- ADMISSIONS & AID
- HEALTH, SAFETY & WELL-BEING
- MEDIA CENTER
COVID-19 Risk Management Protocols
SIT has a team of trained duty officers available 24 hours a day to respond to potential threats to student safety and manage emergency situations.
SIT has implemented the following health and safety protocols with the goal of reducing COVID-19 infection and the spread of the virus from one location to another. To achieve this goal, SIT adheres to host country entry regulations and the U.S. Centers for Disease Control (CDC) regulations. If host country entry regulations are more relaxed than CDC regulations, SIT defers to CDC regulations.
Responding to the dynamic risk horizon caused by COVID-19, and out of an abundance of caution, SIT continues to evaluate and amend many program elements to mitigate risk. These include:
Homestays have always been an integral part the SIT experience. However, due to the elevated health risk posed by COVID-19, they were suspended in most SIT locations during the pandemic. We are optimistic that homestays will resume in more areas as vaccination rates continue to increase globally. Homestays are permitted with the following conditions:
- Key COVID-19 indicators are not at elevated levels (e.g. case numbers, vaccination rate, hospitalizations, and hospital capacity)
- Students participating in homestays are fully vaccinated.
- To the extent possible, students will only be placed only in homestays where all eligible family members, as defined by host country law, are fully vaccinated. (Please note that homestay families may have children that are not eligible yet for vaccination.)
In countries where vaccines are not yet readily available but COVID-19 risk is low (based on key COVID-19 indicators being tracked), homestays with unvaccinated family members may be permitted.
Students will be informed about the vaccination status of their homestay family prior to placement. In certain countries where SIT operates, there may be legal limitations to our ability to verify vaccination status.) If there are any unvaccinated family members who are eligible for the vaccine, or if we are not able to formally verify vaccination status, to the extent possible, students will be given the option of alternative accommodation if they are uncomfortable with the arrangement.
- Homestay families will provide students with single rooms.
To the extent possible, in places where these conditions cannot be met or in locations where risk has increased after students have entered the homestay and the homestay is considered unsafe, SIT will utilize alternative accommodation such as hotels, guesthouses, apartments or other viable and safe options available in the program country.
2. International Excursions
SIT defines “international excursion” as a student educational trip planned and led by SIT outside of the program host country.
Due to the elevated health risk posed by COVID-19, international excursions were suspended in most SIT locations during the pandemic. However, as vaccination rates continue to increase globally, more countries are opening borders and easing entry requirements for international travelers.
SIT will resume international excursion opportunities under the following conditions:
- Key COVID-19 indicators in the excursion country are not at elevated levels (e.g. case numbers, vaccination rate, hospitalizations, and hospital capacity).
- There are no prohibitive entry requirements for the excursion location (e.g. borders are open, testing is readily available, and there is not a long quarantine requirement).
- There are no prohibitive movement restrictions in place within the host country (e.g. limited mobility allowed that would prevent program activities from occurring).
- Following the excursion, students will be required to obtain a viral PCR test 3-5 days after returning to the program host country (unless students have been tested within a day of departure from the international excursion country.) SIT will arrange and pay for this test.
In places where these conditions cannot be met, SIT will replace the international excursion with in-country excursions that have similar learning outcomes.
3. Independent Travel
SIT defines “independent travel” as travel within the host country* that: a) occurs during the program’s defined enrollment period; b) is independently organized by a student; c) is unrelated to program activities; d) does not interfere with scheduled program activities; and e) involves an overnight stay.
*For purposes of this independent travel definition, the countries within the European Schengen zone are considered to be “within the host country.” In cases where independent travel is approved outside of the program host country within the European Schengen zone, students will be required to obtain a viral PCR test 3-5 days after returning to the program host country (unless students have been tested within a day of departure from the country to which they traveled.) Students must arrange and pay for the test.
For Spring 2022, independent travel requests for in-country destinations (including travel to other countries within the European Schengen zone) will be considered under the following conditions, as consistent with the Independent Travel Policy:
- Submission of the independent travel request is consistent with the process steps detailed in the Independent Travel Policy so that a proper review can occur with the academic director and the Student Health, Safety & Well-being regional manager.
- Students are vaccinated.
- Key COVID-19 metrics being monitored by SIT are favorable in the region being visited.
- There are no movement restrictions imposed by the host country government that would impede travel.
SIT reserves the right to deny or rescind approval for independent travel requests for reasons unrelated to COVID-19, including but not limited to: the location is deemed unsafe; the student is in poor academic standing; etc. If a student receives approval for independent travel and their travel is cancelled for any reason, SIT is not responsible for forfeited travel payments (e.g. cancelled flights, lodging, etc.).
As part of our commitment to ensuring the health, safety and well-being of students, staff, and global host communities, SIT requires students to be fully vaccinated against COVID-19 prior to the start of their program. According to the Centers for Disease Control, people are considered fully vaccinated two weeks after their second dose in a two-dose series (e.g. Moderna or Pfizer) and two weeks after a single-dose vaccine (e.g. Johnson & Johnson).
Given the increase of COVID variants resulting in changes to entry requirements from countries around the world, and varying definitions of how countries define “fully vaccinated,” SIT is strongly recommending that all students receive a COVID-19 booster shot prior to the start of the semester. Data from clinical trials has shown that a booster shot can increase the immune response and help prevent COVID-19 symptoms. Additional information about booster shots can be found on the Center for Disease Control’s website.
SIT understands that there are legitimate reasons why students may not be vaccinated against COVID-19. We provide the opportunity to petition for an exemption to our vaccination requirement on the grounds of medical reasons, sincerely held religious beliefs, or vaccine unavailability. Petitions will be reviewed by SIT’s Risk Assessment Committee as long as they do not present undue hardship and/or pose a direct threat to the health and safety of the requesting student or to other members of our programs.
Recognizing that COVID-19 vaccines may not be available in many global locations, SIT strongly encourages—but is not requiring at this time—all program faculty and staff to be fully vaccinated against COVID-19.
The CDC recommends universal indoor masking for all teachers, staff, students, and visitors to schools, regardless of vaccination status. Consistent with this recommendation, and to provide maximum protection from COVID variants and prevent possible spread to others, SIT requires that all participants wear a mask in public indoor settings and anywhere else required by local laws, regulations, and guidance.
6. Tests & Quarantine
The following testing protocols are based on CDC guidelines.
Before Departure to Host Country
- Unvaccinated students must take a viral PCR test 1-3 days prior to departure, or in some cases prior to arrival (based on the specific requirements of the host country). Students who test negative should present the test result to airport officials. Students who test positive may not travel.
- Vaccinated students do not need to obtain a viral PCR test prior to departure (unless required by the host country or when SIT deems it necessary).
Upon Arrival to Host Country
- Unvaccinated students must quarantine after arrival for 7 days with receipt of a negative test (taken between day 3-5 of quarantine) OR must quarantine for 10 days if no test is administered. Quarantine requires remaining in a specific room separate from other non-exposed people.
- Vaccinated students do not need to quarantine upon arrival (unless required by the host country or when SIT deems it necessary).
- Both unvaccinated & vaccinated students must obtain a viral PCR test 3-5 days after arrival. SIT will arrange and pay for this test.
Please note that certain host countries may have additional testing requirements that are not detailed here, such as testing immediately upon arrival or pre-departure testing for all travelers regardless of vaccination status. In these instances, students are expected to pay for the testing required by host countries.
SIT supports CDC recommendations to mitigate COVID-19 risk in transportation settings, to include: a) wear masks, maintain physical distance, avoid touching surfaces, and practice hand hygiene; b) refrain from eating or drinking, and; c) with regard to the driver, maintain physical distance and request ventilation improvements as needed.
COVID RESPONSE PROTOCOL
Quarantine guidelines should be followed when an individual may have been exposed to the virus and may or may not have been infected.
Isolation guidelines should be followed when an individual is sick or when that person has been infected with the virus, even if they are non-symptomatic.
a. Who does not need to quarantine. Students 18 years or older who have a known exposure to someone with suspected or confirmed COVID-19 do not need to quarantine if they have received all recommended vaccine doses, including boosters (or have tested positive for COVID-19 through a viral test within the previous 90 days and subsequently recovered and remain non-symptomatic). However, students should wear a well-fitting mask around others for 10 days from the “date of last close contact” (the date of last close contact is considered day 0) and should get tested at least five days after the date of last close contact. In turn, if students test positive or develop COVID-19 symptoms, they should follow the recommendations in the Isolation section below.
b. Who should quarantine. Students 18 years or older who have a known exposure to someone with suspected or confirmed COVID-19 should quarantine if they are in one of the following groups:
- Have completed the primary series of recommended vaccine, but have not received a recommended booster shot.
- Have received the single-dose Johnson & Johnson vaccine (completing the primary series for J&J vaccines) over two months ago, but have not received a recommended booster shot.
- Are unvaccinated or have not completed a primary vaccine series.
c. What to do for quarantine. Stay inside housing accommodations and away from other people for at least five full days (day 0 through day 5) after the date of last close contact. The date of last close contact is considered day 0. Students should also:
- Wear a well-fitting mask when around others at home.
- For 10 days after the date of last close contact watch for fever (100.4 degrees F or greater) and other COVID-19 symptoms.
- If symptoms develop, get tested immediately and isolate (see below) until test results are returned. If the test result is positive, continue to follow isolation recommendations. If negative, students can leave housing accommodations, but should continue masking when around others at home and in public until 10 days after the date of last close contact.
- If symptoms do not develop, get tested at least five days after the date of last close contact.
2. Positive Test or Symptomatic
If a person tests positive and/or is experiencing symptoms consistent with COVID-19, regardless of their vaccination status, SIT follows these CDC guidelines:
a. Isolate. Isolation is used to separate people infected with COVID-19 from those who are not infected. Isolation means staying home in a specific room and separating from other people for at least five full days (day 0 is the first day of symptoms or the date of the positive viral test for non-symptomatic individuals). Those in isolation should:
- Monitor their symptoms. If students have an emergency warning sign, they should seek emergency medical care immediately.
- Remain in contact with their health care provider
- Stay in a separate room from other household members and use a separate bathroom, if possible.
- Take steps to improve ventilation at home, if possible.
- Don’t share personal household items, like cups, towels, and utensils.
- Wear a well-fitting mask when around other people.
- Take care of themselves (e.g. rest and stay hydrated).
b. Contact Trace. An infected person can spread COVID-19 starting 48 hours before the person has any symptoms or tests positive. By letting one’s close contacts know they may have been exposed to COVID, they are helping to protect everyone. The CDC defines close contact as someone who was within 6 feet of an infected person for a cumulative total of 15 minutes or more over a 24-hour period starting from two days before illness onset (or, for asymptomatic patients, two days prior to test specimen collection) until the time the patient is isolated.
c. Ending Isolation. People who had COVID-19 and were symptomatic may be around others after: a) five full days of isolation (day 0 is the first day symptoms appeared), and b) 24 hours with no fever (without using fever-reducing medications), and c) other symptoms of COVID-19 are improving. These individuals should continue to mask around others at home and in public until day 10 (day 6 through day 10).
- If an individual who was symptomatic would like to test prior to ending isolation, the best approach is to use an antigen test toward the end of day 5. Obtain a test only if fever-free for 24 hours without the use of fever-reducing medication and other symptoms have improved. If the test result is positive, the person must continue to isolate until day 10. If negative, end isolation, but continue to mask around others at home and in public until day 10.
People who had COVID-19 but were non-symptomatic—and continue to have no symptoms—may be around others after five full days of isolation (day 0 is the date the test was conducted). However, these individuals should continue to mask around others at home and in public until day 10 (day 6 through day 10). Furthermore, if symptoms develop after testing positive, the five-day isolation period should start over (day 0 would be the first day of symptoms).
- If an individual who was non-symptomatic would like to test prior to ending isolation, the best approach is to use an antigen test toward the end of day 5. If the test result is positive, continue to isolate until day 10. If negative, end isolation, but continue to mask around others at home and in public until day 10.
BEFORE TRAVEL BACK TO THE UNITED STATES.
Per U.S. government policy, to enter the United States, both unvaccinated and vaccinated travelers must get a viral PCR test no more than one calendar day prior to departure (the first leg of one’s flight). Two types of viral tests can be used: nucleic acid amplification tests (NAATs), and antigen tests. The “one day” time frame is defined by days instead of hours to provide more flexibility to the traveler. SIT will arrange and pay for this test. For any student who is not returning to the U.S., SIT recommends following these same testing guidelines. Additional information about this testing requirement can be found on the Centers for Disease Control website.
Note: If a student tests positive during the return testing process, SIT will assist the student in finding room and board and will extend iSOS insurance coverage during the isolation period. However, students will be responsible for the cost of room and board and other expenses associated with an extended stay (for example airline ticket change fees, local transportation, etc.) beyond the program’s official end date.


