Blog Posts and Ebooklet

Joint Pain

 Congratulations !  If you’re like me you are one of the 30 million adults in the United States who suffer with joint pain, you know the pain often is debilitating. It can keep you from staying active and limits your mobility and it even makes daily chores seem impossible. What you might not know is that many doctors can treat joint pain with more than just pills or surgery. Beware though some doctors will tell you about one procedure and then change it once they know your insurance example Medicare I felt one doctor thought less of me as a patient because I am disabled so he changed or tried to change the procedure. It pissed me off because I was all set to get the procedure we discussed and then he changed it.

Both procedures were covered under Medicare so I felt betrayed as if I wasn’t good enough for the other injection.

Newsflash …..people on Medicare pay for the insurance they have. It’s not free , hell I pay more for insurance than when I was working.

But thankfully Medicare is good coverage. Low deductible.

It’s some doctors that treat you like a second class citizen.

Make sure this doesn’t happen to you.

 

Depending on the severity of your pain, injections can be another option for easing your joint pain and help to get you moving again.

Doctors use these injections to try to reduce inflammation and pain in your joints some come with side effects and some risks.

The injections range from corticosteroids, which have been around for decades, to newer ortho-biologic injections like platelet-rich plasma (PRP) , Stem Cell and placental tissue matrix (PTM)

 

You and your physician will decide which one is best based on your individual needs. The issue is finding doctors qualified to do these.

Not every injection is right for every patient, in my case I hate steroid injections, not only did it make my pain worse it also comes with the risk of developing osteonecrosis. Something I already have. I have noticed that it seems like doctors are quick to prescribe and inject steroids. I stand my ground and refuse. But that’s me.

 

So here are some facts to help you know more about the options.

Corticosteroid injections

 

Use: This injection is the first line of defense against osteoarthritis symptoms and other joint pain in shoulders, knees and hips. Corticosteroids can offer relief for two to three months, and reduce inflammatory cell activity in the joint. In some people.

Side effects and Risks : As with all injections, there’s a small chance of infection about one in 1,000 as well as Joint infection.

Nerve damage.

Thinning of skin and soft tissue around the injection site.

Temporary flare of pain and inflammation in the joint.

Tendon weakening or rupture.

Thinning of nearby bone (osteoporosis)

Osteonecrosis lack of blood supply to the bone

Raised blood sugar level

Whitening or lightening of the skin around the injection site

Cost: Most insurance covers the $100 -$200 usd cost of these injections. Your insurance provider may require that you try at least one corticosteroid injection first to see whether it works. If not, you may move on to a different therapy.

 

Hyaluronic acid injections

Use: Hyaluronic acid (HA) injections often are used when corticosteroid injections don’t work. But they usually are approved only for use in the knee.

In some instances, doctors consider an HA injection first if you don’t have obvious signs of inflammation. HA also is a better option if you have diabetes, as corticosteroids can raise blood sugar levels.

Also known as gel injections, HA injections are chemically similar to your natural joint fluid.

When you have osteoarthritis which is different than osteonecrosis lucky me I have both, the joint fluid becomes watery.

So, this injection helps to restore the fluid’s natural properties and works as a lubricant and a shock absorber.

HA is a cushion or a buffer against inflammatory cells in the joint.  In some cases, it can stimulate the knee to start producing more natural HA.” Some physicians also believe that HA helps reduce pain by coating nerve endings within the joint.

One treatment, which may consist of between one and three injections, usually offers symptom relief for four to five months, but sometimes up to one years. However, pain and stiffness will return. Most insurance companies only approve one HA injection every six months.

In knees with osteoarthritis, the joint fluid (called synovial fluid) can break down and not provide the cushioning your knee needs

Durolane

Euflexxa

Hyalgan

Orthovisc

Monovisc

Supartz

Synvisc, Synvisc-One

Depending on which type your doctor uses, you may get a single shot. Or you’ll get three to five injections spaced a week apart.

 

Side effects: There’s a 1-in-100 chance of an inflammatory reaction, The most common short-term side effects are minor pain at the injection site and minor buildup of joint fluid. These get better within a few days.

 

Cost: HA injections cost more — about $300 to $850 per injection, but most insurance companies cover the cost for knee injections.

 

 

Platelet-rich plasma (PRP) injections

Use: Platelet-rich plasma (PRP) injections can treat osteoarthritis joint pain, and are being thoroughly researched to understand their effects.

These injections use your own blood and platelets to promote healing. Platelets contain growth factors and proteins that aid healing in soft tissues. Research shows PRP injections can alter the immune response to help reduce inflammation,

Side effects: Side effects include a very low risk of infection and pain at the injection site. You must stop oral anti-inflammatory medications for a short amount of time if you get a PRP injection.

Cost: Insurance companies don’t generally cover PRP injections and you will pay between $400 and $1,300 per injection out-of-pocket.

 

Stem Cell Injections

The world’s most advanced regenerative injection treatments for treating knee pain due to arthritis, meniscus tears, traumatic ligament injuries, overuse conditions and other degenerative conditions.

 

Side effects : mild discomfort associated with the procedure. There is a very small risk of infection whenever aspirations and injections are performed. Nerve damage, vessel damage, and injury to other important structures are exceedingly rare

 

Placental tissue matrix (PTM) injections

 

Use: Placental Tissue Matrix (PTM) injections can very profoundly decrease the pain related to osteoarthritis.

 

These are injections of placental tissue, which is obtained after a healthy baby is delivered from a healthy mother. Research has discovered that there is a large number of growth factors in placental tissue that promote healing, Dr. Genin says.

Side effects: Side effects include a  low risk of infection and pain at the injection site. The placental tissue is “immune privileged,” which means the body would not have an adverse reaction to it.

Cost: Insurance companies don’t generally cover PTM injections; you will pay around $1,800 -$2500 per injection out-of-pocket.

 

Many of these injections often are effective in reducing or stopping your joint pain, but it’s important to remember that they may not keep the pain from returning, Dr. Schaefer says. In fact, they’re most effective when used with other therapies.

 

As a patient who has Osteonecrosis, Osteoarthritis, and other stuff I consider surgical options as a last resort only if other treatment options have failed. Unfortunately some treatments I cannot even afford to try. I wish the FDA would get a move on and approve some things so insurance companies can have this as a form of treatment.

 

 

 

 

Stem Cells

 

BONE MARROW AND FAT CELLS

The stem cells used in this point of care clinic are Autologous Cells that we take from your own body.  These cells are taken from your own Bone Marrow or Fat Cells.  The cells are your own Stem Cells and will not be rejected by your body.

Taking the Bone Marrow or Fat Cells from your body is relatively painless as a mild local anesthetic is used prior to harvesting.  These cells are processed to receive the most stem cell gain and then injected into the area of your body where you need the growth factors to go to work the quickest.  Your blood is also drawn and your platelet rich plasma is added to the Stem Cells taken from your Bone Marrow or Fat Cells to increase the activity of the growth factors.

