On the basis of these data, in women with coronary disease, the estimated number needed to screen for factor V Leiden to avoid an HRT-associated VTE during 5 years of treatment is 376. This article does not provide medical advice. However, the mother that has Factor V deficiency or Owrens disease can pass it on her child if the father of her child also has this disease. If you have the heterozygous form of factor V Leiden, the lifetime risk of developing a DVT is 10% or less, but may be higher if you have close family members who have had a DVT. As the national patient advocate for the Coalition to Prevent DVT, Melanie helped to lead awareness efforts in March 2005 which culminated in a national media campaign that Posted May 16, 2017 by Rachael 1000. before prescribing estrogen contraception, hormone replacement therapy (HRT), or selective estrogen receptor modulators (SERMs). However, since anesthesiologists will be introduced to the fact that you have this condition, they will order donated blood for you in case start losing blood severely. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. The biggest risk factor of getting Factor V deficiency or Owrens disease is the genetic factor. A pediatric nurse is treating a 2-day-old infant for jaundice. Since receiving that call, Melanie has become more aware of deep-vein thrombosis (DVT) and pulmonary embolism (PE). ClotCare is a 501(c)(3) non-profit organization generously supported by your tax-deductible donations and grants from our industry supporters. Products & Services Book: Mayo Clinic Family Health Book, 5th Edition Show more products from Mayo Clinic Symptoms The nurse is reviewing modifiable risk factors with the patient to avoid the redevelopment of thromboembolic complications, possibly leading to a second MI. People with factor V Leiden thrombophilia have a higher than average risk of developing a type of blood clot called a deep venous thrombosis (DVT). -Hepatitis His health record reveals that he has been treated for complications of chronic alcoholism for the past 10 years. http://www.clotcare.com/clotcare/canceranddvt.aspx, FAQs About Warfarin (brand name Coumadin) No foods can change your genetics, but having the right type of diet may prevent your condition from getting worse. ClotCare has numerous resources to help you learn about deep vein thrombosis and pulmonary embolism. Most people with factor V Leiden never develop abnormal clots. . WebFactor V Leiden is a genetic blood clotting disorder that increases the risk for recurrent miscarriage and pregnancy complications. Homozygous factor V Leiden increases the risk of developing clots to a greater degree, about 25- to 50-fold. This is a disorder that can cause a condition known as thrombophilia. Having three or more risk factors for DVT may put someone at risk and could lead to a potentially fatal PE. It is estimated that the risk of VTE increases 3 to 5 times in individuals using second-generation COCs and up to 6 to 8 times in those using third-generation COCs.1 The presence of an associated risk factor (eg, thrombophilia) increases this risk.2, Until 1995, the risk of VTE associated with contraception use was exclusively attributed to ethinyl estradiol; therefore, the dose of estrogen was lowered from 100 mcg to 35 to 50 mcg in the newer-generation pills. 3. The overall prognosis for Factor V deficiency or Owrens disease is good if treatment for that disease is incorporated in time. Unlike Factor V Deficiency Disorder, Factor V Leiden can only be inherited, not acquired. This people only have to eat foods that build blood and to avoid accidents, in which they could lose a lot of blood. Talk with your doctor about whether other people in your family should be tested for the faulty gene. Avoidance of alcoholic beverages during long flights. This mutation can increase your chance of developing abnormal blood clots, most commonly in your legs or lungs. -Frequent assessment for signs of thrombosis or hemorrhage. WebThe abnormal Factor V Leiden gene is passed on from our parents. We follow a strict editorial policy and we have a zero-tolerance policy regarding any level of plagiarism. Having 2 Factor V Leiden genes (homozygous type) makes the risk much greater. Discussion. Having recurring DVT or PE. The disorder is most common in people who are white and of European descent. But in people who do, these abnormal clots can lead to long-term About 1 of every 250 Black people in America has the prothrombin gene mutation. Factor V Leiden is an abnormal form of Factor V, it works perfectly in the clotting pathway and speeds up clotting as expected, but it cannot be turned off easily. Regular noncontact exercise, such as walking or swimming, is still recommended for WebSometimes people with the Factor V Leiden mutation may need to go on blood thinning medication to reduce the risk of developing blood clots. The client comes to the emergency department with sudden onset of dizziness. Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. How does heparin work? -Passive range of motion exercises to the nonsurgical joints to prevent hemorrhage. Factor V that becomes impaired can cause numerous issues with the health of the human blood. If your hematologist suspects that you might have this disorder, he/she will order you to have a few tests. Once a person is diagnosed with severe Factor V deficiency or Owrens disease, it must start with a treatment immediately. Third generation oral contraceptives and risk of venous thrombosis: meta-analysis. The physician explains to her that her past medical includes an inherited defect in factor V Leiden, which predisposes her to the development of which of the following? Regular noncontact exercise, such as walking or swimming, is still recommended for The clotting action of Factor V is controlled by another protein called Activated Protein C. To stop blood from forming clots, Activated Protein C easily turns off Factor V. Activated Protein C does not work as well on the abnormal Factor V Leiden protein. The factor V Leiden mutation was found in 17% of venous thromboembolism cases and 6% of controls yielding an odds ratio of 3.3. One of the rarest hematological diseases this article will be devoted to is Factor V deficiency or Owrens Disease. It is a medical condition that is known to cause small blood clots and also excessive bleeding, which happens due to overly active arthropods? Word: FACTOR V LEIDEN is engraved on the front just right of the medical emblem. A nuclide has a half-life of 1.911.911.91 years. Within this cascade, many factors are present and integral to the process, and they are referred to as factor plus a Roman numeral (e.g., factor V and factor VIII). It is advised to avoid supplements with Vitamin K as well as alcohol while taking blood thinner medication like Warfarin. The possible need to wear compression stockings during long flights and road trips. Avoid constant electronic fetal monitoring. -Cardiovascular disease However, your doctor might suggest that you take extra precautions to prevent blood clots if you have the factor V Leiden mutation and are going to have surgery. Which characteristic(s) account(s) for the success of WebFactor V is one of the proteins needed to make blood form clots. Will the pain in my leg ever go away? Most people with factor V Leiden never develop abnormal clots. 2018;43 (5) (Specialty&Oncology suppl):12-15. Therefore people with Factor V Leiden have an increased risk of developing blood clots. Also, Factor V Deficiency makes a person who suffers from it would barely be able to get the blood clotted. d. respiration adapted to environment This FAQ explains post-thrombotic syndrome, which is sometimes referred to as chronic venous insufficiency (CVI) or as post-phlebitic syndrome. Deep vein thrombosis is a potential complication for cancer patients. -assess the child for signs and symptoms of hemophilia A. Inheriting two copies one from each parent significantly increases your risk of developing blood clots. The posting has information on who is likely to get a DVT, the signs and symptoms of a DVT or PE, how a DVT is diagnosed, how a DVT or PE is treated, and how a DVT or PE can be prevented. nutritional supplements, and natural therapies will not alter ones genetic make-up. Here, we have compiled a list of the top 10 factor v leiden supplement to avoid to help you find the right products. Have a midwife provide care in labor and birth. What websites do you recommend? WebThe abnormal Factor V Leiden gene is passed on from our parents. If you have been diagnosed with Factor V Leiden, you should alter your diet to prevent excessive blood clotting. Factor V, coded for by the F5 gene, is a coagulation protein mainly synthesized in the liver. All rights reserved. WebSometimes people with the Factor V Leiden mutation may need to go on blood thinning medication to reduce the risk of developing blood clots. Which of the following medications does the nurse anticipate administering to treat this disorder? -Hematopoiesis WebFactor V is one of the proteins needed to make blood form clots. Other risks Having Factor V Leiden does not appear to increase the chances of developing a heart attack or stroke. About 1 of every 250 Black people in America has the prothrombin gene mutation. Current management strategies involve the use of pharmacotherapy, when indicated, in the event of deep venous thrombosis or It is a medical condition that is known to cause small blood clots and also excessive bleeding, which happens due to overly active The symptoms of Factor V deficiency or Owrens disease are usually very mild. WebMedicines help treat and prevent blood clots in people who are high risk for them. Factor V Leiden is the most common one. This hematological illness resembles Hemophilia. WebWhat should you avoid with factor V Leiden? A nurse working in an ambulatory care unit is working with a patient who has recently been diagnosed with a V Leiden mutation. Not