DEAR DR. ROACH: I wanted to write after reading about a knee replacement in a recent column. I had a knee replacement, followed by physical therapy, but still had stiffness and pain requiring surgery. My friend recommended a massage therapist, and I had a dramatic benefit even after the first session. I continued massage, and the pain and stiffness went away. I had my other knee done years later, and it was a breeze.

I'm 91 now, but doing the knee replacements was the best thing I ever did for myself -- but thank goodness for the massage therapist! -- M.K.

ANSWER: I thank M.K. for writing and giving a useful resource. Studies have shown that people who get massage therapy improve their pain and swelling faster. However, not everyone has as good an outcome as M.K.'s.

DEAR DR. ROACH: How is HIV transmitted sexually? Is it possible to transmit HIV without penetration? -- S.B.

ANSWER: HIV is almost always spread through penetrative intercourse, either vaginal or anal. HIV is not particularly infectious, as far as sexually transmitted infections go.

For heterosexual couples, where one has HIV and the other does not, the risk is approximately one transmission of infection for 1,250 episodes of vaginal sex (for the woman) and one in 2,500 episodes (for the man). However, the presence of high amounts of virus in the blood (especially very early or very late in the infection) or other genital ulcers makes transmission more likely. Anal intercourse is also associated with much higher rates of infection. Without penetration, HIV transmission is unlikely but not impossible.

Using a latex condom dramatically reduces risk of transmission of HIV and other STIs.

DEAR DR. ROACH: I was diagnosed with hyperparathyroidism. Is this hereditary? -- C.B.

ANSWER: Hyperparathyroidism is a condition of excess parathyroid hormone caused by a benign tumor in the neck, and most cases are not hereditary. However, a very few cases are caused by abnormalities in the MEN gene (for "multiple endocrine neoplasia") or other genes.High levels of parathyroid hormone elevate the blood calcium level. The diagnosis is most often found on routine blood testing now. Symptoms of high calcium include kidney stones, bone pain, nausea and vomiting, and decreased concentration or confusion (memorized by generations of medical students as "stones, bones, abdominal groans and psychiatric overtones"). Surgery is the preferred treatment for people with symptoms, when the calcium is very high, and in younger people (younger than 50).

(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 http://www.rbmamall.com.)

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