I am hoping to be selected for the Health eVoice 2020 conference.
This would be such an honor.
Here is a short video
I am hoping to be selected for the Health eVoice 2020 conference.
This would be such an honor.
Here is a short video
Wow I am beyond honored I’ve now also been
Nominated for Patient Leader Hero- Healthcare Collaborator – Rookie of The Year and Best In Show Blog
Endorsements Now Open If You Would Like to Vote (link below)
I have been nominated for the past few years in various categories
Thank You for considering Endorsing my nominations
It’s deeply appreciated
When you have tried everything an all non-surgical treatments stop relieving your chronic hip pain, or your pain reaches debilitating levels, hip replacement surgery may be the best option to relieve your discomfort, restore your mobility and improve your quality of life.
Hip pain due to Osteonecrosis is an increasing problem for many.
After time over-the-counter pain medications can lose their efficacy and chronic hip pain can quickly escalate often requiring prescription medications, physical therapy, and the use of canes or walkers to aid mobility.
If your pain is severe and debilitating, isn’t it time to do something about it.
Talk to your Doctor or Orthopedic because you don’t need to suffer and have a poor quality of life.
What Signs & Symptoms Indicate a Need for Hip Replacement Surgery?
Hip pain can have a number of causes, not all of which can be relieved by a hip joint replacement.
Among the listed causes of AVN are steroid use, trauma, hypertension, rheumatoid arthritis, and alcoholism, blood clot disorder, smoking, vasculitis Bisphosphonate use, Chemo or radiation or it could be idiopathic, meaning no cause can be determined. Certainly Napoli has had his share of wear and tear, being a catcher.
For instance, constant or long-lasting stiffness in your hip joint can be a sign of rheumatoid arthritis while pain that centers in the buttocks region and radiates down the leg may be related to sciatica.
However, many cases of hip pain and discomfort are directly related to your hip joint.
Symptoms and signs that it may be time for hip replacement surgery include:
• Mobility issues, especially if your level of mobility progressively worsens
• Persistent or recurring pain, swelling or discomfort in your hip
• Hip pain that worsens during rainy weather
• Inability to sleep due to hip pain and discomfort
• A “grating” feeling in your hip joint
• Increasing difficulty in climbing stairs or getting in and out of cars, bathtubs, and chairs
• OTC medications no longer effectively manage your hip pain
If you have any or all of these symptoms, talk to an orthopedic surgeon about the possible need for hip replacement surgery.
How Is a Diagnosis Made?
To determine if you are a good candidate for hip replacement surgery, you will need a thorough examination by an experienced orthopedic surgeon. This examination will include:
• A complete medical history evaluation, including any previous injuries or illnesses that could be contributing to your pain
• A physical assessment to determine your range of motion, pain level and the strength of your affected hip
Your orthopedic surgeon may also order additional medical testing, including MRIs and X-rays. If your surgeon decides that the next step is hip replacement surgery, be sure to discuss any questions or concerns you have about the surgery or recovery from hip replacement surgery.
What Do You Need to Know About Hip Replacement Surgical Procedures?
Potential candidates for hip replacement surgery need to know that the surgery is a time-tested procedure that has been used successfully for more than four decades to relieve chronic hip pain and improve both flexibility and mobility. More than 300,000 Americans opt for hip replacement surgery each year to rid themselves of hip pain and improve their quality of life.
Total hip replacement surgery, or total hip arthroplasty, uses a ball and socket prosthetic joint to replace your damaged one. Special metals, such as cobalt-chromium and titanium, and polyethylene plastics, are used to make your prosthetic joints. These materials are safe for use inside the body and are extremely durable and long lasting.
The procedure for your total hip replacement surgery will most likely include the following steps:
1 Separating your femur from your hip socket
2 Removing the damaged ball from the femur
3 Removing your damaged bone and cartilage
4 Inserting a metal shell into your pelvic bone socket and using bone grafting material to secure it
5 Completing the artificial socket by adding the plastic liner
6 Preparing your femur to receive the metal implant
7 Placing the metal implant into the hollowed end of your femur
8 Attaching a metal ball component to the stem
Hip replacement surgery is a very effective procedure, and most patients experience a dramatic reduction in pain and improvements in their mobility and stamina. With the proper recovery procedures and physical therapy, you should be able to enjoy walking, swimming, biking and other low-impact activities without impediment.
If you can no longer bare the pain or have problems walking talk to your ortho about your options.