only should the risk of the particular contraception method be evaluated, but also the individuals risk of VTE. WebHaving 1 Factor V Leiden gene (heterozygous type) slightly increases the chance of developing a blood clot. Population that has Factor V Leiden is at a very high risk of developing giant and abnormal blood clots that can lead to stroke or heart attack. This article may contains scientific references. ", - "I must stop breast-feeding my baby because of the anemia. You should know the warning signs of a problematic blood clot so you can identify it and get help. What is the drug of choice for absence seizure? They said that David's death was due to 'pulmonary embolism', a complication of 'deep-vein thrombosis'. "When I received the call the night David passed away (April 5, 2003), I was clearly in a deep state of shock. This type of medicine usually isn't needed for people who have the factor V Leiden mutation but who have not experienced abnormal blood clots. Although most patients are willing to accept some level of risk with contraception in return for the benefit of avoiding unplanned pregnancy, it is important to consider VTE risk when initiating contraception. Which of the following supplements will the provider recommend to the client? Having venous thrombosis in unusual sites in the body such as the brain or the liver. Regular physical activity and avoidance of staying in a single position for a long period of time can reduce the risk of abnormal clots. COCs, combined injectable contraceptives, and combined patch/vaginal ring contraceptives should all be avoided in those with a history of DVT/PE, acute DVT/PE, DVT/PE while receiving established anticoagulant therapy, major surgery with prolonged immobilization, or known thrombophilia (eg, factor V Leiden; prothrombin mutation; protein S, protein C, antithrombin deficiencies). A family history of factor V Leiden increases your risk of inheriting the disorder. Signs and symptoms may include: Seek medical attention immediately if you have signs or symptoms of either a DVT or a pulmonary embolism. Your doctor may suspect factor V Leiden if you've had one or more episodes of abnormal blood clotting or if you have a strong family history of abnormal blood clots. Having recurring DVT or PE. "He was only 39, an avid tennis player and in great health. Dr. Resseguie is an advanced practice anticoagulation pharmacist for the Brigham & Womens Hospital Anticoagulation Management Service in Boston, Massachusetts. ; Disseminated intravascular coagulation (DIC) also causes Factor V deficiency or Owrens disease. David had four. The nurse should suspect what cause of his clotting disorder? -Agglutination, A client with an apparent clotting disorder is admitted to hospital. Having recurring DVT or PE. http://www.clotcare.com/clotcare/postings.aspx?by=condition&conditionid=6&word=Blood%20Clots, http://www.clotcare.com/clotcare/dvt.aspx, http://www.clotcare.com/clotcare/canceranddvt.aspx, FAQs About Warfarin (brand name Coumadin), http://www.clotcare.com/clotcare/aboutwarfarin.aspx, http://www.clotcare.com/clotcare/ptinr.aspx, http://www.clotcare.com/clotcare/faq_ddimertest.aspx. Will the blood clot in my leg go away now that I am on medication for it? There are also symptoms of severe Factor V deficiency or Owrens disease that include: A pregnant mother that suffers from Factor V deficiency or Owrens disease usually does not have any problems during pregnancy. A few nights before David passed away, Melanie had a seemingly innocuous phone conversation with David. -Corticosteroids Your doctor can confirm that you have factor V Leiden with a blood test. For what complications of hemophilia should the nurse prioritize assessing? Which of the following increases this risk? Posted May 16, 2017 by Rachael 1000. On Thursday evening, April 3, Melanie said her husband called and told her he was sleeping outside on the fender of the tank under the star-lit sky of the Iraqi desert. WebFactor V Leiden testing is not routinely recommended in the following situations: for the general population. This mutation can increase your chance of developing abnormal blood clots, most commonly in your legs or lungs. Select all that apply. http://www.clotcare.com/clotcare/faq_dvtgoaway.aspx. Some people have a genetic mutation of the protein which is called factor V Leiden. The clinician should: Melanie Bloom currently lives in New York with her and David's three children - a five-year old daughter and eleven-year old twin girls. Deep vein thrombosis in a woman taking oral combined contraceptive pills. -The light bleaches the bilirubin, causing it to naturally break down. If we had known more about DVT and PE, then we may have been able to prevent it and ultimately, save his life.". There are numerous diseases that only affect the human blood. This posting explains the PT-INR test, which is the test used to measure how well warfarin is working. How we tested products. Copyright 2000-2018 by