OSTEONECROSIS RESPONSE LETTER 9/2/14
I am glad to help you with diagnosis of underlying coagulation and eNOS T786C abnormalities which can cause or augment osteonecrosis.
If you can get to Cincinnati, then I can assess your case personally, and obtain the necessary blood samples to see if we can provide a medical treatment for your osteonecrosis. Once we have evaluated you here, then we can work with your local MDs to set up a therapy program, which I will help supervise, long-distance. Call 513-924-8250 to make an appointment, which will take about 1.5 hours. Be sure that your insurance covers both the visit in our center and the LabCorp laboratory in our center.
If you cannot come to Cincinnati for a single outpatient visit, then I have attached a orders for a lab evaluation good at either Quest or Lab Corp labs. Get the blood drawn where you live (be sure that your insurance will cover the tests) and get results sent to me. I will assess and make recommendations for therapy.
Separate from the laboratory orders for coagulation determinations at either Quest or LabCorp labs, we need to do a PCR determination of the eNOS T786C mutation. This is done at MDL labs in Covington KY. To get this done, fill out the MDL sheet, get a 5 ml lavender top tube of blood drawn, and have the sheet and the blood sent by overnight courier to MDL laboratories with a note to them to be sure to send me the results so that I can interpret them.
Also please fill out the attached information sheet and get it back to me. All information is entirely confidential and cannot ever be released without your signed consent.
Charles J. Glueck MD Jewish Hospital Cholesterol, Metabolism and Thrombosis Center,
Suite 430, 2135 Dana Avenue, Cincinnati OH, 45207. Phone 513-924-8250; Fax 513-924-8273; email
OSTEONECROSIS INFORMATION QUESTIONNAIRE.
All information strictly confidential will not be released unless you request it with an original signature letter, notarized.
Name:
Date of Birth:
Sex:
Age:
Height
Weight
Race
Current Date:
Mailing address:
Home phone
Cell phone
Email address
Fax phone
1. When did you first develop pain which was later diagnosed as osteonecrosis? ______
2. Which of the following joints were affected.
Right Left
Knee Knee
Hip Hip
Shoulder Shoulder
Ankle Ankle
Other Other
3. For osteonecrosis of the hips and knees, there is a severity index . Ficat I (osteonecrosis by MRI only, X ray normal. Ficat II (osteonecrosis by MRI and X ray, but no collapse. Ficat III (osteonecrosis by MRI and X ray and collapse. Ficat IV (osteonecrosis by MRI and X ray with collapse and severe concurrent osteoarthritis. If the Ficat score of your osteonecrosis is known, please circle the appropriate score I, II, III, IV, and if more than one joint, provide a summary by joint: ______
4. Osteonecrosis can be secondary to Prednisone, Alcoholism, Lupus Erythematosis, and can be acclerated by exogenous estrogen or testosterone use or pregnancy.
1. Did you have a previous history of high dose and/or long term Prednisone (corticosteroid) use which approximated a total dose of 2 grams or more (Y) (N)
2. Have you had a problem with excessive alcohol intake? (Y) (N)
3. Have you had a diagnosis of alcoholism? (Y) (N)
5. Did your osteonecrosis develop while taking estrogen, testosterone, or during or soon after pregnancy? (Y) (N): If Y, please describe including dose of estrogen or testosterone, mode of delivery, and duration between starting the hormone and the development of osteonecrosis:______
5. Have you been diagnosed as having systemic Lupus Erythematosis? (Y) (N)
6. Cigarette smoking (Y) (N). If yes, please provide pack years
7. Marijuana smoking: If yes, please provide estimated number of cigarettes per week and duration of use. ______
To date, how has your osteonecrosis been treated?
1. total hip, knee, or shoulder replacement. Please describe:______
2. Core decompression, drilling into the bone. Please describe. ______
3. Physical therapy only. Please describe.______
Osteonecrosis is often associated with major gene clotting abnormalities.
1. Have you ever had blood clots in your legs, lungs, eyes, brain (Y) (N). If so, please describe.
2. For women, how many pregnancies have you had ( ), how many live births ( ), and how many spontaneous miscarriages ( ). If there were miscarriages, how far out in the pregnancy did they occur______
3. For women, in your pregnancies, did you have pre-eclampsia or eclampsia (Y) (N). If Y, how many times, how severe, and how was it treated. ______
4. Have first degree family members ever had blood clots in your legs, lungs, eyes, brain. If so, please describe.