Avascular Necrosis Mask

Many requested masks as so many cannot find them , so I contacted a local shop in my area and we made these two designs. The mask are washable

I don’t get paid anything for or a portion of the masks just doing this as a way to help those wearing a mask support the cause of Osteonecrosis aka Avascular Necrosis.

If you wish to purchase here is info. And they ship worldwide

They are closed on Sundays and Holidays

Afterburner FX

3600 Schotten Road

Hubbard Ohio 44425

3305347653 phone

Afterburner FX

Mask design

@Debla2020

Osteonecrosis and osteoradionecrosis of the Jaw

Some individuals get ONJ

Osteonecrosis of the jaw, commonly called ONJ, occurs when the jaw bone is exposed and begins to starve from a lack of blood. Most cases of osteonecrosis of the jaw happen after a dental extraction. … ONJ is much more common in those patients who use these medications for cancer of the bone treatment.

Most patients with ONJ who are taking antiresorptive therapy for osteoporosis can be healed with conservative treatment. Surgery is not usually required and could contirbute to the poor bone healing. 

Good oral hygiene and regular dental care is the best way to lower the risk of ONJ

ONJ is associated with cancer treatments (including radiation), infection, steroid use, or antiresorptive medications used for osteoporosis. Examples of antiresorptive medications include bisphosphonates such as alendronate (Fosamax); risedronate (Actonel and Atelvia); ibandronate (Boniva); zoledronic acid (Reclast), and denosumab (Prolia).

ONJ is much more common in those patients who use these medications for cancer of the bone treatment. When used for osteoporosis in much lower doses, it is very rare.

While ONJ is associated with these conditions, it also can occur without any identifiable risk factors.

Osteonecrosis of the jaw is a condition in which an area of jawbone is not covered by the gums, a condition of poor healing. The condition must last for more than eight weeks to be called ONJ. When the bone is left uncovered, it does not receive blood and begins to die. ONJ most often develops after an invasive (surgical) dental procedure such as dental extraction. ONJ also may occur spontaneously over boney growths in the roof or inner parts of the mouth.

ONJ has occurred in patients with herpes zoster virus infections, in those who are undergoing radiation therapy of the head and neck (radiation osteonecrosis), osteomyelitis (bone infection), and in persons taking steroid therapy chronically.

Patients taking antiresorptive medications to reduce their risk of bone fracture also may rarely experience ONJ. Why some patients taking antiresorptive medications get ONJ is unknown. It may be due to a decrease in the bone’s ability to repair itself; a decrease in blood vessel formation; or possible effects of infection.

There is no diagnostic test to determine if an individual patient is at increased risk for ONJ, but some factors are known to raise the risk in very rare circumstances. The condition itself is diagnosed only by the presence of exposed bone, lasting more than eight weeks. Patients typically complain of pain, which is often related to infection, soft tissue swelling, drainage, and exposed bone.

Most patients with osteoporosis who develop ONJ are treated conservatively with rinses, antibiotics, and oral analgesics. Studies have shown conservative treatment to be effective. There are case reports of the use of teriparatide in management of ONJ.

Rheumatologists are specialists in musculoskeletal disorders including osteoporosis and therefore are best qualified to review the risks and benefits of antiresorptive therapy for osteoporosis. They can also advise patients about the best treatment options available.

Prevention

A health program of oral hygiene and regular dental care is the optimal approach for lowering osteonecrosis of the jaw risk. Patients should inform their dentists that they are taking potent antiresorptive therapy, such as alendronate (Fosamax), risedronate (Actonel and Atelvia), ibandronate (Boniva), zoledronic acid (Reclast) or denosumab (Prolia).. Dentists should consider conservative invasive dental care in patients taking potent antiresorptive therapies.

For instance, endodontic (root canal) treatment is preferred to dental extraction if the tooth can be saved. If dental extraction is needed, full mouth dental extractions or periodontal surgery should be avoided. (It may be better to assess healing by doing individual extractions.)

Patients with periodontal disease should consider non-surgical therapy before agreeing to surgical treatment. Many patients taking bisphosphonates may undergo dental implants without problems. Although some dentists recommend the use of blood tests to decide who is at risk, this practice is controversial due to a very limited evidence base and should not be used at this time.This is in agreement with current American Dental Association suggestions.