We’re praying for you
I need you to help me get to my goal
I have started a petition to get the rare disease Osteonecrosis recognized by asking for an awareness month week or day. If they won’t allow a month.
I could use as many supporters as possible to help me and share this.
No money at all is needed.
I hope you will help me raise awareness
Take Action: We Need Osteonecrosis Awareness To Have The Month Of October to Recognized & raise awareness #Osteonecrosis #AvascularNecrosis please help and sign and share
Or copy and paste
To President Donald Trump, The U.S. House and The U.S. Senate
We, the patients of a rare disease called Osteonecrosis respectfully ask the United States of America in this petition to the US Congress to pass legislation to establish and recognize October as Osteonecrosis Awareness Month in the United States.
The people of the United States are called upon to observe the month of October with appropriate educational and awareness opportunities, and recognition.
With hundreds of thousands of US residents suffering from this disease and more being diagnosed everyday , there is a need for this community to have an active voice and recognition.
It is happening in all age groups from child to elderly
Osteonecrosis, also known as Avascular necrosis (AVN), aseptic necrosis or ischemic bone necrosis, is a disease resulting in the death of bone cells. If the process involves the bones near a joint, it often leads to collapse of the joint surface and subsequent debilitating often crippling arthritis due to an irregular joint surface.
Although it can happen in any bone, osteonecrosis most commonly affects the ends (epiphysis) of long bones such as the femur (thigh bone). Commonly involved bones are the upper femur (ball part of the hip socket) the lower femur (a part of the knee joint), the upper humerus (upper arm bone involving the shoulder joint), and the bones of ankle joint. The disease may affect just one bone, more than one bone at the same time, or more than one bone at different times.
Osteonecrosis can cause severe pain and disability. Early diagnosis and early treatment may improve the outcome.
Osteonecrosis may result from use of glucocorticoid (sometimes called corticosteroid) medicine or from drinking too much alcohol but there are many causes and also some that are unknown.
Though osteonecrosis can occur in almost any bone of the body, the hips, knees,ankle and shoulders are the most common sites affected.
The cause and treatment for osteonecrosis of the jaw differs from that for osteonecrosis found elsewhere.
The most common causes of osteonecrosis are:
Serious trauma to bone or joint (injury), which interrupts a bone’s blood supply
Corticosteroid medications (such as prednisone, cortisone or methylprednisolone), mainly when a high dose is used for a prolonged period of time
Excess alcohol consumption
Systemic lupus erythematosus
Other risk factors for osteonecrosis include:
Decompression disease (also called the “Bends” that can occur with scuba diving)
Blood disorders such as sickle cell anemia, antiphospholipid antibody syndrome (APS) and lupus anticoagulant, factor v leiden, and others
HIV infection (the virus that causes AIDS)
Radiation and Chemotherapy
Bisphosphonates, which may be linked to osteonecrosis of the jaw
Osteonecrosis is not life-threatening, but it is debilitating and hurts our quality of life. Although it isn’t well-known and its exact cause is unknown, AVN-ON affects 10,000-to-20,000 Americans annually. Between 30 and 60 percent of patients will experience AVN-ON bi-laterally, which means both sides so if one hip or knee has it most likely so will the other.
Please help those of us that suffer from this condition by creating more research , funding studies and allowing us the recognition, as only through education, research and awareness can we get better treatment options, earlier diagnosis and hopefully prevention.
We are #rare!!
Celebrate You’re Rare
Osteonecrosis – Avascular Necrosis -Aseptic Necrosis-Ischemic Necrosis-Bone Infarction- has many different names and causes.In children its Legg Calves Perthes.
They all mean – A Loss of blood supply to the bone which may lead to bone cell death and can be caused by an injury (meniscal tear -bone fracture or joint dislocation; called traumatic osteonecrosis).
There may be no history of injury (non-traumatic osteonecrosis); however, other risk factors are associated with the disease such as some medications (steroids, also known as corticosteroids), alcohol usage or blood coagulation disorders. Increased pressure within the bone also is associated with osteonecrosis.
One theory is that the pressure within the bone causes the blood vessels to narrow, making it difficult for blood to circulate through the bone. Osteonecrosis can also be associated with other disorders. The exact reason osteonecrosis develops is not fully understood for some risk factors.
