Polycystic Ovary Syndrome (PCOS) - Topic Overview

What is polycystic ovary syndrome (PCOS)?
Polycystic ovary syndrome (say "pah-lee-SIS-tik OH-vuh-ree SIN-drohm") is a problem in which a woman’s hormones are out of balance. It can cause problems with your periods and make it difficult to get pregnant. PCOS may also cause unwanted changes in the way you look. If it is not treated, over time it can lead to serious health problems, such as diabetes and heart disease.

Polycystic ovary syndrome (or PCOS) is common, affecting as many as 1 out of 15 women. Often the symptoms begin in the teen years. Treatment can help control the symptoms and prevent long-term problems.

What are hormones, and what happens in PCOS?
Hormones are chemical messengers that trigger many different processes, including growth and energy production. Often, the job of one hormone is to signal the release of another hormone.

For reasons that are not well understood, in PCOS the hormones get out of balance. One hormone change triggers another, which changes another. For example:

The sex hormones get out of balance. Normally, the ovaries make a tiny amount of male sex hormones (androgens). In PCOS, they start making slightly more androgens. This may cause you to stop ovulating, get acne, and grow extra facial and body hair.
The body may have a problem using insulin, called insulin resistance. When the body doesn't use insulin well, blood sugar levels go up. Over time, this increases your chance of getting diabetes.
What are the symptoms?
Symptoms tend to be mild at first. You may have only a few symptoms or a lot of them. The most common symptoms are:

• Acne.
• Weight gain and trouble losing weight.
• Extra hair on the face and body. Often women get thicker and darker facial hair and more hair on the chest, belly, and back.
• Thinning hair on the scalp.
• Irregular periods. Often women with PCOS have fewer than nine periods a year. Some women have no periods. Others have very heavy bleeding.
• Fertility problems. Many women who have PCOS have trouble getting pregnant (infertility).
• Depression.

Most women with PCOS grow many small cysts on their ovaries. That is why it is called polycystic ovary syndrome. The cysts are not harmful but lead to hormone imbalances.
What causes PCOS?
The symptoms of PCOS are caused by changes in hormone levels. There may be one or more causes for the hormone level changes.

PCOS seems to run in families, so your chance of having it is higher if other women in your family have PCOS, irregular periods, or diabetes. PCOS can be passed down from either your mother's or father's side.

How is PCOS diagnosed?
To diagnose PCOS, the doctor will:

Ask questions about your past health, symptoms, and menstrual cycles.
Do a physical exam to look for signs of PCOS, such as extra body hair and high blood pressure. The doctor will also check your height and weight to see if you have a healthy body mass index (BMI).
Do a number of lab tests to check your blood sugar, insulin, and other hormone levels. Hormone tests can help rule out thyroid or other gland problems that could cause similar symptoms.
You may also have a pelvic ultrasound to look for cysts on your ovaries. Your doctor may be able to tell you that you have PCOS without an ultrasound, but this test will help him or her rule out other problems.

How is it treated?
Regular exercise, healthy foods, and weight control are key treatments for PCOS. Medicines to balance hormones may also be used. Getting treatment can reduce unpleasant symptoms and help prevent long-term health problems.

The first step in managing PCOS is to get regular exercise and eat heart-healthy foods. This can help lower blood pressure and cholesterol and reduce the risk of diabetes and heart disease. It can also help you lose weight if you need to.

Try to fit in moderate activity and/or vigorous activity on a regular basis. Walking is a great exercise that most people can do.
Eat a heart-healthy diet. In general, this diet has lots of vegetables, fruits, nuts, beans, and whole grains. It also limits foods that are high in saturated fat, such as meats, cheeses, and fried foods. If you have blood sugar problems, try to eat about the same amount of carbohydrate at each meal. A registered dietitian can help you make a meal plan.
Most women who have PCOS can benefit from losing weight. Even losing 10lb may help get your hormones in balance and regulate your menstrual cycle. PCOS can make it hard to lose weight, so work with your doctor to make a plan that can help you succeed.
If you smoke, consider quitting. Women who smoke have higher androgen levels that may contribute to PCOS symptoms.1Smoking also increases the risk for heart disease.
A doctor may also prescribe medicines, such as:

Birth control pills. They can help your periods be regular and can reduce symptoms such as excess facial hair and acne. An androgen-lowering medicine, spironolactone, may be used with birth control pills to help reduce symptoms even more. These medicines are not used if you are trying to get pregnant.
A diabetes medicine called metformin. It can help restore regular menstrual cycles and fertility.
Fertility medicines, if you are trying to get pregnant.
It is important to see your doctor for follow-up to make sure treatment is working and to adjust it if needed. You may also need regular tests to check for diabetes, high blood pressure, and other possible problems.

