Avascular necrosis causes

Causes. Avascular Necrosis is broadly defined as the lack of blood flow to a bone. The causes of Avascular Necrosis are equally as broad, and include bone/joint trauma, blockages in blood vessels (typically fatty deposits), as well as diseases like Gaucher's Disease and sickle cell anemia Mnemonics for the causes of avascular necrosis (AVN) or more correctly osteonecrosis: STARS PLASTIC RAGS ASEPTIC Mnemonics STARS Most common causes: S: steroids, SLE T: trauma (e.g. femoral neck fracture, hip dislocation, scaphoid fractur.. Osteonecrosis happens when blood flow to part of a bone is reduced. This can lead to death of bone tissue, causing the bone to break down and joints to collapse. There may be no symptoms of the disease at first, but over time, you will start to feel pain in the affected bone. Treatments may include medications, physical therapy, and surgery

Avascular necrosis is a disease that results from the temporary or permanent loss of blood supply to the bone. It happens most commonly in the ends of a long bone. Avascular necrosis may be the result of injury, use of medicines, or alcohol. Symptoms may include joint pain and limited range of motion Avascular necrosis 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. What are the risk factors for avascular necrosis Other less common risk factors for avascular necrosis include: Decompression disease (also called the Bends that can occur with scuba diving) Blood disorders such as sickle cell anemia, antiphospholipid antibody syndrome (APS) and lupus anticoagulant HIV infection (the virus that causes AIDS).

Avascular Necrosis of Head of Femur - Pain hip joint - YouTube

The Causes & Symptoms of Avascular Necrosis GD

Injury that slows or stops blood flow to a bone is the main cause of AVN. Other common risks and causes of AVN are: drinking too much alcohol; smokin In the adolescent age group, the most common causes of AVN are corticosteroids, sickle cell disease, slipped capital femoral epiphysis, and idiopathic (meaning that it occurs spontaneously with cause unknown); it is termed Perthes disease - extreme late onset

Avascular necrosis of the hip is more common than other sites, presumably due to a combination of precarious blood supply and high loading when standing. Clinical presentation The most common presenting symptom is pain in the region of affecte.. The orthopedic literature finds that CSs are one of the most common causes of AVN. An Internet search of AVN identifies several commercial pages prepared for lawyers that describe references and supplies relevant to initiating lawsuits. Court cases consistently find that patients must be informed of treatment risks and options

Avascular necrosis (AVN), also called osteonecrosis or bone infarction, is death of bone tissue due to interruption of the blood supply. Early on, there may be no symptoms. Gradually joint pain may develop which may limit the ability to move. Complications may include collapse of the bone or nearby joint surface.. Risk factors include bone fractures, joint dislocations, alcoholism, and the use. Avascular Necrosis, commonly known as Osteonecrosis, is a medical condition in which the tissue within the bone dies because of the deficiency of blood supply. Before the tissues collapse, Osteonecrosis causes small breaks within the human bone structure (which eventually breakdowns the tissues within the bone) Osteonecrosis, also known as aseptic necrosis, avascular necrosis (AVN), atraumatic necrosis, and ischemic necrosis, is a pathologic process that is associated with numerous conditions and therapeutic interventions. The cause is clearly identifiable in patients who have direct damage to bone vasculature (eg, femoral neck fracture) or direct injury. Avascular necrosis of the femoral head is a type of osteonecrosis due to disruption of blood supply to the proximal femur. There are approximately 10000 to 20000 new cases reported each year in the United States alone.[1] . It can occur due to a variety of causes, either traumatic or atraumatic in origin

Avascular necrosis may be the result of injury, use of medicines, or alcohol. Or it may occur after bone injury or bone surgery. Symptoms may include joint pain and limited range of motion. Medicines, assistive devices, or surgery may be used to improve functionality or to stop more damage to the affected bone or joint See Avascular necrosis of the femoral head. Causes [edit | edit source]. Osteonecrosis is most common in the hip, but also seen in the humerus, knee, and talus and more rarely seen in the smaller bones of the wrist such as the lunate or scaphoid.. It can be caused by trauma or non-traumatic events Joint or bone trauma; An injury, such as a dislocated joint, might damage nearby blood vessels