Sometimes, osteonecrosis occurs in people with no risk factors (idiopathic). Some people have multiple risk factors. Osteonecrosis most likely develops because of the combination of factors, possibly including genetic, metabolic, self-imposed (alcohol, smoking), and other diseases that you may have and their treatment.
When a joint any joint hip,knee, shoulder, ankle, elbow is injured, as in a fracture or dislocation, meniscus tear the blood vessels may be damaged.
This can interfere with the blood circulation to the bone and lead to trauma-related osteonecrosis.
Studies suggest that this type of osteonecrosis may develop in more than 20% of people who dislocate their hip joint.
Corticosteroids, such as prednisone, are commonly used to treat diseases in which there is inflammation, such as systemic lupus erythematosus, rheumatoid arthritis, inflammatory bowel disease, and vasculitis. Studies suggest that long-term, high dose systemic (oral or intravenous) corticosteroid use is a major risk factor for non-traumatic osteonecrosis with reports of up to 35 percent of all people with non-traumatic osteonecrosis.
And corticosteroids come in many versions – inhaled and ingested corticosteroids for asthma-cold-sinus problems or steroid injections into joints, topical for skin-
Patients should discuss concerns about corticosteroid use with their doctor.
Doctors aren’t sure exactly why the use of corticosteroids sometimes is associated with osteonecrosis. They may have negative effects on different organs and tissues within the body. For example, they may interfere with the body’s ability to build new bones and to break down fatty substances.
These substances would then build up in and clog the blood vessels, causing them to narrow. This then would reduce the ability of blood to flow inside a bone.
Excessive alcohol use is another major risk factor for non-traumatic osteonecrosis. Studies have reported that alcohol accounts for about 30% of all people with non-traumatic osteonecrosis. While alcohol can slow down bone remodeling (the balance between forming new bone and removing bone), it is not known why or how alcohol can trigger osteonecrosis.
Other Risk Factors:
Other risk factors or conditions associated with non-traumatic osteonecrosis include Gaucher disease, pancreatitis, autoimmune disease, cancer, HIV infection, decompression disease (Caisson disease), and blood disorders such as sickle cell disease. Certain medical treatments including radiation treatments and chemotherapy can cause osteonecrosis. People who have received a kidney or other organ transplant may also have an increased risk.
Osteonecrosis usually affects people between 30 and 50 years of age; about 10,000 to 20,000 people develop osteonecrosis each year in the United States.
Osteonecrosis affects both men and women and affects people of all ages. It is most common among people in their thirties and forties.
Depending on a person’s risk factors and whether the underlying cause is trauma, it also can affect younger or older people.
Some Symptoms of the disorders listed below may be similar to those of osteonecrosis. Comparisons may be useful for a differential diagnosis:
Osteopetrosis is a combination of several rare genetically caused symptoms grouped together as one disorder. It can be inherited and is marked by increased bone density, brittle bones, and, in some people, skeletal abnormalities. Although symptoms may not initially be apparent to people with mild forms of this disorder, trivial injuries may cause bone fractures due to abnormalities of the bone. The dominantly transmitted form is milder than the recessive form and may not be diagnosed until adolescence or adulthood when symptoms first appear. More serious complications occur in the recessive form which may be diagnosed from examination of skeletal x-rays during infancy or childhood. (For more information on this disorder, choose “Osteopetrosis” as your search term in the Rare Disease Database.)
Reflex sympathetic dystrophy syndrome (RSDS), also known as complex regional pain syndrome, is a rare disorder of the sympathetic nervous system that is characterized by chronic and severe pain. The sympathetic nervous system is that part of the autonomic nervous system that regulates involuntary functions of the body such as increasing heart rate, constricting blood vessels, and increasing blood pressure. Excessive or abnormal responses of portions of the sympathetic nervous system are thought to be responsible for the pain associated with reflex sympathetic dystrophy syndrome. The symptoms of RSDS typically begin with burning pain, especially in an arm, finger(s), palm of the hand(s), and/or shoulder(s). In some individuals, RSDS may occur in one or both legs or it may be localized to one knee or hip. Frequently, RSDS may be misdiagnosed as a painful nerve injury. The skin over the affected area(s) may become swollen (edema) and inflamed. Affected skin may be extremely sensitive to touch and to hot or cold temperatures (cutaneous hypersensitivity). The affected limb(s) may perspire excessively and be warm to the touch (vasomotor instability). The exact cause of RSDS is not fully understood, although it may be associated with injury to the nerves, trauma, surgery, atherosclerotic cardiovascular disease, infection, or radiation therapy. (For more information on this disorder, choose “reflex sympathetic dystrophy” as your search term in the Rare Disease Database.)