Dermatological manifestations of tick-borne viral infections found in the United States
Virology Journal volume 19, Article number: 199 (2022)
Tick-borne diseases (TBDs) are bacterial, viral, and parasitic diseases transmitted by ticks. Viral TBDs have increased in prevalence over the last decade with many new pathogenic viruses being discovered. Doxycycline is often empirically prescribed by clinicians to treat symptomatic patients following tick bites due to suspicions of bacterial TBDs such as Rocky Mountain spotted fever, anaplasmosis, and ehrlichiosis. However, viral TBDs are included in the differential diagnosis if patients do not clinically improve following antibiotic therapy. Several viral TBDs present with dermatological manifestations. Recognizing the differences in clinical presentations of TBDs, particularly of newly emerging viral TBDs in the United States, can help physicians identify the viral TBD, and possibly rule out viral illnesses with different clinical presentations. Therefore, this review discusses clinical manifestations, with an emphasis on dermatologic manifestations of Heartland Virus, Bourbon Virus, Powassan Virus, Deer Tick Virus and Colorado Tick Fever Virus.
Viral tick-borne diseases have increased in prevalence over the last decade and often have similar clinical manifestations to other tick-borne diseases, including bacterial infections. Here, we review the dermatologic manifestations of Heartland Virus (HRTV), Bourbon Virus (BRBV), Powassan Virus (POWV), Deer Tick Virus (DTV) and Colorado Tick Fever Virus (CTFV) that are important for clinicians.
Tick-borne diseases (TBDs) have doubled in the United States in the last few years, necessitating a greater understanding of the signs and symptoms associated with TBDs for more accurate diagnoses and treatments. . The increase in outdoor activities in parks and national forests during the COVID-19 pandemic combined with limited knowledge of precautionary steps to minimize tick bites, have resulted in a higher incidence of TBDs . A recent study showed that in Delaware, where Lyme disease is prevalent, only 38.4% of people were aware of the TBD, and just 13.2% of the respondents changed their behavior to protect themselves from tick bites, suggesting a general lack of knowledge on the importance of preventing tick bites .
Ticks can transmit various pathogens, including bacteria, viruses, and parasites , including Lyme disease caused by Borrelia burgdorferi, spotted fever rickettsiosis (Rickettsia rickettsii and R. parkeri), Tularemia (Francisella tularensis ) and the parasitic agent Babesia microti . Tick bites result in primary skin lesions and inflammation in the form of firm papules and intense pruritis, due to the immediate reactions to toxins and irritants in the tick saliva. However, tick bites may also develop into chronic edematous nodules due to inflammatory reactions to fragments from tick mouthparts. Moreover, more specific secondary lesions or dermatological presentations are dependent on the specific TBD transmitted, which is often helpful in differentiating between TBDs . In this review, we discuss several emerging viral TBDs in the United States that are caused by Heartland Virus, Bourbon Virus, Powassan Virus, Deer Tick Virus, and Colorado Tick Fever Virus, including their dermatological manifestations.
Heartland Virus (HRTV) belongs to the genus Phlebovirus, family Phenuiviridae. HTRV’s genome is a negative single-stranded (-ss) RNA consisting of small, medium, and large segments. The small segment encodes for nucleocapsid protein and nonstructural proteins. The medium segment encodes for structural glycoproteins, Gn and Gc, and are targets of neutralizing antibodies, whereas the large segment encodes RNA-dependent RNA polymerase. Studies have shown that HRTV is genetically related to Dabie bandavirus, formally known as Severe Fever with Thrombocytopenia Syndrome Virus (SFTSV) or Huaiyangshan Banyangvirus .
HRTV was first identified in two Missouri farmers in 2009 . The two farmers presented with fever, fatigue, anorexia, diarrhea, leukopenia, and thrombocytopenia, now known to be common presenting symptoms of patients with HRTV infection. HRTV-infected patients may also present a local rash at the site of the tick bite. However, case reports of HRTV have shown that patients typically do not have a rash at the site of tick bite, indicating that the rash is not reliable for the diagnosis of HRTV infections . Complete blood counts of HRTV-infected patients show leukopenia and thrombocytopenia often combined with elevated transaminases, indicative of liver disfunction . In addition, a study has reported a severe HRTV case with erythema on the left lower extremity showing 2 cm central necrosis. Systemic viral dissemination can also cause additional symptoms such as altered mental status, gastrointestinal symptoms, and metabolic acidosis . Molecular and serological testing of the HRTV is possible, but can only be performed at the CDC due to the lack of commercially available tests in the United States .
Since January 2021, more than 50 cases have been reported in the Midwestern and Southern United States; specifically in Arkansas, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Missouri, North Carolina, Oklahoma, and Tennessee . Most cases occur in the summer months, typically 2 weeks post tick sighting on patients. The geographical distribution of cases closely matches the distribution of the lone star tick, Amblyomma americanum, which was later confirmed as the primary vector of HRTV [11, 12]. Clinical signs and symptoms of HRTV infections overlap with the more prevalent disease, human monocytotropic ehrlichiosis (HME), which was first discovered in 1987. Ehrlichia chaffeensis is the bacterial causative agent of HME and is also transmitted by the Lone Star tick in the Midwest region of the United States . Symptoms of HME range from mild febrile illness to multi-organ failure. Unlike HRTV, HME has a more distinctive rash that appears as a maculopapular, petechial, or diffuse erythema that affects the whole body except the face, palms, and soles of the feet . Due to the efficacy of doxycycline in treatment of HME, it is recommended to start patients on doxycycline, then evaluate the patients for the possibility of HRTV if symptoms do not resolve. There are currently no vaccines or antiviral drug treatments for HRTV.
Bourbon virus (BRBV) belongs to the genus Thogotovirus, family Orthomyxoviridae. BRBV is a novel enveloped negative-sense RNA virus and consists of six segments in its genome that are predicted to encode for PB2, PB1, and PA polymerase proteins, a nucleoprotein (NP), a surface glycoprotein (GP), and a matrix (M) protein . A single glycoprotein embedded in the viral envelope mediates entry into host cells . Like HRTV, the lone star tick (Amblyomma americanum) is the vector of BRBV [17, 18].
BRBV was first identified when a patient from Bourbon County, Kansas, died in 2014 after multiple tick bites. Since the discovery of the Bourbon virus, the virus has been a relatively rare tick-borne viral illness in the United States, with the CDC reporting only a few cases . The cases have been identified mainly in the Midwest and Southern United States. However, there is some overlap with the HRTV in Kansas .
It has been reported that BRBV-infected individuals develop fever, anorexia, nausea, vomiting, myalgia, and arthralgia. In addition, they may present with diffuse maculopapular or a papular rash that appears on the torso . Blood tests show leukopenia, lymphopenia, thrombocytopenia, hyponatremia, and increased aminotransferases . It has also been reported that progressive BRBV infections could lead to petechiae, which has been noted on the lower extremities and soft palate of onepatient .
Similarly, the Dhori virus (DHOV) is transmitted by metastriate ticks (non-Ixodes ticks) and mosquitoes. DHOV is found in Europe, North Africa, and western and central Asia and share 70% genome sequence identity with BRBV in multiple genomic segments . Unlike BRBV infections, DHOV infections are characterized by encephalitis in 40% of cases including headache and retrobulbar pain . There are no reported dermatological manifestations of DHOV, which could distinguish DHOV infections from HRTV and BRBV infections, further highlighting the importance of recognizing dermatological and clinical manifestations to allow differentiation between viral TBDs.
Currently, there are no routine laboratory tests that can confirm the diagnosis of BRBV infections. Only supportive care (including anti-pyretic, analgesics, and I.V. fluids) can be offered to the BRBV-infected patients since there are currently no vaccines or antiviral treatment approved for BRBV .
Powassan virus and deer tick virus
Powassan virus (POWV) is the only North American member of the family Flaviviridae (+ ss RNA viruses), genus Flavivirus, that is transmitted by the Ixodes tick species, causing tick-borne encephalitis. The POWV genome comprises seven genes coding for nonstructural proteins and three genes coding for structural proteins, including the capsid and envelope proteins . Recently, two genetic lineages of POWV have been described; lineage I was named POWV, whereas lineage II was renamed as Deer Tick Virus (DTV; discussed in the next section) . POWV infects macrophages and dendritic cells, which then transport the virus to the lymphatic system leading to systemic viral dissemination .
The virus was first identified in 1958 and named after a 5-year-old child who died from encephalitis in Powassan, Canada . POWV infections have increased from one case per year prior to 2005 to 10 cases per year after 2005 . Between 2011 and 2020, 194 documented cases of Powassan virus disease cases had been reported in the USA . POWV cases are primarily reported during the season of high tick activity (May-September), in the north-central and northeastern states of the United States. Between 2010 and 2019, 181 cases were reported in the United States, with 166 cases developing the neuroinvasive disease. Human PWOV infections have also been reported in Canada and Russia .
POWV infections can result in neuroinvasive or non-neuroinvasive diseases. Patients with non-neuroinvasive disease present with sore throat, drowsiness, headache, disorientation, and rarely fever. However, POWV infections are primarily neuroinvasive, a distinctive feature compared to other tick-borne illnesses . The neuroinvasive signs of POWV infections include encephalitis, meningoencephalitis, and aseptic meningitis. Ophthalmoplegia and direction-changing nystagmus have also been reported in some cases of POWV encephalitis. Death is reported in 10% of neuroinvasive cases, whereas 50% of surviving patients report long-term neurological sequelae including hemiplegia, muscle wasting, acute headaches, and memory problems .
A faint, diffuse maculopapular rash on the trunk has been described in a few POWV-infected patients , which can include the extremities and back, but is not associated with the tick bite area. A study showed that only three of eight POWV patients presented with rash ; this indicates that rash is not a common presentation in POWV infections. However, it can still be used with other symptoms and diagnostic tests to diagnose POWV infection [28,29,30]. Laboratory diagnosis of POWV infection involves detecting IgM antibodies using enzyme-linked immunosorbent assay (ELISA) and confirmation using plaque neutralization assay. A four-fold increase in antibody titer or IgM detection in CSF is diagnostic of POWV infections . Like HRTV and BRBV, there are no vaccines or definitive antiviral treatments for POWV. There are some documented cases of successful treatment with high-dose corticosteroids and IVIG. However, neither are approved treatments for POWV .
As mentioned earlier, DTV is a genetic variant (lineage II) of POWV. They share 84% and 94% genomic sequence identity and amino acid sequence identity, respectively, and cannot be distinguished serologically . DTV is transmitted by the Rocky Mountain wood tick, Dermacentor andersoni, but is mainly found in deer ticks (I. scapularis) collected from the northeastern United States. Three cases of DTV infections have been reported in the literature through 2017 .