Avascular necrosis occurs due to the temporary or permanent loss of the blood supply to an area of bone. As a result, the bone tissue dies and the bone collapses. If AVN involves the bones of a joint (e.g.: the talus) it often leads to the destruction of cartilage, resulting in arthritis and pain Causes. Reduction or interrupted blood supply to a bone is the main cause of avascular necrosis. Causes of reduction in blood supply to the bone . 1. Bone / Joint trauma - caused by - - dislocation of joint - damage to bone due to injury - cancer treatments weaken bones and harm blood vessels since it involves radiatio Avascular necrosis (AVN) is the death of bone tissue due to a loss of blood supply. You might also hear it called osteonecrosis, aseptic necrosis, or ischemic bone necrosis. If it isn't treated,.. Causes: When normal blood supply to the bone is restricted or slowed down it can cause avascular necrosis. This can happen due to sudden trauma or injury and due to dislocation of joint. People who undergo hip joint surgery are prone to develop avascular necrosis

Avascular necrosis causes (mnemonic) Radiology Reference

Avascular necrosis happens when the blood supply to the end of a bone is disrupted - either on a temporary or permanent basis. Without a supply of blood, the affected bone and the tissue that surrounds it can gradually begin to die Avascular Necrosis is a condition in which the blood supply to a bone, usually of the hips, is cut off and the bone starts to disintegrate as the blood required for new bone formation is no longer available to the bone. In majority of cases Avascular Necrosis does not heal on its own. Avascular Necrosis resulting out of fracture or an accident can also heal naturally once the fracture is treated Osteonecrosis (Avascular Necrosis) Explained Lack of Blood Supply Causes Bone to Die. By. Carol Eustice. facebook; Carol Eustice is a writer covering arthritis and chronic illness, who herself has been diagnosed with both rheumatoid arthritis and osteoarthritis. Learn about our editorial process AVN is caused from insufficient blood supply to the bone. There are several causes of avascular necrosis. However no specific cause is found. The common causes of avascular necrosis include: Trauma: Dislocation or bone fractures can injure blood vessels; Long term or high dose steroid treatment

Avascular necrosis (aseptic necrosis or osteonecrosis) is a death of bone, which leads to destruction of the adjacent joint. Learn about causes, symptoms, diagnosis, treatment, surgery, prevention and prognosis Causes And Risk Factors Linked To Avascular Necrosis. Avascular necrosis occurs when blood flow to a bone is cut off, resulting in the death of the affected bone tissue. Also known as osteonecrosis, bone infarction, and aseptic necrosis, this condition most often affects the hips, knees, shoulders, spine, and wrists Medications, such as alendronate (Fosamax, Binosto), might slow the progression of avascular necrosis, but the evidence is mixed. Cholesterol-lowering drugs. Reducing the amount of cholesterol and fat in your blood might help prevent the vessel blockages that can cause avascular necrosis. Blood thinners What causes avascular necrosis (osteonecrosis)? An injury, such as a forceful impact in an auto accident, or a complication of a hip fracture or dislocation can lead to avascular necrosis. Diseases such as sickle cell disease, gout, and lupus also may lead to avascular necrosis. Long-term use of corticosteroids or drinking a large amount of.

Osteonecrosis (Avascular Necrosis) Symptoms & Causes NIAM

Avascular Necrosis can be a side effect of treatment for several different types of cancer. The main risk factors for developing AVN as a result of cancer treatment include treatment with: Corticosteroids such as dexamethasone or prednisolone (these remain a leading cause of AV Avascular necrosis; Bone infarction; Ischemic bone necrosis; AVN; Aseptic necrosis. Causes. Osteonecrosis occurs when part of the bone does not get blood and dies. After a while, the bone can collapse. If osteonecrosis is not treated, the joint deteriorates, leading to severe arthritis

