FVL: What is it? And Why is The Medical Mama Writing About it?

Photo Credit factorv.org

I would like to introduce you to my biggest nightmare-Factor Five Leiden, or FVL. “What is it?” you are probably asking. I’ll tell you, then I’ll tell you why this has impacted myself and my family so much.

So…What is Factor Five Leiden (FVL)? “Factor V Leiden is a mutation of one of the clotting factors in the blood called factor V. This mutation can increase your chance of developing abnormal blood clots (thrombophilia), usually in your veins” (Mayo Clinic Staff., 2015). It is an inherited gene. I happened to inherit it from my dad and his side of the family.

The Clotting Process

clotting process
Photo Credit World Federation of Hemophilia, http://www.wfh.org. (2014).

When you are injured, or have surgery, you have special proteins that work together to heal the blood vessels in your body. These proteins are your clotting factors. You also have platelets that send signals to other cells to come and clot together to repair this injury. This is called a platelet plug. After that you have coagulation factors (labeled by Roman numerals, like Factor V) that come and help with the clot. Note the image located to the left side of this section.

When you have a coagulation disorder, or blood clot disorder, this is when things get complicated.

How FVL Affects Clotting

When our bodies need to clot we have something called activated protein C (APC). This initially tells the blood clot to not grow too large enough for complications (i.e. deep vein thrombosis, pulmonary embolism, etc). This directly tells the fibrin (clotting factors mentioned above) to not grow and get out of control. When someone has FVL it is a gene mutation in which is can not help but grow too large to the point of blood clots in the body that become harmful (World Federation of Hemophilia., 2014).

How Has This Impacted My Life?

I am not perfect (hard to believe I know. Haha). I have Factor Five Leiden. I have this horrible gene mutation that affects my daily life. If I get injured in any way I am at risk for developing blood clots or hematomas. When you are injured the clotting process is still the same (even in organs). Both of my pregnancies I have had to be on blood thinners (self injections twice a day for 12 months). When you become pregnant your body produces more blood for the baby. More blood=more blood flow. Your heart and blood vessels have to work twice as hard to pump this blood throughout the body. This increases your risks of clotting. Clots will undeniably kill your unborn baby. It’s a fact, not a “maybe”. When I have surgeries (like my two c-sections) I increased my risks for clotting. Patients can throw a clot and die from surgeries if they have FVL.

dad and elexys
Photo Credit The Medical Mama, themedicalmama.wordpress.com. (2012).

Not only do I have FVL, but my father and sister have it as well. This puts both my daughters at risk for it as well. My father almost died from it. We were not aware it “ran” in our family. He fell on ice one day and it went untreated by several doctors (Don’t get me started on that.). He had a deep vein thrombosis in his right leg. The clot broke off and traveled to his lungs leaving him with several pulmonary embolisms. The clots from there then traveled to his heart. He had about 5-7 clots in his heart. This left his heart damaged in some areas permanently. This is something that can not be reversed when damage has been done. He almost died sitting in an ER room waiting for doctors to figure out how the heck it got this far to a life or death situation. With the grace of God and God’s love my father is alive today.

There are two types of gene mutations: heterozygote and homozygote. I have the heterozygote gene mutation. I have the heterozygote gene mutation. This means if a parent with one copy and a parent with no copies has a baby that baby will have a 50% chance of carrying the FVL gene. That is 1 in 2 babies. I have 2 children and that fact just hit me hard in the face…like a pile of bricks. That means AT LEAST one of my beautiful daughters is carrying the gene (maybe both).

FVL and Pregnancy

carrying high or low
Photo Credit Emily Sadler, todaysparent.com. (2017)

As I mentioned above pregnancy increases your risks for blood clots. When you become pregnant your body produces more blood for the baby. More blood=more blood flow. Your heart and blood vessels have to work twice as hard to pump this blood throughout the body. This increases your risks of clotting. Again, clots will undeniably kill your unborn baby. It’s a fact, not a “maybe”.

“The factor V Leiden mutation is associated with a slightly increased risk of pregnancy loss (miscarriage). Women with this mutation are two to three times more likely to have multiple (recurrent) miscarriages or a pregnancy loss during the second or third trimester. Some research suggests that the factor V Leiden mutation may also increase the risk of other complications during pregnancy, including pregnancy-induced high blood pressure (preeclampsia), slow fetal growth, and early separation of the placenta from the uterine wall (placental abruption). However, the association between the factor V Leiden mutation and these complications has not been confirmed. Most women with factor V Leiden thrombophilia have normal pregnancies” (Genetics Home Reference., 2010).

FVL and Surgery

When you have an injury your blood vessels will dilate to keep blood inside your body. This will slow down the rate of blood flow through the blood vessels. This increases the risk of blood clots.

“Injury to your veins or surgery can slow blood flow, increasing the risk of blood clots. General anesthetics used during surgery can dilate your veins, which can increase the risk of blood pooling and then clotting” (Mayo Clinic Staff., 2015).

If you think you have a blood clotting disorder please talk to your doctor right away!

 

 

Resources:

Mayo Clinic Staff. (2015). Factor V Leiden. Retrieved from https://www.mayoclinic.org/diseases-conditions/factor-v-leiden/symptoms-causes/syc-20372423

World Federation of Hemophilia. (2014). The Clotting Process. Retrieved from https://www.wfh.org/en/page.aspx?pid=635

Dictionary.com. (2018). Retrieved from http://www.dictionary.com/

Genetics Home References. (2010). Factor V Leiden Thromophilia. Retrieved from https://ghr.nlm.nih.gov/condition/factor-v-leiden-thrombophilia#resources

Mayo Clinic Staff. (2014). Factor V Leiden. Retrieved from https://www.mayoclinic.org/diseases-conditions/factor-v-leiden/diagnosis-treatment/drc-20372428

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10 Sure Ways of Dealing With the Germs From School

If you are a mom of any child that is in daycare, school, or some sort of regular social setting then you are totally aware of what I am talking about. GERMS! I see it constantly. Some kids are more prone to getting sick than other kids. I will explain why later. It seems like every time I turn around one of my two kids is ill with some nasty cough or cold. It then quickly plagues the house if we don’t take precautionary measures.

So how do we take these precautionary measures?

1) WASH YOUR HANDS!

washing-hands-soap-bathroom-hygiene-260nw-264524252
Wash Your Hands Regularly. Make Sure to Use Soap Too.

