day 6 of hip pain in dd8, what would you do now, any doctors out there?

[piratecat]

I am following on from my other thread on this posted beginning of last week.

DD's hip is STILL awful, but although i havebeen to gp twice and A+E once late last wednesday, and given calpol and ibuprofen it's still hurting.

We are booked for an xray on thurs. I am totally stressed out becuase i have no idea what's causing this , although the visit to a+e (where they sort of looked at me like i was mad) said the following

1. could be bursitis.
2. wasn't infection (which of course is good)

GP number one, said 'might be to do with her clicky hip' but can't tell. I'll get her an appt for orthopedics ( this is end of feckin june)

GP number 2 said, 'it could be inflamed', just give her the anti inflammatories.

On searching around, there is talk of post viral things that can affect hips, knees etc.. DD had a flare up of some sort on her vagina/labia in the preceeding 5 days to this hip thing. Not diagnosed as thrush, or bacterial, but after 2 days they gave her v strong penicillin anyway.

we are oficially pissed off and feeling helpless here.

Gp 2 said if it's not got any worse send her bacl to school on monday. well it's not got any better so what do i do ffs.

sorry am just totally fed up now of seeingher in pain.

pain gets worse on lifting to say get in bed, or in car or up stairs. so have had to carry her alot. Two nights ago the pain was coming like contractions for one hour.

any doctors out there???????

I agree, frustrating though the doc sounds (probably an SHO) you should take her up on the referrals - if it's not too late now.

FYI:
Rheumatology (physical medicine)
Sometimes called orthopaedic physicians, rheumatologists deal with the non-surgical treatment of bone, joint, muscle and the systems involved in locomotion. They work closely with physiotherapists (one of the professions allied to medicine) who are not medically qualified but have their own system of professional training. Rheumatologists also work closely with orthopaedic surgeons (qv). Both may be involved in sports medicine and the consequences and injuries relating to physical training.

Orthopaedics
The surgery of bones, joints and locomotion, working closely with rheumatologists (qv). Trauma is often combined with orthopaedics; a trauma surgeon deals with the consequences of physical injury not only to bones but also to soft tissue. Trauma surgery is to be distinguished from elective orthopaedics, which may be sub-divided into broad areas or individual organs, eg foot, hand and back surgery. Fracture management is a sub-specialty within trauma surgery. Orthopaedic surgeons may be involved, with rheumatologists, in sports medicine and the consequences of physical training injuries. Spinal surgery is sometimes undertaken by orthopaedic surgeons and sometimes by neurosurgeons.

HTH.

I think that continual use of some painkillers can be counterproductive - I remember seeing that over-use of ibuprofen can have a side-effect of headaches (which, since I was using it for ongoing migraine, was counterproductive). I don't agree with that doc's pronouncement though, especially as it can take up to half an hour for the pain-relief to kick in.

I agree with Blu re standard osteopaths/chiropractors - if the cause is hypermobility then they could equally be counterproductive.

I had a client who had extreme hypermobility and kept dislocating her shoulders - when she was an adult (they had to wait that long, sorry!) she was given a type of surgery on the joint to "shrink" the ligaments and make them tighter, stopping her shoulders from dislocating all the time. She was on medical doses of marijuana for pain - she got them from somewhere in Wales, but I think he has been closed down (certainly they've attempted to close him down) - obviously I wouldn't recommend your DD go onto marijuana, just explaining the level of pain relief this girl needed to go to for managing her pain.

Very long post, sorry!

Agree with others: grab a referral to a rheumatologist if you can get it!!!

We did use a chiropractor for a while, but I don't think that really helped- and it did probably cause some extra strain.

As for resistance to painkillers, I am not so sure of that. We have been told the opposite: that ds has to keep taking the painkillers regularly to get the full effect. However, ds says it still doesn't help, and I have great doubts about keeping a 10yo on permanent high doses of painkillers, so we try to get by on cuddles and sympathy.

cory - does warmth help? Have you tried an infrared lamp? Just asking because I know an elderly lady who used it on her osteoarthritic neck and back and it seemed to help - I realise the conditions are utterly different but if warmth does help it might be worth looking into?

hi,yes we do have that orthopedics appt at the end of june. I guess i shuold just go to everything? so confusing.

There is also a ultrasound scan booked by orthopedics man, on june 2nd. Yet, doc we saw theother night said no point to go to it as mri showed nothing?

go to everything you have been offered, including the ultrasound. An ultrasound is not going to hurt, nor cause any problems, so might as well get it done. It gives them more information, even if it's showing what it isn't, and they are still in the dark so every little helps.

ok, will go to all appts, and just feign idiocy, as i havent been actually told otherwise.

thanks thumb.