It is important that these cells are used the day they are extracted from your body in order to insure they remain alive and active.  Our clinic does not grow extra stem cells from your Bone Marrow or Fat Cells to ensure that they are alive and active.  It is an FDA requirement that you receive your cells the same day they are harvested.

You get only the stem cells we extract from your body and there is no other manipulation used except extraction and preparation of the samples taken from your own body.  The cells are taken in a procedure that creates only mild discomfort or none at all.  Ninety nine percent of our patients experience no pain obtaining bone marrow or fat cells.

CORD STEM CELLS:

Embryo and Placenta stem cells can create certain types of cancers.  The cord blood Stem Cells should only be used if they are obtained from a healthy relative and you are a good match.  Cord Stem Cells that are used outside of the country or shipped to this country are illegal.  The FDA has found diseases in these grown cells and states that most of them are dead.  Even though the physicians supplying these Cord Cells claim they are safe to use, you should use extreme caution before considering these procedures.

ARE YOU A CANDIDATE FOR THESE STEM CELL PROCEDURES

REBUILDING JOINTS & SPINE: The Stem Cells that are obtained from your body are placed into all joints and spine to rebuild and regenerate new tissue growth as determined by the clinic physician.   There has been clinical evidence that new cartilage can be grown within your joint provided you are determined a candidate by the clinical physician.  Not all patients will be a candidate and may require joint replacement.

TORN TENDONS:  If the patients tendons are not completely torn this procedure will produce new tissue growth to regenerate torn tendons. Our clinic physician can only determine this with an initial visit and evaluation.

How Does PRP Therapy Work?

To prepare PRP, a small amount of blood is taken from the patient. The blood is then placed in a centrifuge. The centrifuge spins and through a multi-functional process separates the plasma from the blood producing the PRP. This increases the concentration of platelets and growth factors up to 500% also increasing hMSC (human stem cells) proliferation as a function of 8-day exposure to platelet released concentrations 10x. (x= increase above native levels)

When PRP is injected into the damaged area it stimulates the tendon or ligament causing mild inflammation that triggers the healing cascade. As a result new collagen begins to develop. As this collagen matures it begins to shrink causing the tightening and strengthening of the tendons and ligaments of the damaged area.

What is Platelet Rich Plasma?

Platelet Rich Plasma or PRP is blood plasma with concentrated platelets. The concentrated platelets found in PRP include growth factors among the huge reservoirs of bioactive proteins that are vital to initiate and accelerate tissue repair and regeneration. These bioactive proteins increase stem cell production to initiate connective tissue healing, bone regeneration and repair, promote development of new blood vessels and stimulate the wound healing process.

PRP Regenerates Tendons & Ligaments

Tendons connect the muscle to the bone making it possible for you to do many everyday physical activities. Overuse or damage to the tendon over a long period of time causes the collagen fibers in the tendons to form small tears, a condition called tendonitis. Damage to tendons most often occurs in the knees, ankles, hips, spine, elbows, shoulders, and wrists.

Ligaments are composed of collagen fibers that hold one bone to another, stabilizing the joint and controlling the range of motion. When a ligament is damaged, it is no longer able to support the bones in the joint, which often leads to pain symptoms. The instability causing the pain in your joints does not always show up on high tech imaging equipment. Through a thorough neurological and orthopedic evaluation Dr. Baum can determine which ligaments and tendons are unstable due to injury, wear or tear.

Tendons and ligaments have a poor blood supply and they do not usually heal from damage. Combined with the stress of day-to-day activities tendons and ligaments become inefficient causing degeneration of the joint which leads to chronic pain and weakness. Patients who experience chronic pain may not even remember when the injury occurred.

How Does PRP Compare With Cortisone Shots?

Studies have shown that cortisone injections may actually weaken tissue. Cortisone shots may provide temporary relief and stop inflammation, but may not provide long term healing. PRP therapy is healing and strengthening these tendons and ligaments and in some cases thickening the tissue up to 40%.

Treatment Plan

PRP injections with guided ultrasound can be performed on tendons and ligaments all over the body. Cervical, thoracic and lumbar spine, degenerative disc disease, arthritic joints shoulder pain, hip pain, and knee pain, even the smaller joints of the body can all be treated effectively with PRP. Dr. Baum will determine whether prolo solution, Platelet Rich Plasma or a combination of both will be the most effective form of treatment for you during his initial consult and evaluation.

Frequency Of Treatments

While responses to treatment vary, most people will require 3 to 6 sets of injections of PRP. Each set of treatments is spaced 4 to 6 weeks apart.

Is PRP Right For Me?

If you have degenerative spine or joint disease, a tendon or ligament injury, laxity or tear and traditional methods have not provided relief then PRP therapy may be the solution. It will heal tissue with minimal or no scarring and alleviates further degeneration and builds new tissues. There will be an initial evaluation with Dr. Baum to see if PRP therapy is right for you.

What Can Be Treated?

Platelet Rich Plasma injections helps regenerate all areas of the body including the cervical, thoracic and lumbar spine, wrists, elbows, shoulders, hips, knees and ankles as well as tendons and ligaments all over the body.  Dr. Baum is one of the few physicians performing PRP procedures to all areas of the spine.  Our clinic treats patients with sports injuries, arthritic and degenerative joints and degenerative disc disease. More specific injuries including tennis elbow, carpal tunnel syndrome, scoliosis, ACL tears, shin splints, rotator cuff tears, plantar faciitis and iliotibial band syndrome may all be effectively treated with PRP.

What Are The Potential Benefits?

Patients can see a significant improvement in symptoms as well as a remarkable return of function. This may eliminate the need for more aggressive treatments such as long-term medication or surgery.

Special Instructions

You are restricted from the use of non-steroid anti-inflammatory medications (NSAIDs) one week prior to the procedure and throughout the course of treatments.

Initially the procedure may cause some localized soreness and discomfort. Most patients only require some extra-strength Tylenol to help with the pain. Ice and heat may be applied to the area as needed.

How Soon Can I Go Back Regular Activities?

PRP therapy helps regenerate tendons and ligaments but it is not a quick fix. This therapy is stimulating the growth of new tissue requiring time and rehabilitation. Under Dr. Baum’s supervision patients will begin an exercise program immediately following the first procedure. During the treatment program most people are able to resume normal activities and exercise.

