What to Know About Poison Ivy & Ticks

During the summer months, children and adults are more likely to be exposed to poison ivy and ticks. Here are some things to know about them.

Poison Ivy

What is poison ivy?

Poison ivy is a poisonous flowering plant with three almond-shaped leaflets, common to North America.

What are the symptoms of poison ivy?

In most people, poison ivy causes an allergic reaction that typically presents as a rash. For a first time exposure, it can take more than a week for the rash to develop. A second or third (or more) exposure typically appears more quickly, within 8 to 48 hours. The rash appears as red streaks or general redness, raised bumps or fluid filled blisters, and the skin is itchy, irritated, and sometimes painful.

Is poison ivy contagious?

Poison ivy is spread by exposure to urushiol, an oil produced by the plant. A person can spread poison ivy to another person or other parts of their body as long as the oil remains on their fingers. Once the oil is no longer present (no exposure to the plant, hands and other exposed parts have been washed), there is no opportunity to spread it to another person. Still, the rash can also be spread to other parts of the body by scratching it and opening the blisters.

How is poison ivy treated?

Most rashes from poison ivy can be treated at home. If the rash is on the face, near the eyes, or close to genitalia, it is recommended that you see your primary care provider. While most rashes disappear without treatment within 1 to 3 weeks, the healing skin is often itchy. To help soothe the skin and relieve itching, a cold compress, lavender essential oil, calamine lotion, an over-the-counter hydrocortisone cream, or an antihistamine can be used. To avoid making the allergic reaction worse, do not scratch the rash, and clip nails short.

Poison ivy can also be treated with a charcoal poultice (made of cornstarch, charcoal powder, and water) to help draw out the oil from the affected area.

How can poison ivy be prevented?

Be aware of and avoid areas where you know poisonous plants grow. Teach your children what poison ivy, poison oak, and poison sumac look like. (Oak and sumac are poisonous plants which cause a similar reaction and are prevented and treated the same as poison ivy.) Cover up with closed shoes, socks, long pants, long sleeves, and gloves when working or playing in forested areas.

If you or your child does get exposed, wash the skin with soap and water as quickly as possible (pine tar soap works well). Scrub under the nails to prevent the oil from spreading to other parts of the body.


The main ticks which humans encounter are wood ticks and deer ticks. Deer ticks are much smaller than wood ticks and can transmit Lyme disease (the most common disease spread by ticks). Because ticks left in the skin can transmit bacterial infections to human beings, it is important to be thorough when checking for and removing ticks. See a healthcare provider immediately if a tick has burrowed into the skin or if the head, mouthparts, or other tick body parts cannot be removed. Watch for signs of heat, irritation, redness, or swelling around the area of a tick bite. If you or your child experiences fever, chills, headache, fatigue, muscle and joint aches, swollen lymph nodes or a bullseye mark, see your primary care provider immediately.

For an effective tick repellant, try using doTerra’s natural bug spray.

Deer Tick (left) versus Wood Tick

Deer Tick (left) versus Wood Tick

When and how do I check for ticks?

Check for ticks after outdoor activities such as gardening, camping, hiking, and playing outdoors. Check your clothing and your body, paying special attention to the following areas: under the arms, in and around the ears, in and around the hair, around the waist and belly button, between the legs, and behind the knees. The sooner a tick is removed (within 24 hours), the less likely it can transmit infection.

How do I remove ticks?

If the tick is attached to a person’s skin, remove it immediately. Wearing gloves, grasp the tick with a clean tweezers as close to the skin as possible to remove the head and mouthparts. Pull the tick straight out gently and steadily. Do not twist. Clean the bite area with warm water and gentle soap. Apply alcohol to the bite wound to prevent infection. Wash your hands.

Do not try to remove the tick with a hot match or petroleum jelly. This could cause the tick to regurgitate infected fluids into the wound.

Save the tick in a container of alcohol if you are concerned about what kind it is and want to show it to a doctor. Otherwise, dispose of it.

NOTE: In the case of a suspicious rash or bite, seeing your primary care provider will ensure you get the most accurate diagnosis and treatment, rather than a general antibiotic, which you would receive at an urgent care facility. Your primary care provider can follow-up with you to make sure the treatment is working, and adjust it if need be.

Enjoy the summer months keeping these precautions in mind!

Jaimeé Arroyo Novak, FNP

It’ll All Work Out In The End: Constipation Causes & Treatment


Many of my patients (children and adults alike) come into our office with complaints of constipation. I regularly hear that a patient is having a bowel movement (BM) as little as every other day or every three days, and sometimes even weekly. While infrequent BMs can be normal for exclusively breastfed infants under 6 months (which should be evaluated by a medical professional), it’s not normal for anyone else. Ideally, a person should have a bowel movement after EVERY MEAL! This may sound excessive, but it’s not. Think about what happens to food in the intestines and what feces is. The small and large intestines absorb all the valuable parts of food, and what’s left is toxic and needs excreted. We can all agree that the smell lends itself to helping us identify feces as waste. If that waste is allowed to sit in the intestines longer than normal, the body isn’t detoxing effectively. In addition, it can harm the intestines as it sits there, and can make constipation worse.

What are causes of constipation?

Eating too much. Overeating causes back-up in the gut. Eating very large meals or just eating a lot in general overtaxes the digestive tract. It can become difficult for the intestines to continue with regular movement of food if they over-expand.

Starting solids too soon. While every baby is different, most don’t do well starting solids before 6 months. However, sitting up unassisted and getting teeth are biological indicators that their intestines may be mature enough to handle starting solids slowly.

Eating too often can cause irritation because it disrupts the mechanism your body has to sweep the digestive system clean. This self-regulating motor complex requires the intestines to be empty for 12-15 hours before it initiates, and it takes three hours for this sweep to go from the stomach to the large intestine. The rumble you feel in the morning that doesn’t necessarily feel like hunger is the initiation of that sweeping motion.

Eating inflammatory foods causes injury to the lining of the intestines. The list of inflammatory foods is ever-increasing. Sugars, grains (e.g. corn and gluten), legumes, nuts, dairy, soy, etc. are all likely to contribute to intestinal irritation. In addition, nightshades such as tomato, eggplant, bell peppers, etc. can cause inflammation to the intestines and joints. Testing is available to identify one’s specific allergies and sensitivities. However, sometimes they won’t show up in a test, and a person can keep a food diary to determine intolerance.

Medications. Tylenol, antibiotics, muscle relaxers, and other common over-the-counter (OTC) medications are absorbed in the intestines. They have a toxic effect on the intestinal lining as the intestines absorb the medication and send it to the liver for metabolizing.

Vaccines absorbed by the intestines cause inflammation similar to medications. When getting vaccines, I suggest taking an intestinal immune booster such as Enteragam, Xymogen IG 26 DF immunoglobulin booster, or an intestinal blocker such as GI Detox from Biocidin. We have an immune-boosting protocol as well that I highly recommend employing during vaccine administration (you can access it here).

Parasites (which are more common than you think). You don’t have to travel outside the country to have parasite exposure. While symptoms of having a parasite typically manifests as diarrhea, it can also cause constipation, fatigue, dizziness, joint pain, skin irritation, or irritable bowel syndrome (IBS). Regardless of the source, we recommend parasite testing from Genova Diagnostics. You can get this done with us.

Formula feeding. Infants who can’t breastfeed lack exposure to healthy bacteria and other complexes that protect the intestines. Children who are formula-fed should take a probiotic regularly.

Birth by cesarean section. Though a C-section is a one time event, an infant can miss out on exposure to probiotics in the vaginal flora and also the mother’s milk (as it’s depleted of good bacteria due to prophylactic IV antibiotics given before a surgical birth). Also, c-section births can lead to unsuccessful breastfeeding relationships without close support. We encourage any surgical births to find a reputable lactation consultant in order to ensure a healthy breastfeeding experience. We recommend A Mother’s Place, Jane Kershaw of Hope Breastfeeding Support, and Kate Cropp of Nashville Birth and Babies. Lots of skin-to-skin, breastfeeding, and probiotics are also helpful in overcoming this hurdle.

Lack of exposure to good bacteria. In the United States specifically, we use harsh antibacterial soaps and cleansers, avoid playing in the dirt, don’t work with animals, and don’t eat fermented foods. This leads to a lack of healthy gut bacteria. Getting your hands dirty, playing with animals, eating fermented foods, and not over-sanitizing can help support good bacterial growth for the intestines.

Food poisoning shouldn’t be taken lightly. Unfortunately, it’s often treated with Ciprofloxacin (Cipro), which can cause a secondary intestinal infection called Clostridium Difficile (C. diff) if the climate is right. Protecting the gut with GI Detox (under Vaccines above) or charcoal while traveling is beneficial. Food poisoning can trigger genetic markers for more serious and chronic issues, such as Crohn’s disease or IBS.

STRESS is one of the biggest unaddressed issues with stomach pain. Most people aren’t educated on how to deal with stress and how serious it can be on the body. Coping mechanisms vary greatly person to person, but everyone should take time to figure out what best helps them reduce and manage stress.

Head injury. There is a very strong head-to-gut connection. When there is a head injury, great care needs to be taken to make sure the intestines are treated at the same time as the head.

Traumatic events. Traumatic events can cause insult to the intestines, as they also cause stress. Whether someone suffers physiological or emotional trauma, they need support through it to help lessen stress and support the body.

How can constipation be treated?

Treating constipation means addressing all possible contributors and figuring out each person’s puzzle pieces.

For our constipation protocol, we use high-dose vitamin C and treat with different types of magnesium (see our magnesium blog). However, if a child hasn’t had a bowel movement in 3-4 days, their abdomen seems particularly bloated, or they are having severe abdominal pain, we recommend seeing your Primary Care Physician (PCP) or Urgent Care to rule out anything more life-threatening. Glycerin suppositories can also be used in a pinch, however, using them too often can contribute to dependency, excessive stretching of the rectum, injury to rectum, and discomfort for the individual.

Constipation should be taken seriously because it can cause inflammation and malabsorption and even severe withholding issues. Uncontrolled inflammation in the body left untreated can contribute to major malabsorption issues and autoimmune disease expression.

Jaimee´Arroyo, FNP

Integrative Advice for Pediatric Dental Health


NOTE: We are not a dental office. However, in caring for our pediatric population, we get a lot of questions regarding dental care. We’ve had many conversations with parents regarding their children’s teeth, and want to share some of that information with you.

How early should I start brushing my child’s teeth?

As soon as your child gets teeth, you should start wiping them off twice a day. Many babies breastfeed around the clock, which bathes their teeth in sugary milk day and night. Some dentists recommend to stop breastfeeding at night to prevent dental cavities, but as long as you wash or wipe the teeth off with water or brush them before and after bed, weaning prematurely can be avoided.

How important is flossing?

For children’s teeth to be cleaned properly from an early age, they have to have space to clean between them. Dentists agree that flossing between teeth is necessary, as a lot of the bacteria that breaks teeth down gets between teeth and along the gum line. Sometimes a tongue tie can cause unnecessary crowding in the mouth, which doesn’t allow enough space to clean between teeth. Revising a tongue tie early on can allow the jaw to grow to a normal space so the teeth have room to come in.

Why is my child’s enamel wearing off? What causes tooth decay?

Sometimes a lack of nutrients keeps a child’s enamel from getting strong. Vitamin A and D are very important to enamel strength. These can be sourced from cod liver oil, which is also good for the immune system and brain development. We recommend Rosita, Green Pasture, or Nordic Naturals cod liver oil supplements.