I feel like this should be a “no brainer”, but you would not believe how many children (adults included) that do not wash their hands regularly, if at all.

If you touch your face you should wash your hands.

If you cough in your hands you should wash your hands.

If you sneeze in your hands you should wash your hands.

If you get your hands icky you should wash your hands.

If you go to the bathroom you should wash your hands (yes even when you only urinate).

If you touch something that someone else who is sick touches it you should wash your hands.

There….I made a list of when you should, without a doubt, wash your hands to help prevent the spread of germs. It helps everyone around you. Even if you are not sick you should always wash your hands under these circumstances to help prevent you from getting sick. If you are sick you should still wash your hands because you don’t want to be sick longer than you have to be. You also want to minimize your ability to spread your germs to other people.

WASH YOUR HANDS!

2) Teach Your Child/ren to Cover Their Mouth

people-2563491_960_720
Example of How to Cover Your Mouth Properly

This one kind of goes with the first one. Everyone should always cover their mouth when they sneeze or cough. The best way to prevent the spread of germs is to cover your mouth with your shirt. Put the inside of the collar of the shirt up over your nose and mouth when you cough or sneeze. This puts the germs on the inside of your shirt where it is not going to creep out anywhere and spread. This also eliminates the germs being sprayed in to your hands. Gross. Just cover your mouth with your shirt.

3) Up the Kiddie’s Vitamins Dose

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Gummy Vitamins for Kids

If the dose on the back of the vitamin bottle says to take 1 tablet/gummy/chewable a day then give them 2 a day for about 3 days. I find this helps with immune system boosting. I promise you it’s safe, and it works.

4) Push Fluids

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Drink water regularly.

Make sure to drink plenty of water and electrolyte enhanced fluids regularly. This helps bump the immune system to help fight off those germs.

5) Stay Stocked up on Facial Tissues

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At our house we prefer Puff’s Plus Lotion facial tissue.

I’ve noticed we can never have too much Puff’s facial tissue around the house. My household prefers Puff’s Plus Lotion. It helps soothe their noses. The worst thing when you’re ill is running out of tissues.

6) Rest

baby-1151347_960_720REST, REST REST! You can never rest too much when you are not feeling well.

In order to keep your immune system healthy if you are not already sick you should make sure you are getting an adequate amount of sleep at night. Make sure you and your children are going to bed on time. Make sure everyone is getting the right amount of sleep at night.

7) Push Cold Medication WHEN NECESSARY

cold-1947995_960_720The last thing I want to encourage is an overdosing of cold medication. I do believe in not giving your children medication. I also do believe we should be giving our children medication when it is necessary. If your child is in pain from a headache, fall, or something like that why would you not give them Tylenol to help them? That is neglectful not to give them a pain reliever.

The same holds true with cold medication. If your child can have cold medication and they are miserable please give them medicine. If they can not sleep at night because of the cough or stuffy nose it is okay to give them medication. If the medication is not touching the symptoms, or barely alleviating them then it is time to see the pediatrician (notice I didn’t say family doctor).

nurse bearI can also tell you from a nurse’s point of view to please give your child medication if they have a fever. Don’t bring them in the office knowing they have a fever and then when we ask “Have they had any fever reducing medication?” you say “No. I wanted you to see the fever.” I promise we believe you if you give them medication before they come in, and when they come in the fever is gone and we still ask you that question. Give your child the fever reducer BEFORE you bring them to the doctor’s office. We believe you.

8) Use Lysol

spray-35176_960_720According to the Lysol website they pride themselves on being a 99.9% fungi, viruses, and bacteria killer. They also say it kills cold and flu germs. There you go. What more could you want? I use Lysol, and I love it. It really does disinfect all surfaces, kills germs, and prevents the spread of germs with just one spray. I use it on the toilet handles, furniture, and anywhere someone has coughed or sneeze in the air.

9) Don’t Share Food or Dishes (or Germs)

aerial-view-hands-sharing-food-260nw-659367709Teach your children not to share their food at school. Siblings should not be sharing food at home either. I am guilty of this in our home. However, if anyone in our family is sick we do not share food or dishes. We do not eat off each other’s plates or drink our of each other’s cups. We do not try to feed each other food (example: “Try this. It’s yummy.”). Be sure to teach your children to keep their germs to themselves, and do not allow anyone else to share their germs to them either.

10) Eat Healthy

fruit-2305192_960_720Be sure to eat healthy meals regularly. Make sure your children are getting plenty of fruits and vegetables. That vitamin C will go a long way with immune system support just by eating healthier.

So what makes my child more susceptible to getting sick than someone else’s child?

For my children it is their asthma and allergies that make them more susceptible to getting the cold and flu viruses.

Other medical conditions where the immune system or other organs are not up to par can make a child more susceptible to getting sick.

Being in a daycare environment can also make your child more susceptible to getting sick because there are more people (mostly children) who share germs at home from their siblings (who go to school and share germs with those kids), and those germs can come in to the daycare as well and spread. Children also are known for poor hygiene. This is also another reason children can leave themselves open to receiving germs.

Be sure you are taking proper prevention to help stop the spread of germs in your home. This will make you and your family healthier as a whole.

Pregnancy Diets, Breastfeeding diets, and Post Baby Diets. OH MY!

So many questions revolve around pregnancy and dieting (What am I supposed to be eating?), breastfeeding diets (What diet should I be following while breastfeeding my baby to ensure they get the right nutrition?), and then there’s the mom that can’t wait to start losing weight after the baby is born (that’s completely me).

I want to start this article out by stating you should not try to lose weight during pregnancy. This is extremely dangerous for you and for your unborn child. When I say pregnancy diet I mean your overall consumption of food you ingest. You should not count calories and lose weight while pregnant.

The Pregnancy Diet

So what are you supposed to be eating while pregnant? What nutrients are you in dyer need of while pregnant? What does baby need to grow and maintain a healthy “diet” while in the womb?

I am so glad you asked!

folate rich foods
Photo Credit exhibithealth.com. (Unknown).

During your pregnancy make sure you increase your fiber intake. I can not tell you how important this is. Constipation during pregnancy is so common…and very painful. Make sure you are eating good sources of calcium and protein. According to WebMD “Choose at least one good source of folate every day, like dark green leafy vegetables, veal, and legumes (lima beans, black beans, black-eyed peas and chickpeas). Every pregnant woman needs at least 0.64 mg of folate per day to help prevent neural tube defects such as spina bifida” (WebMD., 2018).