Those on oral bisphosphonates are at low risk for ONJ. If patients detect any mouth pain or problems, they should seek dental care right away. It is not necessary to stop bisphosphonate use before a dental procedure, but it may be best to delay starting the drug therapy until after a scheduled dental procedure.

**Osteoradionecrosis is bone death due to radiation. The bone dies because radiation damages its blood vessels.

Osteoradionecrosis is a rare side effect that develops some time after radiation therapy has ended. It usually occurs in the lower jaw, or mandible. The lower jaw is at risk of osteoradionecrosis because it has a limited blood supply. Very rarely, osteoradionecrosis can start in the upper jaw, or maxilla.

Doctors usually classify osteoradionecrosis based on what tissue it affects, if it responds to treatment and if it has caused a fracture. They give osteoradionecrosis a grade from 1 to 3, usually as a Roman numeral (I, II or III). They use these grades to plan treatment.

Causes

Osteoradionecrosis is caused by radiation therapy to the bone. It may develop years after radiation therapy for head and neck cancers. 

The risk of developing osteoradionecrosis increases when the dose of radiation received is greater than 60 grays. It is also higher if the bone treated with radiation is exposed.

There is also a higher risk of developing osteoradionecrosis if a dental exam and necessary dental repairs aren’t done before radiation therapy. People with poor oral hygiene before or after radiation therapy are also at higher risk. So are people who develop dry mouth after radiation therapy.

Damage or trauma to the jaw after radiation therapy, especially within the first year after treatment, can also increase the risk for osteoradionecrosis. Damage or trauma can be caused by:

  • tooth extraction
  • cancer surgery or biopsy
  • denture irritation
  • accidents 

In rare cases, osteoradionecrosis may develop even if there isn’t any trauma or damage to the mouth, teeth or jaw.

Symptoms

Symptoms can vary depending on the grade or extent of the osteoradionecrosis and include:

  • pain
  • swelling
  • a sore, or ulcer, in the mouth or on the jaw
  • difficulty opening the jaw, or trismus
  • an abnormal opening, or fistula, between the jaw and the surface of the body
  • less feeling in the mouth or jaw, or even a complete loss of sensation in the area
  • infection
  • teeth that aren’t aligned properly, which is called malocclusion
  • jaw fracture not related to an accident or other trauma 
  • exposed bone inside the mouth
  • bone sticking out through the skin, which is called sequestrum 

Exposed bones and sequestrum are most often found under the jaw.

Report symptoms to your doctor or healthcare team as soon as possible.

Diagnosis

Your doctor will try to find the cause of osteoradionecrosis. This usually includes doing a physical exam, including a complete head and neck exam. Your doctor may also review your medical records to find out the total dose of radiation you received and the area that was treated.

You may also need the following tests:

  • x-ray of the whole jaw
  • CT scan
  • MRI
  • biopsy of the area to check if the cancer has come back or a second cancer has developed

Find out more about these tests and procedures.

Preventing osteoradionecrosis

Your healthcare team will take steps to prevent osteoradionecrosis. The following measures should be taken before and after radiation therapy.

Before radiation therapy begins

Visit your dentist for a thorough dental exam and teeth cleaning before you have radiation therapy. If you need to have any teeth removed or cavities filled, do so before radiation therapy.

You should also start using daily fluoride treatments. Talk to your dentist or healthcare team about these treatments.

During and after radiation therapy

Be sure to practise good oral care before and after treatment. Keeping the teeth and gums healthy is important for proper healing. Also eat a healthy diet, including foods and beverages that are low in sugar.

Have regular dental exams. Be sure to have any cavities filled or infections in the mouth treated as soon as possible. If a tooth needs to be removed, wait until after radiation therapy is complete. 

Your dentist or healthcare team will recommend fluoride treatments to help prevent cavities. If you have dry mouth, they will also suggest ways to replace saliva and keep your mouth moist.

Managing osteoradionecrosis

Once the extent of osteoradionecrosis is known, your healthcare team can suggest ways to treat it. You will also be given antibiotics if there is an infection in the bone. Other treatment options may include the following measures. 

Surgery

Your doctor may need to do surgical debridement. This means removing dead or infected tissue from around a wound. Dead, or necrotic, bone may also need to be removed. This is called sequestrectomy.

Depending on where osteoradionecrosis develops and how far it progresses, your doctor may need to do surgery to help restore the area.