Avascular Necrosis Johns Hopkins Medicin

Avascular necrosis, also known as Freiberg's disease or Freiberg's Infarction or Infraction, is a painful condition that frequently affects young athletes, especially teenaged girls. The causes of a particular case of avascular necrosis are difficult to pin down, but the condition is often caused by overuse and repetitive stress to the area. Avascular necrosis (AVN) of the femoral head, also referred to as osteonecrosis or aseptic necrosis, is a well-recognized and often devastating complication related to glucocorticoid administration.(1) Avascular necrosis occurs in 3 to 40% of patients receiving corticosteroid treatment and occurs most frequently in the femoral head, which is hypothesized to be a result of the limited blood. Osteonecrosis also known as Avascular Necrosis (bone infarction, aseptic necrosis, ischemic bone necrosis) is when your bone dies due to a lack of blood supply. Known causes of ON (AVN): Alcohol Abuse Steroid treatment Chemotherapy Traumatic blunt force injury Blood clotting disorders (ie. Factor V Leiden, MTHFR) Where ON (AVN) presents itself: Osteonecrosis (Avascular Necrosis

Late effects: Avascular necrosis Alfred Healt

Avascular Necrosis - Causes, Symptoms, Prevention & Treatmen

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 Once other causes are excluded, and avascular necrosis is looking like the culprit, the gold standard for diagnosis is the imaging of the hip. Although MRI has proven to be the most accurate in diagnosis, researchers and radiographers have proposed a classification system based on plain x-rays known as the Ficat system What Causes AVN? Avascular necrosis can be caused by joint injuries, including dislocation and fractures. These conditions cause increased pressure within the bone. Also, blood vessel damage which. Avascular Necrosis (AVN), sometimes referred to as osteonecrosis or ischemic necrosis, may occur as the result of several conditions or incidents, trauma being the most common. However, excessive corticosteroid use (cortisone) is also a high-risk factor that can lead to steroid-induced avascular necrosis Avascular necrosis is a condition of decreased blood supply resulting in the death of bone tissue. This is also known as osteonecrosis. Avascular necrosis usually leads to the tiny breaks in the bone forcing the bone to collapse eventually. The blood supply to a section of bone also gets interrupted in case of fractured or dislocated joints. Know the types, causes, symptoms, treatment, surgery.

Avascular Necrosis (Osteonecrosis): Treatment, Causes, and

  1. Avascular Necrosis and Kummel Disease Share Some Similar Causes and Risk Factors. Injury: This is known as trauma-related avascular necrosis. A broken hip or vertebral fracture may lead to osteonecrosis. Increased pressure within the bone: The pressure within the bone causes the blood vessels to narrow,.
  2. These are few case studies of the Avascular Necrosis, where we have discussed the outcomes of the Ayurvedic treatment in AVN. We have witnessed complete reversal of the AVN in many cases and reversal of grade is common for our AVN patients at Sukhayu. The main challenge for us in the treatment is to stop the progress of the disease like AVN
  3. Avascular Necrosis (AVN) is a disease that occurs from temporary or permanent poor blood supply to the bones, leading to death of the bone tissues. This process can make breaks in the affected bone that eventually causes bone collapse. AVN..
  4. g high amounts of alcohol. Ideally, abstaining from alcohol use itself will, ideally, help stop the progression. From a treatment standpoint, trying to get the Avascular Necrosis to reverse.

Avascular necrosis, also called osteonecrosis is a condition in which bone death occurs because of inadequate blood supply to it. Lack of blood flow may occur when there is a fracture in the bone or a joint dislocation that may damage nearby blood vessels Avascular necrosis happens when the blood supply to the end of a bone is disrupted - either on a temporary or permanent basis. Without a supply of blood, the affected bone and the tissue that surrounds it can gradually begin to die. This can cause the bone itself to change shape which is partly responsible for the joint stiffness that people. Avascular Necrosis is death of bone tissue due to a temporary or permanent lack of proper blood supply. Avascular Necrosis and Osteonecrosis are often interchangeably used. Both terms mean bone death secondary to (i.e. because of) a circulatory disturbance. Our bones constantly renew themselves by way of new bone tissue replacing old bone tissue