Legg-Calvé-Perthes disease (LCPD) is one of a group of disorders known as the osteochondroses. The osteochondroses typically are characterized by degeneration and subsequent regeneration of the growing end of a bone (epiphyses). In LCPD, the growing end of the upper portion of the thigh bone (femur) is affected. The upper section of the thigh bone is known as the head or “the ball” and connects to the hip in a depression or “socket”. This is the hip joint, which is a ball and socket joint. The disorder results from an unexplained interruption of the blood supply (ischemia) to the head of the femur, which causes degeneration and deformity of the femoral head. Symptoms may include a limp with or without pain in the hip, knee, thigh, and/or groin; muscle spasms; and/or limited or restricted movement of the affected hip. The disease process seems to be self-limiting as new blood supplies are established (revascularization) and new healthy bone forms (re-ossifies) in the affected area. The exact cause for the temporary interruption of blood flow to the femoral epiphysis is not fully understood. Most times the disorder appears to occur randomly for no apparent reason (sporadically).
Osteonecrosis-Avascular Necrosis -Broken Down
Osteonecrosis is the death of a segment of bone caused by an impaired blood supply. We all need an adequate blood supply to the bone other wise the bone can collapse and die. The blood supply to bone is delivered to the endosteal cavity by nutrient arteries, then flows through marrow sinusoids before exiting via numerous small vessels that ramify through the cortex. Reductions in vascular supply are associated with bone loss. Bones in our body are living tissue. They have their own blood vessels and are made of living cells, which help them to grow and to repair themselves. As well, proteins, minerals and vitamins make up the bone when you get to little blood flow the bone breaksdown much faster than it can repair and generate new bone.
This disorder can be caused by an injury or can occur spontaneously.
Typical symptoms include pain, limited range of motion of the affected joint, and, when the leg is affected, a limp.
The diagnosis is based on symptoms, the person’s risk of osteonecrosis, and the results of x-rays and magnetic resonance imaging.
Stopping smoking, stopping excessive alcohol use, and minimizing the use of or lowering the dose of corticosteroids reduce the risk of developing the disorder.
Various surgical procedures can be done if nonsurgical measures (such as rest, physical therapy, and pain relievers) do not relieve symptoms. Eat a healthy diet
Each year in the United States, about 20,000 people develop osteonecrosis. The hip is most commonly affected, followed by the knee and shoulder. The wrist and ankle are affected less often. Osteonecrosis does not usually affect the shoulder or other less commonly affected sites unless the hip is also affected. However, osteonecrosis of the jaw (ONJ) is a disorder involving only the jaw bone.
Osteonecrosis is not a specific disease but a condition in which death of the bone is confined to one or more specific (localized) areas. There are two general categories of osteonecrosis:Making it a rare disorder.
Traumatic (following an injury)
Traumatic osteonecrosis is the most common. The most frequent cause of traumatic osteonecrosis is a displaced fracture. In a displaced fracture, a bone breaks into two or more parts and moves so that the fractured ends are not lined up. The type of displaced fracture that causes osteonecrosis most often affects the hip (see Hip Fractures) and most commonly occurs in older people.
Another cause of traumatic osteonecrosis is a dislocation. A dislocation occurs when the ends of bones in joints become completely separated from each other, as in a hip dislocation.
A displaced fracture or a dislocation may damage the blood vessels supplying the upper end of the thighbone (the femoral head, part of the hip joint), resulting in death of this part of the bone. This death of bone occurs less often in other areas of the body.
Some Risk Factors for Osteonecrosis
Traumatic osteonecrosis- injury to bone or joint like meniscal tear -broken bones-dislocations etc…
Fractures (breaks in bones) and dislocations (when the ends of bones in joints become completely separated from each other)
Blood clotting (coagulation) disorders
Bone Marrow Edema
High level of lipids in the blood (hyperlipidemia)
Lupus and other autoimmune connective tissue disorders
Miscellaneous conditions (such as chronic kidney disease and rare genetic mutations)
Sickle cell disease
Nontraumatic osteonecrosis occurs without direct trauma or injury. This type may be caused by a disease or condition that results in the blockage of small blood vessels that supply certain areas of the bone. The areas most commonly affected are the femoral head (which is part of the hip joint), the knee, and the upper arm at the shoulder. This disorder occurs most commonly among men and people between the ages of 30 and 50 and often affects both hips or both shoulders. The most common causes are
Corticosteroids (when given at high doses, for long periods of time, or both)
Chronic, excessive alcohol use (more than 3 drinks a day for several years)
A number of other causes have been identified, but these occur much less often. These other causes include certain blood-clotting disorders, sickle cell disease, liver disease, tumors, Gaucher disease, radiation therapy, and decompression sickness (which occurs in divers who surface too quickly). A number of disorders that are treated with high doses of corticosteroids (such as lupus) also may be associated with osteonecrosis. In these cases, it may not be clear whether the cause is the disorder or the corticosteroids.