This may include microvascular reconstructive surgery to restore blood flow to the area.

Bone grafts may be needed to replace the sections of the jawbone that are removed.

Soft tissue grafts can be used to replace muscle and other tissues that have been removed. You may also need dental implants if teeth are removed.

Hyperbaric oxygen therapy

Hyperbaric oxygen therapy involves breathing pure oxygen in a pressurized room. It is done in a special chamber where the pressure inside is higher than the normal pressure of the atmosphere.

The higher pressure allows more oxygen to get into your blood, which can help heal damaged and infected tissues.

Hyperbaric oxygen therapy is used in combination with wound care and surgery.

The treatment plan often includes 20 treatments before surgery and 10 more treatments after surgery.

This treatment plan may be adjusted based on your personal situation and how well the osteoradionecrosis responds to the hyperbaric oxygen therapy.

After you finish radiation therapy, your healthcare team may recommend that you have hyperbaric oxygen therapy before you have any teeth removed.

Hyperbaric oxygen therapy may not be available in all centres.

Reference https://www.google.com/amp/s/www.mskcc.org/cancer-care/patient-education/osteonecrosis-jaw-onj%3famp

Thank You Arizona

The good news keeps rolling in

Rare Disease Day is February 29 usually 28 on non leap years.

So as you know I have been working very hard on November 29 being National – Avascular Necrosis Osteonecrosis awareness day and all states have come on board so far but still waiting to hear from maybe 10 states.

They are doing all they can. And I am so pleased many states have issues proclamations for November 29 and many still are in the process.

Today The State of Arizona sent a proclamation for rare disease awareness we got the entire week February 20-27

And they will also be recognizing November 29

So blessed.

Hard work pays off

Thank you State of Arizona

Deb Andio

Founder Avascular Necrosis Osteonecrosis Support Int’l

#Osteonecrisis #AvascularNecrosis

Thank You Iowa

Hi I’m Deborah Andio the founder of Avascular Necrosis Osteonecrosis Support Int’l and I am honored and proud to say another state is on board recognizing Avascular Necrosis -Osteonecrosis

A great big thank you to Governer Kim Reynolds the Governor of the state of Iowa for not just recognizing Avascular Necrosis Osteonecrosis as Rare but issuing the proclamation for Rare Disease Month in February 2020 and also Honoring and sending a proclamation for Avascular Necrosis Osteonecrosis day November29.

Another Day Another Victory

Awareness has been good many are responding making Avascular Necrosis Osteonecrosis Awareness Day one step closer to national awareness

Thanks to

Congressman Tim Ryan  Ohio who sent me this today

And thanks again to

Mayor Jamael Tito Brown – Youngstown Ohio

And

Senator Mike Rulli – Ohio

Who sent me awareness proclamations last week.

Its happening one state at a time.

I just heard from 10 states that they also will be supply this.

Life is always good but this week have been fantastic

Scroll on other posts to see other proclamations

 

 

Link to eBooklet   Avascular Necrosis Booklet by Deborah L. Andio

Thank You Proud Moment

Thank you to Youngstown Ohio Mayor Jamael Tito Brown and Senator Michael Rulli and Senate President Larry Obhof

What an honor

Help me raise awareness today and please like and share this post.

Thank You.

1st annual

#AvascularNecrosis #Osteonecrosis

#AwarenessDay #November29

AvascularNecrosis/Osteonecrosis Support Int’l

https://www.vindy.com/news/local-news/2019/11/city-state-recognize-poland-woman-with-rare-disease/

Official Proclamation Avascular Necrosis-Osteonecrosis Awareness Day November 29

Finally Avascular Necrosis-Osteonecrosis has an official awareness date.

The date is November 29

I have been working on proclamations for several months and I am in the process of getting the awareness day Nationally recognized as well.

I’m so grateful that our elected officials took the time to talk to me.

And set a date for AVN-ON awareness

I have heard back from several officials that will also be adopting November 29 .

I have been advocating for over 5 years on Avascular Necrosis -Osteonecrosis and I am proud and grateful that our elected officials are also recognizing this awareness day.

What is a proclamation?

A proclamation is a formal way to make a public announcement or declaration. Government officials, such as mayors and state legislators, often issue proclamations to announce upcoming events or celebrations or to increase public awareness of particular issues.