 

pregnancy food pyramid
Photo Credit Shweta, healthworry.com. (2016).

You should already be taking your prenatal vitamins. In fact,  you should start these as soon as you find out you are pregnant. These are rich in nutrients that baby needs to grow and develop. Your diet is the single most important thing for your baby at this stage of the game. You should be consuming something from every food group in the food pyramid. This helps ensure that baby is getting a well rounded amount of nutrients they need to grow and develop. Naturally, you will need to have a bigger calorie intake. This does not mean indulging in a chocolate cake or a whole pint of Ben and Jerry’s Ice Cream. This means about 300-500 extra calories per day. This is about a peanut butter sandwich and a glass of milk. Depending on your weight before pregnancy determines how many extra calories you really should be consuming. Make sure you talk to your doctor about this.

The Breastfeeding Diet

mom-breastfeeding-baby
Photo Credit Parents, parents.com. (Unknown).

For breastfeeding you still need to follow a copious diet from every group of the food pyramid. You should continue to take your prenatal vitamins as those are still the nutrients being received from mommy to baby. You should continue to consume about 500 extra calories per a day for breastfeeding.

Everyone wants to lose weight after baby is born. Hold off on losing weight and focus on a healthy breastfeeding diet instead. You will want to increase your fish intake. Remember fish was banned while pregnant? Now you need to consume fish to help with baby’s eye sight development.

 

breastfeeding diet
Photo Credit Unknown.

Continue to consume lots of rich proteins and calcium foods. This helps with growth and development still. Don’t forget to increase your fiber intake as well. Again, constipation seems to still be an issue not only for you, but for baby as well. Anything you consume baby consumes. That also means avoid alcohol and caffeine.

The Post-Baby Diet

This is the part of the article I am most eager to talk about. For me counting calories after breastfeeding was over was the key to losing weight and keeping it off.

my fitness pal
Photo Credit My Fitness Pal. (Unknown).

First, set a goal. How much do you want to lose? Be realistic! Start keeping track of your calorie intake. You can use an app that I love so much. It helps you keep track of your calorie intake. It also helps you figure out what is the right amount of daily calorie intake for you to lose weight, maintain weight, or gain weight. It’s called My Fitness Pal. This app helped me lose weight and keep it off. You can also keep track of your exercise and how many calories you burned doing it. It’s the best app that I’ve tried so far.

Make sure to incorporate lots of exercise. You should exercise for 45 minutes per day roughly 3-5 days per week. I am not going to lie it can get addictive counting calories. It’s like a challenge when using the app. “How many calories do I have left? How many can I gain if I do this exercise?” I think that’s why it worked so well for me.

I also wrote an article about several different exercises you can do to help you lose that baby weight. You can find it here: https://themedicalmamac.wordpress.com/2018/03/07/losing-weight-after-baby-is-born/

What are your favorite ways to lose weight?

 

Resources:

American Pregnancy Association. (2015). Diet During Pregnancy. Retrieved from http://americanpregnancy.org/pregnancy-health/diet-during-pregnancy/

WebMD. (2018). Eating Right When Pregnant. Retrieved from https://www.webmd.com/baby/guide/eating-right-when-pregnant#2-2

Murkoff, Heidi, What to Expect. (2018). The Pregnancy Diet. Retrieved from https://www.whattoexpect.com/pregnancy/eating-well/pregnancy-diet.aspx

 

Birth Control Part 2: Can I Get Pregnant While Being on it? And How Soon After Going Off of it Can I Get Pregnant?

I want to let all of my readers know first that there is a list of resources below in case you would like more information about something that was mentioned today. I hope this article helps you with any questions you might have about which type of birth control is right for you.

What is Birth Control?

First, let’s talk about what contraception really is. “the deliberate prevention of conception or impregnation by any of various drugs, techniques, or devices; birth control” (dictionary.com, 2018).

Birth control can be sub-categorized in to two separate categories: hormonal birth control and non hormonal birth control. We can get even more specific and categorize the hormonal birth control in to which hormones they use to prevent pregnancy. We can get even more in depth after that, but we aren’t today. We are going to talk about the overall concept of how each one works, the effectiveness, and how to conceive or avoid conception with each one.

Let’s Jump Right In:

Condoms:

condoms
Photo Credit iStock, daily.jstor.org. (2018)

How It Works: Condoms go on the male “part” and prevent any sperm from passing through to the vagina. The end of the condom has a little sack/pouch (called a nipple) to catch all the semen that is released during sex. This prevents pregnancy.

Effectiveness: When using a condom with foam (spermicide) properly it is 97% effective at preventing pregnancy (MedicineNet, 2018).

Can I Get Pregnant While Using Them: Whenever you are ready to conceive all you have to do is not use them anymore. It’s as simple as that. The only wait time you will face is when mommy-to-be is waiting to ovulate.

If you are not trying to conceive be aware that condoms like to break…a lot. That is why they recommend using lubrication while using them.

 

Diaphragm:

diaphragm
Photo Credit Maria Shevtsova, motherhow.com. (2017)

How It Works: The diaphragm works by blocking sperm from getting in to the uterus. It is placed in the vagina and meant to cover the opening to your cervix. It is meant to be used with a spermicide as well. The spermicide kills the sperm before it can enter the uterus. “You can put it in up to 6 hours before you have sex, and you need to leave it in for at least 6 hours after” (WebMD, 2018).

Effectiveness: When used correctly it is is 94% effective at preventing pregnancy. However, a lot of people misuse it and don’t place the diaphragm correctly in to place, so the rate is more like 88% effective (Planned Parenthood, 2018).

Can I Get Pregnant While Using It: Yes, you can conceive while using the diaphragm as a form of contraception. There’s always that chance. As soon as you are ready to conceive all you have to do is not use it anymore. Again, the only wait time is waiting for mommy-to-be to ovulate.

If you are not trying to conceive be aware they are only 94% effective at preventing pregnancy. There’s always that chance of getting pregnant.

 

 Copper IUD (ParaGard):

paragard
Photo Credit viewpoints, viewpoints.com. (2018)

How It Works: This copper IUD works by releasing copper in the uterus and killing sperm before it enters the cervix. It is an IUD so it is placed in the uterus. It is good for up to 10 years. It is completely reversible and can be removed by a healthcare provider. It does need to be inserted by a healthcare provider too though.

Effectiveness: When used correctly it is over 99% effective at preventing pregnancy (Paragard.com, 2018).