ClotCare. The practitioner is examining a client and notes that he has small, punctate skin hemorrhages on his abdomen and chest. This is known as deep vein thrombosis (DVT), which most commonly occurs in the legs. -Von Willebrand disease Activated protein C (APC) resistance represents the most common cause of inherited venous thrombosis.2 FVL, in turn, is the most common cause of APC resistance, accounting for 95% of such disorders.3 It is an autosomal dominant genetic disorder characterized by a mutation at one of the factor V cleavage sites, making it Introduction: Factor V Leiden mutation and prothrombin G20210A mutation are the most common causes of an inherited thrombophilia and together account for 50 to 60 percent of diagnoses. -Vitamin K Since vitamin K1 is so abundant in leafy green vegetables, most people dont need to worry about becoming deficient or taking a supplement. Learn more at: 4. Most people with factor V Leiden never develop abnormal clots. Click here to see Melanie Bloom on NBC's Today Show, March 7, 2006. WebFactor V Leiden is the name of a specific gene mutation that results in thrombophilia, which is an increased tendency to form abnormal blood clots that can block blood vessels. Manage Settings The clotting action of Factor V is controlled by another protein called Activated Protein C. To stop blood from forming clots, Activated Protein C easily turns off Factor V. Activated Protein C does not work as well on the abnormal Factor V Leiden protein. WebYour treatment may include a medicine (called a blood thinner) that prevents blood clots. This means that both of childs parents need to have Factor V deficiency or Owrens disease to pass it onto their child and the future offspring. You can learn more about the Coalition to Prevent Deep-Vein Thrombosis, of which ClotCare is a member, and the 2006 DVT Awareness Month at http://www.clotcare.com/clotcare/deepveinthrombosisawareness06.aspx. The oral contraceptive pill has been named by the Centers for Disease Control and Prevention as one of the top 10 health advances in the past century. Overview. World Health Organization. Here's some information to help you prepare for your appointment. WebHere you can see if there is any natural remedy and/or treatment that can help people with Factor V Leiden. -Frequent assessment for signs of thrombosis or hemorrhage. -"I need to decrease my baby's intake of whole milk to provide the best nutrition. Click here to read a transcript of Melanie's interview with Larry King on CNN's Larry King Live show, March 8, 2006. Figuring out the best products is an extremely difficult task for buyers, and it gets even more difficult when the product is technology related. -Diabetes If you have the factor V Leiden mutation, you are at greater risk of developing blood clots. Avoid early induction. We didn't think for one moment there was a reason to be concerned. Failure of clot retraction is indicative of what? People with leg pain said that hearing about David's death in the news prompted them to talk to a doctor. -Arthritis They estimate that the number of women with coronary disease needed to screen to prevent one episode of venous thromboembolism is 374. This posting answers some of the most common questions asked by patients on warfarin (brand name Coumadin). This inspired her to think of ways in which she could give back to others and help to educate them about DVT and PE, perhaps preventing another family from suffering the same tragedy. Since vitamin K1 is so abundant in leafy green vegetables, most people dont need to worry about becoming deficient or taking a supplement. This will depend on lots of other factors including a past medical history of clots or a family history of blood clots. ABSTRACT: Factor V Leiden thrombophilia is a genetic disorder that may increase a patients risk of developing a venous thromboembolism (VTE). Having venous thrombosis in unusual sites in the body such as the brain or the liver. The Medical Id Plate 1-5/8" x 7/8" is made from non-allergic, rust free stainless steel, polished to a mirror finish and curved for wrist wear. Melanie will continue these efforts throughout 2006. "My hope is that in telling David's and my story I can help raise public awareness and support health education measures surrounding this silent, insidious killer that took my husbands life - and that also affects two million Americans and takes hundreds of thousands of lives each year.". Vitamin K1 deficiency causes symptoms associated with lack of blood clotting, like easy bruising, bloody nose, excessive bleeding, and heavy periods. Good Foods. WebFactor V Leiden is the most common inherited condition causing increased blood clotting. -Elevated congugated bilirubin ", A nurse is treating a client with aplastic anemia. It is estimated that the risk of VTE increases 3 to 5 times in individuals using second-generation COCs and up to 6 to 8 times in those using third-generation COCs. We comply with the HONcode standard for