Platelet Rich Plasma (PRP) Matrix Graft by David Crane, MD and Peter A.M. Everts PhD

PRP application techniques in musculoskeletal medicine utilize the concentrated healing components of a patient’s own blood—reintroduced into a specific site—to regenerate tissue and speed the healing process

PRP INJECTION APPLICATION SITES

Spine

Cervical/Thoracic/Lumbar/Sacral

Shoulders & Elbows

Wrist & Hand

Hip/Pelvis

Knee & Lower Leg

Ankle & Foot

Fingers & Toes

Arthritic Joints

Osteoarthritis

Some Osteonecrosis

 

Information

http://www.prolotherapy.com/PPM_JanFeb2008_Crane_PRP.pdf

https://drjamesbaum.com/wp-content/uploads/stemcells2002-0109.pdf

 

Important Videos Everyone Should watch on Biologics

https://drjamesbaum.com/2013/07/the-science-of-mesenchymal-stem-cells-and-regenerative-medicine/

 

Scientific Papers on Research of Stem Cells

https://drjamesbaum.com/stem-cells/scientific-papers/

knnz

I will be posting this in my other blog section also

Tired of Doctors? I am also.

If you are like me,your sick of seeing doctors , some see so many my heart breaks for them, pcp, orthos, hematologist, cardiologists, pain management, endocrinologist dentists, optometrist whatever it just gets tiring. then you might get so nervous at your appointment you forget to ask specific questions.

Or maybe your anxiety has gotten you to a place where your heart is beating out of your chest, and your voice quivers or you just become blank.

Either way, having a list of things you mean to ask will help not only you but your doctor be able to better communicate.

So here we go:

1. What is the exact name of whatever is wrong with me? 1a if Osteonecrosis what stage is it? 1-2-3-4-5-5a-6

2. Is this something that is treatable and may possibly go away, or heal on its own or is this something that is chronic?

3. What are the short-term and long-term prognoses?

4. What are the short-term and long-term goals with treatment?

Example : Prp injections- physical therapy- hyperbaric oxygen-water therapy- stem cell treatments- joint replacement .

5. Is this something that genetically I can pass down to my child(ren)?

5a. Will you check me for underlying clot issue like Factor V Leiden-MTHFR-eNOS

6. What do you recommend as far as treatment?

7. What are the medications you recommend? I heard and read statins like Zocor and Lipitor can help lower lipids (fat) in the blood which can help blood flow better. I personally took simvastatin for 6 m and it helped me. I also during that time changed how I ate to consume less fatty meat cheeses etc

To lower my cholesterol on my own and I must say I am grateful I tried this.

Not only do I love eating REAL food but my blood work shows fantastic results and my pain is less.

So it’s good to talk to your doctor about this stuff also. Of course your doctor is not a specialist in nutrition which is kinda sad , you’d think they would teach that in medical school. But a good plant based diet was a great change for me.

 

8. How will this condition and/or medications affect my life?

9. Is there a specialist I can see? So I may try to avoid a joint replacement?

10. Will this condition or medications affect my ability to exercise? Walk-Bike- Swim.

Will this be temporary?

11. Is there a special diet that might ease symptoms or improve this condition?

For me personally it is plant based. I will eat meat (beef) rarely . Chicken or fish 1x a week but I am all about plant based.

My pain is lessened by over 60percent. I still have pain I’m not cured but I’m not in constant misery anymore. I rarely take a pain pill.

Never start or stop anything without talking to your doctor.

As always, if you have any concerns about your health, it’s always best to consult your primary care physician.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

 

Specific Questions To Ask Your Otho

What stage is osteonecrosis?
Will I be checked to make sure it also is not affecting other joints since I have pain in other bones/joints?
What is your treatment plan for Osteonecrosis ?
Why is this procedure being recommended? Are there alternatives?
What are the benefits of this procedure in terms of pain relief, functioning/mobility? How long will the benefit last?
What are the risks involved?
What is the success rate for this procedure?
What is the procedure called? How is it done?
How many patients with osteonecrosis do you see a year?
If Surgery Will this surgery solve the problem? Will any more surgery be required in the future?
How many of these procedures are annually performed at this hospital?
How many patients with osteonecrosis do you see a year?
What percentage of patients improve following the procedure?
What will happen if I don’t have the surgery now?
If I want a second opinion, whom can I consult?
Will I need any tests or medical evaluations prior to the surgery?
What kind of anesthesia will be used?
Are there possible after effects or risks?
Will I meet with the anesthesiologist in advance? Will her or she know my needs/allergies?
What kind of implant or prosthesis will be used? What are the outcomes using this device?
How long will it last?
Will I have pain following the procedure? What pain relief or pain control measures will I be given?
How long will the recovery take? What are my limitations during recovery?
Will I need assistance at home afterwards? For how long?
What will discharge instructions be?
Will I have any disability following surgery? Will I need physical therapy?
When can I return to work? When can I drive my car? When can I have sexual activity?
Are there any materials about this surgery that I can review?
What will I have for pain management?
Are their any patients I can ask about their experience?

 

Here is some info you may be interested in.

Clinical Trials

Atorvastatin to Prevent Avascular Necrosis of Bone in Steroid Treated Exacerbated Systemic Lupus Erythematosus

https://clinicaltrials.gov/ct2/show/NCT00412841

Statin therapy decreases the risk of osteonecrosis in patients receiving steroids.

https://www.ncbi.nlm.nih.gov/m/pubmed/11347831/

Aseptic osteonecrosis of the hip in the adult: current evidence on conservative treatment

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4832407/

Steinberg Stages Of Osteonecrosis-Avascular Necrosis

Steinberg Staging Of Avascular Necrosis/ Osteonecrosis

History and etymology

It is based on the radiographic appearance and location of lesion. It primarily differs from the other systems by quantifying the involvement of femoral head which allows direct comparison between series1. Seven stages of involvement are identified. Following staging, extent of involvement of femoral head is recorded as mild, moderate or severe.

Classification

stage 0: normal or non-diagnostic radiographs, MRI and bone scan of at risk hip (often contralateral hip involved, or patient has risk factors and hip pain)

stage I: normal radiograph, abnormal bone scan and/or MRI

stage II: cystic and sclerotic radiographic changes

stage III: subchondral lucency or crescent sign

stage IV: flattening of femoral head, with depression graded into

mild: <2 mm

moderate: 2-4 mm

severe: >4 mm

stage V: joint space narrowing with or without acetabular involvement

stage VI: advanced degenerative changes

Quantification of extent of involvement is necessary for stages I to V:

stage I and II

A, mild: <15% head involvement as seen on radiograph or MRI

B, moderate: 15% to 30%

C, severe: >30%

stage III

A, mild: subchondral collapse (crescent) beneath <15% of articular surface

B, moderate: crescent beneath 15% to 30%

C, severe: crescent beneath >30%

stage IV

A, mild: <15% of surface has collapsed and depression is <2mm

B, moderate: 15% to 30% collapsed or 2 to 4mm depression

C, severe: >30% collapsed or >4mm depression

stage V

A, B or C: average of femoral head involvement, as determined in stage IV, and estimated acetabular involvement.