DTV can cause severe central nervous system infections in humans, similar to POWV. Symptoms include fever, arthralgias, and headache. Laboratory tests of DTV-infected patients show thrombocytopenia with possible acute kidney injury . Unlike POWV, case reports of DTV infections have shown erythema migrans rash near the site of the tick bite . Erythema migrans rash is also associated with Lyme disease, which is a common bacterial tick-borne disease. The critical distinguishing feature between the two illnesses is the presence of encephalitis, and bilateral maculopapular palmar rash, more commonly found during DTV infection [34, 35]. DTV can be confirmed by serological testing if suspected in a patient. Currently, there are no treatments or vaccines available, and only supportive treatment can be provided for DTV infections .
Colorado tick fever virus
Colorado Tick Fever Virus (CTFV) is a member of the genus Coltivirus, family Reoviridae . Viruses within the genus Coltivirus have double-stranded RNA genomes made of 12 segments that encode for 13 viral proteins (VP) 1–12 . In the life cycle of CTFV, the virus is primarily maintained in nature by Dermacentor andersoni ticks. In contrast, the main vertebrate reservoir is Spermophilus lateralis (golden-mantled ground squirrel) and several other mammals, including chipmunks, wild mice, wood rats, wild rabbits, deer, elk, sheep, and coyotes .
CTFV infections are the second most reported arboviral infections in the United States after West Nile virus infections, with approximately 200–400 cases reported annually [40, 41]. CTFV cases have been reported in the western United States in California, Colorado, Idaho, Montana, Nevada, New Mexico, Oregon, South Dakota, Utah, Washington, and Wyoming. However, the risk of acquiring CTFV increases at elevations above 7000 feet .
Typically, CTFV-infected patients present with biphasic fever, headache, myalgia, and fatigue. In addition, laboratory tests show leukopenia and thrombocytopenia. CTFV-infected patients could develop severe complications such as meningitis, encephalitis, and bleeding disorders, and around 20% of patients require hospitalization . However, fatalities due to CTFV infections are rare .
Macular, maculopapular, and petechial rash, together with hyperesthetic skin, can be associated with CTFV infections in 5–15% of cases [45, 46]. A recent paper attributed the rash to dermal microvascular endothelial cells which are susceptible to CTFV infection and undergo apoptosis . Palatal enanthem, small spots on the mucous membrane, can also be seen as a dermatological manifestation of CTFV infections [40, 44, 48, 49].
Similar to CTFV, Eyach virus (EYAV) which shares 55–88% genetic sequence identity with CTFV presents with a febrile illness . However, dermatologic manifestations are uncommon. Moreover, EYAV causes neurologic complications in a higher number of patients than CTFV; therefore, the presentation of a rash may help distinguish between CTFV and Eyach viral infections, especially if the patient recently traveled to Germany or France, where EYAV has been found in ticks . In addition, Salmon River virus causes a similar disease as CTFV . However, the pathogenicity of California Hare Coltivirus (CTFV-Ca) is currently unknown. Therefore, distinguishing between CTFV and related coltiviruses from EYAV is heavily reliant on serological and molecular testing .
CTFV infections can be diagnosed using serologic tests to detect anti-coltivirus antibodies. These tests include complement fixation tests, seroneutralization assays, immunofluorescence assay, ELISA, and Western immunoblotting. However, serology may not be timely since antibody production can take 14–21 days. More commonly, real-time reverse transcriptase-polymerase chain reaction (RT-PCR) assays are used to detect CTFV RNA or the RNA of its cross-reacting serotypes, including CTFV-Ca and Salmon River virus. Intracerebral inoculation of infected human blood into suckling mice can also be used in the isolation and subsequent diagnosis of coltiviruses, though this method is not practical for most laboratories and clinicians. There are no FDA-approved vaccines or antiviral treatment options for CTFV infections, and only supportive care based on the patient’s symptoms is recommended .
“One world, one health” is a call for an interdisciplinary approach to science due to the interconnected nature of human actions, animals, and ecological health. The rising number of tick-borne diseases and the newly emerging diseases, such as HRTV and Bourbon virus, is an incentive to manage these diseases with an interdisciplinary approach, especially between practitioners and virologists. This article discusses a multidisciplinary approach by bridging viral knowledge with clinical knowledge to aid clinicians in recognizing presentations of tick-borne diseases.
Tick-borne diseases of bacterial origin present with distinctive dermatological manifestations, such as erythema migrans in Lyme disease, caused by Borrelia burgdorferi, and the petechial rash in Rocky Mountain Spotted Fever, caused by Rickettsia rickettsii [53, 54]. Additionally, Southern tick-associated rash illness (STARI) is an emerging zoonotic disease spread by A. americanum, that presents with an annular rash that is almost identical to erythema migrans with lymphocytic dermal infiltrate seen in Lyme disease . While STARI is believed to be caused by Borrelia lonestari, there is some debate regarding its exact etiology [56,57,58].
TBDs of bacterial origin are studied more due to the prevalence in the United States, and as stages of the disease with distinct clinical symptoms have been identified. As a result, bacterial tick-borne infections are also stressed in medical schools across the United States and competency exams (USMLE and COMLEX). In contrast, TBDs of viral origin, primarily those recently discovered, have not been studied as extensively, and more research is needed to distinguish characteristic symptoms, like cutaneous presentations. Underreporting and underdiagnosis of viral tick-borne illness can occur due to overlapping dermatological indications of viral and bacterial tick-borne disease. Many viral TBDs can be mistaken for bacterial TBDs without adequate serological testing.
Bacterial TBDs and viral TBDs can also often overlap due to ticks harboring multiple diseases. For example, the Ixodes scapularis tick that carries Lyme disease can also cause co-infections with Powassan virus . Co-infection has also been shown to enhance disease severity, or alter typical symptoms, thus impeding diagnosis. Lyme disease patients with co-infections presented with more influenza-like symptoms than those with Lyme disease alone . Co-infection can make recognition of dermatological manifestations of tick-borne diseases more important as they can aid clinicians in deciding diagnostic testing to order and treatment plan.
Cutaneous presentations of these viral tick-borne illnesses inform practitioners and patients about which viral disease was transmitted from the tick. The knowledge of the viral particle guides treatment and can prevent death. Performing a detailed skin exam on a patient presenting post tick bite or with symptoms after visiting an area endemic with these diseases helps identify cutaneous presentations of illnesses, such as maculopapular rash, erythema migrans, or petechial rash. Further research on the treatment of tick-borne viral diseases is needed to prevent deaths, mainly due to the doubling in tick-borne disease cases in the past ten years in the United States.
There are no specific drug therapies, or FDA-approved vaccines for tick-borne viral infections in the United States. While hospitalization is common for these infections, treatment is mainly supportive. Personal protection, landscape management, and wildlife management are effective for preventing and controlling tick-borne viral infectious diseases, but vaccines and drug therapies are critically needed. A convenient area to report a case of tick-borne disease is also required, especially because patients with mild forms of TBDs do not come to the hospital, and those mild symptoms are not documented. A website through the CDC where patients can add their symptoms and their location can aid in solving the underreporting of tick-borne illnesses while giving insights on mild forms of the diseases. The database can also lead to more distinctive dermatological manifestations by stage of the disease (Fig. 1, Table 1).
Availability of data and materials
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Fill MMA, Compton ML, McDonald EC, Moncayo AC, Dunn JR, Schaffner W, et al. Novel clinical and pathologic findings in a heartland virus-associated death. Clin Infect Dis. 2017;64:510.
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Godsey MS, Savage HM, Burkhalter KL, Bosco-Lauth AM, Delorey MJ. Transmission of Heartland Virus (Bunyaviridae: Phlebovirus) by experimentally infected Amblyomma americanum (Acari: Ixodidae). J Med Entomol. 2016;53:1226.
Savage HM, Godsey MS, Amy L, Panella NA, Burkhalter KL, Harmon JR, et al. First detection of heartland virus (bunyaviridae: Phlebovirus) from field collected arthropods. Am J Trop Med Hyg. 2013;89:445.
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Savage HM, Burkhalter KL, Godsey MS, Panella NA, Ashley DC, Nicholson WL, et al. Bourbon virus in field-collected ticks, Missouri, USA. Emerg Infect Dis. 2017;23.
Lambert AJ, Velez JO, Brault AC, Calvert AE, Bell-Sakyi L, Bosco-Lauth AM, et al. Molecular, serological and in vitro culture-based characterization of Bourbon virus, a newly described human pathogen of the genus Thogotovirus. J Clin Virol. 2015;73:127.
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Hermance ME, Thangamani S. Powassan Virus: an emerging Arbovirus of Public Health concern in North America. Vector-Borne Zoonotic Dis. 2017;17:453–62.
Kemenesi G, Bányai K. Tick-borne flaviviruses, with a focus on Powassan virus. Clin Microbiol Rev. 2019.
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Krow-Lucal ER, Lindsey NP, Fischer M, Hills SL. Powassan virus disease in the United States, 2006–2016. Vector-Borne Zoonotic Dis. 2018;18:286.
Piantadosi A, Rubin DB, McQuillen DP, Hsu L, Lederer PA, Ashbaugh CD, et al. Emerging cases of Powassan Virus Encephalitis in New England: clinical presentation, imaging, and review of the literature. Clin Infect Dis. 2015;62:707.
Wilson MS, Wherrett BA, Mahdy MS. Powassan virus meningoencephalitis: a case report. Can Med Assoc J. 1979;121.
Partington MW, Thomson V, O’Shaughnessy MV. Powassan virus encephalitis in southeastern Ontario. Can Med Assoc J. 1980;123:603.
Beasley DWC, Suderman MT, Holbrook MR, Barrett ADT. Nucleotide sequencing and serological evidence that the recently recognized deer tick virus is a genotype of Powassan virus. Virus Res. 2001;79:81.
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Cavanaugh CE, Muscat PL, Telford SR, Goethert H, Pendlebury W, Elias SP, et al. Fatal deer tick virus infection in Maine. Clin Infect Dis. 2017;65:1043.
Borchers AT, Keen CL, Huntley AC, Gershwin ME. Lyme disease: a rigorous review of diagnostic criteria and treatment. J Autoimmun. 2015;57:82–115.
Tavakoli NP, Wang H, Dupuis M, Hull R, Ebel GD, Gilmore EJ, et al. Fatal case of deer Tick Virus Encephalitis. N Engl J Med. 2009;360:2099.
Solomon IH, Spera KM, Ryan SL, Helgager J, Andrici J, Zaki SR, et al. Fatal powassan encephalitis (deer tick virus, lineage II) in a patient with fever and orchitis receiving rituximab. JAMA Neurol. 2018;75:746.
Hughes HR, Velez JO, Fitzpatrick K, Davis EH, Russell BJ, Lambert AJ, et al. Genomic evaluation of the Genus Coltivirus indicates genetic diversity among Colorado Tick Fever virus strains and demarcation of a New Species. Diseases. 2021;9:92.
Attoui H, Billoir F, Biagini P, Cantaloube JF, De Chesse R, De Micco P, et al. Sequence determination and analysis of the full-length genome of Colorado tick fever virus, the type species of genus Coltivirus (Family Reoviridae). Biochem Biophys Res Commun. 2000;273:1121–5.
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Davis LE, Beckham JD, Tyler KL. North American encephalitic arboviruses. Neurol Clin. 2008;26:727–57.
Owen S, Gaffney C, Grado L, Woodson ML, King JA, Balaraman RP, et al. Colorado tick fever virus induces apoptosis in human endothelial cells to facilitate viral replication. Ticks Tick Borne Dis. 2021;12:101775.
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The authors would like to thank the Sam Houston College of Osteopathic Medicine for generously paying for page charges associated with this manuscript.
The preparation of this review was not supported by any external funding.
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Rupani, A., Elshabrawy, H.A. & Bechelli, J. Dermatological manifestations of tick-borne viral infections found in the United States. Virol J 19, 199 (2022). https://doi.org/10.1186/s12985-022-01924-w