It may take a while for treatments to help with symptoms such as facial hair or acne. In the meantime:

Over-the-counter or prescription acne medicines may help with skin problems.
Waxing, tweezing, and shaving are easy ways to get rid of unwanted hair. Electrolysis or laser treatments can permanently remove the hair but are more expensive. Your doctor can also prescribe a skin cream that slows hair growth for as long as you use it regularly.
It can be hard to deal with having PCOS. If you are feeling sad or depressed, it may help to talk to a counselor or to other women who have PCOS. Ask your doctor about local support groups, or look for an online group. It can make a big difference to know that you are not alone.

   

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Vaginal Discharge: What’s Abnormal?

Vaginal discharge may not be a popular topic of conversation. But you might like to know that it actually serves an important housekeeping function in the female reproductive system. Fluid made by glands inside the vagina and cervix carries away dead cells and bacteria. This keeps the vagina clean and helps prevent infection.

Most of the time vaginal discharge is perfectly normal. The amount can vary from woman to woman, and the normal color can range from clear to a milky whitish, depending on the time in your menstrual cycle. You may also notice slight changes in the amount and odor of the discharge. For example, there will be more discharge if you are ovulating, breastfeeding, or sexually aroused. The smell may be different if you are pregnant or you haven’t been diligent about your personal hygiene.

None of those changes is cause for alarm. However, if the color, smell, or consistency seems significantly unusual, especially if there is itching or burning in the vagina, you could be noticing a sign of an infection or other condition.

What causes abnormal discharge?

Any change in the balance of normal bacteria in the vagina can affect the smell, color, or texture of the discharge. These are a few of the things that can upset that balance:

• antibiotic or steroid use
• bacterial vaginosis, which is a bacterial infection more common in pregnant women or women who have multiple sexual partners
• birth control pills
• cervical cancer
• chlamydia or gonorrhea, which are sexually transmitted infections
• diabetes
• douches, scented soaps or lotions, bubble bath
• pelvic infection after surgery
• pelvic inflammatory disease (PID)
• trichomoniasis, which is a parasitic infection typically caused by having unprotected sex
• vaginal atrophy, which is thinning and drying out of the vaginal walls during menopause
• vaginitis, which is irritation in or around the vagina
• yeast infections

See the chart below to learn more about what a particular type of discharge might mean.

Types of Abnormal Discharge and Their Possible Causes

Type of Discharge	What It Might Mean	Other Symptoms
Bloody or brown	Irregular menstrual cycles, or less often, cervical or endometrial cancer	Abnormal vaginal bleeding, pelvic pain
Cloudy or yellow	Gonorrhea	Bleeding between periods, urinary incontinence
Frothy, yellow or greenish with a bad smell	Trichomoniasis	Pain and itching while urinating
Pink	Shedding of the uterine lining after childbirth (lochia)
Thick, white, cheesy	Yeast infection	Swelling and pain around the vulva, itching, painful sexual intercourse
White, gray, or yellow with fishy odor	Bacterial vaginosis	Itching or burning, redness and swelling of the vagina or vulva

How does the doctor diagnose abnormal discharge?

The doctor will start by taking a health history and asking about your symptoms. Questions the doctor may ask include:

• When did the abnormal discharge begin?
• What color is the discharge?
• Is there any smell?
• Do you have any itching, pain, or burning in or around the vagina?
• Do you have more than one sexual partner?
• Do you douche?

The doctor may take a sample of the discharge or do a Pap test to collect cells from your cervix for further examination.

How is abnormal discharge treated?

Call your doctor for an appointment if you notice any unusual discharge. How you are treated will depend on the condition that’s causing the problem. For example, yeast infections are usually treated with antifungal medications inserted into the vagina in cream or gel form. Bacterial vaginosis is treated with antibiotic pills or creams. Trichomoniasis is usually treated with the drug metronidazole or tinidazole.

