Covid….

[The Walk of the Penguin Mich]

the gift that keeps giving…..

I moderate a group for avascular necrosis.  AVN is a bone disease that is fairly rare in the US, about 10,000-20,000 cases diagnosed each year.  What happens is the blood vessels in the bone get occluded, bone does not get oxygen and it dies.  It happens primarily in hip joints, but occurs in all joints and bones.  While it happens, it is incredibly painful as bone is dying.  Many analogies have been made to bone cancer-like pain.  Because it is not cancer, the drugs given for cancer are generally not made available for this group.  Then there is a double whammy.  The disease in early stages can only be seen via MRI.  Insurance companies are loathe to approve an MRI when there is nothing on an X-ray.  Unfortunately, the only treatments to salvage the joint are most successful in very early stages……so it is unusual that it gets diagnosed early enough, most times by the time it gets diagnosed the joint is toast.

Causes are not straightforward.  It can happen in a traumatic joint injury, or the bends from scuba diving.  It has been associated with excessive alcohol use, autoimmune disease, asthma, sickle cell disease and clotting disorders.  It has also been associated with steroid usage, like the dexamethasone…..which has been a lifesaver for covid.

A year plus ago, when it was discovered that using this steroid could help with covid, there was speculation that we were going to see an uptick in covid associated AVN cases.  The last 3 days, I have admitted 4 people to the AVN group that have covid associated AVN from being given dexamethasone.  The numbers are coming in faster……which corresponds to the timing covid to joint pain to getting a diagnosis to destruction.   

So, along with possible lung damage, heart damage and kidney damage, you can add bone damage as well for collateral damage.  

[pulmonarymd]

But getting it and surviving is no big deal!

It is not a surprise that these sort of things happen when you do high risk treatments. This is unlikely to be the only issue we see as a result of the disease or the treatments we use.

[azucena]

DH has/had AVN as a 22 yo due to prednisone being used to treat UC.  He had both hips replaced because the pain was just intolerable. 

I can't imagine getting thru covid and finding AVN.

[finnime]

Wow. That's a truly terrible result from treatment. And I had no idea steroids were associated with something so dire.

[kadee79]

Thank you soooo much for this info.  I sent you a PM.

[Cookies Galore]

Oof, awful side effect. A friend of mine developed AVN a few years after radiation therapy (great side effect of pelvic region cancer treatment!) and had a bilateral hip replacement at age 37. Definitely not something I wish on anyone.

I wish all the "but the survival rate is 99.99999%!" people would actually pay attention to what Covid survival can mean.

[Deleted]

Aug 10, 2021 15:18:47 GMT -5 Cookies Galore said:

I wish all the "but the survival rate is 99.99999%!" people would actually pay attention to what Covid survival can mean.

My response to them has always been, "I'm not afraid of dying from it.  I'm afraid of getting it and having long-term effects."

[pulmonarymd]

Aug 10, 2021 15:46:51 GMT -5 @athena53 said:

Aug 10, 2021 15:18:47 GMT -5 Cookies Galore said:

I wish all the "but the survival rate is 99.99999%!" people would actually pay attention to what Covid survival can mean.

My response to them has always been, "I'm not afraid of dying from it.  I'm afraid of getting it and having long-term effects."

Which is why preventing disease is better than treating it once it occurs. Diseases have long term complications and our treatments can come with significant toxicity. But why let facts interfere with what people believe

[movingforward]

Aug 10, 2021 15:46:51 GMT -5 @athena53 said:

Aug 10, 2021 15:18:47 GMT -5 Cookies Galore said:

I wish all the "but the survival rate is 99.99999%!" people would actually pay attention to what Covid survival can mean.

My response to them has always been, "I'm not afraid of dying from it.  I'm afraid of getting it and having long-term effects."

Yep, some things are worse than dying...

Unfortunately, some people have to learn things the hard way

[The Walk of the Penguin Mich]

Aug 10, 2021 16:30:09 GMT -5 movingforward said:

Aug 10, 2021 15:46:51 GMT -5 @athena53 said:

My response to them has always been, "I'm not afraid of dying from it.  I'm afraid of getting it and having long-term effects."

Yep, some things are worse than dying...