Can I Get Pregnant While Using Them: With any IUD you have a higher risk of having an ectopic pregnancy. If you are trying to conceive you can have it removed by a healthcare professional and try to conceive immediately. That’s the beauty of a hormone free birth control. It is hormone free, so you should have your normal cycle while using it as well.

If you are not trying to conceive be aware that sometimes it can dislodge, or embed itself in the uterus wall. Both these scenarios make it less likely for the IUD to work properly.

Rhythm Method:

rhytm method
Photo Credit Cedarmed International Medical Services, cedarmed.com. (2018)

How It Works: The rhythm method is, basically, you track your cycle using a calendar. You track your ovulation window and your periods. You should mark when you start your cycle, and when you end. You should also anticipate 3 days before ovulation day and 3 days after as a window of getting pregnant. If you are going to use this method I highly recommend getting an app on your phone and using a condom for a few months until your app can properly start calculating your ovulation schedule.

Effectiveness: When this process is used correctly it is about 75% effective at preventing pregnancy.

Can I Get Pregnant While Using This: The answer is YES! This method is not always reliable as it is easy to miscalculate your cycle. It also has a 75% rate of prevention. That’s 25% chance of getting pregnant.

If you are trying to conceive this is perfect because you have to track your ovulation schedule.

If you are not trying to conceive this is an issue for birth control. It is more likely you will conceive accidentally with using this method.

 

Surgical Sterilization:

I’m sure we all know what this means. Surgical sterilization is where you go to your doctor and ask to be sterilized so you can not have any more children. This method can not be reversed in most cases. Please consider all options before choosing this method.

-Tubal Ligation-

How It Works: This is the female form of surgical sterilization. It is also known as “getting your tubes tied”. A tubal ligation “is a type of permanent birth control. During tubal ligation, the fallopian tubes are cut, tied or blocked to permanently prevent pregnancy” (Mayo Clinic Staff, 2017).

Effectiveness: “Tubal ligation is a safe and effective form of permanent birth control. But it doesn’t work for everyone. Fewer than 1 out of 100 women will get pregnant in the first year after the procedure. The younger you are at the time it’s done, the more likely it is to fail” (Mayo Clinic Staff, 2018).

Can I Get Pregnant Accidentally: Yes you can. The younger you are the more likely for it to fail. You also have a higher risk of it being an ectopic pregnancy. It is pretty effective though for the most part with the right patients.

-Vasectomy-

How It Works: A vasectomy is the male form of surgical sterilization. In a vasectomy “the surgeon makes a small cut in the upper part of the scrotum, under the penis, and then cuts, ties, or blocks the vas deferens. You’ll get your surgical cuts stitched up and go home right away” (WebMD, 2018).

Effectiveness: This is almost 100% effective. In rare cases it can reverse itself. The man does need to get regular check ups to check sperm counts.

Can I Get Pregnant Accidentally: Yes, you can get pregnant accidentally. Only if the vasectomy reverses itself though.

 

Pills, or Oral Contraceptives:

bc pillsHow It Works: Oral contraceptives come in a wheel or in a package like the picture to the left of this section. How do oral contraceptives work? I am so glad you asked. When used correctly they release a hormone that prevents your body from ovulating. Therefore, your body is temporarily infertile.

Some work by releasing estrogen. Others work by releasing progesterone. They also offer oral contraceptives that release both hormones. You do need to take it every day at the EXACT SAME TIME EVERY DAY. This can be a pain in itself and a huge inconvenience. This can also be impractical for very busy women.

Effectiveness: When the pill is taken correctly it is 99.9% effective (WebMD, 2018).

Can I Get Pregnant While Using Them: Generally speaking, if you are trying to conceive you can have a period in about 2-4 weeks. It is recommended you wait and have at least 2-3 “normal” periods after stopping the pill to try and conceive. This lowers the risk of there being any birth defects in the womb later on.

If you are not trying to conceive you should continue taking the pill. If you go off of the pill or miss a dose you should use back up birth control methods (condoms, diaphragm).

Depo-Provera Shot:

depo shot
Photo Credit Melissa Gardner, pajamamommy.com. (2017)

How It Works: The Depo shot, or Depo-Provera shot, is an injection you get every 3 months. The shot works by releasing progesterone preventing ovulation. It also thickens the mucous in your cervix so the sperm can’t get through.

Effectiveness: When used correctly it is over 99% effective at preventing pregnancy.

Can I Get Pregnant While Using This: Yes, you always have a chance of getting pregnant. Realistically, especially if you’ve used it for several months already, you are not going to get pregnant. If you miss a shot you should use back up birth control methods. I also don’t recommend using this passed your 2-3 year mark.

If you are trying to conceive this makes it a little harder for your body to go back to the “norm” or having a menstrual cycle. It can take months for your body to start having periods again. When that does happen you should wait to have 2-3 “normal” periods before trying to conceive.

If you are not trying to conceive this is actually a better option than some of the other choices out there. This is because it is over 99.9% effective at preventing pregnancy. It also has the ability to take away periods all together while on it. No period means no ovulation.

Hormone IUD:

mirena
Photo Credit Mirena, Mirena-us.com. (2017)

How It Works: I think the most common hormone IUD we think of that’s on the market today is the Mirena IUD. It is a small T-shaped piece that gets implanted in to your uterus. It works by releasing levonorgestrel in to the uterus. It also thickens your mucous in your cervix and thins your uterus lining to prevent a fertilized egg from attaching to the wall of the uterus. It is good for up to 5 years. You have to have a doctor insert it and take it out.

Effectiveness: When used correctly it is also over 99% effective at preventing pregnancy.

Can I Get Pregnant While Using It: Yes, but you can get it put in at the clinic office and forget about it for the next 5 years. You also have the option of taking it out whenever you decide you want to get pregnant. Your cycle should return right away without any issues with conceiving. “Within a year of having Mirena removed, about 8 out of 10 women succeed at becoming pregnant” (Mirena, 2018).

If you are not trying to conceive this is a highly effective method. There’s always a chance of pregnancy with any type of birth control on the market today. IUDs can get dislodged or embed themselves in the uterus wall. This makes it less effective.

This should only be used on full grown women. It is not recommended for teen girls. I also do not recommend it for women who have not had children yet. Your uterus would not be used to it and stretched out and the IUD could expel itself.