The Western diet is high in phytos, which are found in corn, wheat, and other processed foods. Phytos are known to break down teeth, so a diet low in phytos and heavier in animal fat is preferred. When you do intake phytos, isolate them to one part of the day and brush your teeth after. This isn’t as good as not eating phytos at all, but if you’re going to, this is a good option. Follow the same protocol when consuming sugar if possible.

Bacteria that causes tooth decay is often transmitted from parents to their children. While genetics may be part of it, giving your child food that has been in your mouth can transfer bacteria (i.e. you chewed it up some first, they eat off your spoon/fork, etc.). Good dental health for children includes good dental health for parents. When parents have a healthy mouth, their children are more likely to have a healthy mouth. Practice good hygiene and don’t transfer foods from parent to child to help prevent tooth decay from bacteria.

So toothpaste, what do you recommend?

Being aware of what you’re putting on your child’s teeth is important. Some toothpastes have harsh chemicals in them. There is an age old debate about whether fluoride is necessary in toothpaste or not. Fluoride was first introduced to water during the manufacturing of the atomic bomb, of which fluoride was a byproduct. At the time, it couldn’t be proved that fluoride was harmful, so it was promoted as not harmful to protect the bomb industry from liability (Griffiths and Bryson, 1997).

A good remineralization toothpaste consists of pulverized organic egg shells combined with coconut oil and baking soda (see below).

Do you have any thoughts on dental care for children with MTHFR?

Nitrous oxide (laughing gas), which is regularly used during cavity fillings in children, can raise homocysteine (toxin) levels for up to 3 months after the procedure. Children with MTHFR have a more difficult time removing toxins from their body (see our blog on MTFHR for details). If a procedure requiring nitrous oxide is absolutely necessary, make sure your child is taking a good B12 (methylcobalamin) and folate, or a good glutathione, before and after the procedure. A high-dose vitamin C supplement and epsom salt baths also help to support body detox (this step is good whether the child has MTHFR or not).

Some dentists allow children to not use nitrous oxide during fillings, but this will likely require establishing a good rapport with the dentist and the parent being present to talk the child through it. Nitrous oxide is not always necessary in every procedure, and if the child doesn’t need the help, it’s better not to use it.

There is a type of dentistry that doesn’t require drilling, but rather hand tools. It takes a lot longer, but it is less likely to hit a nerve and so pain is minimal. Finding a dentist who will do this technique is another option. There are also techniques such air abrasion or antimicrobial liquids that can be brushed on cavities to stop tooth decay. Talk to your dentist about these options.

For a small dental cavity in a baby tooth, it can sometimes be reversed by putting remineralization toothpaste on it before bed. One paste some of our patients have used is called MI paste. This can keep it from getting worse so you can wait for it to fall out rather than getting it filled. Sometimes filling teeth requires more damage to be done to the tooth before it can be filled. This can make teeth more fragile, and removes the possibility of remineralization. In addition, the filling may fall out, and subsequent work might have to be done to repair the tooth. It’s usually better to work hard to remineralize teeth than fill them whenever possible.

All of these are potential options for any child with dental caries (tooth decay and/or cavities), and especially in the case of MTHFR.

Are there any dentists you recommend?

Dr. Thomas Lokensgard at the Centre for Holistic and Biological Dentistry is the most integrative dentist in the Nashville area. There is a waiting list to see him. Zoo Crew Pediatric Dentistry is convenient, friendly, and allows parents to be present. Though more mainstream in its approach (in terms of getting x-rays and performing procedures, etc.), they are less aggressive than many offices with wanting to fill teeth. Always feel the freedom to ask questions before agreeing to any dental work.

Best of luck as you care for your family’s oral health.

Jaimee´ Arroyo, FNP

Remineralization Toothpaste

¼ cup ground eggshells or calcium magnesium tablets
2-3 Tbsp coconut oil
1 Tbsp baking soda
Optional: 1 tsp castile soap, 1 tsp sea salt, and/or a few drops of peppermint essential oil

Rinse eggshells and boil them for a few minutes. This will help get rid of any pathogens. Let air dry. Grind into a fine powder. Combine ingredients in a bowl, adding coconut oil until it reaches a smooth consistency. Store in a container/jar.

Gesundheit! Good Health Despite The Cold


Wintertime is traditionally the season we think of as cold and flu season. Why is this? Most people think the cause of this is just because it’s cold outside. But in Nordic countries like Sweden, babies take their nap outdoors in freezing temperatures, and in Siberia, children run outside in the winter in their underwear and pour cold water on their heads, all to improve immunity!

So if it’s not the cold, what makes our children (and us) sick?

As the weather gets colder, people stay indoors more, where there is less ventilation and more close contact. As activity lessens, lymphatic system function decreases. The lymphatic system is responsible for transporting infection-fighting white blood cells throughout the body, and helps rid the body of toxins. It relies on skeletal muscles for moving lymph (the system’s fluid) along. So the more sedentary we are, as more people are in the winter, the more stagnant the lymphatic system gets. Therefore, more exposure to viruses and less ability to fight it off causes more respiratory symptoms.

Also, as the temperatures drop, the holidays begin, and with these come an increase in sugar: Halloween, Thanksgiving, Christmas, New Year’s, Valentine’s Day, Easter--these are the holidays that mark the cold season, and sugar consumption skyrockets, which only weakens the immune system.    

In addition, foods high in Vitamin C, D and B12, like the fruits and vegetables eaten during the summer months, are less available and less nutrient-dense during the winter months. For example, have you ever gone to the grocery store in the winter and bought a very orange looking orange, only to cut it open and it’s pale? It’s likely been painted to look in season. Good produce is just not as available during the winter because it’s out of season.

So, what’s good practice to prevent colds?

To avoid sickness when it’s cold outside, you have to be conscious of and creative with your vitamin sources, your movement, and your food choices, especially sugars. Incorporating immune-boosting foods such as turmeric, cumin, garlic, and onion, as well as natural probiotics such as kombucha or sauerkraut are good regular practices to help prevent sickness. Supporting the immune system is very important, which previous blogs have talked about (see our blog on vaccines for immune system support protocol). Avoid foods such as dairy that increase the production of mucus and phlegm. While sometimes people are intentional with these practices once they’re already sick, this isn’t as effective as daily practice preventatively.

Two other good preventative measures during cold season are an ENT probiotic and elderberry syrup. An ENT probiotic specifically cultures the ears, nose and throat, which take the biggest hit when children get sick. When giving it to your child, make sure it’s dissolved in the mouth rather than chewed and swallowed. Elderberry syrup can be administered to children ages 2 and over, and can reduce the severity and duration of a virus. If you or your child has any autoimmune issues, either refrain from using elderberry, or pair it with a heavy dose of turmeric. Elderberry can increase autoimmune responses and induce a flare-up. Also, use cautiously in pregnancy and with breastfeeding (see our blog on elderberry for more information).

How should I treat a cold?

When your child does get sick, their immune system is exercising itself. When they get through it, it actually helps their immune system become stronger and remember how to fight the illness better next time. It takes roughly five years to develop a good immune system memory and completely culture the gut. In fact, the bacteria in the gut can actually help train the immune system. While we can’t do much about time and age, we can help culture the gut, making sure to rotate probiotics in order get a variety of strains of bacteria, as they perform different jobs (see our blog on probiotics for more information).

There are some great tools for treatment to have on hand during cold season:
Wild cherry bark tincture (appropriate for children 1 year old and up) soothes a cough and is beneficial for immune and throat support.
Eucalyptus essential oil (appropriate for infants 6 months old and up) is a cough suppressant. Diffuse 5 drops for 30 minutes at bedtime, or put 3 drops in a bath. Use small doses, as too frequent or large doses can become toxic, and using cough suppressants around the clock can induce pneumonia.
Vitamin C (appropriate for infants and up) helps thin mucus secretions so a child can cough them up easier. For ages 0-12 months, administer 800 IU daily, for 1-3 years, administer 1,600 IU daily, and for 3 years and older, administer 2,000 IU daily. Dr. Suzanne Humphries also has a high dose vitamin C protocol that I recommend.
Vitamin D (appropriate for infants & up) should be increased for the duration of the illness. Give 4,000 IU daily while sick, then return to 1,000-2,000 IU daily following sickness. This can also be dosed based on weight by your physician. Vitamin D works best when used long-term rather than just during an illness. Yet, Vitamin D is fat-soluble, meaning that the body will keep absorbing it, even when it’s had enough, so periodic blood serum checks are recommended.
Increase fluid intake. Not enough can be said about drinking more water. The body loses moisture through coughing and excess breathing, contributing to thickened phlegm secretions. Water is also important for the lymph system to do its job fighting the infection. If a child is breastfeeding, this is an appropriate time to offer breastmilk more often. They need the additional fluids, and also the antibodies the mother’s body is producing automatically in response to the child’s illness.
A good nasal aspirator. NoseFrida and Zoli both make very effective and non-irritating nasal aspirators. To watch how to safely use a NoseFrida, click here. Keep in mind that too much suctioning can actually cause more mucus production, so do it when they really need it, but don’t overdo it.

While most colds can be managed at home, some can lead to croup or bronchiolitis, and sometimes children’s immune systems aren’t able to tolerate these worsening symptoms very well. If you see any of the following symptoms, call your pediatrician: intercostal retractions, supraclavicular or suprasternal retractions, flaring of the nostrils, cyanosis (blue coloring around the mouth), or rapid breathing (see chart below for normal ranges). Your child needs to be seen for further treatment.

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As always, we’re here to help during cold season. We carry most of the above-mentioned products at our office, and can direct you to reputable sources for purchasing the few that we don’t. If you're an established patient, feel free to call us with any questions or concerns as you navigate the winter as healthfully as possible.

Jaimee´ Arroyo, FNP

Mastitis 101


What is mastitis? What causes it? What are its symptoms?

Mastitis is an infection of the breast. The infection can be superficial or deep in the breast tissue. It occurs when bacteria enters a milk duct through a crack in the nipple. Mastitis can be caused by oversupply if a baby is not effectively emptying the breast (which can be due to a tongue tie, among other things) or if a mother goes longer between feedings than usual. Symptoms include pain in the breast, swelling, redness, red streaks, a lump, fever, chills, aching, and/or general malaise.

A clogged duct is not mastitis, though a clogged duct can lead to mastitis if not attended to. A clogged duct is a lump or fullness of a mammary gland without the systemic issues characteristic of mastitis. Initial treatment of a clogged duct includes massaging the lump while breastfeeding or pumping after a hot shower.

Mastitis is traditionally treated with antibiotics (dicloxacillin, clindamycin), which can create several unwanted side effects. These medications are powerful and can disrupt the (good) bacterial flora of the mother and baby. Symptoms of antibiotic side effects include candida (yeast) of the breast in mothers and thrush (also yeast) of the mouth in infants, both of which can take several weeks to get rid of. Infants can experience diaper rash and diarrhea, and mothers can have a general upset stomach. Antibiotics also make the mother and baby vulnerable to sickness depending on the season. In some cases of mastitis, antibiotics can’t be avoided. If a mother with mastitis has a fever for over 48 hours, or if she’s diagnosed with an abscess (pus pocket) of the breast, antibiotics are indicated.

What are some alternative treatments for mastitis?