Unfortunately, some people have to learn things the hard way

It is very hard to watch these people deal with this disease.  Once upon a time, many could get sufficient pain relief.  Now no longer.  Those that hav3 had such severe pain that they’ve gone to the ER get punted back to their orthopedic surgeon and labeled drug seekers,  with little or no relief.  It is heartbreaking to watch.

What is even harder is seeing how many contemplate suicide because they can’t handle the pain any longer.  

[pulmonarymd]

Another fallout from the opioid crisis. We whipsaw between extremes. I can tell you the atmosphere for prescribing them has changed significantly, and there are more hoops to climb through. It has become a hassle, and in many ways not worth doing

[daisylu]

Covid almost killed my dad in December 2020. He was not in perfect health, but other than blood pressure he had no serious health issues. Took him 5 months to recover.
Though he wasn't tested, I'm pretty sure DH had Covid in late February 2020. All respiratory issues, negative for pneumonia, but I heard his lungs gurgling all night for months. My husband who had a TBI and 2 knee surgeries by the age of 30 wished he would die. It took him almost 8 months to be able to do things without getting winded easily.

I have seen Covid up close and personal. I have always been more afraid of the long term effects.

[Deleted]

Aug 10, 2021 16:03:57 GMT -5 pulmonarymd said:

Which is why preventing disease is better than treating it once it occurs. Diseases have long term complications and our treatments can come with significant toxicity. But why let facts interfere with what people believe

Ah, but when I see the number of FaceBook posts from people joking about how overweight they are, or how sedentary, or posting "food porn" recipes that include some combination of cream cheese, bacon, pasteurized process cheese food, bacon, whipped cream, Cool Whip and crushed-up Oreos, I guess it shouldn't surprise me that some people don't bother to get vaccinated and then end up begging the health care professionals to fix them.

[pulmonarymd]

Aug 10, 2021 19:28:03 GMT -5 @athena53 said:

Aug 10, 2021 16:03:57 GMT -5 pulmonarymd said:

Which is why preventing disease is better than treating it once it occurs. Diseases have long term complications and our treatments can come with significant toxicity. But why let facts interfere with what people believe

Ah, but when I see the number of FaceBook posts from people joking about how overweight they are, or how sedentary, or posting "food porn" recipes that include some combination of cream cheese, bacon, pasteurized process cheese food, bacon, whipped cream, Cool Whip and crushed-up Oreos, I guess it shouldn't surprise me that some people don't bother to get vaccinated and then end up begging the health care professionals to fix them.

It is no surprise how we got here. We are one of the unhealthiest countries in the world

[alabamagal]

My mom is just now recovering from her breakthrough Covid case. Because she was vaccinated her symptoms were mild, but lasted for a long time. She believes that Covid caused her leg pain /walking issues. She is scheduled for a doctor visit soon. I was skeptical at first that it was Covid related at first, but it impacts so many systems. My mom has a long history of spinal and back issues, including 3 disk procedures, the most recent was a year ago, so her leg/nerve issues are not totally new.

[NastyWoman]

Aug 10, 2021 12:16:04 GMT -5 pulmonarymd said:

But getting it and surviving is no big deal!

It is not a surprise that these sort of things happen when you do high risk treatments. This is unlikely to be the only issue we see as a result of the disease or the treatments we use.

Just a bad cold right... with ever more little extras it seems. For these early victims I do actually have empathy though as they caught Covid when so much we know today was still unknown. And vaccines were not available to them either.

[Deleted]

Aug 10, 2021 19:29:39 GMT -5 pulmonarymd said:

It is no surprise how we got here. We are one of the unhealthiest countries in the world

I'm wandering a little OT here but I listened to a really good podcast from the BBC on differences in cultures by country- what environments result in a strict, follow-the-rules culture (they mentioned smaller countries subject to the threat of foreign invasion and/or natural catastrophes) and a looser, do-your-own-thing culture (blends of immigrants from other cultures, for example). It explained a lot of why the US is more of a do-your-own-thing culture. The people who came over here and drove out the Native Americans were frequently fleeing religious oppression in their home countries. They were followed by people who were adventurous enough to seek out opportunity in a strange new place and leave everything familiar behind. I'm over-simplifying and I know I'm missing some of the points that made Russia and China "follow-the rules" cultures, but...

They specifically mentioned the poor health of the average America as an example of people not wanting to listen to experts about what's healthy and what isn't. It would also explain the prevalence of people who won't mask and won't take vaccines and who are on their way up to Sturgis for the motorcycle rally right now. It also explains why there's more innovation and entrepreneurship in the US.