Hormone Implant:

nexplanon
Photo Credit MacArthur, macarthurmc.com. (2018)

How It Works: The hormonal implant on the market today is the Nexplanon. This is a little stick looking piece that is filled with hormones. It’s funny because the website doesn’t actually say which hormone (which I find kinda shady). It gets surgically implanted in to the skin of your upper arm. Your arm will be locally numbed, then the stick will be implanted under the skin in your arm. “Immediately after the insertion, you and your health care provider will feel for NEXPLANON to ensure that it has been placed correctly. If you can’t feel it, contact your health care provider immediately and use a non-hormonal birth control method (such as condoms) until your health care provider confirms that the implant is in place. The implant may not be placed in your arm at all due to a failed insertion. If this happens, you may become pregnant. Following the insertion, you’ll have to wear a pressure bandage for 24 hours and a small bandage for 3 to 5 days.” (Nexplanon, 2018).

Effectiveness: When used correctly it is over 99% effective.

Can I Get Pregnant While Using It: The advantages include it is effective for up to 3 years. You can take it out at any time if you plan to become pregnant. You get it inserted at the clinic by your doctor and you don’t have to worry about it for the next 3 years.

If you are not trying to get pregnant please be aware that although there is a low likelihood of pregnancy, there still exists one. These can get punctured easily or broken inside the skin easily. They also can embed themselves which make them less likely to be effective.

Vaginal Ring:

nuvaring
Photo Credit Lydie Stock/Fotolia. (2017)

How It Works: The vaginal ring is not for those who are, what I like to call, “vagina shy”. This is something you replace monthly and you have to personally insert it in to your vagina yourself. On the market there is the NuvaRing. This is a lot different than the other forms of hormonal birth control methods. This is a flexible ring that gets inserted in to your vagina.

Effectiveness: This works using estrogen and progesterone both. It is 98% effective at preventing pregnancy. It is to be removed after 3 weeks. The 4th week you have your menstrual cycle. Then the next month you insert a new one. You will need a prescription for this.

Can I Get Pregnant While Using It: Yes, you can. If it is not inserted properly you can become pregnant. If you do not use it properly you may become pregnant. It can also dislodge.

However, if you are trying to conceive you can remove it at any time and become pregnant.

Hormone Patch:

ortho evra patch
Photo Credit Center for Young Women’s Health, youngwomenshealth.org. (2017)

How It Works: The hormonal patch, also known as the transdermal patch or Ortho Evra Patch, is a patch you wear for 3 weeks. The 4th week you have your period. The next week you will need to re-apply another patch. It uses both estrogen and progesterone. It releases hormones in to the skin. These hormones work like the depo shot. Your body stop ovulation temporarily.

Effectiveness: The patch is only about 91% effective at preventing pregnancy.

Can I Get Pregnant While Using It: Yes, it is only about 91% effective, so your odds at getting pregnant just went up. This is an issue if you are not trying to conceive. If you forget to use the patch make sure you use a back up method of birth control.

If you would like to become pregnant you can remove the patch at any time and should be able to conceive soon after.

Do you have a preference? Have you had a good/bad experience with one of the forms of birth control addressed in this article? I would love to hear from you and hear your experience. This is a great way to help other women who have questions as well.

 

Resources:

Dictionary.com. (2018). Unknown. Retrieved from http://www.dictionary.com/

Medicine Net. (2018). Your Guide to Birth Control: Condoms. Retrieved from https://www.medicinenet.com/condoms/article.htm#introduction

WebMD. (2018). Birth Control: Is the Diaphragm Right for You? Retrieved from https://www.webmd.com/sex/birth-control/diaphragm-birth-control#1

Planned Parenthood. (2018). How Effective are Diaphragms? Retrieved from https://www.plannedparenthood.org/learn/birth-control/diaphragm/how-effective-are-diaphragms

Paragard. (2018). Frequently Asked Questions. Retrieved from https://www.paragard.com/Faqs.aspx

Mayo Clinic Staff. (2017). Tubal Ligation. Retrieved from https://www.mayoclinic.org/tests-procedures/tubal-ligation/about/pac-20388360

WebMD. (2018). Vasectomy: What You Should Know. Retrieved from https://www.webmd.com/sex/birth-control/vasectomy-overview#1

WebMD. (2018). Birth Control Pills. Retrieved from https://www.webmd.com/sex/birth-control/birth-control-pills#1

Mirena. (2018). Mirena. Retrieved from https://www.mirena-us.com/index.php/?pse=google&matchtype=e&Keyword=mirena&campaignid=601337644&adgroupid=29788072950&device=c&adposition=1t1&loc=9016368&gclid=Cj0KCQiAiKrUBRD6ARIsADS2OLmQ54_aMbftwWxjnd0qdC9Edpas08ock9ejoEkKudJ3snnmQs8VufwaAtsuEALw_wcB&dclid=CPPS7ey0stkCFUqDaQodKCAJGQ

Nexplanon. (2018). Nexplanon. Retrieved from https://www.nexplanon.com/

NuvaRing. (2018). NuvaRing. Retrieved from https://www.nuvaring.com/

 

Birth Control Part 1: Which One Should I Use?

Photo Credit Melissa Conrad Stoppler, Medicinenet.com. (2018)

Birth Control is such a personal choice, but one that many people flock to social media, forums, and other sources (other than their OB/GYN) to discuss. I want to talk about the different forms of birth control out there and how to choose the right one for you and your personal lifestyle.

I want to let all my readers know who are reading this that we are about to get very up close and personal about birth control and intercourse.

What is Birth Control?

First, let’s talk about what contraception really is. “the deliberate prevention of conception or impregnation by any of various drugs, techniques, or devices; birth control” (dictionary.com, 2018).

Birth control can be sub-categorized in to two separate categories: hormonal birth control and non hormonal birth control. We can get even more specific and categorize the hormonal birth control in to which hormones they use to prevent pregnancy. We can get even more in depth after that, but we aren’t today. We are going to talk about the most popular forms on the market and prescription today.

Non-Hormonal Birth Control:

Condoms:

condoms
Photo Credit iStock, daily.jstor.org. (2018)Condoms:

I think in the non-hormonal category the most common practiced form of non-hormonal birth control is condoms. How do condoms work? Condoms go on the male “part” and prevent any sperm from passing through to the vagina. The end of the condom has a little sack/pouch (called a nipple) to catch all the semen that is released during sex. This prevents pregnancy and STDs). When using a condom with foam (spermicide) properly it is 97% effective (MedicineNet, 2018).