The purpose of this blog is to identify alternative treatments for mothers who don’t fit into the above categories (48+ hours with fever, abscess of the breast). Keep in mind that every situation is different, and these suggestions should be utilized on a case-by-case basis in conjunction with your care provider.

Cabbage or potato. Cabbage and potato help to reduce the production of milk as to overall reduce inflammation in the breast (though not recommended for women who already have a low milk supply). Green cabbage is recommended over purple cabbage. Put a leaf or slice in your bra to help decrease swelling in the area.

Heat and ice. Heat allows for milk to flow. Taking a hot shower while hand-expressing or using a heating pad while pumping is helpful. Apply heat for no more than 20 minutes at a time so as to not increase blood flow, which can increase inflammation. Following heat, ice the area for 20 minutes to reduce inflammation and bring comfort.

Ibuprofen. Ibuprofen should be taken around the clock every 6 hours. Sometimes the fever can be so high that it doesn’t allow the mother to function well enough to even try these other treatments. Ibuprofen will help keep the fever down, and it is also anti-inflammatory in nature, which will help decrease the inflammation. To help the liver recover after several days of ibuprofen use, take milk thistle herbs and add lemon to your drinking water..

Vitamin C. The immune system uses Vitamin C to help with white blood cell function, and as the body is fighting a bacterial infection, this is very important. Take as much Vitamin C as you can tolerate without getting diarrhea, usually between 1000 mg and 5000 mg.

Echinacea and astragalus. These herbs help the immune system fight infection. They come in tincture form. Take small doses of each 3 to 4 times daily (also see directions on bottle).

Probiotics. Take a probiotic daily. Due to the infection, the flora in the body are becoming imbalanced. Probiotics should be taken whether the mother is using antibiotics or not.

Garlic. Garlic is a natural antibiotic. It is recommended to take 4-5 garlic cloves daily. Chop up and put in hummus to make it more palatable. If it causes upset stomach, pair it with papaya enzyme.

Pump. In situations where the infant is not emptying the breast completely, it is important to pump and empty it. Hand expressing or massaging while using a mechanical pump is up to 50 percent more effective than just pumping alone.

Ultrasound. Ultrasonic waves can break up inflamed tissue and bring healing to the area. Sometimes even after antibiotic use a lump can remain. Dr. Kristen Walkerwicz at Nashville Spine, Sport and Family Chiropractic Center and Dr. Kevin Bradshaw at Bradshaw Chiropractic perform in-office ultrasound therapy. This decreases inflammation so milk can flow freely. Nursing your baby immediately following therapy is ideal (their offices also promote this).

Using the above treatments, you should start to see improvements in your symptoms within 24 hours. Continue treatment for two days following the resolution of symptoms. If there are no improvements within 24 hours, consider taking antibiotics. All of these treatments can continue to be used in conjunction with antibiotics. Your provider can also culture your milk to confirm exactly what’s growing.

Mastitis is a normal occurrence that affects many moms, but knowing how to address it, and early, helps to lessen its effects.

Jaimeé Arroyo, FNP

Let's Talk About It


The purpose of this blog is not to answer the many questions surrounding the use of vaccines. What I am going to do is talk about the multiple factors that should be considered in a discussion on vaccine administration. Not sure what those would be? Keep reading.

Before I get into that, I want to share briefly my individual approach as a practitioner to vaccine administration and the families we see at Hopewell Family Care. While this communication is not an endorsement of vaccine administration, neither is it aimed at censoring the CDC’s schedule. As a healthcare professional, it is incredibly cavalier for me to tell you that your children will be fine if you decide to defer vaccinations or adhere to a delayed schedule. However, it would also be negligent of me to not point out the potential risks, including those documented in the inserts provided by vaccine manufacturers. There are many factors at play when deciding what your child’s schedule should be, too many to cover all of them here.

What I desire to make abundantly clear is that HFC is a supporter of parental choice and education. We are happy to discuss at length the particularities of each individual child in order to help parents make the decisions that are right for them and harmonious with their convictions and beliefs. It is not always the same process for every child because children are not all biologically identical. Layering vaccines may pose no risk to one, but may to others. Vaccines may provide sufficient immunity for one child, but not for another. Some children react to certain additives in vaccines (even having intense repercussions that take years to recover from), others do not. And so on. We go to great lengths to provide our patient population with the resources to help parents feel supported in this decision-making process.

I firmly believe that science is a method of investigation and not a belief system. I am a healthcare provider that sees clearly the ebb and flow of science, as it is constantly being reevaluated and rarely concrete. Much of what we do requires faith, and I have faith that the parents of the children I see will ultimately do what they truly believe is best for their child. While I cannot make strong recommendations for a particular schedule that will protect your child with no ill effects, I can give you tools to help you make your own decision while attempting to remove fear as a motivating factor for the decision. We are happy to journey with your family through whatever life may bring, and ready to help achieve early diagnosis and treatment for vaccine-preventable diseases, regardless of your child's vaccination status. We at Hopewell Family Care are honored to be a part of your child's healthcare journey.

Now, what factors should you consider prior to vaccine administration for your child?

Genetics. As stated in a previous blog, MTHFR is a talking point that should be considered when vaccinating children. MTHFR decreases a child’s ability to detox, which is especially important when receiving vaccines due to the various chemicals in them. Preservatives such as thimerosal, gelatin and MSG, and other ingredients such as formaldehyde, aluminum and antibiotics, are likely going to have an increased impact on a child who is unable to detox well. Outward signs that a child may have MTHFR include a hemangioma, cherry growths, or other similar skin conditions that can indicate a baby may not have completely developed neurologically in utero. Other signs are a sacral dimple and tongue tie. While these signs can correlate with MTHFR, they are not a diagnosis. MTHFR can be tested for in the blood or saliva. We can test for MTHFR in the blood at our office. A saliva test is a more extensive (and expensive, not covered by insurance) genetic testing, and we refer patients to MaxGen Labs for this. If you don’t want to have your child tested, parents can have themselves tested first, but this is only helpful if both parents are negative. If one or both parents are positive, testing the child is the only way to know if the child has MTHFR, and what type they have.

Age. In regard to age, there are two elements to think about. One is that when a child is young, their immune system is most at risk. An issue with low immunity is that children’s tissues aren’t well defined, their structures are very thin, so an infection can spread from point A to B much easier than in an adult. For example, if a child contracts Haemophilus Influenzae Type B as a respiratory infection, it can move from their lungs to their spinal cord, causing meningitis. Another element is that children also have rapid brain growth in their first 3 years of life. While the side effects of vaccines could cause neurological damage during rapid brain growth, ages 1 to 3 years also poses the greatest risk for contracting vaccine-preventable illnesses. This does not make the decision of if/when to start vaccinating your children an easy one. Some parents decide to wait until rapid brain growth slows after 2 years, or stops after 3 years. But again, this is also the most vulnerable time for a child in regard to lower immunity and increased risk of contracting disease.

Gut injury. Having an already-existing gut injury can make recovering from vaccines difficult. Oral and injectable vaccines are metabolized in the gut. Gastroenterologists can confirm that the intestinal wall is impacted by the absorption of vaccines, which can make an existing problem worse or can start a new problem. Much of a child’s immunity is derived in the intestines, so keeping their gut healthy is paramount to keeping them healthy, regardless of whether they’ve been vaccinated or not. If an infant has been unusually fussy, colicky, or gassy, these can be indicators of a disrupted intestinal environment. If a child is being treated for constipation, diarrhea, eczema, other skin issues, frequent upper respiratory infections, or ear infections, we recommend resolving those issues before adding any additional insult to the intestine.

Immune system support. If your child does receive a vaccine, s/he could present with a virus due to a compromised immune system. This happens frequently, and even when immune system support is given, it can still occur. Sometimes giving one vaccine at a time can decrease the chances of overtaxing the immune system. It can also lessen the risk of vaccine reaction, and in the case of a reaction, you would know which vaccine caused it, and could avoid such a response in the future. But immunizations are scheduled together to create a bigger immune response so the child has better coverage. When one vaccine is given at a time this synergy is forgone. Vaccines are not 100% effective, so relying on them solely for protection against infection is not adequate. Immune system support is important for all children.

What are some things you can do to support your child’s immune system and detox mechanisms before and after receiving a vaccine?

Breastfeeding gives your child the best advantage immunologically. We do our best to give every motherbaby dyad the support necessary to ensure a healthy and sustainable breastfeeding relationship. We encourage our patients to breastfeed as long as possible.

Increase Vitamins C and D two days before and one week after vaccine administration. We carry Vitamin D for children in our office. With Vitamin C, give 125 mg for children under a year, 250 mg for children 1-3, and 500 mg for children over 3. With Vitamin D, give 800 IU for children under a year, 1600 IU for children 1-3, and 2000 IU for children over 3.

Soak in an Epsom salt bath for 15-20 minutes on the day the vaccine was received and for few days after, especially if there is swelling at the site of administration. For children under 1, add 1 cup of Epsom salt to a bath, and for children over 1, add 2 cups.

Increase water intake, which will augment the lymph nodes’ ability to detox from heavy metals and preservatives in vaccines.

Avoid sugar. Sugar increases the workload of the body by increasing inflammation, which compromises the body’s detoxing abilities and immune function.

Avoid Tylenol. Tylenol blocks the liver’s ability to detox properly. If a fever reducer and pain medication is needed, use ibuprofen. Children must be 6 months of age to use ibuprofen. Contact your PCP for dosage instructions as indicated on the label.

Get chiropractic care before and after to stimulate the immune system and thymus gland (which stimulates the development of disease-fighting cells in children).

Support gut health. Give a probiotic daily for two weeks before and four weeks after vaccine administration. Try adding Enteragam. Enteragam is a pharmaceutical food that helps to close the gaps in the gut, reducing inflammation and allowing the immune system to function at its best. To get a prescription for Enteragam, schedule an appointment with Hopewell Family Care one month in advance.

The content of this blog is by no means a substitute for a conversation between you and your child’s medical provider. As stated above, every child is biologically different and every situation unique. As you make vaccine decisions for your family, use these factors as talking points with your provider to help ensure optimal health for your children.

Jaimeé Arroyo, FNP

Tongue-Tie Troubleshooting for Breastfeeding Moms

You’re an expecting mom, thinking about birth and motherhood, all of the unknowns and potential stresses accompanying this time in your life. Here’s another thing to consider! Yay huh!? Seriously though, tongue and lip-ties can impede your breastfeeding relationship. No, I’m not trying to stress you out, but I am trying to make you aware of potential issues and offer effective solutions so that, should you have breastfeeding difficulties, you aren’t defeated.

What is a tongue-tie? What is a lip-tie?

Most people have a small piece of flesh (called a frenulum) that anchors the tongue to the floor of the mouth, and another that anchors the top lip to the gums above the teeth. Sometimes a frenulum is too tight (graded 1-4 depending on these factors: tightness, stretchy or non-stretchy, and functional or non-functional), anchoring too far up the tongue (tongue-tie), which doesn’t allow the tongue to come out under the nipple, or too far down the gum line (lip-tie), which doesn’t allow the upper lip to flange around the areola (see photos). Both of these are important for the mother to feed comfortably and the baby to drink enough milk. When they don't happen, the mother’s nipples can blister, and the baby can’t adequately drain the breast.



Are tongue and lip-ties a new thing?

