DEAR DR. ROACH: It would be helpful if you described some of the warning signs/symptoms of a bad hip that requires replacement. I now know that such a condition does not necessarily announce itself with chronic severe pain in the hip. Indeed, what sent me to the doctor was a recurrent pain in my groin. My hip was relatively pain-free and even then I had only a mild discomfort that I thought was simply some arthritis. What I failed to appreciate over the past few years was the very gradual loss of my range of motion, leading to difficulty with simple activities, such as tying my right shoe or cutting my toenails. In retrospect, I feel rather foolish that I did not realize sooner that I was having hip problems. Perhaps you can alert others to the signs of gradual hip degeneration that fall short of acute hip pain. — B.A.

ANSWER: You have done a lot of the work for me. The groin is the most common location for pain from hip osteoarthritis, but other locations — especially pelvis and knee — all can be coming from the hip. We suspect arthritis when pain is worse after activity and improves with rest. But it is the range of motion and pain with movement that we as internists look for on exam to help us decide whether the complaints are likely from the hip joint or from another location. Pain is common with internal rotation (such as placing the outside of your ankle on the opposite knee and letting the elevated knee fall to the side). I think the main message is that pain in the hip or groin, especially if worse with exercise, suggests arthritis, and an X-ray can confirm the diagnosis.

The arthritis booklet discusses rheumatoid arthritis, osteoarthritis and lupus. Readers can order a copy by writing: Dr. Roach — No. 301, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. ROACH: I was diagnosed with beta thalassemia about 10 years ago. My blood tests keep showing that I’m anemic, but I’m not. My blood count was 11. My red blood cells are misshapen and smaller than normal. The only reason thalassemia was diagnosed was because I had a Middle Eastern doctor who was familiar with the condition.

I am always tired and lethargic. Do you think there could be a connection? — S.M.

ANSWER: The thalassemias are a group of diseases related by the reduced or absent production of one or more of the four globulin chains that compose hemoglobin. There are two alpha and two beta chains. Beta thalassemia is a reduction in the beta chains. With no beta chains (thalassemia major), the disease is evident early in childhood, requiring frequent transfusions. By contrast, beta thalassemia minor, also called beta thalassemia trait, is just a reduction in the amount of beta chains, and people with this condition have variable severity of disease. Many people have a mild anemia, only discovered with a blood count obtained for some other reason.

The normal hemoglobin level depends a bit on the laboratory, but is generally around 12-16 g/dL for women and 13-18 for men. A level of 11 g/dL, like yours, is definitely an anemia. If a woman is normally 16 and suddenly drops to 11, she is likely to have symptoms; however, there are usually no symptoms with so mild a low hemoglobin level if it is chronic. There are unusual red cells seen by microscopy, especially “target” cells, that give a clue to the diagnosis. Electrophoresis is the best way to be sure of the diagnosis.

I think your symptoms of fatigue and lethargy are unlikely to be from your thalassemia, and your doctor needs to evaluate this further.

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 [email protected] or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from

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