Sunday, February 24, 2019

AVN… A New Acronym Is Added to My List

Did you ever notice how may acronyms and abbreviations we need to learn as we navigate through our health journeys? It’s pretty crazy, isn’t it? And I bet we all know exactly what our doctors and nurses are talking about when they use these terms. I recently decided to come up with a list of the acronyms and abbreviations that I have come across over the years. I’m sure I missed a few but here is what I came up with:
·        MCL - Mantle Cell Lymphoma
·        hyperCVAD - Hyper is short for hyperfractionated. CVAD stands for the initials of some of the drugs used: Cyclophosphamide. Vincristine.
·        RBAC - rituximab, bendamustine, and cytarabine
·        SCT: Stem Cell transplant
·        DLI -Donor lymphocyte infusion
·        IVIG - Intravenous immunoglobulin
·        IgG - immunoglobulin (antibody) G
·        GVHD - Graft versus host disease
·        MDS - Myelodysplastic syndrome
·        ITP - Immune thrombocytopenic purpura
·        E. coli - Escherichia coli
·        C-Diff - Clostridium difficile
·        VRE -vancomycin-resistant enterococci
·        CMV - Cytomegalovirus
·        APT - Acute Pulmonary Toxicity
·        RSV - Respiratory syncytial virus
·        MFC - Microbacterium Fortuitum Complex
·        WBC - White Blood cell Count
·        CBC - blood count (CBC) test
·        CT - computed tomography scan
·        PET - Positron-emission tomography Scan
·        MUGA - multigated acquisition scan
·        TEE - Transesophageal Echocardiogram
·        MRI - Magnetic resonance imaging
·        VATS - Video Assisted Thoracic Surgery
·        CPR - Cardiopulmonary resuscitation
·        EKG - electrocardiogram
·        PK - Pharmacokinetic
·        PICC - percutaneous indwelling central catheter
·        GI - gastrointestinal
·        ATG - Anti-Thymocyte Globulin
·        MTX - Methotrexate
·        BTK - Bruton's Tyrosine Kinase
·        PD-1 - drug known as Opdivo
·        FDG - fluorodeoxyglucose
·        SUV - standardized uptake values
·        CAR T - chimeric antigen receptor T cells
·        DTap - Diphtheria, Tetanus, and Pertussis
·        Hib -  Haemophilus influenza type b
·        PCV13 - Pneumococcal conjugate vaccine
·        HLA - human leukocyte antigen

Now you may be asking yourself why I would take time to come up with this list. Well, believe it or not I have a new one to add to my list. I have recently been diagnosed with AVN or Avascular necrosis in my right hip. In short, AVN is caused by the lack of blood flow to the bone, causing it to eventually collapse and die. Here is a write up I found on this:

AVN - Avascular necrosis (AVN), also called osteonecrosis, aseptic necrosis, or ischemic bone necrosis, is a condition that happens when there's loss of blood to the bone. Because bone is living tissue that needs blood, an interruption to the blood supply causes bone to die.
Avascular necrosis (AVN), also called osteonecrosis, aseptic necrosis, or ischemic bone necrosis, is a condition that happens when there's loss of blood to the bone. Because bone is living tissue that needs blood, an interruption to the blood supply causes bone to die. If it's not stopped, this eventually makes the bone collapse.
Avascular necrosis (AVN) is a disorder resulting from a temporary or permanent loss of blood supply to the bone. Blood carries essential nutrients and oxygen to the bones. When the blood supply is disrupted (avascular), the bone tissues begin to break down (necrosis). This can weaken the bone and eventually result in its collapse. If this occurs near a joint, it can lead to the collapse of the joint surface, resulting in pain and inflammation (arthritis). AVN is also referred to as osteoradionecrosis, aseptic necrosis, or ischemic bone necrosis.
AVN can occur in any bone, but most commonly affects the ends (epiphysis) of long bones such as the thigh bone (femur), causing hip and knee problems. Other common sites include the bones of the upper arms, shoulders, and ankles. AVN can occur in a single bone, but more commonly occurs in several bones at one time (multifocal AVN). AVN can sometimes be disabling, depending on what part of the bone is affected, how large an area is involved, and how well the bone rebuilds itself.
Causes of AVN
AVN is caused by interruption of the blood supply to the bone. If blood vessels are blocked with fat, become too thick or too small, or get too weak, they may not be able to provide the amount of blood necessary for the bone tissue to survive. Corticosteroids (such as prednisone and dexamethasone) given during cancer treatment can affect the bone and blood vessels, resulting in AVN.
Other factors that increase the risk of AVN in people who received corticosteroid therapy include treatment with high doses of radiation to weight-bearing bones, treatment with orthovoltage radiation (commonly used before 1970), being older than 10 at the time of treatment, and having sickle cell disease. AVN is most likely to occur during cancer treatment, but it can sometimes happen after completion of cancer therapy.
Steroids and AVN
Corticosteroids are commonly used for treatment of many cancers, such as leukemia and lymphoma. Dexamethasone is also sometimes used for treatment of nausea and vomiting associated with chemotherapy and to control brain swelling. There is no clear explanation as to how steroids cause AVN, but it is believed that they interfere with the body’s ability to break down fatty substances.
These substances can clog the blood vessels, causing them to narrow. This reduces the amount of blood that gets into the bone.
Symptoms of AVN
People in the early stages of AVN may not have any symptoms. However, as the disorder progresses, most people will experience some joint pain. At first, the person may only experience pain when bearing weight on the affected bone or joint. As the disorder progresses, symptoms may be present even at rest. Pain may develop gradually and its intensity can range from mild to severe.
If AVN progresses and the bone and surrounding joint surfaces collapse, the pain can increase considerably and may become severe enough to limit movement in the affected joint. The period of time between the first symptoms of AVN and the loss of joint function is different for each person and ranges from several months to years.
Diagnosing AVN
An X-ray is usually the first test performed when AVN is suspected. It can help distinguish AVN from other causes of bone pain, such as fracture. Once the diagnosis is made, and in the later stages of AVN, X-rays are useful in monitoring the course of the condition.
MRI is sometimes used to diagnose AVN because it can detect AVN in the earliest stages, when symptoms are not yet present.
Bone scans may also be used to diagnose AVN. They are useful because one scan can show all the areas in the body affected by AVN. However, bone scans do not detect AVN at the earliest stages.
A CT scan provides a three-dimensional image of the bone and can be useful in determining the extent of bone damage.
Surgical procedures, such as a bone biopsy, can conclusively diagnose AVN but are not commonly done.
Treating AVN
The goals of treatment for AVN are to improve the person’s use of the affected joint, reduce pain, stop bone damage, and ensure joint survival. Treatment can be categorized as conservative or surgical. In order to determine the most appropriate treatment, the following factors are taken into consideration:
·        The person’s age
·        The stage of the disorder (early or late)
·        The location and the amount of bone affected (small or large)
·        The status of cancer and cancer treatment
·        Conservative treatments
·        Medication – to reduce pain.
·        Reduced weight bearing – to slow the damage and promote natural healing. Crutches may be recommended to limit weight or pressure on the affected joint.
·        Range of motion exercises – to keep the joints flexible. This is also important to maintain movement and increase circulation in the joints. This can promote healing and may relieve pain.
·        Electrical stimulation – to induce bone growth.
·        Conservative treatments may be used alone or in combination, but they do not always provide lasting improvement. Some people may require surgery to permanently repair or replace the joint.
Surgical Treatment
Core decompression – is a surgery that removes the inner layer of bone. This may reduce pressure within the bone and create an open area for new blood vessels to grow. Sometimes a piece of healthy bone with good blood vessels (bone graft) is put in this area to speed up the process. This procedure works best in the early stages of AVN and should help relieve pain and promote healing.
Osteotomy – is a surgery that involves taking out a piece of bone, usually a wedge, to reposition the bone so that the tissue lacking blood supply (avascular area) bears less weight than an adjacent healthy area.
Arthroplasty – is 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 is destroyed.
Health Promoting Behaviors/Interventions
Avoid activities that put stress on your joints, including running, jumping, football, soccer, volleyball, basketball, and similar sports. Activities that are good for joints with AVN are swimming and bicycling.
Be consistent with recommended exercises.
Rest joints when they hurt.
Let your healthcare provider or physical therapist know if there are any changes in your symptoms.
Take pain or anti-inflammatory medications as prescribed.

I am at the point where my orthopedic doctor recommends that I get a hip replacement using an anterior approach:
  • A total hip replacement is a type of surgery. It replaces your hip joint with an artificial one. It is also called total hip arthroplasty. An orthopedic surgeon can do these procedures from behind the hip, to the side of the hip, or from in front of the hip. 
  • Total hip replacement with anterior approach refers to surgeries done from in front of the hip. These surgeries may also be called mini, modified, minimally invasive, or muscle-sparing surgeries.
 I am not so sure why this happened to me but it’s not surprising with all the chemo and steroids I have had over the past decade. In truth, I have been through much more difficult things and I expect this to be a breeze for me.

My current plans are to get this done sooner versus later. With me still in a job search I figure I take a few weeks off, get the surgery and then resume my search a couple of weeks after the surgery. I plan to discuss this with my doctor next week.

On my MCL/SCT front, my recent scans and have been fantastic, my blood tests are close to perfect and, Thank God!!!... I am enjoying great health.

Please accept my apology that I haven’t posted in a while. I guess this is a sign that all is well with me.

I would like to again thank my wife, daughters, family and friends for all the support they give me.

This past Friday I went to a to a Switchfoot concert with my brothers Bob and Steve. Here is a link to their song “Float”. Enjoy!!!

Or do you not know that your body is a temple of the Holy Spirit who is in you, whom you have from God, and that you are not your own?
1 Corinthians 6:19

More to come…

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