If you are allergic to latex you might want to reconsider this option. Side effects of condoms are very minimal. The biggest being pregnancy or STDs. The other one being an allergic reaction to latex (American Pregnancy Association, 2018). Condoms like to break. That’s why they recommend using a lubrication with it. You do not need a prescription and they are extremely cheap to buy at your local super store.

The downsides include you have to stop “in the moment” and put one on. They can break easily, and they’re not 100% effective. The upsides include it being hormone free. You don’t have to remember to “take it every day” like you would a pill.

Diaphragm:

diaphragm
Photo Credit Maria Shevtsova, motherhow.com. (2017)

The diaphragm works by blocking sperm from getting in to the uterus. It is placed in the vagina and meant to cover the opening to your cervix. It is meant to be used with a spermicide as well. The spermicide kills the sperm before it can enter the uterus. “You can put it in up to 6 hours before you have sex, and you need to leave it in for at least 6 hours after” (WebMD, 2018).

When used correctly it is is 94% effective. However, a lot of people misuse and don’t place the diaphragm correctly in to place, so the rate is more like 88% effective (Planned Parenthood, 2018). You do need a prescription for a diaphragm though. Talk to your doctor and they should also be able to teach you how to properly “install” it before intercourse.

Risks and side effects include risk of STDs. They do not protect against STDs just to be clear. The more serious side effect is toxic shock syndrome. This is caused from a bacteria from the vagina being plugged up for several hours and turns in to an infection. It is also believed that women are more likely to get a urinary tract infection from using them from the bacteria being in the area.

Some downsides to this method include having to put it in 6 hours prior to having intercourse. You don’t have the option of “spur of the moment”. The upsides though are you can put it in and forget about it for 6 hours. You don’t have to remember to take a pill every day. It is hormone free. You can use it several times, but spermicide needs to be reapplied before each use and in between intercourse.

Copper IUD (ParaGard):

paragard
Photo Credit viewpoints, viewpoints.com. (2018)

This copper IUD works by releasing copper in the uterus and killing sperm before it enters the cervix. It is an IUD so it is placed in the uterus. It is good for up to 10 years. It is completely reversible and can be removed by a healthcare provider. It does need to be inserted by a healthcare provider too though.

When used correctly it is over 99% effective (Paragard.com, 2018). Risks and side effects include STDs, heavier and longer periods with bleeding in between cycles, pelvic inflammatory disease (PID), perforation of the uterine wall, and hard surgical removal. This is not a complete list of all side effects for the Paragard, but these are the more common ones. Make sure you talk to your doctor before making a decision.

This is a good option for people who can’t take certain hormones due to diseases or disorders or medication interactions.

Rhythm Method:

rhytm method
Photo Credit Cedarmed International Medical Services, cedarmed.com. (2018)

The rhythm method is, basically, you track your cycle using a calendar. You track your ovulation window and your periods. You should mark when you start your cycle, and when you end. You should also anticipate 3 days before ovulation day and 3 days after as a window of getting pregnant. If you are going to use this method I highly recommend getting an app on your phone and using a condom for a few months until your app can properly start calculating your ovulation schedule.

This method has so many risks. This does not protect against STDs, high risk for pregnancy (100%), and miscalculations when tracking your cycle.

Surgical Sterilization:

I’m sure we all know what this means. Surgical sterilization is where you go to your doctor and ask to be sterilized so you can not have any more children. This method can not be reversed in most cases. Please consider all options before choosing this method.

-Tubal Ligation-

This is the female form of surgical sterilization. It is also known as “getting your tubes tied”. A tubal ligation “is a type of permanent birth control. During tubal ligation, the fallopian tubes are cut, tied or blocked to permanently prevent pregnancy” (Mayo Clinic Staff, 2018).

-Vasectomy-

A vasectomy is the male form of surgical sterilization. In a vasectomy “the surgeon makes a small cut in the upper part of the scrotum, under the penis, and then cuts, ties, or blocks the vas deferens. You’ll get your surgical cuts stitched up and go home right away” (WebMD, 2018).

 

Hormonal Birth Control:

There are so many choices to choose from with hormonal birth control methods. Make sure you talk to your doctor about the best option for you. These contraceptives work by using hormones released in to your body. Some patients are not allowed to have certain types of hormones due to diseases and disorders. There’s also your medical history and medication list to take in to consideration.

In most cases you can use hormonal birth control methods while breastfeeding. They are not meant to be used while pregnant or planning to get pregnant.

Pills, or Oral Contraceptives:

 

bc pillsOral contraceptives come in a wheel or in a package like the picture to the left of this section. How do oral contraceptives work? I am so glad you asked. When used correctly they release a hormone that prevents your body from ovulating. Therefore, your body is temporarily infertile.

Some work by releasing estrogen. Others work by releasing progesterone. They also offer oral contraceptives that release both hormones. You do need to take it every day at the EXACT SAME TIME EVERY DAY. This can be a pain in itself and a huge inconvenience. This can also be impractical for very busy women.

Depo-Provera Shot:

depo shot
Photo Credit Melissa Gardner, pajamamommy.com. (2017)

The Depo shot, or Depo-Provera shot, is an injection you get every 3 months. This method has so many advantages and disadvantages. It is a private form of birth control. No one, except you and your doctor, knows you’re using it. There is no stall of “being in the moment” with intercourse. You get injected every 3 months, then you can forget about it until you need to go to your next appointment.

The disadvantages include weight gain. You should maintain a proper diet and exercise regularly. The pain of getting a shot every 3 months is also something you should consider. If shots make you nervous you should reconsider this method. The other downside includes no prevention from STDs.

The shot works by releasing progesterone preventing ovulation. It also thickens the mucous in your cervix so the sperm can’t get through. When used correctly it is over 99% effective at preventing pregnancy.

Side effects include sporadic spotting for a few weeks, absence of periods, weight gain, dizziness, changes in appetite, and hair loss. These are just to name a few.

Hormone IUD:

mirena
Photo Credit Mirena, Mirena-us.com. (2017)

I think the most common hormone IUD we think of that’s on the market today is the Mirena IUD. It is a small T-shaped piece that gets implanted in to your uterus. It works by releasing levonorgestrel in to the uterus. It also thickens your mucous in your cervix and thins your uterus lining to prevent a fertilized egg from attaching to the wall of the uterus. It is good for up to 5 years. You have to have a doctor insert it and take it out.