[Opti]

According to a weather.com video 40% of the wild deer in the Midwest and East have Covid antibodies. I don't know how that happens.

Are Russians really rule followers though, or are they just people that are aware that stepping out of line certain ways can have deadly consequences in their country? 

[pulmonarymd]

Aug 11, 2021 8:27:42 GMT -5 @athena53 said:

Aug 10, 2021 19:29:39 GMT -5 pulmonarymd said:

It is no surprise how we got here. We are one of the unhealthiest countries in the world

I'm wandering a little OT here but I listened to a really good podcast from the BBC on differences in cultures by country- what environments result in a strict, follow-the-rules culture (they mentioned smaller countries subject to the threat of foreign invasion and/or natural catastrophes) and a looser, do-your-own-thing culture (blends of immigrants from other cultures, for example). It explained a lot of why the US is more of a do-your-own-thing culture. The people who came over here and drove out the Native Americans were frequently fleeing religious oppression in their home countries. They were followed by people who were adventurous enough to seek out opportunity in a strange new place and leave everything familiar behind. I'm over-simplifying and I know I'm missing some of the points that made Russia and China "follow-the rules" cultures, but...

They specifically mentioned the poor health of the average America as an example of people not wanting to listen to experts about what's healthy and what isn't. It would also explain the prevalence of people who won't mask and won't take vaccines and who are on their way up to Sturgis for the motorcycle rally right now. It also explains why there's more innovation and entrepreneurship in the US.

There are positives and negatives to cultural traits. However, the advantages we may get from those traits are eroded by an unhealthy society. If we were really smart, society would advance in a positive direction. From a health standpoint, we are going backwards

[daisylu]

This is the type of stuff people should be afraid of, but they think it won't happen to them:


Michelle De La Isla describes herself as one of the healthiest people she knows. She is a biker and runner, so when she caught the coronavirus in January, the Topeka, Kan., mayor said she expected a speedy recovery.



Eight months and three hospitalizations later, the 45-year-old mom of three - who ran for Congress in 2020 - now says she will have a pacemaker implanted next week to fix heart damage inflicted by the virus. De La Isla is one of millions thought to be suffering from long covid, a lingering condition that leaves some facing heart palpitations, shortness of breath, fatigue, joint pain and other health problems months after their initial illness.



Covid is no joke," De La Isla, a Democrat who has served as mayor since 2018, said during a Topeka city council meeting on Tuesday. "On Monday I'm going to have a pretty big procedure. This post-covid has been extremely difficult and it has impacted my heart, so I am going to have a bionic heart starting on Monday with a new pacemaker."



Four studies published this year show as many as a third of coronavirus cases result in long-haul covid. Some of those cases followed mild infections, according to the University of California at Davis.



link




She is 1 year younger than me. 

[The Walk of the Penguin Mich]

Aug 12, 2021 10:24:11 GMT -5 daisylu said:

This is the type of stuff people should be afraid of, but they think it won't happen to them:


Michelle De La Isla describes herself as one of the healthiest people she knows. She is a biker and runner, so when she caught the coronavirus in January, the Topeka, Kan., mayor said she expected a speedy recovery.



Eight months and three hospitalizations later, the 45-year-old mom of three - who ran for Congress in 2020 - now says she will have a pacemaker implanted next week to fix heart damage inflicted by the virus. De La Isla is one of millions thought to be suffering from long covid, a lingering condition that leaves some facing heart palpitations, shortness of breath, fatigue, joint pain and other health problems months after their initial illness.



Covid is no joke," De La Isla, a Democrat who has served as mayor since 2018, said during a Topeka city council meeting on Tuesday. "On Monday I'm going to have a pretty big procedure. This post-covid has been extremely difficult and it has impacted my heart, so I am going to have a bionic heart starting on Monday with a new pacemaker."



Four studies published this year show as many as a third of coronavirus cases result in long-haul covid. Some of those cases followed mild infections, according to the University of California at Davis.



link




She is 1 year younger than me. 

I have a 35 year old online friend undergoing this exact situation.  Her case of covid was not bad enough to be hospitalized, but she has been hospitalized 3x since recovering only to deal with the heart problems it caused.  Last I heard, there was one more drug to try and if that didn’t work a pacemaker was the next step.