Here are some tips for preventing vaginal infections that can lead to abnormal discharge:

• Keep the vagina clean by washing regularly with a gentle soap and warm water.
• Never use scented soaps or douche. Also avoid feminine sprays and bubble baths.
• After going to the bathroom, always wipe from front to back to prevent bacteria from getting into the vagina and causing an infection.
• Wear 100% cotton underpants, and avoid overly tight clothing.-WebMD

  

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Top Tips for Pregnancy Nutrition

Which vitamins and nutrients are key to your baby's health?

Good nutrition during pregnancy improves your chances of having a healthy baby. It may even reduce the risk of certain chronic conditions in your child, long after he has grown.


Eating for Two During Pregnancy

Whether you waited months for a positive pregnancy test or this pregnancy took you by surprise, you'll probably need to make over your eating habits. Many women begin pregnancy with shortfalls of nutrients central to a healthy pregnancy, including iron, calcium, and brain-building fats.


"Never in a woman's life is nutrition so important as when she's pregnant and nursing," says Elizabeth Somer, MA, RD, author of Nutrition for a Healthy Pregnancy.


Indeed. Research suggests that, along with other healthy habits during pregnancy, eating right influences a child's well-being at birth, and beyond.

"We've discovered that a child isn't only what she eats, but also what you ate during pregnancy, and possibly what your mother ate," says Randy Jirtle, PhD, a researcher in the field of epigenetics. Increasingly, research shows that mom's lifestyle affects her baby's chances for conditions such as obesity, diabetes, and heart disease.


Focus on Folic Acid During Pregnancy


Getting adequate folic acid is one way of helping your child become the healthiest person possible. During the first month of pregnancy, folic acid reduces the risk of neural tube defects, including spina bifida.


Be sure to take a daily multivitamin with 400 micrograms folic acid until you replace it with a prescription prenatal vitamin and mineral supplement. Choose grains fortified with folic acid, including breakfast cereals, breads, rice, and pasta, every day too.


Multivitamins Have Multiple Effects During Pregnancy


Multivitamins do more than supply the necessary folic acid for growing babies, according to a population study conducted at the University of Pittsburgh.

Researchers there found that women in early pregnancy who took a multivitamin or prenatal vitamin regularly reduced their risk of preeclampsia by 45%. Preeclampsia, which causes elevated blood pressure and protein in the urine, is a leading cause of premature delivery and fetal death.

Despite the benefits, you may find swallowing pregnancy supplements difficult. The pills are often large, and they contain high doses of iron that can irritate your stomach and cause constipation.


"If you find yourself having trouble taking prenatal vitamins or you're having unwanted side effects, talk to your doctor about other, safe options," advises Jennifer Shu, MD, pediatrician and co-author of Heading Home with Your Newborn: From Birth to Reality.


And always tell your doctor or midwife about all the dietary supplements you take, including herbal remedies.


Make Calories Count During Pregnancy


During the first few months of pregnancy, you may not notice a big weight gain.


Some women may even lose weight during the first trimester of pregnancy because of queasiness that prevents them from eating and drinking normally. Tell your doctor if you experience persistent vomiting or nausea – you may become dehydrated. So-called morning sickness can last for the entire pregnancy, but it typically starts to dissipate after about 13 weeks.

As your baby begins growing, you'll need to make sure your extra calories are nutritionally rich. Pregnancy is not a license to overeat, however. A pregnant woman only needs an additional 300 calories a day. "Three hundred calories sounds like a lot, but it's about the amount in two large apples," Somer says.


Of course, it's OK to splurge on a hot fudge sundae on indulge pregnancy food cravings from time to time. On a daily basis, here's how to make those 300 additional calories matter most:


16 ounces 1% low fat milk
2 slices bread; 2 ounces chicken; 1 teaspoon reduced fat mayonnaise
8 ounce vanilla non-fat yogurt mixed with 1/2 cup fruit and 1 ounce whole grain crunchy cereal
Weighty Matters During Pregnancy


Gaining the recommended number of pounds limits pregnancy and delivery complications and ensures a healthy infant. Women who start pregnancy at a normal weight can expect to put on between 25 and 35 pounds. For twins, expect to gain between 34 and 45 pounds.


Underweight women may need to gain more, while overweight moms may be advised to put on fewer pounds.