There are a lot of advantages and disadvantages with this one as well. The advantages are you can get it put in at the clinic office and forget about it for the next 5 years. You don’t ruin a “in the moment” moment. You also have the option of taking it out whenever you decide you want to get pregnant. When used correctly it is also over 99% effective at preventing pregnancy.

The disadvantages include no protection against STDs. It can get implanted in to the uterus wall and need surgical removal. You can experience pain from placement, excessive bleeding and spotting in between cycles, ovarian cysts, and pregnancy.

This should only be used on full grown women. It is not recommended for teen girls. I also do not recommend it for women who have not had children yet. Your uterus would not be used to it and stretched out and the IUD could expel itself.

Hormone Implant:

nexplanon
Photo Credit MacArthur, macarthurmc.com. (2018)

The hormonal implant on the market today is the Nexplanon. This is a little stick looking piece that is filled with hormones. It’s funny because the website doesn’t actually say which hormone (which I find kinda shady). It gets surgically implanted in to the skin of your upper arm. Your arm will be locally numbed, then the stick will be implanted under the skin in your arm. “Immediately after the insertion, you and your health care provider will feel for NEXPLANON to ensure that it has been placed correctly. If you can’t feel it, contact your health care provider immediately and use a non-hormonal birth control method (such as condoms) until your health care provider confirms that the implant is in place. The implant may not be placed in your arm at all due to a failed insertion. If this happens, you may become pregnant. Following the insertion, you’ll have to wear a pressure bandage for 24 hours and a small bandage for 3 to 5 days.” (Nexplanon, 2018).

When used correctly it is over 99% effective. With this form of birth control there are so many advantages and disadvantages. There will more than likely be a scar where the hormonal stick is implanted. When removed they will need to cut you open to remove it. Also, you may experience longer or shorter periods, spotting in between periods, weight gain, acne, depression, mood swings, pain, pain at insertion site, and problems with removal. The problems with removal include pain, irritation, scarring, swelling, bruising, injury to nerve or blood vessels at site, it may also break. These are just to name a few.

The advantages include it is effective for up to 3 years. You can take it out at any time if you plan to become pregnant. You get it inserted at the clinic by your doctor and you don’t have to worry about it for the next 3 years.

Vaginal Ring:

nuvaring
Photo Credit Lydie Stock/Fotolia. (2017)

The vaginal ring is not for those who are, what I like to call, “vagina shy”. This is something you replace monthly and you have to personally insert it in to your vagina yourself. On the market there is the NuvaRing. This is a lot different than the other forms of hormonal birth control methods. This is a flexible ring that gets inserted in to your vagina.

This works using estrogen and progesterone both. It is 98% effective at preventing pregnancy. It is to be removed after 3 weeks. The 4th week you have your menstrual cycle. Then the next month you insert a new one. You will need a prescription for this.

Risks and side effects include blood clots in your legs, lungs, heart, eyes or brain. You also could develop liver problems, high blood pressure, diarrhea, and gallbladder problems. Again, these are to just name a few of the risks and side effects.

Hormone Patch:

ortho evra patch
Photo Credit Center for Young Women’s Health, youngwomenshealth.org. (2017)

The hormonal patch, also known as the transdermal patch or Ortho Evra Patch, is a patch you wear for 3 weeks. The 4th week you have your period. The next week you will need to re-apply another patch. It uses both estrogen and progesterone. The patch is only about 91% effective at preventing pregnancy. It releases hormones in to the skin. These hormones work like the depo shot. Your body stop ovulation temporarily.

Risks and side effects include skin irritation, STDs, bleeding, vomiting, weight gain, and bloating. These are to name a few. You also have a higher risk of developing yeast infections and can develop depression issues.

Do you have a preference? Have you had a good/bad experience with one of the forms of birth control addressed in this article? I would love to hear from you and hear your experience. This is a great way to help other women who have questions as well.

Resources:

Dictionary.com. (2018). Unknown. Retrieved from http://www.dictionary.com/

MedicineNet. (2018). Your Guide to Birth Control: Condoms. Retrieved from https://www.medicinenet.com/condoms/article.htm#femalestds

American Pregnancy Association. (2018). Male Condom. Retrieved from http://americanpregnancy.org/preventing-pregnancy/male-condom/

WebMD. (2018). Birth Control: Is the Diaphragm Right for you? Retrieved from https://www.webmd.com/sex/birth-control/diaphragm-birth-control#1

Paragard. (2018). Frequently Asked Questions. Retrieved from https://www.paragard.com/Faqs.aspx

Planned Parenthood. (2018). How Effective are Diaphragms? Retrieved from https://www.plannedparenthood.org/learn/birth-control/diaphragm/how-effective-are-diaphragms

Mayo Clinic Staff. (2018). Tubal Ligation. Retrieved from https://www.mayoclinic.org/tests-procedures/tubal-ligation/about/pac-20388360

WebMD. (2018). Vasectomy: What You Should Know. Retrieved from https://www.webmd.com/sex/birth-control/vasectomy-overview#1

Mirena. (2017). What is Mirena? Retrieved from https://www.mirena-us.com/index.php/?pse=google&matchtype=e&Keyword=mirena&campaignid=601337644&adgroupid=29788072950&device=c&adposition=1t1&loc=9016368&gclid=Cj0KCQiAiKrUBRD6ARIsADS2OLmQ54_aMbftwWxjnd0qdC9Edpas08ock9ejoEkKudJ3snnmQs8VufwaAtsuEALw_wcB&dclid=CPPS7ey0stkCFUqDaQodKCAJGQ

MedlinePlus. (2018). Levonorgestrel Retrieved from https://medlineplus.gov/druginfo/meds/a610021.html

Nexplanon. (2018). Unknown. Retrieved from https://www.nexplanon.com/

NuvaRing. (2018). Unknown. Retrieved from https://www.nuvaring.com/

American Pregnancy Association. (2018). Birth Control Patch. Retrieved from http://americanpregnancy.org/preventing-pregnancy/birth-control-patch/

Type 1 Diabetes VS Type 2 Diabetes

Have you ever wondered what the difference is between type 1 diabetes and type 2 diabetes?

Type 1 Diabetes Mellitus

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Definition:

So what is type 1 diabetes mellitus? “Type 1 diabetes (also known as Type 1 diabetes mellutis, (or T1DM) is an autoimmune condition. This means that the body’s immune system turns on itself; in this case, it attacks the beta cells of the pancreas. These are the cells that produce insulin. As a result, the pancreas produces very little, if any, insulin.” (Campbell, A., 2016).