No, babies have been born with tongue and lip-ties for as long as we know. Yet, their occurrence has been increasing in frequency due to MTHFR and folic-acid supplementation during pregnancy (see our blog on MTHFR). Tongue and lip-ties were traditionally clipped by the midwife or doctor shortly after birth or during the first week. During the early and mid-1900s, due to marketing from formula and brassiere companies, breastfeeding took a backseat to formula feeding. Tongue and lip-ties don’t impede formula feeding the way they do breastfeeding, so the conversation surrounding revisions (the clipping of tongue and/or lip-ties) died down. In more recent decades, breastfeeding has been coming back into practice, due to efforts of La Leche League, other breastfeeding support groups, and increased knowledge and education on infant nutrition.

What are the signs of a tongue and/or lip-tie?

When a baby has a tongue and/or lip-tie, signs and symptoms manifest for both the mother and the baby. For the mother, she may experience thrush (yeast infection) of the nipple, clogged milk duct(s), mastitis (painful breast inflammation caused by infection), a lipstick (beveled) shape to one or both nipples, pain, cracking, and/or bleeding of one or both nipples, and low milk supply. For the baby, there may be a clicking sound while breastfeeding, s/he may come off the breast frequently, experience general fussiness at the breast, slow growth, weight loss, wakefulness, gassiness, colic, musculoskeletal issues, torticollis (top of the head and chin tilted to opposite sides), tight shoulder(s), a lip blister, and spitting up and acid reflux (often being prescribed Nexium). Parents usually have an easier time noticing a lip-tie, and while lip-ties are typically less problematic, whenever there’s a lip-tie there’s often a tongue-tie as well. At Hopewell Family Care (when suspecting a tongue or lip-tie), we’re primarily checking to see if 1) the mom is having any pain, 2) the baby is gaining well/poorly, and 3) if the baby is having any gastrointestinal issues.

What can be done for a tongue and/or lip-tie?

Lactation consultation. Referral to lactation for an additional assessment can be helpful. While symptoms can point to a tongue or lip-tie, and some general practitioners can suspect them, a lactation consultant (IBCLC) should be seen to determine if and exactly what kind of tie a baby has, and to determine a course of action. They often recommend trying new breastfeeding positions, such as laying reclined or on your back so the baby is on top of the breast, or on all fours so the baby is under the breast. They can also suggest tongue stretches for the baby. Sometimes they will recommend a referral to an ENT or dentist for further diagnosis or treatment, as IBCLCs can't give an official diagnosis.
Nipple shields. Though not a long-term solution, nipple shields can help temporarily relieve nipple pain while making adjustments to improve the breastfeeding relationship. Nipple shields create a barrier between the mother’s nipple and baby’s mouth, and help shape the nipple in a way the restricted tongue or lip doesn’t allow the baby to.
Craniosacral therapy and chiropractic care. Craniosacral massage therapy can help to loosen jaw muscles in order to open the jaw wider for a better latch. Find a massage therapist who is certified and experienced in this kind of therapy. Chiropractic care can address maladjustments made during birth, and also torticollis and limited head turning.
Revisions. Typically, I give babies up to two weeks using alternative therapies (those just mentioned) to see if it can become functional (adequate for proper breastfeeding). If after two weeks the symptoms of the dyad (mother and baby) aren’t improved, referral for a revision (clipping of the tongue and/or lip-tie) is our next discussion. Choosing whether to get a revision or not is a subjective decision for parents to decide. Revisions are done by a doctor (ENT specialist or a neonatologist) or dentist. We recommend our patients to Dr. Prather at P.S. Smiles in Franklin. A revision is a two-minute procedure done with either sterile scissors or laser. A small incision is made in the frenulum to release the tongue and/or lip. Local anesthesia can be used, but is not required. If used, the procedure won’t hurt, but the tongue will be uncoordinated initially, so the baby won’t be able to learn a good latch until it wears off. If not used, the procedure will hurt, but the baby can practice a good latch immediately. This would be an appropriate time to use Tylenol, though be sure to dose your child based on their weight. Exercises need to be done for up to five weeks after the procedure to ensure that no scar tissue forms, which could re-adhere the tongue or lip (this happens frequently when exercises aren’t done). A revision isn’t a magic fix-all. Babies have to relearn how to latch, and lactation consultation is recommended to achieve an efficient latch.

What about a tongue-tie in an older child?

There is no age limit for a child to have a revision done. Symptoms of a tongue-tie in an older child include several cavities, the need for orthodontics (bottle feeding changes the shape of the palate, often requiring such), sleep apnea (bottle feeding also contributes to the narrowing of the maxillary sinuses, occasionally causing such, and is sometimes misdiagnosed as ADHD), being a picky eater (called ‘goldfish babies,’ preferring soft foods as the tongue is little help in eating), and headaches and migraines (even into adulthood). Knowing the cause, if it is a tongue-tie or not, can help in addressing and treating these symptoms.

If your breastfeeding relationship is challenging, these are some considerations to make. Receiving education in breastfeeding can help you determine if your baby is latching correctly, and foresee potential issues that may point to a structural issue like a tongue or lip-tie. If you are concerned about this issue when your baby is born, consider seeing a lactation consultant early on (even in the hospital), or asking your care provider at their newborn exam to look for this. Being aware of potential issues, and knowing they can often be fixed, is a great first step.

Jaimeé Arroyo Novak, FNP

Don't Ovary-Act! Tips for a Better Cycle

For the majority of women, menstruation should last 4 days with scarlet-colored blood and no cramping. Any variation of this is not considered normal or healthy. During menstruation, the uterus sheds its lining from the top to the bottom. But factors such as environmental toxins, inflammatory processes, miscarriage, childbirth (especially by cesarean), trauma, abuse, infections, and scar tissue can disrupt regular flow. Tissue and blood material that should have been cleansed out is left behind and builds up, causing the reproductive system to work harder the following month(s). Cramping results when the uterus has to contract more to get rid of more debris. Build up in the uterus can cause hormones to flare, which manifests in symptoms of Premenstrual Syndrome (PMS), and over time can lead to fibroids. Old blood can even back up into the fallopian tubes and cause pain and issues in the ovaries. While most of these issues can be prevented (to a degree), you’re likely already experiencing these symptoms and need treatment. What can be done? OB-GYNs have instruments and procedures to address every issue--dilation and curettage (D&C), ablation, fibroidectomy, oophorectomy, and hysterectomy. Sometimes they work, sometimes they don’t. When they fail to correct the problem, they leave a whole set of irreversible symptoms, often requiring more procedures and hormone supplements. While such procedures are necessary at times, we’ll be exploring other options for achieving a healthy reproductive cycle.

What are some natural things I can do before I menstruate to reduce PMS?

Exercise. Women who exercise throughout the month have less PMS, less depression, less cramping, and lighter periods. Exercise is very important to the detoxing process, and can help you detox the abundance of hormones flooding your system prior to menstruation. Drinking water also helps to augment this process. Exercise helps regulate fat cells. Fat cells increase inflammation in organ systems throughout the body. Exercise helps us de-stress. Stress is one of the leading causes of inflammation.
Avoid salt and sugar. Comfort eating is common when you don’t feel good. But comfort foods are often salty and sugary, like chocolate, potato chips, ice cream, and pizza. Salt makes you bloat, which increases pain, and sugar increases inflammation, which also increases pain and disrupts mood. Rather than comfort eating, try doing other things that make you feel good, like getting a manicure or pedicure, giving yourself a facial, or buying a comfortable pair of lounge pants.
Avoid cosmetics, shampoos, and lotions that contain phthalates, parabens, and triclosan. Products containing these substances can disrupt hormones.
Consider an anti-inflammatory diet. Inflammation can manifest in many ways, even as irregular cycles and painful periods. In many cases, if you can heal the gut, it leads to greater health throughout the body. Foods that can cause inflammation include dairy, corn, soy, sugar, wheat, peanuts, eggs, and almonds, among others. You can have allergy and sensitivity testing done to find out which foods trigger inflammation in your body. Encourage gut healing and health by taking probiotics, digestive enzymes, and fish oil, and using collagen or bone broth. Consult your doctor to discuss what would be best for you.
Have a wellness exam. During a wellness exam, your doctor will check your vitamin and mineral levels, many of which are important to know in terms of reproductive health. Vitamin D is a precursor to estrogen and progesterone, meaning you need it, and enough of it, for the body to produce adequate levels of estrogen and progesterone. 100-200 mg of B vitamins can act as a diuretic and decrease bloating. 100 mg daily of Vitamin E can help with breast soreness. Low iron levels actually predispose you to heavier periods, so anemia leads to greater anemia. Low vitamin A levels can predispose you to dysmenorrhea (pain during menstruation). Low thyroid levels (hypothyroidism) can cause heavy periods. Don’t assume a hard period is normal. Check where your body is at and what you may need to supplement.

What are some natural things I can do during my period to make it more manageable and comfortable?

Chaste Berry (vitex). Chaste Berry helps to relieve PMS and regulate irregular periods. Talk to your doctor about when and how to take it. This supplement can lower breast milk supply. Do not take if you are breastfeeding.
Clary Sage/ClaryCalm. Clary Sage is an essential oil that helps with hormone balance and menstrual pain. ClaryCalm by doTerra is a topical blend of Clary Sage and other oils that provides a soothing and calming effect for women during menstruation.
Heating pads. Heat helps to soothe muscles, ease the body’s discomfort, and minimize cramps.
Avoid taking tylenol. Tylenol depletes the body of glutathione, an important substance for detoxing, which is important during menstruation.
Pamper yourself, and don’t forget to laugh!

In addition to what I’ve already mentioned, I’d like to recommend two other treatments: Mayan Abdominal Massage and vaginal steaming.

Mayan Abdominal Massage. The uterus is supposed to bleed from the top of the uterus down. In order for this to happen, the position of the uterus is very important. I had a partial uterine prolapse during the birth of my third child. When this happens, the uterus can fold down on itself like a sandwich instead of being straight up and down. For a number of reasons, the uterus can become flat, lying backward, or folded at the top (see photo), and all of these mal-variations affect normal flow, leading to longer periods (up to 8-10 days), excess brown blood, excess mucus, and increased risk for infection. Mayan massage is a deep abdominal massage (typically painful, especially the first time) that resets the position of the uterus. Sometimes it also includes wrapping material around your hips to keep them at a certain angle. A mayan massage therapist will teach you self-care so you can help yourself at home. The more you do it, the less painful it is. For more information, click here.

Vaginal steaming. Many cultures around the world practice regular vaginal steaming, and consider western women extremely dirty for not. The practice was handed down through the generations via midwives. When men started to dominate the OB-GYN occupation, the sharing of such techniques was replaced by the cutting and scraping of modern instruments. I do acknowledge that in some cases of dysmenorrhea, medical intervention is necessary. But many cases can be treated by vaginal steaming. Women steam to shorten or lengthen their cycles, regulate ovulation, and even lose baby weight.

Vaginal steaming is done by steaming herbs like a tea, then placing the pot in a premade box (see photo), and sitting over it. If you don’t have a box, place the pot on a towel on the floor and kneel over it. A cape can be worn around the waist and over the box to keep steam inside from only coming out of the hole. The steam works to help infiltrate the tissues and break up all hard and sedimented debris so it liquefies and comes out.