I am proud to say I was issued a proclamation by my local Mayor of Youngstown Ohio

And also by Senator Michael Rulli of Ohio.

I have heard from Washington DC and it’s a longer procedure but it’s being looked at.

Right Now AVN-ON falls under the rare disease / disorder category.

In the United States, a rare disease is defined as a condition that affects fewer than 200,000 people. This definition was created by Congress in the Orphan Drug Act of 1983. Rare diseases became known as orphan diseases because drug companies were not interested in adopting them to develop treatment

Well I am hoping that now that AVN is getting recognition we can get more research to help all of us that are dealing with this painful condition.

Thank you to

Senator Michael Rulli -Ohio

and

Mayor Jamael Tito Brown – Youngstown Ohio

For helping us who suffer finally get the awareness day we deserve

God Bless You and Thank You.

Official Proclamation Avascular Necrosis -Osteonecrosis Awareness Day is November 29,2019 and every year after.

Meet Julie Croner

To Our Dear Readers

 

Often being diagnosed with a rare disease is not easy , it can often  leave you feeling alienated  exhausted and at times discouraged. We often end up having more questions than answers.

 

There also is very little to no public attention when you have a rare disease/disorder such as fun runs, fundraisers ,even research money  is limited when it comes to having a rare disease.

 

Far too often doctors may not be as educated  or skilled on a certain a rare medical condition which often causes patients to be misdiagnosed.

 

Those suffering often go months to years without a proper diagnosis.

 

Then there is the treatment options which appear just as limited.

 

There are about 7,000 different types of rare diseases with new discoveries every day. In the United States alone there have been approximately 25-30 million people given the diagnosis of an uncommon medical condition.

 

But we cannot give up. We must keep going, we must live mindfully and even in pain we must try to live our best life.

 

Avascular Necrosis/Osteonecrosis is one of those rare diseases and today I am happy to introduce you to the creator of it’s just a bad day not a bad life.

 

 

But before I do, I want to tell you a bit about her.

 

She  is the VP of WEGO Health patient network as well as a Patient Empowerer, Certified Holistic Health Coach, Yoga Instructor, Speaker and Patient Leader Blogger who is thriving with psoriatic arthritis and avascular necrosis of the femur and has battled melanoma, complex regional pain syndrome, depression, and anxiety.

 

 

Please welcome Julie Croner

 

She is using her personal mantra ‘It’s just a bad day, not a bad life’, she started itsjustabadday.com, which has been named one of the top 5 Psoriatic Arthritis blogs by EveryDay Health, top 7 Psoriasis blogs by HealthLine, top 40 Arthritis blogs by Feedspot and has been highlighted by The Mighty, WedMD, The National Psoriasis Foundation, and many other online sources.

 

 

Staying busy is a way of life for Julie. Some of her accomplishments and activities include:

 

 

Vice President of the Patient Leader Network for WEGO Health, 2016 Standford MedX Ignite Talk and Oral Presenter, 2014 Stanford Medicine X ePatient Scholar, Psocial Ambassador for the National Psoriasis Foundation, member of the Advocacy and Mission Committee for Arthritis Foundation, WEGO Health

 

 

Best In Show: Twitter in the 2015 Health Activist Awards, Psoriasis Social Media Ambassador and Health Guide for HealthCentral, blogger for PsoStrong.com, contributor to Everyday Health and Yoga Instructor.

 

 

 

Julie is an army wife and new mama. When she’s not working, Julie can be found jamming out to Celine Dion, taking a yoga class, traveling, cooking, geeking out over health-related things or enjoying life in Pittsburgh, PA.

 

You can find Julie at

 

Blog: Itsjustabadday.com

 

Twitter: twitter.com/justagoodlife

 

Facebook: Facebook.com/itsjustabaddaynotlife Instagram: Instagram.com/itsjustabaddaynotlife LinkedIn: http://www.linkedin.com/in/juliecerrone

 

Blog Email: justabaddaynotlife@gmail.com

 

 

Please welcome Julie Cerrone

 

 

 

So Julie : How long have you had Avascular Necrosis -Osteonecrosis?Where do you have avn-on?

 

 

I was diagnosed with AVN in my left femur bone in December of 2012.

 

 

 

Is your Avascular necrosis in more than one joint or bone?

 

 

It was in just one bone, but I had 2 places within the bone. A smaller section and then a larger section that was crumbling due to me putting weight on my leg.