In addition, "Overweight women tend to have heavier babies that are more difficult to deliver," says obstetrician Erin Tracy, MD.

Overweight moms should not diet during pregnancy. Work closely with your health care provider and a registered dietitian to determine a pregnancy eating plan tailored to your needs.


More Nutrients of Note During Pregnancy


Every nutrient that's important to you as a woman is necessary for your baby's growth and development. Yet, certain nutrients stand out as particularly important to your child, especially as pregnancy progresses.


Protein: Protein is the structural material of every cell in your baby's body.


Insufficient protein during pregnancy restricts fetal growth. And it may even affect your child's chances for high blood pressure later in life, according to a study in The New England Journal of Medicine.


Pregnancy protein needs climb 25 grams a day above what was needed before you were pregnant, for a total of about 70 grams -- the amount found in three eight-ounce glasses of milk or about seven ounces of cooked meat, chicken, or seafood.


Iron: You require about 50% more iron when you are pregnant. Iron is important in the formation of hemoglobin, which is the oxygen-carrying protein on red blood cells. In pregnancy your need for iron and hemoglobin goes up, especially in the second and third trimesters.

Iron-deficiency anemia during pregnancy can cause fatigue in mom, and possible problems for baby. "Some studies show severe iron deficiency anemia in mom is linked to low birth weights and iron-deficient infants," says Tracy.


Calcium: The baby needs calcium for development. If you don't consume enough calcium, your body will take it from your bones. This can cause a decrease in bone mass and increase your risk for osteoporosis.


Docosahexaenoic Acid (DHA): DHA is important for brain and eye development. Fish harbors this omega-3 fatty acid, but there's a catch.


Women in their childbearing years, and pregnant and nursing women, should steer clear of shark, swordfish, king mackerel, and tilefish because of methylmercury, a heavy metal that's toxic to a developing baby's neurological system. Safer DHA-rich sources include salmon and fortified eggs. Ask your doctor whether you may need a DHA supplement.
Rethink Your Drink During Pregnancy


Pregnant women require about 10 cups of fluid every day. Although plain water is preferable, milk and juice count toward your fluid quota too.


Beer, wine, and spirits work against a healthy baby, however. Drinking alcohol during pregnancy promotes physical and mental birth defects.


"There is no known safe level for alcohol when you are expecting, so the best thing to do is avoid it," Tracy says. If you're worried about taking a drink before you knew you were expecting, talk with your doctor or midwife about your concerns.


What about caffeine? Its effects on developing babies is a subject of debate. Limit coffee to one or two eight-ounce cups a day to be on the safe side, advises the March of Dimes.


Juice seems like a healthy alternative to soft drinks, and it is. However, juice is laden with calories that can cause unwanted weight gain. Other soft drinks, such as soda, supply about as many calories as juice, and may also contain caffeine.


Your Pregnancy Eating Plan


Prescription prenatal pills may provide what your diet lacks on any given day, but when you're pregnant, healthy eating takes center stage. A balance of nutrients is key, according to Jirtle.


"Just because a little of something is good does not mean a lot is necessarily better," Jirtle says.


Moderately active women who start pregnancy at a healthy weight need about 2,400 calories a day. Here are some ideas of what to include on a daily basis:


Grains: 8 servings, such as 1 slice whole wheat bread, 1 cup whole grain cereal; 1/2 cup cooked pasta or rice. (Choose high fiber whole grains often to reduce pregnancy constipation.)

Vegetables: 4 or more servings, such as 2 medium whole raw carrots; 1 cup dark leafy greens; 1 cup cooked broccoli or cauliflower.


Fruits: 2 to 4 servings, such as 1 small apple, orange, pear, or banana or 1 cup berries.

Dairy: 3 servings, such as 8 ounces milk or yogurt or 1 1/2 ounces hard cheese.


Meat, poultry, fish, eggs, nuts, and beans: 2-3 servings, such as 2-3 ounces cooked meat, poultry, or seafood.


Fats, oils and sweets: sparingly.


Click here and here to download free ebooks on pregnancy nutrition.


or buy from Amazon:

-WebMD

Abotion: Frequently asked questions

What is an abortion?

Abortion is the early ending of a pregnancy.

Sometimes abortion happens on its own. This is called miscarriage or spontaneous abortion. But women can also choose to end a pregnancy by getting surgery or taking medicine.

When should you see a doctor?

