DEAR DR. DONOHUE: I was diagnosed with avascular necrosis in June of 2011. No one will help me or give me information on this condition. I cannot afford medical insurance. I am 68 and on a meager Social Security payment. Doctors refuse to take me as a patient. I need to know what the prognosis will be if this is left untreated. — C.S.

ANSWER: Avascular necrosis also goes by the name osteonecrosis. It indicates that a section of bone has died due to a loss of its blood supply. It’s the bone’s equivalent of a heart attack. Diabetes, prolonged use of cortisone drugs and illnesses like lupus, trauma and sickle cell disease are some of the ailments seen in association with it. In some people, a cause can’t be found; it just happens.

If only a small section of bone is involved, the bone might regenerate in time. Patients often use crutches until that happens. For larger areas of bone, that section of bone collapses and becomes painful. Some intervention is needed. Removing the dead bone is helpful in healing. A procedure called decompression is favored by some doctors. Tiny holes are dilled into the bone to stimulate blood vessel growth. Replacement of an affected joint is another possibility. The hip joint is a case in point.

Have you explained your situation to Medicare? You’re eligible for it. Do so. Call local hospitals to see if they sponsor clinics that provide services for minimum fees. You live not far from large cities with medical schools; contact them to inquire if they will accept your case. Call your county medical society and see if it can offer you help.

DEAR DR. DONOHUE: I am a 62-year-old male and have been very active my entire adult life. I have ridden more than 2,000 miles this year on a racing bike. Then I suddenly developed intermittent cardiac arrhythmias and a few bouts of atrial fibrillation. I now have a cardiologist, who performed a battery of tests without discovering a reason why I have developed the rhythm problem. I take medicines to suppress the abnormal beating. I still experience irregular heartbeats in the evenings when I work out aerobically during the day. The atrial fibrillation episodes are so disruptive that I cannot sleep. I can’t help wondering if intensive exercising for decades has promoted the problem. Do other treatment options exist? — W.B.

ANSWER: Atrial fibrillation is the most common heartbeat disturbance. It’s a fast and completely irregular beat that throws off the heart’s pumping action and lays the groundwork for clot formation in the heart’s upper chambers, the atria. Heart clots or pieces of them can find their way into the circulation and be swept into a brain artery, where they cause a stroke.

If you’re still having episodes of atrial fibrillation, you have to let your heart doctor know. He will want to change your medicines. Or he might have to put you on blood thinners (anticoagulants) to prevent clot formation. Or he might consider you a candidate for ablative therapy, a procedure that destroy the tissues in the upper heart chambers that generate atrial fibrillation. If the episodes are occurrences of premature beats, the situation isn’t all that pressing. Former intensive exercise did not cause your problem.

DEAR DR. DONOHUE: In March of last year, I was found passed out on the floor. When I woke up about a month later, they said I was toxic and had sepsis. What is that? — C.M.

ANSWER: Sepsis is invasion of the blood with bacteria that produce toxins (poisons). That’s the “toxic” part. Bacteria find their way into the blood in many ways. They can enter the blood if there’s a minor breach in the colon, which houses millions of bacteria. Or something like a boil can spread bacteria into the blood. Or a cut so minor that you paid no attention to it can allow bacteria access to the blood.

The bacteria and their toxins cause a profound drop in blood pressure. That’s probably what landed you on the floor. Toxins can lead to the failure of important organs — liver, kidneys, heart and lungs. Septic shock, your illness, carries a high risk of death. Only through the intravenous infusion of antibiotics and medicines that keep organs alive and working do patients survive this harrowing and deadly illness. Whoever took care of you deserves praise for the wonderful outcome you had in the face of a lethal condition.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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