UK's COVID lockdown to gradually ease
By Nick Dole on AM
As the vaccine rollout continues here in Australia, data from the UK shows the jabs are having a major impact on hospital admissions and deaths.
Matt Choat, London resident
Rachel Thomas, London resident
Boris Johnson, UK Prime Minister
Sir John Bell, professor of medicine at Oxford University


NetWellness is a global, community service providing quality, unbiased health information from our partner university faculty. NetWellness is commercial-free and does not accept advertising.
Sunday, September 24, 2017
I pain across the back of my pelvis-between my hips. It is worse in the mornings. It is stiff, with burning pain. My doctor took an x-ray and MRI. The physical therapist said I had sacroiliac joint dysfunction. My doctor said I did not. He said the imaging studies were normal. But the radiologist report said: Multi-level DDD, several hemangiomas, mild scleroses at the symphysis pubis; and incidental note of phleboliths in pelvis. My question is: what are these things and could they be causing my pelvic pain. My doctor does not answer me.
Thank you of your question. It is hard to identify the source of the pelvic pain. Definitely the Sacroiliac and the DDD may be a factor in that. What we can do is a diagnostic injection at the SI joint and another one at the facet joint to see if that would relief your pelvic pain after making sure that there are no other pathology for your pelvic pain coming from the pelvic organs.
Hammam Akbik, MD, FIPP
Formerly, Assistant Professor of Anesthesia
College of Medicine
University of Cincinnati


Researchers have developed a test to detect traces of cancer from within patients' blood, the Guardian reports. The test, which it notes is still in development, only takes about 10 minutes, but cannot determine what type of cancer is present.
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At a meeting this week, researchers and others discussed the regulatory oversight needed for germline genome editing.
The US Food and Drug Administration has asked questions about Myriad Genetics' GeneSight test, according to Bloomberg.
Researchers report that neutrophil extracellular traps appear to binds gallstones together, according to New Scientist.
In Science this week: approach to infer genotype-by-environment interaction from genetic variants associated with phenotypic variability, and more.