If you think you might be pregnant, see a doctor as soon as possible. If you are pregnant, this is an important time to learn as much as you can about your options. If you are thinking about having an abortion, it’s best not to wait. The earlier you are in your pregnancy, the more options you are likely to have. Also, the risk of problems will be lower.

Your doctor will ask about your medical history and will do a physical exam. You will have lab tests to make sure that you are pregnant. You may also have an ultrasound.

Whether you are an adult or a teen, the law protects your privacy. Your exam and test results are your private information. Your doctor or clinic won't share them unless you give your permission.

How will you know what decision is right for you?

Deciding to continue your pregnancy or end it is very personal. Counseling may help you to decide what is best for you. If you're comfortable, you can start by talking with your doctor. Family planning clinics also offer counseling to help you decide what is best for you. You may also want to talk with someone close to you who understands how pregnancy and raising a child would affect your life. Carefully think through your choices, which are to:

• Have a baby, and support and raise your child to adulthood.
• Have a baby, and place the baby for adoption.
• Have an abortion.

When can an abortion be done?

It will depend on how many weeks pregnant you are. You may have a choice between a medical abortion (which means taking medicine to end the pregnancy) and a surgical abortion such as vacuum aspiration, or dilation and evacuation (D&E).

After 9 weeks, surgical abortion is the only option. The risks from having an abortion in the second trimester are higher than in the first trimester.

Abortion choices

When	Medical abortion	Surgical abortion
First trimester (around 5 to 12 weeks)	Mifepristone withmisoprostol Methotrexate with misoprostol (Experts do not recommend medical abortion after 9 weeks.)	Manual vacuum aspiration, as early as 5 weeks after the last menstrual period (uses a tube attached to a handheld syringe that draws tissue out of the uterus) Machine vacuum aspiration (uses a tube attached to an electric pump that draws all tissue out of the uterus)
Second trimester(13 to 24 weeks)	None	Dilation and evacuation (D&E), a combination of vacuum aspiration, forceps, and dilation and curettage(D&C) Induction, possibly with D&E, seldom used

Abortions done early in the pregnancy can be done by your doctor or gynecologist. Some nurse-midwives, nurse practitioners, and physician assistants may also be trained to do some types of abortions. Abortion services are most likely to be offered at university hospitals and family planning clinics.

Some states have legal restrictions on abortion. Talk to your closest Planned Parenthood or other family planning clinic to learn more about restrictions in your state.

In some states, women younger than 18 will need a parent’s permission. A minor can get a court order that will allow an abortion without a parent’s consent.

Abortions are rarely done after 24 weeks of pregnancy (during the late second trimester and entire third trimester). Many states in the U.S. have restrictions on abortions after 24 weeks.

How safe is abortion?

Abortions done by doctors are very safe. Less than 1 in 100 women have a serious problem from an abortion.

The safest timing for an abortion is usually during the first trimester.¹ This is when a low-risk medicine or vacuum aspiration procedure can be used. Medicine is not recommended after 9 weeks.

After 9 weeks, only surgical abortion can be used. Problems from surgical abortion in the second trimester include heavy blood loss, infection, and moderate to severe pain.

The most widely used methods for abortion do not prevent a woman from becoming pregnant later.

Keep in mind that you can get pregnant in the weeks right after an abortion. This is a good time to start using birth control that works well and fits your lifestyle.

It will probably take you 1 to 3 weeks to heal and feel better after an abortion. You should not have sex during this time. But when you do have sex again, be sure to use a condom for several weeks or for as long as your doctor tells you to. This will help to prevent infection.

Source: WebMD

Bleeding During Pregnancy

Cause for concern:

Bleeding during pregnancy is common, especially during the first trimester, and usually it's no cause for alarm. But because bleeding can sometimes be a sign of something serious, it's important to know the possible causes, and get checked out by your doctor to make sure you and your baby are healthy.

Bleeding in the First Trimester

About 20% of women have some bleeding during the first 12 weeks of pregnancy. Possible causes of first trimester bleeding include:

Implantation bleeding. You may experience some normal spotting within the first six to 12 days after you conceive as the fertilized egg implants itself in the lining of the uterus. Some women don't realize they are pregnant because they mistake this bleeding for a light period. Usually the bleeding is very light and lasts from a few hours to a few days.