The herbs used differ depend on the treatment needed. Cleansing herbs are used for old residue, postpartum, and general use, though not for women with short menstrual cycles. Gentle herbs are used for short menstrual cycles (27 days or less) and interim bleeding. Disinfecting herbs are used for active infections. Cooling herbs are used for hot flashes, night sweats, and vaginal dryness. Consult a vaginal steaming specialist before treating. For more information, visit Steamy Chick online.

Jaimeé Arroyo Novak, FNP

Magnesium: What It Is And Why You Need It


What is magnesium? Why is it important?

Magnesium is touted as the most essential mineral in the whole body. It is responsible for insulin regulation, muscle relaxation (including the heart), metabolism, parathyroid gland function, teeth and bone integrity, digestion, sleep quality, and body detoxification. Without enough magnesium, these functions and systems will not operate optimally.

Most people groups used to live close to water sources (for dietary and economic reasons), and sand has high magnesium levels. People who live, walk, and work in and around the sand have a higher absorption of natural magnesium than people who live in cities away from water sources. Without natural sources of magnesium, supplementation is necessary.

Food sources such as seaweed, chard, kale, legumes, green beans, almonds, cashews, pumpkin, and sesame seeds can contain high magnesium levels, depending on where and how they were grown. But unless you eat significant amounts of these foods, you’re still likely to be deficient in magnesium without supplementation.

What are symptoms of magnesium deficiency? What factors contribute to its depletion?

Carolyn Dean, MD, a leading expert on magnesium, lists 100 factors associated with magnesium deficiency here. Some of the most common symptoms include irritability and anxiety, lethargy, impaired memory and cognitive function, anorexia or loss of appetite, nausea and vomiting, seizures, weakness, muscle cramps and spasms (including the heart), impaired muscle coordination, tics and tremors, involuntary eye movements and vertigo, and irregular or rapid heartbeat.

Magnesium is a rescue mineral, meaning it is released when the body is in potential danger. Every time you do something that could inherently damage the body, it’s going to deplete the body’s magnesium. Processed foods, pharmaceutical drugs, calcium supplements, certain types of Vitamin D, unbound copper, caffeine, nicotine, dehydration, sweating, phosphates, and stress all burn up the body’s magnesium supply.

Age also contributes to magnesium depletion. Magnesium use increases with age, specifically due to the amount of stress that increases with events that come later in life. Think about the difference between the stress of getting married and losing a spouse. The latter burns up a significantly larger amount of magnesium. Some relatively new thinking proposes that diseases that accompany old age are moreso symptoms associated with an imbalance of vital electrolytes (such as magnesium).

How can I test for magnesium deficiency?

Aside from doing a symptom checklist, you can also test for magnesium levels with an RBC blood test  (optimal levels from an RBC test are 6.0-7.0). A routine blood test is inaccurate to determine body magnesium levels. Only about 1% of total magnesium is found in the bloodstream. The body takes magnesium stored in the bones and muscles to keep 1% in the bloodstream because it supplies the heart with the magnesium it needs to continue relaxing after each contraction. So a routine test will generally give a good reading (unless you’re severely dehydrated, or have a severe case of vomiting and diarrhea), but it won’t show what’s actually in the body. We offer RBC blood testing at Hopewell Family Care. If your doctor’s office doesn’t offer it, you can request a test for $45 here.

How should I go about supplementing magnesium?

A general rule for magnesium supplementation is to take five times your bodyweight (if you weigh 150 pounds, supplement with 750 mg daily).Magnesium supplements are best absorbed through the skin rather than orally. Oral magnesium supplements give the body too much magnesium at one time so that the body enacts a fail-safe system to get rid of most of it (only about 4% is absorbed), which results in a laxative effect. It’s ideal to find alternative ways for the body to absorb magnesium so it bypasses the gastrointestinal tract and gets into the tissues. If you are going to take an oral magnesium supplement, we recommend a slow-release tablet by Jigsaw Health.

We recommend a topical magnesium chloride oil spray by Ancient Minerals. Health and Wisdom also sells a similar quality and less expensive magnesium oil, which we carry in our office. Epsom salts (which are magnesium sulfate) can be used in a bath or foot soak. Vitamin B6, bicarbonate, boron, selenium, taurine, and zinc are also cofactors that improve magnesium absorption and retention. While getting these from natural sources is ideal (for instance, you can get B vitamins from bee pollen and desiccated liver), taking them in supplement form is sufficient.

There are multiple types of magnesium supplements, recommended based on symptoms. Magnesium Chloride is indicated for detoxing, Magnesium Glycinate for nerve pain or leaky gut, Magnesium Malate for fibromyalgia and muscle pain, Magnesium Threonate for depression, anxiety, or PTSD, and Magnesium Taurate for cardiovascular health. Even so, determining the type and amount of magnesium that’s optimal for you can be difficult. Feel free to discuss this with your medical provider.

Jaimeé Arroyo Novak, FNP

MTHFR What!?

What is MTHFR?

MTHFR stands for methylenetetrahydrofolate reductase, which is why it is called MTHFR. It is a genetic mutation, and approximately 30% of the population worldwide has it. The mutation affects the ability of the body to turn vitamin B12 and folate into forms the body can utilize. Useable forms of B12 and folate are called methylcobalamin and methylfolate respectively. The body needs methylcobalamin and methylfolate to make the compound glutathione. Glutathione is one of the major antioxidants in the body. Without it, expressions of abnormal genetic DNA are more likely. Meaning, if you have cancer, heart disease, or diabetes in your family history, but don’t have an effective way of detoxing your body, you are more likely to express the diseases of your ancestors. Chronic disease, chronic stress, Tylenol, steroids, injuries, genetically modified foods, artificial sweeteners, overuse of antibiotics, and environmental toxins all strip the body of glutathione. And if the body is already not making enough glutathione due to the MTHFR mutation, disease is even more so likely.

NOTE: While folate and folic acid are both forms of Vitamin B9, they are not equal. Folate occurs naturally in foods such as dark green vegetables and dried legumes. Folic acid is a synthetic form used in most supplements and fortified foods. Folic acid competes with folate for binding sites in the body, keeping the body from absorbing natural forms of folate. Folate is preferred, especially when the body is unable to convert folic acid into folate, as in the case of an MTHFR mutation.

What are the various MTHFR mutations?

There are many different combinations of the MTHFR mutation, and science is still trying to understand them all. The reason for variations is how the genes are passed on from each parent. If both parents pass on healthy genes, then the child won’t have a mutation at all. If one parent passes on mutated genes, and the other parents passes on healthy genes, different variations occur. If both parents pass on mutated genes, different variations also occur. The two more common mutations that we know of are the C677T mutation and the A1298C mutation. These note where the mutation is on the gene. The various combinations are homozygous, heterozygous, and compound heterozygous. A homozygous combination occurs when both parents pass the same gene to the child, either both on the 677 mutation or both on the 2398 mutation. A heterozygous combination occurs when one parent passes on the 677 mutation or the 1298 mutation, and the other parent passes on a normal gene. A compound heterozygous combination occurs when one parent passes on the 677 mutation, and the other parent passes on the 1298 mutation. Depending on the combination of the mutation, it affects the body’s ability to convert B12 and folate into glutathione by upward of 20-70%. For more on this, click here.

What are symptoms of MTHFR? 

Symptoms of the MTHFR mutation include multiple miscarriages or stillbirths, preeclampsia, newborns with neural tube defects, tongue/frenulum ties, depression, anxiety, bipolar disorder, autism and other learning developmental problems, ADHD, Down syndrome, spina bifida, thyroid disease and other autoimmune disorders, migraines, hormonal problems, diabetes, chronic fatigue syndrome, irritable bowel syndrome and other digestive issues, high cholesterol and heart disease, and stroke.

How can I find out if I have MTHFR?

A medical practitioner can check for the MTHFR mutation from a blood draw. Talk to your doctor to see if you have a set of symptoms that would warrant laboratory testing. They would test for MTHFR (the mutation itself, including the mutation combination), B12 and folate levels, glutathione levels, and homocysteine levels (increased homocysteine levels are a sign that the body needs to remove waste).

What should I do if I have MTHFR?

Management of MTHFR should be a plan tailored to your specific needs determined by you and your doctor. On a basic level, you can supplement with B12 and methylfolate. While most people who have MTHFR benefit from taking methylcobalamin (methylated B12), if you have any other genetic mutations, it can increase anxiety to take methylcobalamin due to overmethylation, and you may need a different type of B12 (such as acetal B12). In addition, consume more natural forms of B12, folate, and vitamin B6 (also important in the process of detoxification), such as beans, lentils, asparagus, broccoli, and avocado. Treat digestive problems, such as leaky gut syndrome and irritable bowel syndrome, so that your body can absorb the nutrients necessary to promote detoxification. Be cautious when taking medications or other products that strip the body of glutathione. Detox by exercising, drinking water, and consuming fresh vegetables and fruits with antioxidants in them. Get adequate sleep.

MTHFR isn’t damaging as long as you know you have it. There are plenty of ways to manage it. Depending on the scenario, some people ask whether it is better to know a diagnosis or not. In the case of MTHFR, it is better to have more information.

At Hopewell Family Care, we carry methylcobalamin and methylfolate alone and in combinations from Metagenics, Thorne, and Klaire. NuMedica has a natural neuromethylation cream for children to rub on their feet, which we also carry. Check if your vitamins contain folic acid or folate. If they have folic acid, consider switching to folate, whether you have an MTHFR mutation or not.

Jaimeé Arroyo Novak, FNP

There's A Fungus Among Us

What is Candida?

Candida is a type of yeast (which is a fungus) that exists naturally on the surfaces of the skin, in the internal gastrointestinal system, and on/in orifices such as the mouth and genitals. Likely, unless you’ve done a Candida cleanse recently, Candida is just a part of your skin and body. Candida can cause a fungal infection called Candidiasis, more commonly known as a yeast infection. For example, thrush is candidiasis of the mouth. Yet even before you have a yeast infection, Candida can be problematic. Candida can live beneath the radar until periods of sickness, stress, and other immuno-compromising situations, during which the body is often overexposed to stimuli that helps the yeast grow, which can then become a problem known as Candida overgrowth.

How can I know if I have Candida overgrowth?

Perform a home test. There are three simple self home tests that you can do to confirm the presence of Candida. One is a spit test. First thing in the morning before, rinsing, spitting, eating or drinking, spit a large amount of saliva into a glass of water (use a clear glass). While the saliva will/should float, within 15 minutes, if there is Candida present, there will be stringy legs projecting downward from the spit, and cloudy saliva that is sinking/has sunk to the bottom of the cup (see photo).

Another is an itch test. Over the course of 2 days, make a record of every time you scratch your body. Pay attention to both location (where) and frequency (how often). The itching can be noticeable anywhere, and likely particularly common in warm places of the body (armpits, groin, etc).

The last home test is a tongue check. A healthy tongue is pink. A tongue with a white or yellowish coating is significant for Candida, even more so in conjunction with bad breath.

Note your symptoms. Symptoms of Candida overgrowth include digestive issues (including bloating), brain fog, recurring fungal infections (of the skin, nails, vagina,* etc), mood swings (including bouts of irritability, anxiety, and depression), skin problems (including eczema and acne), fatigue/chronic fatigue, and strong seasonal allergies. Strong cravings for sugars and carbohydrates can also be indicative of Candida overgrowth. Sugar feeds Candida growth, and the yeast triggers the gut to crave sugar, ensuring its continued growth.

[*For some women with frequent vaginal yeast infections, they have an additional issue of vaginal pH imbalance. Stay tuned for a future blog on vaginal pH.]