Progenics uses the unique, modified double stem cell extraction processing technique developed by Progenics' Research & Development Team (Yang H et al., Transfusion (2011) 51;284-292 and Yang H et al., Transfusion (2015) 55:70-78). The quality is significantly superior to other techniques, regardless of whether they are automated or manual (compared with published information).
Higher Viability of Cells
The viability of transplantable cells (nucleated cells) in the final cord blood product that is banked for future transplant is higher with the double stem cell extraction technique† than with banks using other methods§.
Another critical reason that contributes to a higher viability of cells is that Progenics processes cord blood samples more quickly after collection. The viability of stem cells (CD34+ cells) was 99.43%.
† Yang H et al., Transfusion (2011) 51;284-292
§ Solves P et al., Cytotherapy (2009) 11:1101-1107
Progenics' Research & Development Team works diligently at improving and perfecting the process of cryopreservation of cord blood. In 2015, our findings on how temperature interruptions during controlled-rate-freezing affect the cord blood unit were published in a peer reviewed journal, Transfusion. Furthermore, we discussed procedures to preserve the viability of cord blood stem cells in the event of unexpected temperature interruptions during cryopreservation. This is one of the many advantages of storing your baby's cord blood with Progenics, as cord blood samples are professionally prepared and cryopreserved by technicians with the highest level of training in the field.
Assurance of Secure Long Term Storage
Cord blood is stored in a two-compartment Pall freezing bag that is over-wrapped with another cryobag and stored in an MVE -190ºC vapor (gas) phase freezer.
The freezers containing cord blood samples are stored in a secure, fire-resistant storage facility. The freezers are equipped with a backup power generator to provide power in the event of a power failure. In addition, the storage facility and the temperature in the freezers are monitored 24 hours daily by security and video surveillance. Among the three most commonly used sizes of freezers, Progenics uses the smallest size. If there is ever an emergency, the smaller size of the freezer will require us to transfer fewer cord blood samples from a dysfunctional freezer to a backup freezer and subsequently avoid extra cell damage due to warming. Nevertheless, there is always a backup liquid nitrogen freezer available at our storage facility which can be used immediately to transfer the contents of a dysfunctional freezer.
Validated Quality Assurance
Quality assessment has been validated in previous studies carried out by Progenics' Research and Development Team.
For details see:
Yang H, Loutfy MR, Mayerhofer S, Shuen P. Factors affecting banking quality of umbilical cord blood for transplantation. Transfusion (2011) 51:284-292.
Yang H, Pidgorna A, Loutfy MR, Shuen P. Effects of interruptions of controlled-rate freezing on the viability of umbilical cord blood stem cells. Transfusion (2015) 55:70-78.
In conclusion, should one compare our data with published information from other cord blood banks, one would see that Progenics can store more cells based on our professional and reliable banking process.


Infectious disease assessment for migrants - consultation document
The draft document "Infectious disease assessment for migrants" is now available for consultation.
The document has been prepared by the Migrant Health Screening sub-committee of the HPSC Scientific Advisory Committee. The purpose of the guidelines is to give appropriate guidance on the assessment of infectious diseases in migrants. The guidelines do not take into account or offer guidance on other aspects of health and social needs of the migrant population in Ireland. They are intended to be used opportunistically across a wide range of health services. The guidelines do not advise on how migrants might access health services, nor make recommendations on the type of services that should be made available to migrants. It is intended that the guidelines will be published as an on-line resource.
All comments and suggestions on any aspect of this document are very welcome. The comments will be reviewed by the guideline sub-committee and taken into consideration when preparing the final document. Please submit your comments by completing the response form and returning it by email to firstname.lastname@example.org.
The final date for submission of comments is 15th September 2014.


Many Patients With Polyps Delay Follow-up Colonoscopy: Study
MONDAY, Nov. 26, 2018 (HealthDay News) -- Many people found to have colon polyps (adenomas) that can lead to cancer don't have follow-up colonoscopies at recommended times, a new study finds.
Patients who have certain types of adenomas, or large or numerous ones, are at increased risk for colorectal cancer, the study authors reported in the Nov. 20 issue of the journal Cancer Epidemiology, Biomarkers & Prevention.
"When a patient is found to have some of these higher-risk findings, guidelines recommend that they come back for another colonoscopy in three years. This is called surveillance colonoscopy, and it improves our chances of preventing colorectal cancer or detecting it at an early stage," study author Jessica Chubak said in a journal news release.
Chubak is a senior scientific investigator at Kaiser Permanente Washington Health Research Institute.
Her team analyzed data from more than 6,900 U.S. patients, aged 50 to 89, with high-risk adenomas. The patients had their initial colonoscopies done at one of three Kaiser Permanente systems, or at the Parkland Health & Hospital System, which treats patients regardless of their insurance status or ability to pay.
Between 47 percent and 59.5 percent of the Kaiser Permanente patients had a follow-up colonoscopy within 3 1/2 years, compared with 18.3 percent of Parkland patients.
The significantly lower rate at Parkland was most likely due to differences in patient populations and resources, according to Chubak.
The study found that patients with more adenomas or with higher-risk adenomas were more likely to get the follow-up colonoscopy at the recommended time.
Age was another factor. Patients between the ages of 60 and 74 were more likely than those between the ages of 50 and 54 to get timely colonoscopies, while those in their 80s were less likely to do so.
"We encourage patients and health care providers to talk about how and when to test for colorectal cancer, and we encourage health care systems to find ways to support patients and providers in following the guidelines," she said. "In the future, it will be important to understand what types of reminders work best for different patient populations and in different health care settings."
The American Society of Colon and Rectal Surgeons has more on colorectal polyps.
The news stories provided in Health News and our Health-E News Newsletter are a service of the nationally syndicated HealthDay® news and information company. Stories refer to national trends and breaking health news, and are not necessarily indicative of or always supported by our facility and providers. This information is provided for informational and educational purposes only, and is not intended to be a substitute for medical advice, diagnosis, or treatment.


The Society of Healing Arts Institute is a holistic and alternative health treatment center that specializes in a number of different healing methods. Many of these do not involve the use of drugs at all, but more include an alternative approach to heal and healing.
SOHAI is an establishment that takes great pride in its ability and knowledge to successfully treat patients. We believe that it is important for patients to be comfortable with their healing practitioners in order for them to receive the most out of their visit. That is why we welcome all questions, follow up with our patients and why we have worked tirelessly to create a warm and inviting atmosphere.
MICHIGAN MEDICAL MARIJUANA CARDS
Marijuana is a power and safe medicine, as effective as any medical drug, but natural and much safer. Yet the sigma of using Marijuana as a medicine, keeps many people away from using it. We specializes in the recommendation, evaluation and consultation of Michigan Medical Marijuana, according to the laws of the Michigan Medical Marijuana Program. A Michigan Medical Marijuana card will legally protect you from incarceration in the state of Michigan for marijuana possession and use.
MICHIGAN MEDICAL MARIJUANA CARD RECOMMENDATIONS
If you are a resident living in Michigan and are looking to use marijuana medicine as an alternative to prescription based pills, you have come to the right place. At SOHAI, we provide recommendations for medical marijuana. We also provide education, follow-up care, and in depth-knowledge regarding all things medical marijuana. We believe in the healing properties of medical marijuana and want to ensure you understand all the benefits medical marijuana has to offer.
In order to become a medical marijuana patient, you must a resident of Michigan with a valid state issued photo id. You also must have qualified condition diagnosed by your primary care physician that is listed under the Michigan state medical marijuana laws. If you are in Grand Rapids, Flint or Muskegon Michigan and want to obtain a medical marijuana card, please don't hesitate to contact us. We welcome all Michigan state residents.
WHO QUALIFIES FOR MEDICINAL MARIJUANA IN MICHIGAN
On November 4, 2008, Michigan voters approved the Michigan Medical Marihuana Act (MMMA), which allows seriously ill patients to use medical marijuana (also referred to as medical weed, medical pot or medical cannabis). The Act permits an individual with a qualifying debilitating medical condition to register as a medical marijuana patient with the Michigan Department of Community Health (MDCH) and avoid criminal penalties under state law for certain medical uses of marijuana. The Michigan Medical Marihuana Program (MMMP) was established to administer the registration program provided for in Michigan medical marijuana law. The MMMP reviews applications submitted by patients and caregivers wishing to participate in the MMMP and issues medical marihuana registration identification cards to those individuals whose applications are approved.
HOW TO QUALIFY FOR MEDICAL MARIJUANA IN MICHIGAN
To qualify to use medical marijuana in the state of Michigan, a patient must: Obtain a copy of your medical records indicating diagnosis of a qualifying condition, as listed below. Be sure to bring these records with you to your marijuana evaluation appointment. Learn how to request your medical records. Receive a recommendation from a Michigan licensed MD or DO. Find a qualified medical marijuana doctor in Michigan here. Register with the Michigan Department of Community Health to obtain a medical marijuana card.
WHAT AILMENTS CAN BE TREATED WITH MEDICAL CANNABIS IN MICHIGAN
Patients must suffer from a debilitating medical condition, defined by the Michigan Medical Marihuana Act as: Cancer, Glaucoma, HIV/AIDS, hepatitis C, amyotrophic lateral sclerosis, Crohn's disease, agitation of Alzheimer's disease, or nail patella.
A chronic or debilitating disease or medical condition or its treatment that produces one or more of the following:
Cachexia or wasting syndrome;
severe and chronic pain
Seizures, including those characteristic of epilepsy; or
Severe and persistent muscle spasms, including those characteristic of multiple sclerosis
Any other medical condition or treatment for a medical condition adopted by the department by rule.
MEDICAL MARIJUANA ACCESS
Some medical marijuana patients will claim they have a doctor's prescription for medical marijuana, but marijuana prescriptions are in fact illegal. The federal government classifies marijuana as a schedule I drug. Therefore doctors are unable to prescribe marijuana to their patients, and medical marijuana patients cannot go to a pharmacy to fill a prescription for medical marijuana. Instead, medical marijuana physicians will supply patients with a medical marijuana recommendation in compliance with Michigan state law.
According to Michigan marijuana laws, patients and their caregivers are allowed to grow medical marijuana only for the qualified patient's private medical use; they can possess up to 2.5 usable ounces and 12 plants; and they cannot purchase or sell medical cannabis.


