Question
Hello Sharon:
I am an otherwise-healthy 47 year old. For the last several years I have experienced moderate pain in my right hip at night (I always end up sleeping on my right side). It will awaken me and then I'll roll onto my back. The pain will quickly subside, usually in 10 minutes or less. Then I'll fall back asleep and not awaken until I end up on my right side again. This has never been a real problem until just recently. Now the hip hurts constantly, making even sitting down at work painful. The pain is in the outside of the hip and is constant unless I take an Aspirin/Acetaminophen combination en masse, which I know is bad. The obvious next step is an orthopedic specialist - but I was hoping you could give me a bit of your experience and expertise before I further consider that step. Do you think it will "go away" on its own? Thanks for your input. RSP, Seattle


Answer
Hi Ron

Wow, this is a hard one to start my day off.  My gut reaction is to go to your primary physican first. I don't know what your health insurance does in the way of referrals, or if you can just go straight to an orthopedist.

The reason I dont suggest an orthopedist first is becuase surgeons, operate.  I sort of give this analogy.  If your only tool is a hammer, everything looks like a nail.  Many orthopedists don't know of any other way to attack arthritis pain other than to operate.  In fact, I have just found I have my disease in my knees as well as my hips.  My orthopedist is the best surgeon in the world, but wants to operate and do a procedure that won't work on me because my immune system is low and my healing is compromised.  So the surgery won't work.  I'll eventually need a knee replacement but I don't want it yet.

Back to your problem, if you go to an internist, or family practictioner, they can send you for an X ray or MRI and once you figure out what the problem is, then you can start with the ortho guys.  Does your hip hurt when you walk on it?  The first sign of AVN, or arthritis is pain when you walk.  If you don't have pain when you walk or move, you probably have some sort of bruise.  By the time arthritis is hurting when you sleep or rest, it's usually time to replace the joint.  But again, you have to get that opinion from your ortho should you go to one.

Please be careful with the Tylenol.  Many doctors are very bad with pain meds becuase they fear addiction of the patients.  The problem with that is that there are many reports out now that state the fact that when people are being treated for pain, they do not become addicts.  They only take the amount of drugs needed to function at their daily routines.  You might want to try alleve or motrin for your pain as long as you don't have any bleeding problems.  Those drugs are anti inflammatories and if you overdo those, you can bleed or develop ulcers.  The tylenol can attack your liver if you take too much.  Don't take more than 6 tylenol 500 mgs tabs in a day. That's toxic.

Since your pain is on the outside of the hip, it does not sound like arthritis. Normally when a person has arthritis of the hip, the pain is in the groin, and it's a horrible pain.  If you have bursitis, they might want to inject you with cortisone to alleve the pain.  I can't stomach the idea of a cortisone shot in a joint, but those who get them, swear by them.

Please keep me updated as to what the diagnosis is, and I wish you the best of luck.

Sharon