Steinberg Staging Osteonecrosis

See also

Avascular Necrosis Of The Hip

Fixated and Arlet Staging

Legg-Calvé Perthes Disease

AVN CharityUK

References

1. Steinberg ME, Hayken GD, Steinberg DR. A quantitative system for staging avascular necrosis. J Bone Joint Surg Br. 1995;77 (1): 34-41. Pubmed citation

How Our Joints Work and Move

How Our Joints Work

Joints are the place where two or more bones meet. All of your bones, except for one (the hyoid bone in your neck), form a joint with another bone. Joints hold your bones together and allow your rigid skeleton to move.

Fixed joints
Some of your joints, like those in you skull, are fixed and don’t allow any movement. The bones in your skull are held together with fibrous connective tissue.

Slightly movable joints
Other joints such as those between you vertebrae in your spine, which are connected to each other by pads of cartilage, can only move a small amount.

Synovial movable joints
Most of your joints are “synovial joints”. They are moveable joints containing a lubricating liquid called synovial fluid. Synovial joints are predominant in your limbs where mobility is important. Ligaments help provide their stability and muscles contract to produced the desired movement. The most common synovial joints are listed here:

Ball and socket joints, like your hip and shoulder joints, are the most mobile of joints in the human body. They allow you to swing your arms and legs in many different directions.
Hinge joints like in your knee and elbow , enable movement similar to opening and closing a hinged door.
The pivot joints in your neck allow you to turn you head from side to side.
Ellipsoidal joints such as the joint at the base of your index finger, allow bending and extending, rocking from side to side, but rotation is limited.
Gliding joints occur between the surfaces of two flat bones that are held together by ligaments. Some of the bones in your wrists and ankles work by gliding against each other.

Conyloid joints. These joints are similar to ball-and-socket joints, just without the socket (the “ball” simply rests against another bone end).
Saddle joints are found in your thumbs, the bones in a saddle joint can rock back and forth and from side to side, but they have limited rotation.

 

yoga

Terminology

I have taken the time to list all the jargon on avn-on

Medical Definition of Avascular necrosis

Avascular necrosis: A condition in which poor blood supply to an area of bone leads to bone death. Abbreviated AVN. Also known as aseptic necrosis and osteonecrosis.

avascular necrosis Death of a tissue, especially bone, as a result of deprivation of its blood supply. Avascular necrosis of bone is often referred to as osteonecrosis.

Medical Definition of avascular

: having few or no blood vessels the lens is a very avascular structure avascular necrosis

Necrosis is

The death of cells, tissues, or organs. Necrosis may be caused by insufficient blood supply, pathogenic microorganisms, physical agents such as trauma.

superficial necrosis

Necrosis affecting only the outer layers of bone or any tissue.

coagulation necrosis

Also found in: Dictionary, Thesaurus, Legal, Encyclopedia.

Related to coagulation necrosis: coagulative, liquefaction necrosis, Necrotic tissue

necrosis [nĕ-kro´sis, ne-kro´sis] (Gr.)

the morphological changes indicative of cell death caused by enzymatic degradation.

aseptic necrosis necrosis without infection or inflammation.

central necrosis necrosis affecting the central portion of an affected bone, cell, or lobule of the liver.

Links

 

Glossary of terms used in  Avascular Necrosis –Osteonecrosis

Acetabulum – In the pelvis the hip socket is called the acetabulum and forms a deep cup that surrounds the ball or femoral head of the upper thigh bone.

 

Acute pain – Pain that is rapid to develop, and for a shorter duration than Chronic pain.

Ref – Wikipedia

 

Analgesic – A member of a group of drugs to give relief from pain.

 

Arthroplasty – Surgical repair of  joint., also referred to as joint replacement. The affected bone is removed and replaced with an artificial joint. This treatment may be needed in the late stages of AVN, or when a joint has collapsed.

 

Articular cartilage – White smooth tissue that covers the ends of bones in joints. It enables bones in a joint to glide over one another with very little friction, allowing easy movement. See Cartilage

 

Aseptic Necrosis – Another name for Avascular Necrosis or Osteonecrosis.

 

Asymptomatic – A disease is considered Asymptomatic if a patent is a carrier for a disease or infection but experiences no symptoms. A condition might be considered Asymptomatic if it fails to show the noticeable symptoms of which it is usually associated. The term clinically silent is also used.

 

Atherosclerosis – Condition in which an artery wall thickens as a result of the accumulation of fatty materials such as cholesterol.

Ref – Wikipedia

 

Avascular – Having few or no blood cells.

Ref – Encyclopaedia Britannica

 

Bone Marrow Edema – Only cited since 1988 after the introduction of MRI scans – is bruising of the bone or additional fluid (water) content in the bone marrow. This condition often accompanies avascular necrosis. On the MRI image it is shown as light areas of the bone which should be seen as dark.

 

Bone Infarct – Bone Infarct is another name for osteonecrosis . It’s a more descriptive term for what has happened, a blockage of blood circulation leading to the death of part of the bone.

 

Bilaterally –  avascular necrosis  in both sides -in both hips, or both knees etc.

 

BRONJ – Biphosphonate-Related OsteoNecrosis of the Jaw (BRONJ). This usually only occurs in people receiving high dose intravenous biphosphonate injections for bone cancers, and is often associated with a dental operation. If taking biphosphonates it is important to inform your dentist and to take extra care with dental hygiene.

 

Cartilage – Flexible tissue between the joint bones. It is not as hard and rigid as bone, but is stiffer and less flexible than muscle.

 

Caisson disease – Name given to a variety of symptoms suffered by a person exposed to a reduction in the pressure surrounding their body. Typically it occurs when a person subjected to great atmospheric pressure suddenly has that pressure removed – as when a scuba diver returns rapidly to the surface after a long submerged period.  Also known as Barotrauma.

 

Chronic pain – This is pain that has lasted for a long time, the distinction between acute and chronic pain has traditionally been determined as Acute pain lasts for 30 days while Chronic pain last much longer.

 

Condyle – Smooth surface area at the end of a bone forming part of a joint with another bone.

 

Corticosteroid – Corticosteroids, more often known as steroids, are an anti-inflammatory medicine prescribed for a wide range of conditions.

Diabetes – A group of diseases in which a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced. This high blood sugar produces the classical symptoms of frequent urination, increased thirst and increased hunger.

 

Diaphysis – Shaft of the bone.

 

Distal – The more (or most) distant of two (or more) things. For example, the distal end of the femur (the thigh bone) is the end down by the knee; the end more distant from the torso.

 

Ellipsoidal – Joint that can move in two planes, example wrist and ankle.