In about 20% of people with osteonecrosis, the cause is unknown.
If one bone has nontraumatic osteonecrosis, the same bone on the opposite side of the body sometimes has it also, even if there are no symptoms. For example, if one hip is affected, about 60% of the time the other hip is affected.
Spontaneous osteonecrosis of the knee (SPONK or SONK) can occur in older women (occasionally men) who have no specific risk factors for the disorder. SPONK differs from other forms of osteonecrosis. SPONK is thought to be caused by an insufficiency fracture. An insufficiency fracture is caused by normal wear and tear on bone that has been affected by osteoporosis. SPONK occurs without direct trauma or injury.
As osteonecrosis progresses, more and more tiny fractures may occur, particularly in bones that support weight, such as the hip. As a result, the bone usually collapses weeks or months after the blood supply is cut off. Most often pain develops gradually when the bone begins to collapse. At times, however, pain may begin suddenly and could be related to increased pressure that develops in and around the affected area of bone. Regardless of how sudden, pain is increased by moving the affected bone and typically is alleviated with rest. The person avoids moving the joint to minimize pain.
If the affected bone is in the leg, standing or walking worsens the pain and a limp develops.
In osteonecrosis of the hip, pain is usually present in the groin and may extend down the thigh or into the buttocks.
Spontaneous osteonecrosis of the knee causes sudden pain along the inner part of the knee. There may be tenderness in this area, and the joint often becomes swollen with excess fluid. Bending the knee may be painful, and people may have a limp.
Osteonecrosis of the shoulder often causes fewer symptoms than osteonecrosis that occurs in the hip or knee.
Osteoarthritis (damage to the cartilage covering the joint surfaces) develops over time, often after a large part of the bone collapses.
Magnetic resonance imaging
Because osteonecrosis is often painless at first, it may not be diagnosed in its earliest stages. Doctors suspect osteonecrosis in people who do not improve satisfactorily after having certain fractures. They also suspect the disorder in people who develop unexplained pain in the hip, knee, or shoulder, particularly if these people have risk factors for osteonecrosis.
X-rays of the affected area usually show osteonecrosis unless the disorder is in its earliest stages. If x-rays appear normal, however, magnetic resonance imaging (MRI) is usually done because it is the best test for detecting osteonecrosis early, before changes appear on ordinary x-rays. The x-rays and MRI also show whether the bone has collapsed, how advanced the disorder is, and whether the joint is affected by osteoarthritis. If doctors discover nontraumatic osteonecrosis in one hip, they also examine the other hip with an x-ray or MRI.
Blood tests may be done to detect an underlying disorder (such as a blood-clotting disorder).
To minimize the risk of osteonecrosis caused by corticosteroids, doctors use these drugs only when essential, prescribe them in as low a dose as needed, and prescribe them for as short a duration as possible.
To prevent osteonecrosis caused by decompression sickness, people should follow accepted rules for decompression during diving and when working in pressurized environments (see prevention of decompression sickness and see Diving Safety Precautions and Prevention of Diving Injuries).
Excessive alcohol use and smoking should be avoided.
Various drugs (such as those that prevent blood clots, dilate blood vessels, or lower lipid levels) are being evaluated for prevention of osteonecrosis in people at high risk.
Nonsurgical measures to relieve symptoms
Some areas affected by osteonecrosis need only nonsurgical measures to relieve symptoms. Other areas need to be treated with a surgical procedure.
