the parathyroid glands. That can be detected by a scan of those glands.

Quite often, hyperparathyroidism – an overabundant production of parathyroid hormone – progresses very slowly, and quite often treatment can be safely put off. Considerations that call for a prompt surgical attack include a young age (less than 50), evidence of osteoporosis, a high level of urine calcium, or a blood calcium level that stays elevated to more than 1 mg (0.25 mmol) above normal for a long time. Naturally, if a person has symptoms, that is another reason for surgery.

Restricting calcium in your diet won’t work. In fact, it makes matters worse.

DEAR DR. DONOHUE: You wrote about trigeminal neuralgia some time ago. I have it very bad and need to know what you have to say about it. Will you repeat the information? – M.N.

ANSWER: The trigeminal (try-JIM-in-ul) nerve transmits sensations from the face to the brain. Trigeminal neuralgia is a malfunction of that nerve that causes repetitive, brief but intense paroxysms of intolerable pain on one side of the face. The attacks can come out of the blue, or such innocent acts as shaving, chewing or talking or even a light breeze touching the cheek can spark an attack. Even though attacks are brief, they are so violent that a person spends every waking minute living in fear of the next wave of pain.

Usually the cause is a wearing away of the insulation that surrounds the nerve. Often that occurs at the spot where the nerve leaves the brain, where a blood vessel wraps around it. The pulsation of the blood vessel can fray the nerve insulation.

Medicines used to control seizures can often control trigeminal-neuralgia pain. Tegretol, Dilantin and Neurontin are examples of such medicines.

Another treatment is destruction of the pain-carrying fibers of the nerve. That can be achieved with radio-frequency waves, with injections of substances like glycerol, or by balloon compression of the nerve.

A surgical technique has brought many patients relief. It entails placing a spongelike material between the nerve and the encircling blood vessel. The sponge absorbs the pulsations of the vessel on the nerve.

DEAR DR. DONOHUE: I am in a dilemma as to whether I need a cataract operation. My ophthalmologist recommends a cataract operation on both my eyes. My vision is pretty good. I can read a newspaper, drive and read street signs a quarter block away. I am 81. What do you advise? – J.R.

ANSWER: Ask your doctor why the rush to surgery. It is the patient, not the doctor, who usually requests it. And the patient does so when sight is so affected that it is difficult to perform the daily chores of life. You sound like you are doing quite well. If no answer is forthcoming, get a second opinion.

DEAR DR. DONOHUE: I have recently developed a condition that doctor calls bullous pemphigoid.

Can you tell me what causes it, how to treat it and how to get rid of it? Is there a cure? – D.B.

ANSWER: Bullous pemphigoid usually happens to people older than 60. At its onset, the skin breaks out in blotches that look like hives. They can itch severely. In a matter of weeks, the hives turn into blisters that break open, weep and then heal. Outbreaks are most commonly seen on the skin of the lower abdomen, the groin, the arms and the legs. Sometimes they occur in the mouth.

The cause is an antibody attack on skin cells. What prompts the immune system to generate antibodies that besiege skin cells is something waiting for an explanation.

“Cure” is too strong a word to use when speaking of this condition. Control, however, is possible. Atarax, an antihistamine, is often prescribed for itching. In mild cases, cortisone creams and ointments can be applied to the skin.

For more stubborn cases, doctors turn to the family of oral cortisone medicines. Often they are used in combination with azathioprine or cyclophosphamide, which can turn off the immune attack.

For many bullous pemphigoid patients, the process resolves in five to six years.

DEAR DR. DONOHUE: I have amyloidosis, and I can’t find any information on it. How will this affect me in the future? I am 82. – B.L.

ANSWER: I wish I could give you a direct answer, but amyloidosis is not one disease. There are many varieties, and each has its own prognosis. Amyloid is an abnormal protein that seeps into many tissues and organs. It looks like lava from a volcano. The prognosis depends on how widespread the process is, which organs and tissues are affected and if there are any amyloid-associated illnesses involved.

Those illnesses include rheumatoid arthritis and the cancer multiple myeloma.

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.