Have a clinical test done. A blood test can be performed to check for a) the amount of IgG, IgA, and IgM antibodies in your blood [high amounts indicates the immune system is attacking a high amount of pathogens, which include yeast], and b) the levels of neutrophils and lymphocytes [a pattern of high neutrophils and low lymphocytes, though non-specific, often presents itself with Candida overgrowth]. A stool test can also be performed to take a comprehensive look at the gastrointestinal tract and what’s in it. (At Hopewell Family Care, we use Geneva Diagnostics to perform this test. Check with your doctor’s office to see what they can provide for you.)

How can I treat Candida overgrowth?

What to avoid. It’s important to understand what fuels Candida. Any disruption in the microbiota can increase Candida growth. For example, steroids contribute to that disruption, and consequently to Candida growth. While steroid use is common, there are many indications for its use that can be addressed with gut health. Explore the route of gut health before using steroids. As mentioned previously, sugar also helps fuel Candida growth. (In the 1960s, the sugar industry started pointing the finger at fat, making it responsible for autoimmune and cardiovascular issues, and taking the attention off of the ill-health effects of high sugar intake. Read more about this here.) Be aware of the foods you eat made with refined sugars or that are high in carbohydrates, such as potatoes, breads, and pastas. It’s also good to know the glycemic levels of natural sugar sources. (See chart below on glycemic levels of fruits.)

Additionally, avoid fermented, moldy, and yeast-containing foods for the time that you have Candida overgrowth.

What to add. S. boulardii is a probiotic that specifically helps balance yeast overgrowth. Take two capsules twice daily for two weeks, followed by one capsule twice daily for six weeks. (We carry S. boulardii at Hopewell Family Care for your convenience.) Goldenseal root, barberry root, and oregon grape root contain berberine, a chemical effective against fungi (as well as bacteria and protozoa) that increases blood supply to the skin, which helps increase immune function. Grapefruit seed extract has a yeast growth-inhibiting effect (use as directed by the manufacturer). Calcium undecylenate is a broad-spectrum antifungal. As a last resort, antifungal medications such as diflucan and nystatin can be used, though they include other side effects.

NOTE: Treat Candida overgrowth in conjunction with your healthcare professional. If a large number of yeast cells die too rapidly, they can release toxins and cause allergic reactions (called a herxheimer reaction). Rapid yeast-die off is more likely with use of antifungal medications. More natural products kill yeast off more slowly. While fast treatment is more desirable, an ‘easy-does-it’ approach is more beneficial in this case. Regardless of your approach, it’s important to drink plenty of fluids and consume 30-40 grams of fiber daily, which helps to rid the body of debri from dead yeast.

Jaimeé Arroyo Novak, FNP

What You Need to Know About Kids and Iron


What is anemia?

Anemia by definition is an iron deficiency. Iron is a trace metal found in the environment, including some food sources, and is absorbed by the intestine when consumed. A healthy gut is essential to absorbing the vitamins, minerals, and trace metals necessary for doing life. (See our blog on probiotics for how to help augment a healthy intestine for yourself and your family.)

Red blood cells need hemoglobin in order to carry oxygen to the body. Each hemoglobin needs four atoms of iron to bind to a molecule of oxygen. Without enough iron, the body doesn’t have enough hemoglobin, and the blood isn't able to transport enough oxygen to keep the body systems functioning properly. Low iron makes activities of daily living increasingly difficult. For example, a child with low iron may be fatigued, unable to think, play, or do life well.

How do I know if my child is anemic?

At Hopewell Family Care, we check iron levels at every wellness exam, starting at 1 year of age. Acute anemia occurs in 1 out of every 2 of the children we see. Childhood anemia, if not corrected, can become chronic adult anemia, which is more difficult to correct and contributes to greater health problems. We do an in-office toe prick to measure the amount of hemoglobin in the blood (the majority of children hardly notice). A reading of less than 11.5 is indicative of low iron. Age and gender are also taken into consideration when determining whether or not iron levels are low.

How did my child become anemic?

In addition to what the iron level is, it’s important to know the reason why a level is what it is. Is the child not getting enough iron-rich nutrients? If your child is anything like mine, they beg for crackers and empty nutrients rather than a large plate of kale. Is the child’s intestine unable to absorb the iron its receiving? Some children have issues of gut absorption, which requires more attention than simply supplementing with iron. If the intestine is inflamed, it won’t absorb iron (or other nutrients), no matter how much iron-rich foods are consumed. The gut needs healed for supplementation to be effective. Has the child’s iron been too low for too long? The body works on a negative feedback system. If iron levels get too low, the body forgets to absorb it. With supplementation, the body can be reminded to do its job again.

What are some iron treatments that we recommend?

Iron-rich foods. High doses of iron-rich foods, such as almonds, blackstrap molasses, spinach, kale, and organ meats are important to help increase iron levels. For children, I make a green smoothie and molasses cookies to help them get more of the iron they need (see recipes below). I have also successfully introduced kale chips! I recommend eating a handful of strawberries, a clementine, or a chewable Vitamin C tablet after an iron-rich meal, as Vitamin C assists in the absorption of iron and other nutrients.

*Floradix. Because many children are picky eaters, a daily supplement approach is often more successful. Floradix is a plant-based iron supplement that has a weight-based dose. It can be taken on its own or added to a smoothie or other drink. If masking it with another drink, mix it with a small amount to ensure that the child gets all of the iron in the dose. It’s important to determine the dosage with your pediatrician and schedule iron rechecks before continuing supplementation, as self-treating can cause iron overload, which presents with other side effects.

*Chlorophyll. Some sources recommend chlorophyll drops. They are added to water and give a minty taste. However, there is no child’s dose in any literature, so its use is more or less trial and error until iron levels increase. As it is under-researched, use chlorophyll with caution.

*Iron Fish. We understand that the inconsistencies of life can make consistency with iron treatment difficult. We recommend using an Iron Fish, which can help meet 90 percent of daily iron needs. To use, cook with the Iron Fish regularly in stir fry, boiling water for soup or oatmeal, or anything else on the stovetop (do not use in microwaves). Supplementing iron in this way increases iron intake for the whole family rather than one child at a time. For more information, visit www.luckyironfish.com.

[*We carry Floradix, Chlorophyll, and the Iron Fish in our office for your convenience.]

I typically see adequate improvement in my pediatric patients’ iron levels after three to six months of supplementation. The key to effective iron treatment is consistency. Whatever you do, do it as regularly as possible in order to get the results you want, and your child’s body needs.

Jaimeé Arroyo Novak, FNP

Green Smoothie

½ pineapple
3 clementines
2 tbsp blackstrap molasses or local honey
4 cups spinach

Blend together with preferred amount of ice

Molasses Cookies

1 ½ cups blanched almond flour
¼ tsp sea salt
¼ tsp baking soda
1 tsp ginger
½ tsp ground cinnamon
¼ cup grapeseed oil or palm shortening
¼ cup blackstrap molasses

Combine dry ingredients in a large bowl
Combine wet ingredients in a small bowl
Mix wet ingredients into dry ingredients
Scoop onto baking sheets lined with parchment paper 1 tablespoon at a time, gently press
Bake at 350° for 6-10 minutes
Cool and serve

Possibilities For A Healthy Birth Rest

For starters, I like to talk about practicing birth control as an attempt to have a birth rest. No one sexually active can really have control--babies are known to defy science. Yet there are times when a woman and her family find the need for rest from having children. Though women can and do healthily have children close together, it takes a woman’s body approximately 3 years to fully recover from pregnancy and birth, for the uterus to heal itself, and for the body to reabsorb vitamins and minerals to support another baby. Additional factors to consider are the mother’s stress levels, her mental and psychosocial health, and any adrenal fatigue, among others. So, if you find yourself in a season of needing a birth rest, and you’d like to do so without risking damage to your body, I’d like to offer some hormone-free alternatives in order to help your attempts.

Before I continue, it’s important to understand the female menstrual cycle, especially if you are going to be using hormone-free birth control. The average female menstrual cycle lasts about 28-31 days, from the first day of her period to the start of the next. The average female ovulates around 14 days after her period starts. A woman is most fertile in the days surrounding ovulation.

What are some hormonal methods of birth control?

The pill. Birth control pills have been in use since the 1960s. They are taken daily to prevent pregnancy. They use progesterone and estrogen (female reproductive hormones) to trick a woman’s body into thinking she’s pregnant. They have a Pearl index of 0.1-1, which means that they are very effective. (A Pearl index indicates the effectiveness of a birth control method. The lower the Pearl index, the lower the chance of unintentionally getting pregnant while using the contraception method, and vice versa.) But birth control pills also have a slew of side effects, including weight gain, blood clots, gut disturbances, hormone imbalances, cancers, and infertility after use.

Depo-Provera shot. A Depo shot is a massive amount of hormones administered to the woman every 3 months. It prevents the ovaries from releasing eggs, and thickens the cervical mucus to block sperm from getting to the egg should one be released. It has a Pearl index of 0.3, and shares the same side effects as the birth control pill.

Intrauterine device (IUD). An IUD’s basic function is to create inflammation in the uterine wall lining so that white blood cells are continuously coming to the surface and engulfing any sperm present. The device is inserted by a physician and can be removed by a physician at any time upon request. There are IUDs with and without hormones, which can last for up to 5-10 years (shorter for hormonal IUDs, longer for non-hormonal IUDs). The Pearl index for an IUD is 0.1-1.5 (hormonal IUDs have a bit higher Pearl index than non-hormonal IUDs). Side effects include high blood pressure, autoimmune disorders, cervical dysplasia (the development of precancerous cells in the cervix), dysmenorrhea (pain during menstruation), and abnormal cycles and/or periods.

What are some hormone-free methods of birth control?

Condoms. When used correctly, condoms have a Pearl index of 3-12, and are 82 percent effective with typical use (sometimes they are used incorrectly, or they break). Condoms have no physical side effects, though they can limit spontaneity during sexual intercourse, and the male partner may not want to use them or may forget to apply.

Cervical cap/diaphragm. A cervical cap is a cup inserted into the vagina that covers the opening to the cervix to prevent sperm from entering. It is inserted before intercourse and removed after. While it used to have to be fitted by a doctor, today’s modern, sleek diaphragm (Caya) can be ordered online. The Pearl index for a cervical cap is 4-20, and is most effective when used with a spermicide, though it can be used without.

Lady-Comp. One of the natural forms of birth control that has been coming into integrative circles is the Lady-Comp Fertility Monitor. Lady-Comp is completely non-invasive, hormone-free, and without side effects. It has a Pearl index of 0.7 (99.3 percent effective). After at least 3 hours of sleep, a woman takes her basal body temperature with the thermometer attached to the monitor. The monitor uses your temperature and compares it to 40,000 other women’s cycles to account for sickness and irregularities in cycle. The monitor will then give you a green, yellow, or red light. The more you use the device, the more it will learn your cycle, and it will give you increasingly less yellow lights and more red and green lights. Green means you may engage in unprotected sex, yellow means to use caution, and red means to use backup protection or abstain. Lady-Comp can also be used as a fertility guide, though there is additional software to the thermometer to help augment the device for that function. You can also choose to use a basal body thermometer, which is much cheaper, but it does not provide the interpretive element or comparison to other cycles.