Elena M Schmidt, OD Email Elena Schmidt
- INSTRUCTOR | Ophthalmology
- Hospital Affiliations
- The Mount Sinai Hospital
- Mount Sinai Queens
- New York Eye and Ear Infirmary of Mount Sinai
Elena M. Schmidt, OD, is an instructor at the Icahn School of Medicine at Mount Sinai and practices optometry at Mount Sinai Doctors Queens and The Mount Sinai Hospital. She earned her optometry degree from the Indiana University School of Optometry and then completed an ocular disease residency in Baltimore, where she gained valuable experience diagnosing and managing ophthalmic conditions like glaucoma, diabetic eye disease, dry eye, cataracts, and macular degeneration.
Dr. Schmidt provides expert and comprehensive eye care with an emphasis on vision correction and ocular disease. As an optometrist, she specializes in helping patients manage vision changes to see better. Dr. Schmidt supports the efforts of patients who are interested in their eye health, and she is committed to providing the highest standard of care to those who come in for an evaluation. She is delighted to serve the Queens community and to help patients preserve and improve their vision and ocular health.
- Allergic Eye Problems
- Annual Eye Exam
- Comprehensive Dilated Eye Exam
- Contact Lenses
- Diabetic Retinopathy
- Double Vision
- Dry Eye Disease
- Eye Emergency Visit
- Eye Infection
- Macular Degeneration
- Nearsightedness And Farsightedness
OD, Indiana University School of Optometry
Baltimore VA Medical Center
Dr. James O. Hormuth Award
Dr. James D. Hurt Award
Beta Sigma Kappa Optometric Honor Society
Physicians and scientists on the faculty of the Icahn School of Medicine at Mount Sinai often interact with pharmaceutical, device and biotechnology companies to improve patient care, develop new therapies and achieve scientific breakthroughs. In order to promote an ethical and transparent environment for conducting research, providing clinical care and teaching, Mount Sinai requires that salaried faculty inform the School of their relationships with such companies.
Dr.Schmidt did not report having any of the following types of financial relationships with industry during 2020 and/or 2021: consulting, scientific advisory board, industry-sponsored lectures, service on Board of Directors, participation on industry-sponsored committees, equity ownership valued at greater than 5% of a publicly traded company or any value in a privately held company. Please note that this information may differ from information posted on corporate sites due to timing or classification differences.
Mount Sinai's faculty policies relating to faculty collaboration with industry are posted on our website. Patients may wish to ask their physician about the activities they perform for companies.
Physicians who provide services at hospitals and facilities in the Mount Sinai Health System might not participate in the same health plans as those Mount Sinai hospitals and facilities (even if the physicians are employed or contracted by those hospitals or facilities).
Information regarding insurance participation and billing by this physician may be found on this page, and can also be obtained by contacting this provider directly. Because physicians insurance participation can change, the insurance information on this page may not always be up-to-date. Please contact this physician directly to obtain the most up-to-date insurance information.
Insurance and health plan networks that the various Mount Sinai Health System hospitals and facilities participate in can be found on the Mount Sinai Health System website.


Emotional pain : Important points about emotional pain
What is emotional pain?
Not all pains are physical and there are pains that our soul experiences and you must understand the meaning of this definition well.
Research and studies show that feelings of anxiety and stress can also affect us physically.
On the other hand, these feelings are caused by stimuli such as a feeling of danger or even a normal feeling of thirst.
Emotional pain can be caused by many conditions, including the loss of a long-term relationship, job loss, illness or loss of a loved one, and so on.
During and after these life events, we often experience feelings of stress, anxiety, depression, or even personal destructive behaviors, which can eventually put us under pressure.
Of course, these feelings come in many forms.
Coping with them is not a very difficult and complicated task.
Physical and psychological pain can also involve people in various treatment processes.
What causes psychological damage?
Mental injury or trauma is usually the result of a stressful event that includes the following conditions:
1- Conflict in an accident or some kind of attack
2- Divorce conflict
3- An unhealthy or violent relationship
4- Loss of a loved one
5- Suffering from an illness
6- Witnessing a difficult mental scene
Symptoms of pain or trauma
Emotional pain usually affects people mentally as well. Physiological responses are different for everyone and the type of treatment will be different.
These negative feelings are sometimes very intense and frustrate the person and have symptoms that include the following:
Physical symptoms include emotional pain and trauma
Problems with excessive sleep or insomnia
Withdrawal from past close relationships
How does emotional pain appear in children?
Trauma can occur at any stage of a person’s development.
For example, a teenager who lives in a house with moral problems is more likely to suffer psychological trauma.
He may also be a victim of violence, which will usually destroy his sense of security.
Psychological trauma can begin in childhood and continue into adolescence.
These children must be taken to a specialist and treated as soon as possible to have a better chance of recovery.
Mental pain and stress disorder after injury
Sometimes these conditions last longer than people think and may lead to a post-traumatic stress disorder that usually has the following symptoms:
Nightmares and revisiting past damage
Emotional and emotional stress
Memories of an event fade
Feeling disconnected from past relationships
What are the treatment options for these people?
The best way is to accompany a second person.
Being with a specialist is the most ideal treatment option.
In that case, you can get help from a psychiatrist or find a qualified counselor or psychologist.
Sometimes a person is treated with medicine and sometimes without medicine.
These methods help people find their emotional pain and with the guidance of a specialist can take gradual steps in this direction and move towards recovery.
By doing this, these people learn how to overcome the negative patterns of their thinking and move towards recovery and improvement.
In addition to these consultations, they should also follow a regular exercise routine and diet in order to be in better physical condition.


Detailed Notes on Cannabis and Seizures
After which, remarkably, the main tincture we experimented with from the collective seemed to ratify All those conclusions. For 3 days, Sam’s seizures went from what had been 10 to 20 an hour or so to about one particular each and every hour.
He performed a crucial part in having Minnesota’s clinical cannabis legislation passed in 2014. He is currently asking: “Can cannabinoids heal seizures in pet dogs also?”
But in some way we certain ourselves which the collective had mastered the fundamentals—that you choose to don’t explain to mother and father a medicine is a certain potency Except if you’ve had it analyzed. We actually only had ourselves guilty, nevertheless. We didn’t contain the tinctures examined both.
For The 1st time in ten years Sam resides like a traditional boy. He requires a bus as well as a coach house from college. He plays Halo
All of the youngsters in the review had been getting at least 1 seizure drug throughout the demo, possibly incorporating noise to the info, says William Catterall, professor of pharmacology with the University of Washington in Seattle, who was not associated with the study.
The expertise With all the unscientific ways of the collective and Along with the Bogus labeling of solutions in dispensaries was infuriating and demoralizing. We knew the collective was nevertheless obtaining its way when we joined. And we knew that buying tinctures at dispensaries wasn’t like gonna Walgreens.
By the point he achieved London, Sam had been on a giant dose of your corticosteroid prednisone on and off for the 12 months. It designed him get 30 lbs .. It built his face appear to be it were pumped jam packed with air—a facet influence known as “moon facial area.
For Evelyn this was revelatory. CBD was The one thing remaining that might assistance control Sam’s seizures. And more than in the united kingdom there was a drug company building the stuff with the pound.
Exploration also finds that cannabis is helpful in the remedy of critical pediatric epilepsy Diseases like Dravet syndrome, Doose syndrome and Lennox-Gastaut syndrome. In a single questionnaire review, 85% of mom and dad documented a discount inside their little one’s seizure frequency with cannabis treatment. Out of Those people mothers and fathers, eleven% of these responded that their kid Discover More has reached comprehensive seizure flexibility, while forty two% described a bigger than 80% reduction in seizure frequency. The mothers and fathers also described extra useful consequences, for example amplified alertness, much better temper and improved sleep11.
Scientists have found a hyperlink between women while in the later on levels of pregnancy who ended up prescribed The most frequent kinds of antidepressant medication, and autism diagnosed in children underneath seven decades of age
Thank you for keeping with us. It really is good to Have you ever on board! Aww, shucks. Potentially you'll be able to explain to us what we could do to cause you to interested in subscribing? Certain No
Coyote. Nevertheless it in no way occurred to me that you may purchase one. Would UCSF in fact purchase a little something such as this? Even though it will, I envisioned months of paperwork just to have the College’s approval.
fifteen/forty six Extensive commutes carry wellness risks Hours of commuting might be mind-numbingly boring, but new investigation displays that it might also be having an adverse effect on each your overall health and functionality at do the job.
A lot of children with Dravet syndrome get many epilepsy medicines to regulate their critical seizures. But some children usually do not respond to the medications. Some mom and dad of youngsters with Dravet syndrome or autism turn to marijuana, based purely on anecdotal evidence.