trustworthy health information. before prescribing estrogen contraception, hormone replacement therapy (HRT), or selective estrogen receptor modulators (SERMs). Having a DVT or PE during or right after pregnancy. WebHere you can see if there is any natural remedy and/or treatment that can help people with Factor V Leiden. However, it is now thought that the type of progestin may also influence the risk of VTE. Regular noncontact exercise, such as walking or swimming, is still recommended for After enduring days and nights working, eating and sleeping in cramped conditions inside the army vehicles, he needed to get out and stretch - even if that meant being outside, unprotected, while only miles from the Baghdad border. The levels of Factor V can drop to only 20% percent in the blood and still do not cause any serious problems with the clotting of blood. No special lifestyle changes have to be made by people who suffer from Factor V deficiency or Owrens disease. However, there are certain lifestyle changes one can make to reduce the risk of abnormal clot formation. Long periods of sitting. Factor V, coded for by the F5 gene, is a coagulation protein mainly synthesized in the liver. This protein helps in the conversion of prothrombin into thrombin. Data sources include IBM Watson Micromedex (updated 5 Feb 2023), Cerner Multum (updated 22 Feb 2023), ASHP (updated 12 Feb 2023) and others. - "I must stop breast-feeding my baby because of the anemia." Learn more at: They're called clotting factors. It is advised to avoid supplements with Vitamin K as well as alcohol while taking blood thinner medication like Warfarin. Obstetrics & Gynecology, http://www.clotcare.com/clotcare/faq_graduatedcompressionstockings.aspx. Medically reviewed by Drugs.com. Available for Android and iOS devices. We and our partners use cookies to Store and/or access information on a device. nutritional supplements, and natural therapies will not alter ones genetic make-up. Most people with factor V Leiden never develop abnormal clots. Figuring out the best products is an extremely difficult task for buyers, and it gets even more difficult when the product is technology related. The client is at risk for: Posted May 16, 2017 by Rachael 1000. Other factors that increase a patients risk of VTE include advancing age, cancer, prior VTE, venous insufficiency, pregnancy, trauma, frailty, immobility, and thrombophilia.6, World Health Organization Recommendations. WebFactor V Leiden testing is not routinely recommended in the following situations: for the general population. -Administration of a platelet transfusion, if deemed necessary. Factor V deficiency or Owrens disease was described by a well-known and appreciated medical doctor Paul Owren. Factor V Leiden is also called Factor V Leiden Thrombophillia. But in people who do, these abnormal clots can lead to long-term This extremely rare hematological disorder either results in prolonged or slow clotting of the blood after an injury or surgical procedure. What root cause likely underlies the client's increased risk for hemorrhage? Several cancers can also induce the development of Factor V deficiency or Owrens disease. What does the light do to the bilirubin? -Thrombosis, -Hepatitis Those diseases that only affect the most important liquid in the human beings which is blood, are called hematological diseases. No foods can change your genetics, but having the right type of diet may prevent your condition from getting worse. -Bleeding Vitamin K1 deficiency causes symptoms associated with lack of blood clotting, like easy bruising, bloody nose, excessive bleeding, and heavy periods. What are graduated compression stockings, where do I get them, and how do I put them on? WebFactor V Leiden (FVLeiden ) is a common hereditary thrombophilia that causes activated protein C (APC) resistance. Factor V Leiden should not be confused with factor V deficiency. Factor V, coded for by the F5 gene, is a coagulation protein mainly synthesized in the liver. Web-Factor V gene mutation A 40-year-old patient has been admitted to the cardiac intensive care unit after having an anterior wall myocardial infarction (MI). The best way to cope with this disease is to talk about it with family and friends. That very day, David and the troops were going to face the most dangerous mission thus far by making the push across the Baghdad border. This disease is either inherited from both of the parents in an autosomal recessive fashion or acquired by a person after its birth. One Factor V Leiden gene and one normal gene (heterozygote) Two Factor V Leiden genes (homozygote) Approximately 1 in 25 people will inherit one factor V Leiden gene and fewer than 1 in 1000 people will inherit 2. WebSymptoms of Factor V Leiden include: Having a first DVT (deep vein thrombosis) or PE (pulmonary embolism) before 50 years of age. WebAll surgery and hospitalization increases the risk of clotting, but the risk for someone with FVL is substantially greater than