Cervical changes. Paying attention to signs that your body is ovulating is also a helpful tool. These include being aware of the consistency of your cervical mucus, and the length of your cervix, as together they are telling of whether or not you are about to ovulate or past ovulation. This method requires you to be comfortable and familiar with your vagina.

Any of these methods can be used separately or together. I recommend Lady-Comp, charting cervical mucus and lengthening, and using condoms for backup in order to continue having a healthy sexual balance while allowing your body and family to rest before (another) birth and baby. I also recommend making the decision to use birth control and what to use together, as a couple. A woman’s shouldn’t feel pressure to use birth control, nor should she feel pressured to have children, as neither creates a healthy environment. Discuss the options and decide what’s best for you.

Jaimeé Arroyo Novak, FNP

The Ups & Downs of Parenting: What To Do When Your Child Falls

Children hit their heads all the time. An exaggeration I know, but they do, and frequently. I often say that you haven’t been inducted into parenthood until your child hits their head.

It is also said that an ounce of prevention is worth a pound of cure. Always look for safety hazards in your home and other environments you are in regularly. Could your child open the window? Could your child fall out of the window? Could your child fall down the stairs? Off the table? Off a bookshelf? Does your child climb furniture? Can the furniture fall on them if they try to climb it? Are they secured in their highchair every time they eat? Is their booster seat secured properly to the chair? Are they secured appropriately in their carseat and stroller? Is the trampoline zipped shut every time they are on it? Do they know how to play safe at playgrounds? On monkey bars? Do they wear a helmet when riding bikes or scooters? Do your part to prevent falls and head injuries.

How do I know if I need to take my child into the ER after a fall or head injury?

The consequences of a head injury can range from very minor to severe. If your child can do appropriately after the fall everything that they could do before the fall, then they are likely not in need of medical attention. Talking, eating, walking, and being able to see like normal are all good signs that no serious damage has been done.

If there is loss of consciousness at the time of the accident, take your child to the ER, even if it is just for a moment and they resume consciousness after. Loss of consciousness could be indicative of a concussion (jarring or shaking of the brain inside the skull), which is the most common type of traumatic brain injury. A more serious brain injury can cause a subdural hematoma (swelling caused by blood collecting outside of the brain), which can be life-threatening.

If your child is vomiting, has any seizure activity, any loss of vision, confusion, or is unable to talk (any one of these symptoms), take them to the ER.

A child with a contusion (a bruise, typically called a goose egg) may or may not need medical attention. Consult your pediatrician with any questions you may have.

If my child is sleepy after a fall, should I let them sleep?

Being sleepy after a fall is not a positive or negative sign in and of itself. Inconveniently, many children fall just before nap time because they are more clumsy, so it is normal for them to fall asleep after. Children also become sleepy after a hard cry. In the absence of any other signs (like those mentioned above), let your child sleep. Sleep is healing for the body and calming for the emotions.

If my child seems ok, is there anything I should do?

For bumps and bruises, use arnica oil on the area topically (as long as the skin is intact). Any cuts or lacerations should be bandaged and monitored for signs of infection, including excessive redness, pain, pus, or a fever. Watch for any serious symptoms or signs of injury (like those mentioned above). Frequently re-evaluate your child, especially for the first day. The possibility of a brain bleed significantly decreases 24 hours after a head injury. 

For any additional concerns, contact your pediatrician. Also, trust your gut feeling. If you feel like you should take your child into the ER to be evaluated, do it. Pack some snacks, a few favorite toys or an iPad, and settle in for a little wait.

And welcome to parenthood.

Jaimeé Arroyo Novak, FNP

Essential Oil Safety With Children

When it comes to using essential oils, the phrase ‘less is more’ is particularly relevant. Essential oils are extremely powerful. One drop of peppermint oil is equal to 28 cups of peppermint tea. When applied topically, an essential oil reaches the bloodstream and enters the cells of the body very quickly and easily. Essential oils must be treated with respect, including choosing an appropriate dose, route, site of application, frequency, and duration of use. For example, as part of my ear infection treatment protocol, I recommend a ratio of 1 drop of oregano oil to 5 drops of coconut oil and applying a dime size to the bottom of the foot twice daily for 7 days. ‘A dab of this, a dab of that’ is not a safe practice. For advice on administration (dose, route, site, frequency, and duration), contact your local aromatherapist or pediatrician.

Can I use essential oils with my baby?

I do not recommend the use of any essential oils via any route with infants 0 to 6 months of age.

How should I give essential oils to my children?

Essential oils can be applied topically, inhaled by diffusion, and internally ingested. Topical administration is a great way to use essential oils. It allows you to treat one person at a time (as opposed to diffusing, where everyone in the room receives the administration). When applying topically, it is very important to use a diluent, also called a carrier oil. Most essential oils cannot be applied NEAT (without a carrier oil). You must have an appropriate diluent with essential oil use, such as coconut oil, grapeseed oil, or olive oil. I highly recommend fractionated coconut oil, as it uses the most antiviral, antibacterial, and antifungal properties of the coconut, and helps absorb the oil very quickly into the skin. For young children especially, use no less than 5 drops of diluent for every 1 drop of essential oil. Diffusing essential oils is helpful when you are trying to treat everyone in the room, and you only need to diffuse for 30 minutes per dose to receive the benefits of the oil. Ingesting essential oils should never be used for children 7 years of age or younger, or pregnant women. Some essential oil professionals recommend ingesting no more than 3 drops of an essential oil 3 times a day. While this is a general safety precaution, it is oversimplified as every oil is unique and can affect the body differently. When ingesting, always do so with the help of a medical professional or aromatherapist. While the benefits can be numerous, not all essential oil use comes without side effects.

Are certified therapeutic grade essential oils necessary?

While companies such as Young Living and DoTerra market the pureness of their oils, some oils are of lesser quality, and have added ingredients and diluents, making them less pure. I happily recommend Young Living, DoTerra, Mountain Rose Herbs, and Vintage Remedies essential oils. Always feel free to do your own research and make choices you are comfortable with.

What are some family friendly oils?

Basil for ear infections, cedarwood for sleeping and calming, cilantro for anxiety, eucalyptus for respiratory issues, frankincense for inflammation and warts, lavender for itching, pain, and burns, lemon for cleansing, tea tree for disinfecting, oregano for viruses, peppermint for fevers, and wild orange for uplifting, among others. Some doTerra blends I recommend are Breathe for respiratory issues, DigestZen for nausea and stomach pain, OnGuard for infectious diseases, and Balance for short attention span. Be aware that blends are not always ‘one size fits all.’ You may need to make your own blend to avoid a particular oil in a pre-made commercial blend. Also, not all blends are age appropriate, so exercise discretion. Again, always discuss administration practices with your care provider to ensure the proper dose, route, site, frequency, and duration are used.

Any other safety precautions?

Some people have sensitivities and allergies to certain essential oils. I recommend doing a whiff or spot test before using a particular oil regularly or covering a large area. A reaction to an essential oil could appear as symptoms of chest tightness or wheezing when inhaled, a skin rash or burn when administered topically, or imbalance of intestinal microbiota when ingested. Oils should always be kept high and away from children. Diffusers should always be placed above eye level to prevent a young child from drinking the water. In the case of accidental overdose or ingestion, immediately call the Poison Control Center Hotline at 1 (800) 222-1222.

Essential oils can be a helpful, natural alternative to chemically-laden creams, unwarranted antibiotic treatments, and other pharmaceutical medical treatments. Integrative healthcare attempts to weigh the risks and benefits of each treatment and proposes essential oils when it is medically indicated and appropriate for the person receiving them. At Hopewell Family Care, we respect the use of essential oils and work to help our patients utilize them in a safe and therapeutic manner.

Jaimeé Arroyo Novak, FNP


AromaTools (October 2013). Modern Essentials: A Contemporary Guide to the Therapeutic Use of Essential Oils, 5th Ed. Orem, UT: AromaTools.

Vintage Remedies, Inc (2016). https://vintageremedies.com/

Liver Cleanse: Is It For Me?

Why is my liver important?

The liver processes everything you eat or drink. While the intestines break down food and help the body absorb it, the food then goes to the liver, which does the work of metabolizing it. The liver stores most nutrients until the body needs them. The liver helps the body use what is good for the body’s systems, and eliminate what is not. When you are consistently consuming food and drinks that are not good for the body (as most Americans are), the liver has to overwork in order to process out all that is bad. Even when you do eat clean, it is difficult to eliminate all environmental toxins, such as smog, plastic, car fumes, etc., which most people are exposed to daily. While the liver works hard, it cannot always process everything out. When it cannot keep up, it can send damaging substances (toxins) to the organs. The potential for damage (to the liver and other organs) remains high as long as exposure to difficult-to-metabolize chemicals remains high.

How can I take care of my liver?

A healthy diet is vital to a well-functioning liver. Get protein from mainly plant-based sources. Eat natural foods, foods you have to prepare, foods consumed in their raw state, not packaged. While the body needs fat, reduce fat to natural sources, such as avocados, nuts, fish, and seeds. Other good foods include beans, legumes and lentils, and vegetables and fruits that are not produced or processed with harmful chemicals. Purchase organic foods and products as much as possible. Learn about and avoid foods such as wheat, which is sprayed with over ten chemical treatments from seed to store. Get to know who grows your food and what they use in its production. Think about visiting a farmer’s market.

Exercise regularly and keep your weight in check. Weight gain can cause your liver to slow down, which can slow your metabolism down, which can cause you to gain more weight. Obesity is linked to fatty liver disease, which can lead to cirrhosis (scarring) of the liver, and liver failure. Liver disease is rising even among adolescents due to juvenile obesity.

Exposure to cleaners, nail polish, hair dye, makeup, paint fumes, alcohol, and other synthetic chemicals requires the liver to filter them out of the body to keep them from getting into the bloodstream. Even with a healthy diet, chemical exposure can cause the liver to overwork. (See below for how to cleanse the liver.)

How could I suspect that my liver is malfunctioning?

Symptoms of liver damage include fatigue, nausea, decreased appetite, discolored (dark) urine, and yellowing of the skin and eyes (jaundice). While there is a liver function test, the liver has to be functioning very poorly in order to trigger results.

What can I do if my liver is damaged?

In order to detoxify the body (hair, skin, nails, intestines, etc.), begin by detoxifying the liver. I recommend doing a liver cleanse. In fact, it is recommended to do a liver cleanse yearly, due to overexposure to toxins in the environment. Liver cleanses are not advised for pregnant or breastfeeding women, or while sick.

I recommend Metagenics 10-day Clear Change (or 28-day for a more comprehensive cleanse), Global Health Center Liver Cleanse Kit, or Gaia Liver Cleanse. In addition to taking the products, liver cleanses are paired with a specific diet during the cleanse that helps facilitate your body getting rid of massive amounts of toxins. Your body will eliminate liver stones, which are clumps of toxins, along with bile, fat, and excess dietary cholesterol that crystallize into pebbles (see picture). At the end of the cleanse, you can opt to do a stone elimination with USP epsom salts and olive oil. Following the cleanse, continue with clean eating and keeping your weight in check for healthy maintenance. Without a heavy cleanse, regular intake of green teas, and herbs such as milk thistle, turmeric, and dandelion root help promote liver wellness, and can also be used to follow up a liver cleanse. More information can be found here.