Several nonsurgical measures are available for treating the symptoms caused by osteonecrosis. Taking anti-inflammatory drugs or other pain relievers, minimizing activity and stress (such as weight bearing for osteonecrosis of the hip and knee), and undergoing physical therapy are ways to relieve symptoms but not cure the disorder or change its course. These measures, however, may be adequate for treatment of the shoulder, the knee, spontaneous osteonecrosis of the knee, and small areas of osteonecrosis of the hip, which may spontaneously heal without treatment. Osteonecrosis heals without treatment in about 80% of people if the disorder is diagnosed early and if the affected area is small.
Spontaneous osteonecrosis of the knee is usually treated without surgery, and pain usually resolves.
There are a number of surgical procedures that slow or possibly prevent progression of the disorder. These procedures are done to preserve the joint and are most effective for treating early osteonecrosis, particularly of the hip, that has not yet progressed to bone collapse. If bone collapse has occurred, a type of joint replacement procedure may be done to decrease pain and improve function.
Core decompression, the simplest and most common of these procedures, involves drilling one or many small tracks or holes (perforations) into the area in an attempt to decrease pressure inside the bone. Core decompression often relieves pain and stimulates healing. In about 65% of people, the procedure can delay or prevent the need for total hip replacement. In younger people, core decompression may also be used even if a small amount of collapse already has taken place. The procedure is relatively simple, has a low rate of complications, and requires the use of crutches for about 6 weeks. Most people have satisfactory or good results overall. However, results for any particular person can be hard to predict. About 20 to 35% of people require a total hip replacement.
During core decompression, surgeons may inject a person’s own bone cells into the small hole or holes. This enhancement to the core decompression procedure may help heal the femoral head (which is part of the hip joint).
Bone grafting (transplanting bone from one site to another) is another procedure. For osteonecrosis of the hip, this can involve removing the dead area of bone and replacing it with more normal bone from elsewhere in the body. This graft supports the weakened area of bone and stimulates the body to form new, living bone in the affected area.
An osteotomy is another procedure designed to save the affected joint. This procedure is done particularly in the region of the hip and may be suitable for younger people in whom some degree of collapse already has occurred, which makes them poor candidates for core decompression or other procedures. Usually the osteonecrosis is in the weight-bearing area of the femoral head. An osteotomy changes the position of the bone so that the weight of the body is now supported by a normal area of the femoral head and not by the collapsed area.
Bone grafting and osteotomy are difficult procedures, however, and are not often done in the United States. They require a person to spend up to 6 months on crutches. These procedures are done only at selected centers that have the surgical experience and facilities to achieve the best results.
A total joint replacement is an effective procedure to relieve pain and restore motion if osteonecrosis has caused significant joint collapse and osteoarthritis. About 95% of people benefit from total replacement of the hip or knee (see Hip replacement). With modern techniques and devices, most daily activities can be resumed within 3 months and most joints should last more than 15 to 20 years.
In younger people with osteonecrosis, a total joint replacement may have to be revised (called revision surgery) or replaced at some later time. However, with modern devices, revision surgery has become much less common. Because total joint replacement is now so successful, there is much less need to do other procedures that replace part of the joint or remove the surface cartilage and place a cap on each bone end.
Occasionally, a partial or total replacement of an extremely painful knee or shoulder may be needed for advanced osteonecrosis that is not alleviated by nonsurgical treatment.
National Institute of Arthritis and Musculoskeletal and Skin Diseases
The first image at top of page I was given special permission to tweak it for rare disease awareness day
Click link below
To access link on cell press on above link and you will be re-directed to Booklet.
If on computer just click above link.
🌻 Hi, I’m Deborah Andio
I wrote this booklet in 2016 to help patients like myself and their families understand avascular necrosis- osteonecrosis and give helpful ideas to patients and help our doctors understand the pain we often feel.
My goal is throughout this booklet is to first let you know you are not alone .
Those who also have been diagnosed with avn know exactly how your feeling,scared, afraid, searching for knowledge and resources and coming up with very little.
That’s why I started a support group and wrote this booklet.
I give an actual copy to members of my support group. But many felt the information was so helpful, I wanted to share it with everyone.
I have recently completed a better spell check and next print will have all errors corrected.
No-one can use any contents of this booket words or graphics
Supprt Group Link Avascular Necrosis/ Osteonecrosis Support Int’l
Wishing you all a pain free and relaxing day
All rights reserved. Thia booklet on line or in print may not be reproduced in any form, stored in any retrieval system, or transmitted in any form by any means—electronic, mechanical, photocopy, recording, or otherwise—without prior written permission of the publisher, except as provided by United States of America copyright law. For permission requests, write to the author on this web site.