 

Endothelial NOS (eNOS), also known as nitric oxide synthase 3 (NOS3) or constitutive NOS (cNOS), is an enzyme that in humans is encoded by the NOS3 gene located in the 7q35-7q36 region of chromosome 7.[5] This enzyme is one of three isoforms that synthesize nitric oxide (NO), a small gaseous and lipophilic molecule that participates in several biological processes.[6][7] The other isoforms include neuronal nitric oxide synthase (nNOS), which is constitutively expressed in specific neurons of the brain[8] and inducible nitric oxide synthase (iNOS), whose expression is typically induced in inflammatory diseases.[9] eNOS is primarily responsible for the generation of NO in the vascular endothelium,[10] a monolayer of flat cells lining the interior surface of blood vessels, at the interface between circulating blood in the lumen and the remainder of the vessel wall.[11] NO produced by eNOS in the vascular endothelium plays crucial roles in regulating vascular tone, cellular proliferation, leukocyte adhesion, and platelet aggregation.[12] Therefore, a functional eNOS is essential for a healthy cardiovascular system.

 

Epiphysis – Ends of the bone.

 

Factor V (pronounced factor five) is a protein of the coagulation system, rarely referred to as proaccelerin or labile factor. In contrast to most other coagulation factors, it is not enzymatically active but functions as a cofactor. Deficiency leads to predisposition for hemorrhage, while some mutations (most notably factor V Leiden) predispose for thrombosis.

Factor VIII (FVIII) is an essential blood-clotting protein, also known as anti-hemophilic factor (AHF). In humans, factor VIII is encoded by the F8 gene. Defects in this gene result in hemophilia A, a recessive X-linked coagulation disorder

 

Femoral head – The ball at the upper end of the thigh bone that sits inside the hip socket or acetabulum.

 

Gaucher’s disease – A disease in which a fatty substance accumulates in cells and certain organs. Symptoms may include enlarged spleen and liver, liver malfunction, skeletal disorders and bone lesions that may be painful, severe neurologic complications, swelling of lymph nodes and (occasionally) adjacent joints, distended abdomen, a brownish tint to the skin, anemia, low blood platelets and yellow fatty deposits on the white of the eye. Persons affected most seriously may also be more susceptible to infection.

 

Gout – Condition usually characterized by recurrent attacks of acute inflammatory arthritis – a red, tender, hot, swollen joint. The joint at the base of the big toe is the most commonly affected (approximately 50% of cases). It is caused by elevated levels of uric acid in the blood which crystallizes, and the crystals are deposited in joints, tendons, and surrounding tissues.

Idiopathic – An adjective used primarily in medicine meaning arising spontaneously or from an obscure or unknown cause.

In Greek; Idios translates to one’s own and Pathic translates to suffering or disease; so together becomes “a disease of it’s own” or “it comes from nothing” and medical jargon for “we don’t know what the cause is”.

 

Infarct – Bone infarct is another name for AVN. It’s a more descriptive term for what has happened, a blockage of blood circulation leading to the death of part of the bone.

 

Ischemic – Restriction in blood supply to tissue, causing a shortage of oxygen and glucose needed to keep tissue alive.

 

Legg Perthes disease – Avascular Necrosis in young children and can lead to Osteoarthritis in adults, also known as Calve Perthes or Perthes Disease

 

Lesions – Any abnormality in the tissue of an organism, for AVN we mean the bone structure at the joint site has started to break away. Usually caused by disease or trauma. Lesion is derived from the Latin word laesio which means injury.

 

Ligaments – Fibrous tissue that connects bones to other bones.

 

Medial Condyle – Inner side of the lower extremity of the femur (thigh), see Condyle.

 

MRI – Magnetic Resonance Imaging, is a medical imaging technique used in radiology to visualise internal structures of the body in detail. MRI makes the use of the property of nuclear magnetic resonance (NMR) to image nuclei of atoms inside the body.

 

MRI provides good contrast images between the different soft tissues inside the body, which makes it especially useful in imaging the brain, muscles, heart and cancers; compared with other medical imaging techniques such as computed tomography (CT) or X-rays. Unlike CT scans or traditional X-rays, MRI does not use ionizing radiation.

 

MTHFR is an enzyme that adds a methyl group to folic acid to make it usable by the body. The MTHFR gene produces this enzyme that is necessary for properly using vitamin B9. This enzyme is also important for converting homocysteine into methionine, which the body needs for proper metabolism and muscle growth and which is needed for glutathione creation . The process of methylation also involves the enzyme from the MTHFR gene, so those with a mutation may have trouble effectively eliminating toxins from the body.

 

 

Multifocal – Having many focal points. With regard to avascular necrosis AVN it means that it has affected many different joints in the body,. For example the hips, shoulders, knees and jaw.

 

Multilateral – Having many focal points. With regard to avascular necrosis AVN it means that it has affected many different joints in the body,. For example the hips, shoulders, knees and jaw.

 

Necrosis – Death of living tissue.

 

Oedema – also known as edema – Bone marrow oedema occurs when excess fluid build up in the bone marrow and causes swelling. Caused by the bodies reaction to a trauma or other condition. Symptoms are pain and/or swelling at the bone site.

 

Osteoarthritis –  degradation of a joint from partial loss of cartilage and damage to the bone joint surface.

 

Osteonecrosis – Another name for Avascular Necrosis.

 

Osteoradionecrosis ORN – Another name for Avascular Necrosis caused by radiotherapy.

 

Osteopenia – Condition where bone mineral density is lower than normal. It is considered by many doctors to be a precursor to osteoporosis. However, not every person diagnosed with osteopenia will develop osteoporosis.

 

Osteophytes – Commonly referred to as bone spurs, they are bony projections that form along the joint margins.

 

Osteoporosis – Condition of fragile bones.

 

Osteotomy – Osteotomy surgery involves cutting and re-aligning the bone (usually shin bone/tibia) in order to re-distribute the weight going through the knee. Re-alignement can be achieved by either taking a slice of bone out of the tibia (shin bone) or femur (thigh bone) close to the knee joint (closing wedge) or opening a gap in the bone (opening wedge).

A hip osteotomy is a surgical procedure in which the bones of the hip joint are cut, reoriented, and fixed in a new position. Healthy cartilage is placed in the weight-bearing area of the joint, followed by reconstruction of the joint in a more normal position.

 

Perthes disease – Avascular Necrosis (AVN) in young children and can lead to Osteoarthritis in adults also known as Legg Calve Perthes or Calve Perthes Disease.

 

Sacrum – Large triangular bone at the base of the spine and at the upper and back part of the pelvic cavity.

 

Sagittal – Imaginary line, used in MRI scans.

 

Sclerosis – Osteosclerosis, condition where bone density is significantly increased.

 

Sickle cell disease Sickle cell disease is a group of disorders that affects haemoglobin, the molecule in red blood cells that delivers oxygen to cells throughout the body. People with this disorder have atypical haemoglobin molecules called haemoglobin S, which can distort red blood cells into a sickle, or crescent, shape.