 

 

 

How did you feel when you were diagnosed?

 

 

Up to the day I was diagnosed I had been continuously going to my doctor complaining I was in pain. I had 2 back to back surgeries (my 4th and 5th knee surgeries overall), had been in therapy, was on crutches and was in so much pain I had been unable to work for the previous 6 months. He kept saying that there wasn’t anything wrong – but I pushed for every test under the sun.

 

 

I’ll always remember December 17th, 2012 and the look on my doctor’s face when he came into my exam room. He said you have AVN. I know what it is, I’ve seen it before, but I don’t know really how to best treat it and I don’t know where to send you.

 

 

 

I’m a pretty positive person – but hearing that from someone I had trusted for years as my orthopedic surgeon really hit me. I literally went home, laid on the couch and cried for the rest of the night. I had NO idea bone could die. And for my doctor to tell me he had no idea what to do . . . . that was hard.

 

 

Did they say what may have been the cause of your avn-on?

 

 

So obviously no one can pinpoint it exactly, but this is what I have deduced from reflecting on it for the past 7 years.

 

 

In February of 2012, I started having knee problems. I had had knee problems my whole life, so it was kinda like “here we go again” thing in the back of my mind.

 

As months went on, it wasn’t getting any better – in fact it was getting worse. I went to my orthopedic and in June I had surgery. I ended up going back into the OR in September because I was still in so much pain.

 

 

Looking back, it’s very clear to me now that there wasn’t anything surgery could have fixed- I was having a psoriatic arthritis flare. In middle school a doctor had suggested that I had PsA but I never took it seriously because 1) I had no idea what it was 2) I was young and thought there’s no way I had arthritis.

 

 

December 26th, 2012 (right after I was dx with AVN) I ended up in the hospital because I was in so much pain I couldn’t stop shaking. That’s when I was officially dx with psoriatic arthritis.

 

 

A year after getting diagnosed with AVN I found out that I have prothrombin thrombophilia which is a blood clotting mutation. Basically, I think that the mutation predisposed me to be susceptible to AVN, and then coupled with the back to back unneeded surgeries and a psoriatic arthritis flare = the perfect storm.

 

 

Did you ever hear of avn-on before your diagnosis?

 

 

Nope. I had never heard of it. And honestly, I didn’t even know your bone could die!

 

What are some of the treatment options have you tried? Were any helpful?

 

 

So I was on crutches for 3.5 years. The longest ‘treatment’ I did was to stay off of it and give my knee a chance to recover. I also took pain killers around the clock to deal with the pain. I then subsequently did 2 things that ultimately got my pain under control and helped me get my life back together.

 

 

1) I took high doses of blood thinner injections to get my blood flowing to the necrosed areas of my bone. This actually worked wonders and it revived the smaller AVN part of my bone. Today on MRIs you can’t even see it!

 

 

2) I had a Regenexx stem cell procedure done. This was AMAZING. I blogged the entire journey: http://www.itsjustabadday.com/regenexx-avn-procedure/

 

 

 

I’m 4.5 years out from the procedure and feel amazing. I haven’t had ANY pain, ANY issues or ANY concerns. The last MRI I had was at a year out and my bone had regenerated 60%. The way it had regenerated it encapsulated the dead part that was crumbling and strengthened the bone. I’m able to live life, function, walk, run – do anything I want without any worry of AVN.

 

 

Can you tell me do you work or are you unable to work?

 

 

I was on disability for almost 4 years. I’m back to work full-time now. I’m even a yoga instructor!

 

 

How many doctors have or did you see before getting diagnosed?

 

 

 

I was only going to my 1 orthopedic doctor and it took me 6 months to get a proper diagnosis. But in order to TREAT my AVN, I lost track at 29 providers.

 

 

You know who ended up helping me? PATIENTS. Patients online were my saving grace and the reason I found out about the blood thinner injections and the stem cell procedure.

 

 

 

What would you tell someone who has been newly diagnosed with avn-on?

 

 

 

Stop what you’re doing, go to the Regenexx website and lookup an office near you. They’re the ones who have been doing this the longest, have the most research and help AVN patients all the time. I’m living testimony that this can work. But don’t just take my word for it – I’ve connected with hundreds of other patients who have received benefits fro the Regenexx stem cell procedure.