Causes of Avascular Necrosis. High-dose use of corticosteroids (steroids) is a common cause of AVN. Joint or bone trauma. Idiopathic (a disease with no identifiable cause). Heavy alcohol use. Some disease states (Sickle cell, Lupus, Gaucher's, Caisson's, Pancreatitis). Symptoms of Avascular Necrosis Avascular necrosis (AVN) is the death of bone tissue due to a lack of blood. There may be poor retrograde blood flow from the distal to the proximal scaphoid. This can result in tiny breaks in the bone and the bone's eventual collapse. The scaphoid is the most frequently fractured wrist bone (see Chapter 38, Scaphoid Fractures), and AVN. Causes and risk factors. The cause of avascular necrosis is not well understood. It is thought that a combination of metabolic factors, mechanical stress, and local factors in the affected bone that interrupt its blood supply may contribute to the development of disease and lead to the eventual collapse of the affected bone Causes of AVN. So let's talk about some of the causes of AVN of your knee. Typically, it's from high doses of cortical steroid use, high consumption of alcohol, or trauma-related; but rare, it could also be from that knee meniscal surgery or arthroscopic knee surgery you had - can sometimes cause and start Avascular Necrosis in your knee. Avascular necrosis (AVN) of the femoral head occurs commonly after long term corticosteroid use. The corticosteroids such as prednisone are prescribed for a number of medical conditions. Long term use is associated with AVN of the femoral head requiring total hip replacement, particularly in younger patients

Kienbock's Disease - Everything You Need To Know - Dr

Avascular Necrosis (AVN) of the Hip International Center

Causes of Frieberg's Infarction. The cause of metatarsal avascular necrosis or Frieberg's Infarction is not fully understood, but risk factors include chemotherapy, alcohol abuse, excessive steroid use, vascular compression, and high blood pressure. Frieberg's Infarction seems to be due to chronic micro-trauma and overload of the metatarsal head Avascular necrosis (AVN) or osteonecrosis is defined as a disease resulting from temporary or permanent loss of the blood supply to bone ().Bone without blood supply and nourishment will necrose, causing the bone to collapse ().This process is often very painful and debilitating, particularly in the case of the talus since it supports both the ankle and subtalar joints (STJs) (Fig. 115.1A) Who is at risk for avascular necrosis of the hip? According to Dr. Michael Chamblee, an expert on the hip at Baldwin Bone and Joint, there are a number of factors that can put you at risk for avascular necrosis of the hip. It could be from a traumatic injury that causes the hip to dislocate or come out of the socket, Dr. Chamblee explained Keizer SB, Kock NB, Dijkstra PD, et al. Treatment of avascular necrosis of the hip by a non-vascularised cortical graft. J Bone Joint Surg Br 2006; 88:460. Ficat RP, Arlet J. Necrosis of the femoral head. In: Ischemia and Necrosis of Bone, 3rd ed, Hungerford DS (Ed), Lippincott Williams & Wilkins, Philadelphia 1980. p.171

Avascular necrosis of the hip Radiology Reference

Avascular necrosis of the femoral head causes significant morbidity and occurs in up to 20,000 people per year. A variety of nonoperative and operative measures have been trialled however a definitive treatment algorithm is yet to be established. Young adults in many cases have undergone multiple surgical procedures in their lifetime with increasing risks of complications Avascular necrosis of the hip is a condition resulting from the disruption of vital blood supply. No blood supply (avascular) leads to bone death called necrosis. The condition is also known as osteonecrosis, aseptic necrosis or ischaemic necrosis. Here at Complete Orthopedics, we are specialists in treating Avascular Necrosis

Avascular Necrosis (AVN) Treatment Options. The first goal of AVN treatment is to prevent further damage to the hip and give the bone a chance to heal. Avascular necrosis treatment also focuses on: Targeting the cause of the AVN. Fixing the problem. Healing the joint. Nonsurgical AVN treatment. Your doctor will first try conservative treatment. Osteonecrosis (aseptic, avascular, or ischemic necrosis of bone) refers to skeletal infarction. Bone infarcts may be asymptomatic, cause self-limited discomfort, or engender painful collapse of subarticular bone that leads to joint destruction. Pathobiology and Pathogenesis. Many conditions are associated with osteonecrosis (Table 256-1). In. A Patient's Guide to Avascular Necrosis of Femoral Head. Avascular Necrosis of femoral head can cause hip joint pain. It is defined as, death of the femoral head following partial or complete obliteration of its blood supply. Anatomy. Avascular necrosis of the hip occurs when blood flow to the top portion of the thigh bone (femur) is interrupted Aseptic necrosis (avascular necrosis or osteonecrosis) develops when blood supply diminishes to an area of bone and causes bone death. Whether it's aseptic necrosis of the hip, aseptic necrosis of the bone, or aseptic necrosis of the femoral head, we have expert medical information to help The clinical characteristics and complications of Cushing syndrome (CS) are well known and described in the literature. Nevertheless, rare, atypical presentations may go unnoticed. Osteonecrosis is a well-documented complication of glucocorticoid therapy. However, endogenous hypercortisolism is a rare, but relevant, cause of bone avascular necrosis