 

Signs and symptoms of sickle cell disease usually begin in early childhood. Characteristic features of this disorder include a low number of red blood cells (anaemia), repeated infections, and periodic episodes of pain. The severity of symptoms varies from person to person. Some people have mild symptoms, while others are frequently hospitalised for more serious complications.

 

SPONK – SPontaneous OsteoNecrosis of the Knee, a type of AVN or osteonecrosis specifically of the knee, either femur or tibia, and spontaneous means it occurred without an obvious cause

 

Subchondral – Below the cartilage.

 

Systemic lupus erythematosus – (SLE), often known just as lupus, is an autoimmune disease where your immune system produces antibodies that attack your body’s own tissues, causing inflammation. Lupus usually affects your skin and joints, but it may also involve your heart or kidneys, when the effects can be severe. SLE isn’t the same as discoid lupus, which only affects the skin.

 

Synovial – Synovial tissue is found around the tendons (bands of fibre that connect muscle to bone), and can form bursa (fluid filled cushioning pouches or sacs found in spaces between tendons, ligaments and bones) found in the area of joints.

 

Synovial fluid is the clear, viscid, lubricating fluid secreted by synovial membranes.

Ref – Synovial Sarcoma Survivors Network

 

Trabecular – The inner part of the bone. The spongy bone, as it is frequently called, is highly vascular and is responsible for blood cell production. The trabecula bone contains the red bone marrow that is responsible for this blood cell production.

Ref – Trabeclularbone.org

 

UKR – Unicompartmental Knee Replacement, or partial knee replacement.

 

Vertebrae – The Vertebral Column (Spinal Column) supports the head and encloses the spinal cord.

 

The spinal column is comprised of 26 individual bones, these bones are referred to as vertebrae. The spinal column is divided into five (5) different areas containing groups of vertebrae, and are grouped as follows:

 

Seven (7) Cervical vertebrae in the neck.

 

Twelve (12) Thoracic vertebrae in the upper back corresponding to each pair of ribs.

 

Five (5) Lumbar vertebrae in the lower back.

 

Five (5) Sacral vertebrae which are fused together to form 1 bone called the sacrum.

 

Four (4) Coccygeal vertebrae that are fused together to form the coccyx or tailbone.

 

 

X-Ray – A form of radiation that can pass through solid and semi-solid substances. In carefully controlled doses, they can be used to capture images of the body’s internal structures.X-ray is a safe and painless procedure often used to produce images of the inside of the body.

It is a very effective way of looking at fractured bones, such as a broken arm or wrist.

An X-ray can also be used to examine organs and identify problems. For example, an X-ray will show up an infection in your lungs, such as pneumonia.

X-rays are also often used during therapeutic procedures, such as a coronary angioplasty, to help the surgeon guide equipment to the area being treated.

AVN is not always seen on an Xray

 

 

term

 

 

Guest Speaker

Tonight the support group I started

Avascular Necrosis/ Osteonecrosis Support Int’l has a guest speaker

I can’t wait to hear Dr. Michael Mont discuss Osteonecrosis and Joint preservation

More to come ……

He discussed Osteonecrosis and the 3 decades he has been treating it.

He answered a lengthy Q and A from several members.

He prefers to preserve the joint so we discussed CD(core decompression) it’s success and failure rates, surgery

He is doing a second Q and A

June 19,2018

Avascular Necrosis / Osteonecrosis Support Int’l.

https://www.facebook.com/groups/DeadBoneDiseaseAVN/

Non -Surgical Treatment’s of Avascular Necrosis – Osteonecrosis

Non -Surgical Treatment s of Avascular Necrosis – Osteonecrosis

If osteonecrosis is diagnosed while damage is limited to a small area of bone sometimes doctors can try PRP injections, A2M injections, or Stem cell injections which is said to be the gold standard of injections.

I will get into those treatment options another day . And it may also be effective in up to stage 3 of AVN-ON but the faster you get it treated the better the outcome. It also depends on how you got your avn that will determine the outcome.

Let’s be real here

Avascular Necrosis –Osteonecrosis can be incredibly painful. And only those who have it understand the pain.

Medication to treat osteonecrosis may not be effective in people who have medical conditions that require treatment using corticosteroids, immunosuppressant medications, or chemotherapy. These medications may counteract osteonecrosis treatment.

During treatment with medication to stop the progression of osteonecrosis, your doctor monitors bone damage by taking periodic images of the affected bone for six months to a year or more. Some doctors may also recommend using crutches or a brace to remove stress from the affected bones.

As the bone starts to heal, physical therapy can help you maintain joint mobility, strengthen muscle groups that support the joint, and make changes to the way you walk to protect the affected bones.  If the disease does not progress and putting weight on the joint becomes less painful, nonsurgical treatment may be all that is needed to recover from osteonecrosis.

Bisphosphonates

Bisphosphonates are prescription medications that reduce bone loss by destroying cells that contribute to the degeneration of bone. This helps preserve healthy bone tissue.

Your doctor may recommend that you take this medication by mouth or injection for six months or more, depending on the size of the osteonecrosis lesion or lesions and whether symptoms improve during the first six months. If an injected form of medication is prescribed, your doctor may give the injection in his or her office or show you how to administer your injections at home. Some bisphosphonates are taken by mouth or injection once a week or once a month, others less frequently.

Your doctor will continue to evaluate the effectiveness of treatment, using periodic X-rays or MRI that can reveal changes in the bone’s health. The doctor also looks for signs of side effects from bisphosphonates, which may include bone fractures outside the affected joint, and conducts regular blood tests.

Long-term use of bisphosphonates should be monitored by your doctor.  And also may cause avn-on in jaw if you need on going dental work.

Nonsteroidal Anti-inflammatory Drugs

Bone loss due to osteonecrosis may be painful, especially in the hip and knee joints, which bear much of the body’s weight. Nonsteroidal anti-inflammatory drugs, or NSAIDs, sometimes work by reducing inflammation in the soft tissues surrounding the joint, relieving pain and swelling. These over-the-counter pain relievers include ibuprofen, naproxen, and aspirin. It may help in the short term but again talk to your doctor.

Long-term use of NSAIDs can cause side effects, including upset stomach or ulcers. If joint pain persists for more than a month, talk to your doctor before continuing use.

Statins

Statins are medications that lower cholesterol levels by reducing the amount of fatty substances called lipids in the bloodstream. If statin’s remove lipids from blood vessels leading to a diseased bone, more blood can reach the bone, allowing it to rebuild bone tissue. This may slow or stop the progression of osteonecrosis.

Statins can cause liver abnormalities and muscle damage, so your doctor takes your overall health and medical history into consideration before prescribing them for long-term use.