 

 

But on that note, be weary of stem cell procedures. I personally endorse the Regenexx procedure because of their process and their standard of quality. Others do not do it the same way they do it (even Mayo Clinic or Cleveland Clinic). Also- do not get stem cell injections that are not your own. If you’re getting anything other than your own mesenchymal stem cells you’re wasting your money.

 

 

 

And for those who are worried about the financial aspect of the stem cell procedure, I say this to you. Yes, it’s an investment. But without your health- what do you have? I was on disability, didn’t have a ton of money in the bank and still found a way to get it done. I’m not any more entitled than anyone else out there. If there’s a will, there’s a way.

 

 

Most people look at it from the upfront cost – but you don’t consider this…

 

 

To get a joint replacement, on average, in most markets it costs around $40k. (sure, you don’t pay all of that, but you’re paying your insurance costs). Then you’ll have follow up doctor visit, etc.

 

Then you have to go to therapy – for MONTHS.

 

With a joint replacement, you’ll be off work, you’ll be unable to really function properly for a good amount of time.

 

And to be blunt, a lot of people have problems with joint replacements and end up spending more time and money on fixes and follow-ups.

 

Oh- and also, depending on your age – you’ll need to get another one because they don’t last very long. Especially if you live an active life.

 

 

People always think that having insurance cover a core decompression or a joint replacement is the better way to go. I BEG you to think of it not in those terms. Think of YOUR LIFE. The quality of life you want to have.

 

 

By having a stem cell procedure, I not only still have my own joint, but it’s healthy and I don’t have to worry about having to go through it all again in the future.

 

 

 

 Name something positive that has been a result of getting avn-on?

 

 

I’ve had amazing experiences since being diagnosed with AVN. I had the opportunity to share my story of how patients were the ones who got me back to walking and regrew my femur bone at Stanford MedX: http://www.itsjustabadday.com/2017/03/09/medx-ignite-talk-replay/ (If you scroll to the bottom of the post you can see my Ignite talk)

 

 

And I was invited by the FDA to share my story on stem cells at a hearing: http://www.itsjustabadday.com/2016/09/28/fda-stem-cell-hearing/ (If you scroll down to the bottom of this post you can see my testimony)

 

 

But honestly, the most positive thing that has resulted from my diagnosis is getting to connect with patients all over the world, on a weekly basis, and helping them know they’re not alone. I try to pass on my own advice, my own journey and my own thoughts to help them feel a little less alone and to have a bit more knowledge than I did when I was in their shoes. It really helps me to know that I didn’t go through this for nothing. I went through this to help others and to really find my passion in life.

 

 

 

Thank you so much Julie not only for this interview but for being a great inspiration to so many and educating others while raising awareness on this rare disease. May you have continued success in your advocacy and all that you do and wishing you continued wellness.

 

 

To follow Julie on social media her links are listed below.

 

Blog: Itsjustabadday.com

Twitter: twitter.com/justagoodlife

Facebook: Facebook.com/itsjustabaddaynotlife Instagram: Instagram.com/itsjustabaddaynotlife LinkedIn: http://www.linkedin.com/in/juliecerrone

Blog Email: justabaddaynotlife@gmail.com

 

 

Please help raise awareness by sharing this blog post in the hopes it reaches someone who may benefit from the information provided.

 

 

 

*If you are interested in sharing your Avascular Necrosis -Osteonecrosis story or Group  in an interview please email me at.

 

If you know of someone or if you are someone who suffers from AVN-ON and you need a great support group

 

Click on the link to find this Facebook group – Avascular Necrosis/Osteonecrosis Support, Int’l.

 https://www.facebook.com/groups/DeadBoneDiseaseAVN/?ref=share

Also please like and subscribe to my blog and if you want to follow me you can find me at the links below.

 

Thank you again Julie and

 Here is wishing everyone a pain free day.

 

 

To learn more about me check out

Deborah Andio links below please like follow and share.

Thank you God Bless You.

 

Click on the link to visit and subscribe to my website :

www. ChronicallyGratefulDebla.com

 

Instagram Personal :

http://www.instagram.com/deborah_andio

 

Instagram Awareness Chronically Grateful Me

http://www.instagram.com/chronicallygratefulme

 

Twitter:

 

 

More links are in my blog

 

Deborah Andio

Patient Leader Blogger Empowerer