AVN - Avascular Necrosis Support, Mumbai, Maharashtra, India. 977 likes · 5 talking about this. It's an NGO for the support of AVN Patients or those who have loved ones affected by AVN. It still.. Avascular Necrosis- The pain. 654 likes · 1 talking about this. I created this page to offer information and support to those diagnosed or those who have loved ones affected by AVN Along with these common causes of avascular necrosis, it can also be caused by: Cancer treatments Fatty deposits found in the blood vessels Sickle cell anemia Gaucher's disease Caisson disease HIV infection Lupus Prolonged exposure or repeated exposure to high pressure Aseptic or Avascular Necrosis Causes. Aseptic or Avascular necro sis can be caused by a variety of factors, but are most often linked to other diseases or medications used to treat those diseases. Corticosterioids are a major offender in this area. These medications can weaken joints overtime to cause collapse or destruction of the cartilage.

Kienböck's disease: Symptoms, causes, and treatment

Short-term corticosteroids and avascular necrosis: medical

  1. Causes. Avascular necrosis occurs when blood flow to a bone is interrupted or reduced. Reduced blood supply can be caused by: Joint or bone trauma. An injury, such as a dislocated joint, might damage nearby blood vessels. Cancer treatments involving radiation also can weaken bone and harm blood vessels
  2. Avascular necrosis (also called osteonecrosis and aseptic necrosis) is a localized death of bone due to blood loss that may be a result of local injury (trauma), drug side effects, or disease. It is a serious condition because the process causes bones to become weakened and eventually collapse. This can lead to destruction of the joints next to the affected bone
  3. Read more about the risk factors for avascular necrosis including injury, steroid use, Gaucher disease, alcohol use, and chemotherapy
  4. Osteonecrosis is also called avascular necrosis of the bone. It refers to the condition in which part of a bone dies because its blood supply is interrupted. We use cookies to enhance your experience
  5. Freibergs disease or avascular necrosis of the metatarsal head is a rare, painful bone disorder. It is most commonly seen in adolencence between 12 and 18 years of age. Causes of Freibergs Infraction. There is no known cause of Freibergs Infraction, it is thought that trauma may initiate the problem

Avascular necrosis - Wikipedi

Necrotic tissue is a medical condition in which there are dead cells in your body organ. It is considered to be a damaging health condition and can result in severe diseases like skin cancer. Book an appointment at Medanta to know more about its causes, symptoms, diagnosis, types, signs, treatment and prevention Avascular necrosis or Osteonecrosis is death of a bone due to ischaemia or deficient blood supply. This can have serious consequences like degenerative changes and disabling osteoarthritis of the. One of the hardest things I was ever told was I would be living with avascular necrosis the rest of my life. Worst, told you will be in a wheel chair at the age of 21. Living with avascular necrosis or any chronic pain comes with challenges particularly with exercise and dieting Delayed Diagnosis of Hip Fracture Causes Avascular Necrosis Author: Michael Talve, CEO This case involves the failure to diagnose a hip fracture in a 49-year-old female who had recently started running and acutely developed severe groin pain

What is Avascular Necrosis? Causes, Stages, and Treatment

Avascular necrosis is a progressive, degenerative disorder that kills bone tissue. Loss of blood supply causes the tissue death, which causes tiny breaks and weakening in the bone, eventually causing the bone to collapse. 2. Avascular necrosis is also called osteonecrosis, aseptic necrosis and ischemic bone necrosis. 3 Avascular Necrosis of the Hip Avascular Necrosis of the Hip. Print Email Written by eOrthopod Category: Hip Published: 20 July 2006 The pressure causes tiny bubbles to form in the blood stream which can block the blood vessels to the hip, damaging the blood supply. Symptoms