Liver stones

Liver stones

Taking care of your liver is vital to a healthy life. Rather than experiencing chronic fatigue, depression, headaches, constipation, digestive difficulties, and chemical sensitives, as you would with a sluggish liver, and also increased risks of chronic and autoimmune diseases, you can give your body the best chance at health by keeping your liver as toxin-free as possible.

Jaimeé Arroyo Novak, FNP

The Whats & Whys of Probiotics

What are probiotics?

Probiotics are good bacteria and yeasts that 1) help aid in digestion, and 2) counter the effects of harmful bacteria. The human digestive system already has good bacteria in it. The intestinal tract is teeming with bacteria that help the body break down and digest food. Unfortunately, certain conditions (see below) have a tendency to wipe those good bacteria out. In such cases, it is important to supplement with probiotics and help reculture our gut.

What conditions tend to affect the body’s good bacteria?

Taking antibiotics, taking birth control, receiving vaccinations, exposure to parasites, and exposure to foods causing sensitivities and allergies all can affect the ecoculture of the intestinal tract. If any of these apply to you, and especially if you have apparent gut issues, you are at greater risk of not having enough good bacteria in your body to adequately digest your food and protect against harmful bacteria.

What forms do probiotics come in?

Capsules, water kefir, and kombucha tea are 3 of the most common probiotic supplements. There are billions of live bacteria in every probiotic, as well as different strains of probiotics in each. A few of the probiotic capsules that I recommend are Metagenics UltraFlora Balance (15 billion live cultures and 2 probiotic strains), Jarrow’s Fem-Dophilus for women (5 billion live cultures per capsule and 2 probiotic strains) and RenewLife’s Buddy Bear chewable probiotic for children (1 billion live cultures per tablet and 4 probiotic strains).

Water kefir and kombucha tea are probiotic beverages. Water kefir is fermented water made with kefir grains and kombucha tea is fermented tea made with a scoby (symbiotic culture of bacteria and yeast). Water kefir and kombucha tea can be made at home, and also purchased. Note that home-brewed water kefir and kombucha tea are not recommended for pregnant women. It is recommended that pregnant women take a probiotic capsule.

Probiotics for infants are available in powder form and can either be applied directly to the baby’s mouth with a finger, or applied to the nipple of the breast or bottle before feeding. Klaire Laboratories Ther-Biotic For Infants (10+ billion live cultures and 10 probiotic strains) is a great probiotic in powder form for infants.

 When taken with antibiotics, use probiotics either 3 hours before or after every antibiotic dose.

How much do probiotics cost?

Fem-Dophilus costs $20 for 30 capsules, and Buddy Bear costs $15 for 60 tablets. Homemade water kefir and kombucha is significantly cheaper (hundreds of dollars a year) than store bought probiotic beverages.

Why take probiotics?

The intestines digest food and absorb the nutrients and minerals from it. There are thousands of bacteria in the intestines that help to digest and absorb food. Some foods are more difficult to digest than others. Such foods put a strain on the intestines, and the intestines aren’t able to absorb nutrients like they are supposed to. This contributes to issues of gas, constipation, malabsorption, leaky gut syndrome, irritable bowel syndrome, crohn’s disease, and other bowel problems and systemic issues. In addition, the immune system and the majority of the body’s neuroreceptors (which affect mood) start in the intestines. Taking care of, and in some cases, fixing the problems with the intestines increases health throughout the body. Probiotics are a useful tool that help the intestines do their job more beneficially. Taking probiotics is a good way to help a malfunctioning gut, and to prevent malfunctioning in a healthy gut.

Jaimeé Arroyo Novak, FNP

Elderberry: What, Why, & How



NOTE: Flu vaccines, while effective against some flu strains, do not provide complete coverage. Each year, epidemiologists predict which flu viruses will be present in order to develop the most accurate vaccines. While they do their best, it is similar to predicting the weather, so there is a chance of inaccuracy. To receive the flu vaccine is a personal decision, one that you make for yourself and your family, as with every health choice. This article is not about the flu vaccine. This article highlights the use of elderberry for cold and flu prevention and treatment. Elderberry can be used as an adjunct or alternative therapy to the flu vaccine.

What is elderberry?

Elderberry (Sambucus Nigra) is the berry of the flowering elder plant. It has antiviral properties; it disarms flu viruses’ ability to invade cells. It is immune boosting; it dramatically increases the production of antibodies called cytokines. Elderberry is a very effective natural remedy against the flu virus. In 2002 in Oslo, Norway, a study was done to determine the efficacy of elderberry in comparison to Tamiflu. Patients given elderberry recovered from the flu in 2-3 days, patients given Tamiflu recovered in 4.5-5 days, and patients given a placebo recovered in 6 days. Tamiflu, which is also an antiviral, is the most common treatment for flu symptoms. Unfortunately, its side effects mimic flu-like symptoms, it can allow for secondary bacterial infections, and it has even been linked to cases of suicidal ideation. It is also expensive. Elderberry has relatively no side effects (for those with autoimmune disorders, special consideration is discussed below) and is inexpensive.

Where is elderberry grown?

Elderberry is native to the many parts of the United States and Europe.

Can I grow elderberry?

Yes. Elderberry bushes are very easy to maintain. Elderberry grows best in full sun, with slightly acidic, well-draining soil. It typically begins producing fruit within 1-2 years of planting. Raw berries are poisonous and must be cooked before consumption. The raw plant contains a cyanide-producing substance that is inactivated by cooking.

What forms can elderberry be taken in?

Syrup, teas and tinctures, and jam.

Where can I purchase elderberry?

Any health food store and some local farmers markets. You can also grow and make your own.

Who is elderberry contraindicated for?

Elderberry is safe and effective for adults and children over the age of 2. It should be used cautiously in pregnancy and with breastfeeding. As it is an immune-stimulant, those with autoimmune disorders should not take elderberry without discussing it and the potential side effects with their healthcare provider. Always read the product label and information and use as directed. Elderberry can either be prepared as a plain syrup or with additives, such as honey, cinnamon, ginger and clove, which can have additional health benefits, but can be harmful to some demographics, like those mentioned above. Additionally, there is a possibility that elderberry can contribute to the overproduction of cytokines (proteins released by white blood cells to attack pathogens), which can cause them to attack healthy tissues. In order to avoid the chance of this, you can take a natural anti-inflammatory with elderberry, such as turmeric.

When should I take elderberry?

Elderberry not only helps at the onset of cold and flu symptoms, but even prior to exposure to the flu virus. For best results, take elderberry throughout the fall and winter months.

How much elderberry should I take for each dose?

Dosing for prevention and for treatment are different. Increasing the dosing during sickness helps give you a boosted immune response when you need it most. For prevention, ages 12 years and older take 2 tsp a day, and ages 2-11 years take 1 tsp a day. For treatment, take the same dose (1-2 tsp, depending on age) 4 times a day. Each dose should be 3-5 hours apart. Parents, always use a measuring tool to give the proper amount to your children. Refrain from guessing to prevent overdosing. Be consistent with your dosing. Syrups, as with all medicines, should be respected. Never assume that taking more is helpful.

Jaimeé Arroyo Novak, FNP

(1) Fassa, P. (2009, May 30). Elderberry trumps tamiflu for flu remedy. Retrieved from http://www.naturalnews.com/026354_flu_Tamiflu_elderberry.html#

Is Your Child Getting Enough Vitamin D?


What does Vitamin D do for the body?

Vitamin D is essential for regulating the absorption of calcium and phosphorus, and facilitating normal immune system function. Too little Vitamin D results in soft bones in children and fragile, misshapen bones in adults. There are many other possible correlations between Vitamin D and its treatment or prevention of autism, autoimmune disease, cancer, chronic pain, depression, diabetes, heart disease, high blood pressure, flu, neuromuscular diseases, and osteoporosis. However, there have been no definitive clinical trials.

Do children need Vitamin D supplementation?

Yes, if they are deficient. Children need 400-600 International Units (IU) a day. Though Vitamin D deficiencies in children are common, it’s important to you know if your child is deficient or not before you begin supplementing. Over 75% of our patients are Vitamin D deficient, including children.

Can Vitamin D levels be tested?

Yes, by a simple blood draw. For children, the draw site (backs of hands and upper forearms) can be numbed with a cream beforehand so it doesn’t have to be an unpleasant experience.

Can children intake too much Vitamin D?

Yes, though not likely without supplementation. Vitamin D is a fat-soluble vitamin; it dissolves in fat and is stored in body tissues. Rather than excreting the excess like water-soluble vitamins, the body stores it, and it can accumulate to dangerous levels. The upper-level intake of Vitamin D for children is 3,000 IU/day for kids ages 4-8, 2,500 IU/day for kids ages 1-3, 1,500 IU/day for infants ages 6-12 months, and 1,000 IU/day for infants ages 0-6 months. In most cases, symptoms of Vitamin D toxicity is actually caused by a lack of Vitamin K2. In cases where high dose Vitamin D supplementation is recommended, Vitamin K2 supplementation is also recommended. Ask your provider if you need Vitamin K2 supplementation in conjunction with Vitamin D supplementation or not.

Can children get enough Vitamin D in food?

Yes, though not always easily or healthily. Natural sources of Vitamin D include wild-caught fish, beef or calf liver, egg yolks, canned fish, and shiitake mushrooms. Fortified sources of Vitamin D include milk, yogurt, almond milk, pudding made with milk, orange juice, breakfast cereals, fortified tofu, oatmeal, cheese, eggnog, and margarine. The problem with fortified Vitamin D sources is that the majority are dairy and sugar products, which can and do cause many other problems in children.

Is the sun a good source of Vitamin D?

Yes, though not for everyone. Many people, including children, have issues with absorption in their intestines. These are due to many different variables, including antibiotics, food allergies and sensitivities, parasites, and more. In cases of malabsorption, the gut is not able to properly absorb, manufacture, and store the form of Vitamin D derived from the sun.

How long should supplementation last?

I recommend supplementing in the winter into early spring when the immune system typically has to work harder. Vitamin D levels can sometimes be difficult to improve, depending on the health of the gut. Regular testing of Vitamin D is recommended to know whether a patient needs to increase or decrease their dose.

Do you recommend a brand of Vitamin D supplement?

Metagenics D3 Liquid is a daily Vitamin D supplement that I recommend for children. D3 is the naturally-occurring form of the vitamin. It should be dosed by your provider based upon your child’s age, weight and Vitamin D levels. This product is listed on our website under Patient Resources > Metagenics > General Wellness.

Jaimeé Arroyo Novak, FNP

Acetaminophen Guidelines for Infants


The correct dose of acetaminophen for your child is based on their weight, not their age. If you don't know how much your child weighs and they are too young to stand on a scale, weight yourself while holding them and then weigh yourself alone. Subtract your weight from the combined weight to get your child's weight. Do not give acetaminophen to a baby under 3 months of age without a doctor's approval. Shake liquid medicine well before measuring. Never give acetaminophen to a child who is taking other medicine that contains acetaminophen unless a doctor advises it. Infants' and children's liquid acetaminophen (both labeled 'oral suspension') have the same concentration: 160 mg per 5mL. The only difference is that the infant version comes with a syringe and the children's version comes with a cup. You can repeat the dose every 4 hours as needed. Do not give more than 5 doses in a 24-hour period.

A child weighing 6-11 pounds should receive a 1.25mL dose. A child weighing 12-17 pounds should receive a 2.5mL dose. A child weighing 18-23 pounds a 2.75mL dose. And 24-35 pounds a 5mL dose. Click here for chart.