Medical Marijuana

No other pain relieving medication is less toxic than cannabis, even aspirin or Tylenol. This is why cannabis as medicine can be an excellent choice for pain.  A proper cannabis recommendation requires more than just a few minutes of a doctor’s time, and includes information on cannabinoid content, strain selection, and delivery methods. If you’re not getting this information from your doctor, you’re not getting a real cannabis consultation and are missing information on the full value and healing potential of the plant. Cannabidiol, a nonpsychotropic component of marijuana, may enhance the healing process of bone fissures, according to a new study.

CBD oil is an entirely different compound, and its effects are very complex. It is not psychoactive, meaning it does not produce a “high” or change a person’s state of mind. Instead, it influences the body to use its own endocannabinoids more effectively and can ease pain.

Pain medication  

Most pain medications for bone cancer are taken by mouth, in pill or liquid form. If swallowing is difficult, pain medication can also be delivered through a patch placed on the skin, an injection,talk to your doctor or see a pain management specialist if needed . No one needs to suffer in pain

Physical Therapy

When prescribed in addition to medication, physical therapy may slow down the progression of osteonecrosis and provide some pain relief. During the early stages of treatment, if the disease has affected the hip or knee, physical may suggest using crutches or a cane to help you move around without putting any weight on the affected joint.

You may use crutches or a cane for six weeks or more, depending on your age, the location of the lesion, and the severity of the disease. This gives the lesions time to heal and may prevent further joint damage.

Rehabilitation experts also offer heat and ice therapy, which may provide temporary pain relief deep within the joint, as well as acupuncture and acupressure, in which very thin needles or massage are used to stimulate blood flow and reduce inflammation.

After you can put weight on the affected joint without pain, physical therapists can customize a routine of simple, low-impact exercises to maintain range of motion in the affected joint as well as build strength in muscles that surround and support the joint. For example, stretching exercises and movements such as leg lifts or squats can prevent the joint from becoming stiff.

In addition, adding exercise such as tai chi or  or my favorite is  qi gong ,  or using a stationary  or recumbent bike  another favorite of mine or add swimming to your regular workout routine can help you maintain flexibility in the joints without putting too much stress on the bones. These exercises may prevent the disease from limiting your ability to walk and participate in everyday activities. They also improve blood flow throughout the body, which may help the bone heal more quickly.

A physical therapist can also help you alter the way you walk to avoid limping or putting too much stress on the affected joint. This helps ensure that you are able to use the joint without feeling pain for the long term.

The duration of physical therapy varies depending on the location of a lesion and how quickly your body responds to medication and physical therapy. After four to eight weeks, your therapist and physician assess your progress and determine whether additional treatment is required.

The most important thing you can do is have a good ortho , talk to him or her openly and honestly about your condition, your pain, your limitations etc…. together you can work together to find the best treatment plan for you . And also remember if you are unsatisfied you can always get a second opinion and or new ortho.

All content found on this Website, blog,, including: text, images, audio, or other formats were created for informational purposes only.

The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment.

Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

Never disregard professional medical advice or delay in seeking it because of something you have read on this website,blog,page.

If you think you may have a medical emergency, call your doctor, go to the emergency department, or call 911 immediately.

I do not recommend or endorse any specific tests, physicians, products, procedures, opinions, or other information that may be mentioned on here .

Reliance on any information provided by this website , blog is solely at your own risk.

I discuss and educate.

I tell my story.

National Orthopedic Societies By Country

I talk so many people around the world with Avascular Necrosis/ Osteonecrosis so often it’s sad because they struggle to find qualified doctors and surgeons knowledgeable about the disease.

I also here in the USA found it hard to find doctors who are not just educated in avn but really know about it and have a true interest in helping their patients.

The only I have spoke with are listed in my list for USA doctors.

I am working on a world wide list.

Here is also great information on orthopedic societies by country.

Deb

They are in alphabetical order.

National Orthopedic Societies By Country

Argentina

Asociación Argentina de Ortopedia y Traumatología (AAOT)

Australia

Australian Orthopaedic Association (AOA)

Austria

Österreichischen Gesellschaft für Orthopädie und Orthopädische Chirurgie (ÖGO)

Bangladesh

Bangladesh Orthopaedic Society (BOS)

Belgium

Société Royale Belge de Chirurgie Orthopédique et de Traumatologie (SORBCOT)

Belgische Vereniging voor Orthopedie en Traumatologie (BVOT)

Orthoweb

Bolivia

Sociedad Boliviana de Ortopedia y Traumatología (SBOLOT)

Bosnia and Herzegovina

Orthopaedic and Traumatology Surgeons Association of Bosnia and Herzegovina (OTSABH)

Brazil

Sociedade Brasileira de Ortopedia e Traumatologia (SBOT)

Bulgaria

Bulgarian Orthopedics and Traumatology Association (BOTA)

Canada

Canadian Orthopaedic Association (COA)

Chile

Sociedad Chilena de Ortopedia y Traumatología (SCHOT)

Colombia

Sociedad Colombiana de Cirugía Ortopédica y Traumatología (SCCOT)

Croatia

Croatian Orthopaedic and Traumatology Association (HUOT)

Czech Republic

Ceská Společnost pro Ortopedii a Traumatologii (CSOT)

Denmark

Dansk Ortopaedisk Selskab (DOS)

Ecuador

Sociedad Ecuatoriana de Ortopedia y Traumatología (SEOT)

Egypt

Egyptian Orthopaedic Association (EOA)

El Salvador

Asociación Salvadoreña de Ortopedia y Traumatología (ASOT)

Estonia

Estonian Association of Traumatology and Orthopedics (ETOS)

Finland

Finnish Orthopaedic Association (SOY/FOA)

France

Société Française de Chirurgie Orthopédique et Traumatologique (SOFCOT)

Germany

Deutsche Gesellschaft für Orthopädie und Orthopädische Chirurgie (DGOOC)

Berufsverband der Fachärzte für Orthopädie und Unfallchirurgie e. V. (BVOU)

Greece

Hellenic Association of Orthopaedic Surgery and Traumatology

Hong Kong

Hong Kong Orthopaedic Association

Hungary

Magyar Ortopéd Társaság (MOT)

Iceland

Icelandic Orthopedic Society

India

Indian Orthopaedic Association (IOA)

Iran

Iranian Orthopaedic Association (IOA)

Ireland

Irish Orthopaedic Association

Israel

Israel Orthopaedic Association

Italy

Società Italiana di Ortopedia e Traumatologia (SIOT)

Japan

Japanese Orthopaedic Association (JOA)

Jordan

Jordan Orthopedic Association (JOA)

Korea

Korean Orthopaedic Association (KOA)

Kosovo

Kosovo Society of Orthopaedics and Trauma Surgeons (KSOTS)