What are HA Fillers?
Hyaluronic acid is a naturally occurring substance that is found in your skin, joints, eyes and other tissues. It helps keep these tissues plump and hydrated. HA (hyaluronic acid) fillers have varying degrees of softness as well as other properties that make them each unique. These gel-like substances are made from a sugar molecule that is derived from bacterial fermentation. HA fillers are used to replace lost volume, smooth lines, soften creases, and/or enhance facial contours. The results are temporary, typically lasting 6 months to two years or longer. Most HA fillers are infused with lidocaine to help minimize discomfort during and after treatment.
Which filler do I need?
As previously mentioned, each product is uniquely formulated to have a certain texture, density, and intended injection depth, which means that certain fillers work better for certain areas of concern. It is best to allow your injector to chose the appropriate product for the intended goal, anatomical location and tissue layer intended for correction/enhancement.
What is the process?
Dermal fillers are one of our most popular treatments at rēVive. Prior to a dermal filler treatment appointment, all new patients will undergo an in person consultation. This time will be used to develop a plan including determining the areas in need of treatment, a review of each patient’s medical history to ensure the procedure is safe and appropriate. Expected side effects and possible adverse effects will be reviewed and instructions to be followed both before and after the treatment will be discussed and provided in writing. Expected pricing will be provided as well as additional information on the products and procedures suggested. A consultation appointment is generally scheduled for one hour. A dermal filler treatment appointment may last from 45-90 minutes depending on the areas being treated.
Pricing By Area:
(All prices are subject to individual variability and if necessary, adjustments will be discussed during you consultation.)
– Pre-auricular Area: $800
– Midface Area (cheeks/pyriform): $1800
– Chin Area (chin/chin shadows/ mental crease/prejowl): $1800
– Midface & Chin: $3,400
– Jaw to Chin-The Entire Low Face: $3,500
– Mini Lip: $450
– Full Lip: $700
– Lips, Lip Lines & Corners: $1000
– Full Face (excludes forehead and nose): $5000
– Filler dissolving w/ Hyaluronidase: begins at $500


Elevate Your Health and Fitness with VO2 Max Testing in Dallas
Uncover the Key to Optimal Health and Longevity with VO2 Max Testing
Discover and Enhance Your True Potential
The American Heart Association highlights VO2 Max testing as the most predictive measure a person can take to understand their risk for all-cause mortality, disease risk, and overall longevity. At DFW Back to Health in Dallas, we’ve embraced this powerful test, offering comprehensive VO2 Max testing to help you unlock the full potential of your health and fitness.
VO2 Max Testing goes beyond traditional fitness assessments by measuring the maximum amount of oxygen your body can use during intense exercise. And while you might think these stats only matter to athletes, VO2 Max testing is for anyone who wants to gain deep insights into their overall health and life expectancy. By understanding your VO2 Max, you can will know exactly what to do to create optimal health and vitality.
At DFW Back to Health, we’re setting a new standard for personalized health care in Dallas. Our VO2 Max testing services are designed to provide you with the insights you need to improve your fitness, reduce your health risks, and extend your lifespan. Whether you’re looking to enhance your athletic performance or simply want to know more about your health, our team is here to guide you every step of the way.
Benefits of VO2 Max Testing
Understanding your VO2 Max can revolutionize the way you think about fitness and health. This isn’t just another fitness fad; it’s a scientifically backed measure that offers clear insights into your cardiovascular health and endurance. Here’s how VO2 Max testing at DFW Back to Health in Dallas can benefit you:
What is VO2 Max Testing?
VO2 Max testing is like getting a sneak peek into the engine of your body. It measures the maximum amount of oxygen your body can utilize during intense exercise, and it’s considered the gold standard for assessing cardiovascular fitness and endurance capability. But it’s more than just a number. Understanding your VO2 Max gives you valuable insights into your physical condition, highlighting areas for improvement and guiding your training to be as effective as possible.
Why does this matter for anyone, not just athletes? Because your VO2 Max score is directly linked to your overall health and fitness. It tells you how well your body can perform when pushed to its limits, which is essential information whether you’re looking to run a marathon, improve your cycling time, or just want to make sure you’re in top shape. At DFW Back to Health in Dallas, we use VO2 Max testing to tailor fitness programs that meet your personal goals, ensuring you train smarter, not harder.
Knowing your VO2 Max can transform the way you approach your fitness routine. With this insight, our team at DFW Back to Health crafts personalized training plans that leverage your strengths and address your weaknesses, setting you on a path to achieving your healthiest self. Let’s use science to take the guesswork out of your training and propel you towards your fitness goals.
Who Should Consider VO2 Max Testing?
You might wonder if VO2 Max testing is right for you. The truth is, this powerful tool isn’t just for elite athletes or fitness buffs. At DFW Back to Health in Dallas, we recommend VO2 Max testing for a wide range of individuals, each with different goals and starting points. Here’s who stands to gain from understanding their VO2 Max:
- Competitive Athletes: For those looking to optimize performance, refine training strategies, and gain a competitive edge.
- Fitness Enthusiasts: If you’re passionate about fitness and curious about your aerobic threshold, VO2 Max testing can guide your training to new heights.
- Beginners on a Fitness Journey: Knowing your VO2 Max provides a starting point that helps tailor a fitness plan to your current level, ensuring safe and effective progress.
- Individuals with Health Goals: If you’re aiming to reduce the risk of chronic diseases or manage existing conditions, VO2 Max testing offers insight into your cardiovascular health.
- Anyone Seeking Personalized Fitness Advice: For those who want a fitness program designed specifically for their body’s needs, VO2 Max testing is a game-changer.
No matter where you are in your fitness or health journey, VO2 Max testing provides valuable insights that can help guide your path forward. At DFW Back to Health, we use these insights to help you set realistic goals, track your progress, and stay motivated. Whether you’re aiming to improve your stamina, lose weight, or just want to know more about your physical capabilities, VO2 Max testing is a powerful first step.
Components of VO2 Max Testing at DFW Back to Health
At DFW Back to Health in Dallas, our VO2 Max testing process is comprehensive, ensuring you get the most accurate and beneficial insights into your fitness and health. Here’s a closer look at the two main components of our VO2 Max testing service:
Resting Metabolic Rate Test
The resting metabolic rate (RMR) test measures how many calories your body burns at rest, providing crucial information about your metabolism. Understanding your RMR can help tailor your nutrition plan to your body’s specific needs, whether you’re looking to lose weight, gain muscle, or maintain your current physique. It’s a simple, non-invasive test that lays the groundwork for personalized dietary recommendations and a more effective fitness routine.
Active Metabolic Test
The active metabolic test assesses how your body uses oxygen and burns calories during exercise. This component of VO2 Max testing is key to optimizing your training intensity, understanding your aerobic and anaerobic thresholds, and improving endurance. By analyzing how your body responds to different levels of physical activity, we can create a customized workout plan that maximizes efficiency and results, helping you reach your fitness goals faster and more effectively.
What to Expect During Your VO2 Max Test at DFW Back to Health
How to Interpret Your VO2 Max Results with DFW Back to Health's Advanced AI Analysis
Integrating VO2 Max Results into Your Training Plan
VO2 Max Testing Frequently Asked Questions
The standard cost for a comprehensive VO2 Max test, which includes both the Resting Metabolic Rate (RMR) and Active Metabolic Rate (AMR) assessments, is $299. However, we believe in making this valuable test accessible to those committed to improving their health and fitness. That’s why we offer substantial discounts on VO2 Max testing as part of our treatment or weight loss plans. When you choose to engage in a broader program with us at DFW Back to Health, you can access these critical insights into your health and fitness at a more affordable rate, ensuring you have the tools you need to succeed in your health journey.
Absolutely. VO2 Max testing goes beyond traditional fitness assessments by offering a detailed look into your aerobic fitness—the cornerstone of your overall health and athletic performance. Whether you’re a seasoned athlete aiming to fine-tune your training or someone interested in improving their health, VO2 Max testing provides invaluable insights. It helps tailor your fitness and nutrition plans, ensuring you work smarter, not harder, towards your goals. Given its comprehensive benefits, VO2 Max testing is a worthwhile investment in understanding and enhancing your physical capabilities.
The cost of VO2 Max testing can vary, but at DFW Back to Health, we strive to provide value by combining the Resting Metabolic Rate (RMR) and Active Metabolic Rate (AMR) assessments for $299. While this might seem like a significant upfront cost, the personalized insights and tailored guidance you receive can be instrumental in optimizing your health and fitness regimen. Additionally, we offer discounts when VO2 Max testing is included as part of a treatment or weight loss plan, making it a more accessible option for those committed to their health journey.
VO2 Max testing is generally considered a specialized fitness assessment and may not be covered by all insurance plans. Coverage can depend on your insurance provider and the specific reasons for the test. In some cases, if the testing is recommended as part of a medical treatment for specific health conditions, it might be partially covered. We recommend checking with your insurance provider to understand your coverage options. At DFW Back to Health, we’re also here to discuss affordable solutions to ensure you can access the benefits of VO2 Max testing regardless of insurance constraints.


I don’t think pills work. But what your having is an allergic reaction and it’s doing your body more harm than good (although I don’t think much good would of come out of pills even if you didn’t have an allergic reaction.).
This is what I believe:
Just like PE, certain way works for some people not the other, and so drugs, some people can be healed by certain drugs not the other.
I took VigRX 2 weeks prior to my first exercise, I will say it DID NOT help enlargement, even until now I can get only FL gain, but I notice that my unit is fuller during daytime, no turtle.
As far as I know, pills work in the way it helps blood flow ONLY, but it does not targeting blood flow in the unit, ONLY exercise DOES targeting/helping blood flow in our unit.
My conclusion is if you are not allergic to any of the ingredient, then pills will help (a little bit though) the exercise.
VigRX does not contain L-Arginine & Zinc, that’s bad.