Osteonecrosis of the Humeral Head

Clinical manifestations and diagnosis of osteonecrosis

  1. Avascular necrosis: Avascular necrosis of the hip? Can definitely cause low back pain.In fact many patients come to the doctor complaining of back pain and not hip pain.But, many other things can cause low back pain as well. Have it checked to see if due to the avn or due to something else
  2. e at what stage your disease is. The stages are as follows: Stage I: X-Ray: ON (AVN) is not detectable
  3. Avascular Necrosis Causes. Avascular necrosis (AVN) is a complex process. The main cause of AVN is a loss of blood supply to the bone. When blood vessels are too small or become damaged or clogged, nutrients and oxygen cannot get to the bone, and bone cells begin to die

Avascular Necrosis Prognosis The outcome for this condition depends on the area of the bone that is affected, largeness or smallness of the area involved, and how well the rebuilding of the bone occurs Avascular necrosis (AVN) is officially defined as a disease that results from the temporary or permanent loss of blood supply to the bones. Without the blood supply, the bone tissue dies, and ultimately the bone could collapse. According to the Mayo Clinic, there are many complications of Lupus, and AVN is one of them. But why There is no definitive or clear pattern on speed of progression, which complicates decision making. It is important to rule out secondary causes of avascular necrosis of the femoral head (AVNFH) and ask historical questions about chronic steroid use, alcohol use, clotting disorders, sickle cell disease, autoimmune disease, or trauma

Femoral Head Avascular Necrosis - StatPearls - NCBI Bookshel

  1. In thalassemia and sickle cell anemia, the avascular necrosis is a result of a change of shape of the blood cells, which cause them to clump and block off the small, microvessels in the bone. Steroid-induced osteonecrosis is usually the result of prolonged high-dose steroid therapy as sometimes necessary in the treatment of lupus and other.
  2. Avascular necrosis is also known medically as osteonecrosis, aseptic necrosis and ischemic necrosis. If avascular necrosis is not treated, the joint can deteriorate and cause severe arthritis. There are no symptoms in the early stages but, as the bone damage worsens, the person may feel pain in the affected area and the range of motion may be.
  3. What causes avascular necrosis? MD. what is in a decocompressiom with some ome with avasulaer necousis 0have had avasulael necousis since last july 2003 how can a person treat it View answer. Answered by : Dr. Chobufo Ditah ( General & Family Physician) Suggest treatment for avascular necrosis . MD
  4. The pathogenic mechanisms of avascular necrosis of the femoral head caused by endogenous hypercortisolism or exogenous glucocorticoid excess are not fully understood, but it has been proposed that fat cell hypertrophy, fat embolization, and apoptosis of osteocytes cause compromise of blood perfusion in the femur, leading to ischemic necrosis of.
Stress Fractures Of The Femoral Neck - Everything You NeedThe Radiology Assistant : Hip pathology in Children

Osteonecrosis (Ischemic or Avascular Necrosis) Osteonecrosis, the cellular death of bone tissue, may occur after a fracture or dislocation when the bone is deprived of a sufficient supply of arterial blood. However, it is important to recognize that this condition may also develop as a result of factors unrelated to mechanical trauma. 2. Avascular Necrosis (AVN) of the femoral head is a pathological process that results from interruption of the blood supply to the bone. Also known as Osteonecrosis/ Osteochondritis Dissecans/ Chandler's Disease. 3. First described by Munro in 1738. In 1835 Curveilhier depicted femoral head morphological changes secondary to interruption of. Bone marrow edema most commonly occurs in the hips, knees and ankles. In this case, bone marrow edema of the knee is a main cause of localized knee and joint pain, and is only diagnosable via a Magnetic Resonance Imagining test (MRI). It is usually caused by the following scenarios: • Avascular necrosis, or bone death Avascular necrosis is a disease resulting from the temporary or permanent loss of the blood supply to the bones. Without blood, the bone tissue dies and causes the bone to collapse. If the process involves the bones near a joint, it often leads to collapse of the joint surface. Avascular necrosis is also known as: Osteonecrosis. Aseptic necrosis Avascular necrosis of the hand is a severe complication that could lead to a functional loss. If you or a family member has developed serious injuries after a motor vehicle accident, contact me at (916) 921-6400 or (800) 404-5400 for free, friendly legal advice. I am a member of the Million Dollar Advocates Forum

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