Lebanon

Lebanese Orthopaedic Association (LOA)

Lithuania

Lithuanian Society of Orthopaedics and Traumatology (LSOT/LOTD)

Luxembourg

Luxembourgian Society of Orthopaedics and Traumatology (SLOT)

Macedonia

Macedonian Association of Orthopaedics and Traumatology (MAOT)

Malaysia

Malaysian Orthopaedic Association (MOA)

Mexico

Sociedad Mexicana de Ortopedia (SMO)

Montenegro

Association of Orthopaedics and Traumatology of Montenegro (AMOT)

Morocco

Société Marocaine de Chirurgie Orthopédique et de Traumatologie (SMACOT)

Netherlands

Dutch Orthopaedic Association (NOV)

New Zealand

New Zealand Orthopaedic Association

Norway

Norsk Ortopedisk Forening (NOF)

Pakistan

Pakistan Orthopaedic Association

Paraguay

Sociedad Paraguaya de Ortopedia y Traumatología (SPOT)

Peru

Sociedad Peruana de Ortopedia y Traumatología (SPOT)

Poland

Polskie Towarzystwo Ortopedyczne i Traumatologiczne (PTOiTr)

Portugal

Sociedade Portuguesa de Ortopedia e Traumatologia (SPOT)

Puerto Rico

Sociedad Puertorriqueña de Ortopedia y Traumatología (SPOT)

Romania

Societatea Romana de Ortopedie si Traumatologie (SOROT)

Russian Federation

Association of Orthopaedists and Traumatologists of the Russian Federation

Saudi Arabia

Saudi Orthopaedic Association

Serbia

Serbian Orthopaedic Trauma Association (SOTA)

Singapore

Singapore Orthopaedic Association (SOA)

Slovakia

Slovenská Ortopedická a Traumatologická Spoločnosť (SOTS)

Slovenia

Slovenian Orthopaedic Society (ZOSZD)

South Africa

African Orthopaedic Association (SAOA)

Spain

Sociedad Española de Cirugía Ortopédica y Traumatología (SECOT)

Sweden

Svensk Ortopedisk Förening (SOF)

Switzerland

Société Suisse d’Orthopédie et de Traumatologie (SSO/SGO)

Taiwan

Taiwan Orthopaedic Association

Thailand

Royal College of Orthopaedic Surgeons of Thailand (RCOST)

Turkey

Turkish Society of Orthopaedics and Traumatology (TOTBID)

United Kingdom

British Orthopaedic Association (BOA)

United States

American Academy of Orthopaedic Surgeons (AAOS)

Uruguay

Sociedad de Ortopedia y Traumatología del Uruguay (SOTU)

Venezuela

Sociedad Venezolana de Cirugía Ortopédica y Traumatología (SVCOT)

Legg-Calve-Perthes Kids Avascular Necrosis

What is Legg-Calvé-Perthes disease?

Legg-Calvé-Perthes disease (LEG-cal-VAY-PER-theez) is a problem in the hip. It is often called Perthes disease.

Legg-Calvé-Perthes disease occurs when blood temporarily stops flowing to the ball (femoral head) at the top of the thighbone that fits into the hip socket. If the bone does not get enough blood, it dies. The bone collapses and becomes flat. As a result, the ball no longer moves smoothly in the hip socket.

Over the course of several months, the blood supply comes back to the bone. New bone cells gradually replace the dead bone. This process may take 2 or 3 years.

The disease can occur in both hips, but usually not at the same time.

Children with Legg-Calvé-Perthes disease may develop arthritis early and lose some movement in their hips.

Legg-Calvé-Perthes disease in children

Although any child can get Perthes disease, boys with the disease outnumber girls 4 to 1. Usually, they are thin, wiry, very active boys who are smaller than others their age.

Perthes disease usually develops when children are between the ages of 4 and 8. But children as young as age 2 and as old as age 12 can develop the disease.

Symptoms

Signs and symptoms of Legg-Calve-Perthes disease include:

• Limping

• Pain or stiffness in the hip, groin, thigh or knee

• Limited range of motion of the hip joint

Legg-Calve-Perthes disease usually involves just one hip. Both hips are affected in some children, usually at different times.

When to see a doctor

Make an appointment with your doctor if your child begins limping or complains of hip, groin or knee pain. If your child has a fever or can’t bear weight on the leg, seek emergency medical care.

Causes

Legg-Calve-Perthes disease occurs when too little blood is supplied to the ball portion of the hip joint (femoral head). Without an adequate blood supply, this bone becomes unstable, and it may break easily and heal poorly. The underlying cause of the temporary reduction in blood flow to the femoral head is still unknown.

Risk factors

Risk factors for Legg-Calve-Perthes disease include:

• Age. Although Legg-Calve-Perthes disease can affect children of nearly any age, it most commonly occurs between ages 4 and 8.

• Your child’s sex. Legg-Calve-Perthes is up to five times more common in boys than in girls.

• Race. White children are more likely to develop the disorder than are black children.

• Family history. In a small number of cases, Legg-Calve-Perthes appears to run in families.

Complications

Children who have had Legg-Calve-Perthes disease are at higher risk of developing hip arthritis in adulthood particularly if the hip joint heals in an abnormal shape

If the hip bones don’t fit together well after healing, this can cause the joint to wear out early. Hip replacement surgery eventually may be required.

In general, children who are diagnosed with Legg-Calve-Perthes after age 6 are more likely to develop hip problems later in life.

The younger the child is, the better the chances for the hip joint healing in a normal, round shape.

Avascular Necrosis – Rare Disease-Disorder©

Rare Disease

Approximately 15-20,000 New cases if Avascular Necrosis are diagnosed each year.

Treatment can often help, but this condition can’t be cured.

The earlier the stage of your diagnosis and the sooner you get treatment.

The better the outcome.

A Chronic condition : can last for years or be lifelong

Avascular necrosis is associated with trauma to the bone or joint, clotting disorders,long-term steroid use and drinking too much alcohol.

It’s most common in people between the ages of 30 and 60 and often affects the hip.

Avascular Necrosis can happen in any bone but the most common are

Hip

Knee

Ankle

Shoulder

Early stages of Avascular Necrosis may be symptom-free.

You may not even know you have it until you start to experience pain.

The affected joint may hurt when weight is put on it or even when lying down.

Treatment includes physical therapy, surgery, prp and or stem cell injections and medications.

 I am working every week writing to Senators asking for an awareness day.

I know they are busy but I am confident it will happen eventually.

I write them because when you have a rare condition, there isn’t much research being conducted and sometimes I feel like myself and my group are the only ones raising awareness.

So if I have to be the one to plow through and get proclamations in every state.

Let the writing begin

God Bless you all and wishing everyone a pain free day

Deb Andio

©Debla2018 text and art 2014-2019