for the general population. Homozygous factor V Leiden increases the risk of developing clots to a greater degree, about 25- to 50-fold. Terms of use. Just eat your veggies! Genetic Disorders : List of Different types of Genetic Disorders, What is Acid Lipase Disease or Lysosomal Acid Lipase Deficiency: Types, Causes, Symptoms, Treatment, What is Beckers Myotonia, Know its Causes, Symptoms, Treatment, Pathophysiology, Complications, Risk Factors, Dietary Dos and Donts for Migraine Sufferers, Shirshasana (Headstand) Versus Inversion Therapy Using Inversion Table, Understanding Joint Pain and Tips to Get Relief Using Home Remedies, Erectile Dysfunction: Does Opioid Cause ED, Libido: Opioid Induced Female Sexual Dysfunction. Web-Factor V gene mutation A 40-year-old patient has been admitted to the cardiac intensive care unit after having an anterior wall myocardial infarction (MI). . Drinking too much alcohol, or -Caffeine intake -"Have you been taking aspirin or any nonsteroidal anti-inflammatory drugs (NSAIDs)?". For factor V Leiden, some basic questions to ask your doctor include: If your doctor recommends genetic testing, some questions you might want to ask the genetic specialist include: 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). Kemmeren JM, Algra A, Grobbee DE. Clots can form in the veins near your bones that carry a lot of blood (deep veins), a condition called deep vein thrombosis. Introduction: The incidence of factor V Leiden is documented to be around 5% in Caucasian population and is a known risk factor for venous thromboembolism (VTE). The two most common hematological diseases the impairment of Factor V causes are Factor V deficiency or Owrens disease, and Factor V Leiden. WebFactor V (factor 5) is one of several special proteins in your blood that help it clot. It accelerates the process by which prothrombin becomes converted to thrombin, which is an essential and initial step in the formation of blood clots. These conditions include multiple risk factors for cardiovascular disease, hypertension, history of high blood pressure during pregnancy, superficial venous thrombosis, ischemic heart disease, stroke, hyperlipidemia, and valvular heart disease. 1 The presence of an associated risk factor (eg, Due to the replacement of normal bone marrow with malignant cells, the nurse teaches the client to prevent scratches, scrapes, and cuts. -Hypercholesteremia The factor V Leiden mutation was found in 17% of venous thromboembolism cases and 6% of controls yielding an odds ratio of 3.3. Patients with other cardiovascular conditions also require special attention when selecting contraception. How we tested products. The nurse tells the patient the importance of smoking cessation to avoid which of the following? -Promotes the inactivation of factor VIII, -Promotes the inactivation of clotting factors, The process of clot retraction squeezes serum from the clot, thereby joining the edges of the broken vessel. Clots can form in the veins near your bones that carry a lot of blood (deep veins), a condition called deep vein thrombosis. If you would like to change your settings or withdraw consent at any time, the link to do so is in our privacy policy accessible from our home page.. 4. Long-haul flights also increase the risk, and David had recently been traveling back and forth on assignment. http://www.clotcare.com/clotcare/ptinr.aspx, What is the d-Dimer Test? 1 The presence of an associated risk factor (eg, Piparva KG, Buch JG. There are also organizations present all around the world such as American National Hemophilia Foundation where you can hang out with other people who suffer from Factor V deficiency or Owrens disease and share your experiences with the illness. Can the results of the test affect my ability to obtain health insurance? All rights reserved. As the national patient advocate for the Coalition to Prevent DVT, Melanie helped to lead awareness efforts in March 2005 which culminated in a national media campaign that reached millions of Americans across the country, and a Senate resolution sponsored by Senator Arlen Specter (R-PA) and Senator Byron Dorgan (D-ND) officially declaring DVT Awareness Month. Medical conditions that might be a ground for the development of acquired Factor V deficiency or Owrens disease are the following: People who were treated with certain types of fibrin glue can also get this disorder. http://www.clotcare.com/clotcare/aboutwarfarin.aspx, Understanding the PT-INR Test Links to some featured postings and frequently asked questions (FAQs) are below. The nurse determines further teaching is necessary when the mother states: Since her husband's passing, Melanie has received over 80,000 letters and emails of support, including those from people who said his story saved their life. To view the purposes they believe they have legitimate interest for, or to object to this data processing use the vendor list link below.

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