This just in from McLean Hospital, the Harvard-affiliated psychiatric hospital known as a major center for research on mental health:
Belmont, Mass. – Thanks to a $500,000 gift from international best-selling author and mental health advocate Patricia Cornwell, McLean Hospital and Harvard Medical School researchers will launch a landmark new program that will more fully explore the potential impact of medical marijuana on cognition, brain structure and function. This first-of-its-kind program, known as the Marijuana Investigations for Neuroscientific Discovery (MIND) Program, will also gauge study participants’ perceptions of their own quality of life as it relates to medical marijuana treatment.
“We are seeing the country’s view on marijuana shift dramatically and now is the time to allow science to inform our policies and our decisions,” said Cornwell, who is a member of McLean Hospital’s National Council and was presented with the hospital’s highest honor in 2012 for her mental health advocacy. “The MIND Program has the potential to revolutionize what we know about medical marijuana and what we think we know.”
Despite the move toward the legalization of medical marijuana, with 23 states and the District of Columbia legalizing its use, no published studies to date have assessed its direct and specific potential impact on cognition and brain function. Therefore, it is critical to investigate the impact that medical marijuana has on patients, the results of which could inform the course of treatment, safety guidelines and public policy. As the number of states who have passed medical marijuana laws continues to grow, the “need to know” has never been more important, relevant or timely.
“At this point, policy has vastly outpaced science, with little empirical data available regarding the impact of medical marijuana on cognitive function, despite the legal status of the product in a growing number of states,” said lead investigator Staci Gruber, PhD, director of the Cognitive and Clinical Neuroimaging Core at McLean Hospital and associate professor of Psychiatry at Harvard Medical School. “Findings from this investigation will ultimately foster a greater understanding of the impact of medical marijuana on cognitive function and brain structure, and may in turn facilitate the examination of the efficacy of marijuana for the different disorders for which it is prescribed.”
Medical marijuana is controversial, but few dispute that more research on it is needed as more states legalize it. Eager to sign up to be in a study? Dr. Gruber is already actively recruiting at firstname.lastname@example.org.


If you’ve had a rough day, you’re probably dying to head home and rip into any junk food you can find. How good is comfort food, right? Well, unfortunately, a new study has some bad news for you.
According to research published in the journal Brain, Behavior and Immunity, eating food high in saturated fats can affect your ability to cop with stress.
Scientists from Loma Linda University in California found that the parts of the brain responsible for handling fear and stress changed as a result of the diet, mirroring the behaviours usually linked to post-traumatic stress disorder (PTSD).
“The teen years are a very critical time for brain maturation, including how well (or not) we’ll cope with stress as adults,” says Dr. Johnny Figueroa, Assistant Professor, Division of Physiology, Department of Basic Sciences and Centre for Health Disparities and Molecular Medicine, Loma Linda University School of Medicine.
RELATED: Stress Could Be Limiting Your Gains
“The findings of our research support that the lifestyle decisions made during adolescence — even those as simple as your diet – can make a big difference in our ability to overcome every day challenges.”
The study observed the impact of a diet high in saturated fats on the development of the areas of the brain used to respond to fear and stress. Findings suggest that during adolescence, regular consumption of an obesogenic diet lead to changes in response to fear in adult rats. Interestingly, the diet affected their learning abilities and impaired fear-startle responses while the rats that consumed the high-saturated fat diet also displayed more anxiety.
The diet also impacted the rat’s ability to asses the level of threat in their surroundings while reducing the extinction of fear memories – a major impairment observed in people suffering from PTSD.
According to researchers, the results came down to the alterations in the structure of brain regions associated with PTSD, including the amygdala and the prefrontal cortex.
Figueroa and his team are still unsure if the alterations in the brain structure are permanent or whether the effects can be reversed. Regardless, the findings are still significant in helping overweight adolescents who develop anxiety and stress-related disorders.
Unfortunately there isn’t enough information on how the high-saturated fat diet impacts the adult brain.


Are People with Type 1 Diabetes Immunocompromised?
Editor’s Note:A version of this article first appeared at BenaroyaResearch.org from Benaroya Research Institute at Virginia Mason (BRI). BRI, a world-renowned biomedical research institute focusing on the immune system, is also a clinical center for type 1 Diabetes TrialNet, an international network that conducts clinical studies that evaluate new approaches to preventing, delaying and reversing the progression of type 1 diabetes.
It’s important to remember that having well-controlled diabetes alone does not seem to put anyone more at risk for contracting the novel coronavirus, but diabetes care itself is made far more complicated after contracting COVID-19. That’s why we encourage everyone with diabetes to get vaccinated, if your healthcare provider recommends it, as soon as possible.
Words like “immunocompromised” are broad by design: They’re meant to encompass how a wide variety of conditions impact the immune system. But when we see headlines like “COVID-19 vaccines might not work as well for people who are immunocompromised” it’s hard to know exactly what that means and if it applies to you.
We recently spoke with BRI immunologist Bernard Khor, MD, PhD. He provided context and clarity for people with immune-related conditions and their loved ones.
Does having an autoimmune disease mean you’re immunocompromised? Are people with Type 1 diabetes immunocompromised?
The term “immunocompromised” typically implies that your immune system is weaker than it should be. People with autoimmune diseases like type 1 diabetes aren’t typically considered immunocompromised, unless they take certain medications that slow down their immune system.
“The connotation for immunocompromised is that the immune function is reduced so you are more prone to infection,” Dr. Khor says. “Typical autoimmunity—say someone with type 1 diabetes (T1D)—is not necessarily associated with a highly increased risk of all infections or ineffective vaccine response.”
Dr. Khor explained that “immune dysregulated” could be a better term for most people with autoimmune disease. That means that the immune system isn’t quite working right, but that doesn’t necessarily impact your ability to fight off infection or respond to a vaccine.
What does immunocompromised mean?
Immunocompromised broadly means that your immune system isn’t working properly, typically in terms of its ability to fight off infection. This could happen for a number of reasons. As people age, their immune system gets weaker, affecting their ability to fight off infections. Immunodeficiencies and medications to suppress the immune system (often called immunomodulatory) can also compromise the immune system.
What is immunodeficient/immunodeficiency?
Immunodeficiency means that your immune system isn’t working properly, typically because important components (like cells) either aren’t present in adequate numbers or aren’t working properly. This can leave a person’s immune system in a weakened state, where it’s not as effective at fighting off bacteria or viruses.
“One well-understood example is people with AIDS (caused by uncontrolled HIV infection),” Dr. Khor says. “You see immune problems caused by the absence of important cells like T cells. There’s a physical deficiency that you can measure.”
I have read that some immunocompromised people may not mount a strong immune response to vaccines. Is this true? What does this mean?
In general, vaccines help train your immune system to fight off diseases. They do this by teaching the immune system to recognize an invader (say COVID-19) and attack if they see it, for example by making tiny proteins called antibodies. A “strong immune response” means the immune system has the right players in place, they know the game plan, and they’re strong enough to beat the other team.
But some people’s immune systems might have trouble training those proteins: Immunosuppressive drugs might slow some players down. With immunodeficiencies like HIV, people may be missing some players altogether.
“If everyone is moving slower or if you’re missing players, that might make it difficult to score a touchdown,” Dr. Khor says. “If the immune system is suppressed or missing certain components, it’s hard for the immune system to create the antibodies to fight off a virus.”
Most people with autoimmune diseases can make a protective response to vaccines. However, some therapies may change the body’s ability to respond to vaccination, including COVID-19 vaccination. BRI scientists are working hard to understand which medications impact the ability to respond to immunization, and how big of an impact this may have on infection risk.
The CDC recommends getting vaccinated as soon as possible and talking to your healthcare provider if you have questions about COVID-19 vaccination and underlying conditions.
How can we protect our loved ones who are immunocompromised and who may not be protected by the COVID-19 vaccine?
First, Dr. Khor recommends that the loved ones of immunocompromised people get vaccinated. “The more people are vaccinated, the fewer places the virus can hide, live, mutate and spread to those who are especially vulnerable,” he says.
People in close contact with high-risk populations can also continue to live in ways that minimize their risk of being exposed to COVID-19. That might mean gathering only with vaccinated or small groups, wearing masks, doing activities outdoors and avoiding crowded indoor spaces. Dr. Khor has continued to take many of these precautions despite being vaccinated, because his wife works in close contact with high-risk groups.
“Part of this challenge is not having all the answers,” he says. “For example, there are still questions about whether vaccinated people can spread the virus and if so, how likely that is. While we’re building better tools, better treatments and developing better understanding, for me there’s a component of personal choice. How much is this thing I want to do worth? Is it worth passing the virus to someone at risk?”
What is the Benaroya Research Institute doing to advance research surrounding vaccines for people with autoimmune disease and other conditions?
Most people with autoimmune diseases create a protective response to vaccines. BRI researchers are working to answer specific questions surrounding how some medications for these conditions may impact the ability to respond and if so, how much. Dr. Khor is also working on a study looking at how having Down syndrome affects the body’s response to COVID-19 vaccines. All of this work feeds into BRI’s larger goal of better understanding the immune system and working to predict, prevent and reverse disease.
“At BRI, we’ve developed much more sophisticated tools to bring to bear on this kind of problem,” Dr. Khor says. “For example, with vaccine response, we know the defense isn’t working right in some people. Next, we hope to figure out which particular player isn’t working right, and why. We want to develop a pipeline that allows us to say ‘it’s player number 74, he needs to run 2 miles per hour slower. It’s this specific cell and it needs this exact change’—and to have therapies that allow us to do that.”
Please consult with your health care provider if you have concerns about your health and before making any changes to your treatment plan. For more information about COVID-19 and diabetes, visit CoronavirusDiabetes.org