Go to every appointment and keep repeating "do you think we should see a rheumatologist?". If it is Ehlers Danlos/hypermobility, then the rheum (if competent) should be able to diagnose that, and your dd will need that diagnosis to get help at school and elsewhere.

hiya, the arsey jumped up doc form yesterday, has written in our discharge notes that she has reffered dd to physio, and to rheumatologist. I told her about what you had said Cory, and she said well i don't thik it will help, but i will refer you if you want. So i said yes do that.

Now, the Ehlers Danlos/hypermobility thing is interesting.

One of the symptoms/ponters it stretchy skin. DD doesn't have this, BUT ex dh, dd's dad had this skin thing. You could pull his skin away from his body, by about 1- 11/2inches. It was as tho the actual skin wasn't stuck to the fat underneath!! Not that he had much as he was super skinny. Could be a connection?

That sounds definitely interesting, piratecat. Ehlers Danlos syndrome is hereditary: apparently you have a 50% chance to pass it on to your children. However, all the symptoms will not necessarily show up in every person who has inherited the syndrome. But the fact that there is another close relative with Ehlers Danlos traits is definitely another thing to mention.

I would go back to your GP now and say:

"I have been thinking it over and there are some reasons why I think dd's problems may be due to a connective tissue disorder such as hypermobility syndrome: she has very mobile joints and her dad has stretchy skin which is another symptom. As I know this is a hereditary disorder, could you be so kind as to refer us to a rheumatologist, so it can at least be ruled out."

If for some reason you don't want to say this to your GP, say it to the orthopaedics person or whoever. But it would be good to get those wheels moving.

yes, we are being reffered,to a rheumatologist, becuase of you flagging it up for me the other day cory.

I am also on the lax side with my ligaments etc... Having had spd in pg which still niggles me and dd is now 8. I always thought dd was hypermobile cos of me.

Ehlers DAnlos is what my client had, the one who had her shoulders done. I couldn't remember the name of the condition until you typed it, Cory, and I recognised it.

Just popped in on this thread and really sorry to hear about your experiences in the health system for your daughter.

Felt prompted to post by Blu's comment "unless you have been referred for physio for a known condition, I would leave it - physio can actually make some things worse, and if there isn;t a dx, then what is the physio for?"

As a physio who specialises in children with various orthopaedic and musculoskeletal conditions, I'm afraid that comment made me slightly fume
I often see children in pain where the underlying diagnosis is still unclear; part of my input often then aids diagnosis e.g. by a full assessment of joint mobility, muscle control function and also taking into account other 'stressors' that may be contributing to the pain state. Good physio should never "make things worse" - and pain can be relieved, minds reassured and recovery can begin in the absence of the magical "diagnosis". Of course, that doesn't mean we aren't always conscious that there may be an underlying problem, but this shouldn't be a reason to not consider physio at this stage.

Sorry - physio rant over - just wanted to air my point of view that I would request a physio referral, ideally to a paeds physio, as this may well be what's recommended in the end and you may as well get started now.

Wish you and your daughter well soon

pushki, thanks there for your advice, that makes me feel that physio is indeed a good thing to look into. It's good to hear also, that other kids coem to you with things undiagnosed, but 'real' iyswim.

I was getting the impression that becase they couldn't find anything with theri tests, they thought there was nothing wrong, when clearly there is!

Piratecat, yes a lot of children do have 'unexplained' pains - and sometimes the search for the diagnosis can get in the way of starting some useful management of their pain. The generation of pain is so unique to each individual - and sometimes a seemingly trivial injury, stress, can escalate into disabling, severe pain, whch of course is very worrying when t is your child. Mixed messages and poor communication from often well meaning health professionals often just causes increased anxiety and in he middle of it is a child in pain who wants some reassurance things can get better.

So - it's reassuring that her investigations have been normal although you may feel frustrated by this! I hope that you manage to see a physio who has the right background to help - a paeds physio will be best, as sometimes physios who don't see children often will panic and just cause more worry if they don't have a good understanding of pain in children. Good luck

Hi Piratecat,
I have just come across this thread and would like to help. My DS had a problem with his knee, which swelled up and he couldn't put any weight on it. We had six months of going to different doctors who couldn't find anything. It is hugely worrying.
He had an MRI, an ultrasound, x-rays and blood tests, even investigative keyhole surgery. Eventually we were referred to a rheumatologist, who was furious with the delay at diagnosis.
My Ds is hypermobile too, and he was treated with a steroid injection under general anaesthetic, he is going to have physio and orthotics in his trainers and should be fine now. He has a form of juvenile arthritis - it sounds scary but can often be a one off thing and the majority of kids grow out of it in adulthood.
I would strongly suggest you see a rheumatologist.