Miscarriage. Because miscarriage is most common during the first 12 weeks of pregnancy, it tends to be one of the biggest concerns with first trimester bleeding. About half of women who bleed in pregnancy eventually miscarry, but that doesn't necessarily mean that if you're bleeding you've lost the baby, especially if you don't have any other symptoms.

Other symptoms of miscarriage are strong cramps in the lower abdomen and tissue passing through the vagina.

Ectopic pregnancy. In an ectopic pregnancy, the fertilized embryo implants outside of the uterus, usually in the fallopian tube. If the embryo keeps growing, it can cause the fallopian tube to burst, which can be life-threatening to the mother. Although ectopic pregnancy is potentially dangerous, it only occurs in about 2% of pregnancies.

Other symptoms of ectopic pregnancy are strong cramps or pain in the lower abdomen, and lightheadedness.

Molar pregnancy (also called gestational trophoblastic disease). This is a very rare condition in which abnormal tissue grows inside the uterus instead of a baby. In rare cases, the tissue is cancerous and can spread to other parts of the body.

Other symptoms of molar pregnancy are severe nausea and vomiting, and rapid enlargement of the uterus.

Additional causes of bleeding in early pregnancy include:

• Cervical changes. During pregnancy, extra blood flows to the cervix. Intercourse or a Pap test, which cause contact with the cervix, can trigger bleeding. This type of bleeding isn't cause for concern. 
• Infection. Any infection of the cervix, vagina, or a sexually transmitted infection (such as chlamydia, gonorrhea, or herpes) can cause bleeding in the first trimester.

Bleeding in the Second and Third Trimesters

Abnormal bleeding in late pregnancy may be more serious, because it can signal a problem with the mother or baby. Call your doctor as soon as possible if you experience any bleeding in your second or third trimester.

Possible causes of bleeding in late pregnancy include:

Placenta previa. This condition occurs when the placenta sits low in the uterus and partially or completely covers the opening of the birth canal. Although placenta previa is very rare, occurring in only one in 200 pregnancies, it is an emergency requiring immediate medical attention.

Bleeding from placenta previa can often occur without any pain.

Placental abruption. In about 1% of pregnancies, the placenta detaches from the wall of the uterus before or during labor and blood pools between the placenta and uterus. Placental abruption can be very dangerous to both the mother and baby.

Other symptoms of placental abruption are abdominal pain, clots from the vagina, tender uterus, and back pain.

Uterine rupture. In rare cases, a scar from a previous C-section can tear open during pregnancy. Uterine rupture can be life-threatening, and requires an emergency C-section.

Other symptoms of uterine rupture are pain and tenderness in the abdomen.

Vasa previa. In this very rare condition, the developing baby's blood vessels in the umbilical cord or placenta cross the opening to the birth canal. Vasa previa can be very dangerous to the baby because the blood vessels can tear open, causing the baby to bleed severely and lose oxygen.

Other symptoms of vasa previa include abnormal fetal heart rate and excessive bleeding.

Premature labor. Vaginal bleeding late in pregnancy may just be a sign that your body is getting ready to deliver. A few days or weeks before labor begins, the mucus plug that covers the opening of the uterus will pass out of the vagina, and it will usually have small amounts of blood in it (this is known as "bloody show"). If bleeding and symptoms of labor begin before the 37th week of pregnancy, contact your doctor right away because you might be in preterm labor.

Other symptoms of preterm labor include contractions, vaginal discharge, abdominal pressure, and ache in the lower back.

Additional causes of bleeding in late pregnancy are:

• Injury to the cervix or vagina
• Polyps
• Cancer

What to Do If You Have Abnormal Bleeding During Pregnancy

Because vaginal bleeding in any trimester can be a sign of a problem, call your doctor. Wear a pad so that you can keep track of how much you're bleeding, and record the type of blood (for example, pink, brown, or red; smooth or full of clots). Bring any tissue that passes through the vagina to your doctor for testing. Don't use a tampon or have sex while you are still bleeding.

Go to the emergency room or call 911 right away if you are experiencing any of the following symptoms, which could be signs of a miscarriage or other serious problem:

• Severe pain or intense cramps low in the abdomen
• Severe bleeding, whether or not there is pain
• Discharge from the vagina that contains tissue
• Dizziness or fainting
• A fever of more than 100.5 degrees Fahrenheit and/or chills