So What Does That Mean?

“People with type 1 diabetes do not produce insulin, and as a result sugar builds up in the blood instead of going into the cells, where it’s needed for energy.” (Iliades, C. 2017).

People who have T1DM do not produce the insulin needed to help regulate your blood sugar levels. When this happens you can have too much glucose in your body leading to complications.

Causes and Symptoms:

Scientists are not exactly sure what causes T1DM. However, genetics can play a roll in it. If you have a family history of T1DM or a family history of auto immune diseases you are more at risk for T1DM.

Symptoms include blurry vision, high glucose levels, dehydration, weight loss, extreme thirst constantly, and frequent urination. Please make sure you are getting your yearly blood work done with your yearly exams. You will need to get a CMP (complete metabolic panel). This will show your glucose number. If it is high then further testing will be done.

Type 2 Diabetes Mellitus

diabetes-1270350_960_720

Definition:

“Type 2 diabetes is not an autoimmune condition. Rather, it’s a chronic condition that affects how the body uses glucose. Type 2 diabetes generally results in part from insulin resistance, which means that the body has difficulty using insulin, along with abnormal insulin secretion. As a result, glucose builds up in the bloodstream.” (Campbell, A., 2016).

So What Does That Mean?

People who have T2DM have an issue with their body absorbing glucose from the bloodstream. The body still produces insulin, but the body can’t take it in and use it.

Causes and Symptoms:

Being over weight, little to no exercise, poor dieting, family history of type 2 diabetes, and poor lifestyle choices can all contribute to you developing T2DM.

Some symptoms include feeling fatigued, blurry vision, thirst, and increased urination. Again, blood work will need to be done to confirm.

 

References:

Campbell, Amy. (2016). Diabetes Self Management. Type 1 Diabetes VS Type 2. Retrieved from https://www.diabetesselfmanagement.com/blog/type-1-diabetes-vs-type-2/

Dansinger, Michael. (2017). WebMD. Type 2 Diabetes: The Basics. Retrieved from https://www.webmd.com/diabetes/type-2-diabetes#1
Iliades, Chris, MD. (2017). Everyday Health. What’s the Difference Between Type 1 and Type 2 Diabetes? Retrieved from https://www.everydayhealth.com/diabetes/difference-between-type-1-type-2-diabetes/

How to Keep Your Child Healthy During Cold/Flu Season

Hi Medical Mama fans and followers! Today we’re going to talk about keeping you and your children healthy during cold and flu season. Cold and flu season is among us! The one thing I hate more than ice and snow is spreading germs (no seriously).

1) Hand Washing

This might seem the logical thing everyone says. However, it really is. According to Mayo Clinic Staff in an article they said “As you touch people, surfaces and objects throughout the day, you accumulate germs on your hands. You can infect yourself with these germs by touching your eyes, nose or mouth, or spread them to others. Although it’s impossible to keep your hands germ-free, washing your hands frequently can help limit the transfer of bacteria, viruses and other microbes.” (Mayo Clinic Staff, 2018).

hands-2238235_960_720Washing your hands is the single most effective way to not spread germs and to prevent YOU from getting sick. When you touch something chances are you touched a germ that can make you sick. Keep your hands away from your face and out of your nose and mouth. Make sure you teach your child this. Have they wash their hands frequently to prevent the spread of germs to them and to other people.

2) Get Enough Sleep

baby-1151347_960_720Getting enough sleep allows your body to heal and fight off germs and infections. When we sleep it resets our metabolism and helps even out our moods (Huffington Post, 2017).

Make sure you know how much sleep your child needs.

3) Take Your Vitamins

birth control pillsEveryone needs their vitamins to help boost their immune system during a time when germs are rampid. Plus, when the weather changes it lowers your immune system response to catch up. Lower immune systems means higher chance of getting a germ making us sick.

4) Exercise

mom with child exercisingObviously, the best thing you can do for your body is to eat healthy and exercise. Eating healthy is #7 on this list.

“Exercise is better than any advertised cure or miracle,” says Harley A. Rotbart, M.D., Parents advisor and author of Germ Proof Your Kids: the Complete Guide to Protecting (Without Overprotecting) Your Family from Infections.

With that being said make sure you exercise. Make sure your kids are exercising.

5) Vaccinate

nurse bearThis one is going to ruffle some feathers. Vaccinate your children! I’m not going to go in to detail as to why you should vaccinate your child to keep them healthy. Don’t be neglectful! VACCINATE.

6) Stay Away From Cigarette Smoke

cigarette-3288363_960_720There a million and one reasons to stay away from cigarette smoke! I’ll give you only one because I could literally spend a day writing about this topic! Cigarette smoke lowers your immune system and compromises your lungs healthy tissues needed to fight off infections and viruses.

7) Eating Healthy

child watching parent eatLike I said earlier in the article eating healthy is so important! Eating healthy helps you consume your vitamins you need in order to stay healthy. Also, eating healthy boosts your metabolism. This in turn increases your immune’s system to “jump start” to fight off anything that could potentially make you sick.

8) Brush Your Teeth

toothbrush-3297525_960_720Brushing your teeth is just as important as washing your hands. All the bacteria that lives in your mouth daily needs to be brushed away.

Don’t forget to use mouth wash and floss!

9) Stay Hydrated

aqua-3445987_960_720Keeping your body hydrated also helps your immune system. It also helps keep your mouth free from bacteria and germs.

“Our brains are 80 percent water, so hydration is extremely important…” (Huffington Post, 2017).

10)Cover Your Mouth and Wash Your Hands Regularly

 

 

Resources and References:

Huffington Post. (2017). 7 Ways to Keep Your Kids Healthy and Happy in 2016. Retrieved from https://www.huffingtonpost.com/kidsinthehousecom/7-ways-to-keep-your-kids-_b_8923884.html

Crouch, M. (Unknown). Healthy Kids: 6 Secrets of Kids Who Rarely Get Sick. Retrieved from https://www.parents.com/health/cold-flu/cold/6-secrets-of-kids-who-rarely-get-sick/

CDC Office of Women’s Health. (2014). Tips for Raising Safe and Healthy Kids. Retrieved from https://www.cdc.gov/family/parenttips/index.htm

Mayo Clinic Staff. (2018). Hand-Washing-Do’s and Don’ts. Retrieved from https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/hand-washing/art-20046253