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How to Protect Your Child From COVID-19, Flu, and RSV This Fall

Sep 16, 2024 | Your Health

As summer comes to an end, it is common to see a rise in cases of respiratory viruses, such as influenza and respiratory syncytial virus (RSV). We have also seen what we now recognize as a seasonal rise in COVID-19 cases throughout the summer. Those combined with back-to-school season make it particularly important to stay vigilant with your child’s health and vaccinations.

Jennifer Duchon, MD, DrPH, MPH, Associate Professor of Pediatrics at the Icahn School of Medicine at Mount Sinai offers ways you can keep your child protected and discusses vaccination recommendations.

“Vaccines for influenza, RSV, and COVID-19 are our most important tools for preventing these viruses and their complications,” says Dr. Duchon. “Staying up to date on vaccinations is critical to safeguarding not only ourselves but our most vulnerable populations, including young children, the elderly, and those with weakened immune systems.

In addition, there are practices you can teach your child to prevent the spread of viruses. It is recommended that everyone wash their hands often, cover coughs and sneezes, and avoid people who are sick. If you are sick, try to stay home, and keep kids at home when they are sick.

COVID-19

Though COVID-19 cases are much lower than during the pandemic, there has still been a rise in the number of cases over the summer and it is advised that parents remain cautious.

Some symptoms of COVID-19 include a fever, cough, shortness of breath, congestion and fatigue. Symptoms may be similar to a cold or the flu, so it is important that if your child presents any symptoms, they get a test to determine the best course of treatment.

It is recommended that children over six months old receive the new COVID-19 vaccine, regardless of whether they have received doses of earlier versions. The updated COVID-19 vaccines are aimed at protecting people from the latest strains of the virus. The Pfizer and Moderna vaccines are similar to earlier versions, relying on the same “messenger RNA” or “mRNA” technology and are expected to remain effective as the new strains emerge throughout the year.

RSV

The respiratory syncytial virus (RSV) commonly causes mild, cold-like symptoms. The RSV “season” typically starts in October in the Northeast, and cases tend to reach a peak in December. Babies and young children are more at risk to develop severe RSV.

RSV is the most common cause of bronchiolitis and pneumonia in children younger than one year of age. Additionally, most of the deaths or severe disease from RSV occur in infants up to six months old.

The most at-risk groups are premature infants; infants younger than six months of age; children younger than two with chronic lung disease or congenital heart disease; children with weakened immune systems; and children who have neuromuscular disorders.

Early symptoms for infants and children include a runny nose, eating or drinking less, or a cough, which may progress to wheezing or difficulty breathing. Very young infants may display irritability, decreased activity, eating or drinking less or apnea (pauses in breathing for more than 10 seconds).

There are two immunizations strategies available to protect infants. Babies and some young children may receive an RSV antibody vaccine (passive immunization), nirsevimab. Nirsevimab contains monoclonal antibodies, which are man-made proteins that protect against RSV, and reduces the risk of severe RSV disease by approximately 80 percent. It is recommended to get this immunization between October and March.

Additionally, pregnant mothers may receive an RSV maternal vaccine (active vaccination), Abrysvo®, at weeks 32-36 of pregnancy. When a pregnant person receives this vaccine, their body responds by making a protein to protect against RSV. These are then passed to the baby. This vaccine is more than 80 percent effective in preventing severe RSV disease through three months of age and about 70 percent effective through six months of age. Immunization of pregnant people is recommended between September and January.

Speak to your health care provider to learn more about these vaccines and choose the right option for you.

Influenza

Children younger than five, especially those younger than two, are at a higher risk of developing serious flu-related complications. Children of any age with certain chronic health conditions are also at a higher risk. While children over five are not at a higher risk, they can spread the flu to vulnerable groups, such as older family members.

It is recommended that children over six months old get vaccinated, not only for their own protection, but to protect those around them. There are two types of vaccine options currently available: the flu shot or the nasal spray vaccine. Speak to your child’s health care provider to find out which vaccine would be right for your child. It is recommended to get vaccinated between September and October.

Are Women Who Drink More at Risk Than Men?

Updated on Sep 13, 2024 | Featured, Your Health

There are many areas where women and men face different health and medical issues. Now there is evidence that one area where they may differ is in a key part of our culture: how they respond to consuming alcoholic beverages.

For example, according to a recent study published in JAMA Health Forum, alcohol-related health issues rose faster among women than men during the pandemic. And surprisingly, women ages 40 to 64 experienced the fastest rate of increase. Another recent study found that women who binge drink are more likely to develop heart disease.

Timothy Brennan, MD, MPH

In this Q&A, Timothy Brennan, MD, MPH, Chief of Clinical Services for the Addiction Institute of Mount Sinai, discusses some of the ways alcohol can be harmful, including how alcohol can affect women differently than men and what you can do if you think you may have a drinking problem.

Why do women and men respond differently to alcohol?

People born biologically female or born with two X chromosomes, have a higher percentage of body fat and a lower percentage of water on average compared to men of the same weight. Alcohol is water soluble. So, if you’ve got a lower percentage of water, the alcohol concentration in a woman is higher after consumption of the same quantity of alcohol.

Here’s a scenario to illustrate: a biological XX person and biological XY person who have the same weight each consume three 12-ounce beers. The biological XX person will have a higher blood alcohol concentration compared to the other person and is therefore more impaired.

There’s also a difference in the way that women process alcohol. There’s an enzyme in our livers called alcohol dehydrogenase (ADH), that’s responsible for metabolizing alcohol in our bodies. Women have lower levels of ADH, meaning they have less ability to metabolize that alcohol. So bottom line, the alcohol hangs around longer and exerts more of an effect on women.

What amount is considered safe for a woman to drink?

Our understanding is evolving quickly, but what we now know is, no alcohol is best. Alcohol simply does not appear to convey any health benefit, whatsoever. There used to be some belief that drinking certain types of alcohol, red wine, for example, might lower your risk of cardiovascular disease. That doesn’t seem to be the case anymore. Different countries have looked at this question differently. The Canadian government has been much more emphatic than the United States that no alcohol is best.

However, if we’re defining “safe” as not being at risk to develop an alcohol use disorder, then we can look to the National Institute on Alcohol Abuse and Alcoholism for some general guidelines. They recommend that women have no more than seven drinks per week and no more than three drinks on any one day. By comparison, their recommendation for men is no more than 14 drinks per week and no more than four drinks on a single day. That means no more than a drink a day for a woman, which might strike the lay person as pretty low.

Isn’t it hard to limit drinks when we regard alcohol as a social lubricant and ingrained in our society?

Alcohol is pervasive in our cultures and in our social interactions. It’s ritualized across a variety of our holidays and traditions. It’s part of our everyday vernacular. It’s hard to even ask someone to do something in the evening without drinking being implied. Happy hour is a big component of our recreation.

But alcohol is technically a neurotoxin, which means that it is destructive to nerve tissue. I heard someone suggest that instead of using the term “alcohol,” we should use the term “neurotoxin.” It’s a provocative thought, but imagine someone saying, “Hey, would you like to get a couple neurotoxic beverages after work?” The response would most likely be, “Not really.” Just the way we talk about alcohol is very interesting.

A recent study found that women ages 40 to 64 were the fastest growing segment of people with alcohol related health problems during the pandemic. Why is that?

Most likely a lot of factors are involved. First, there’s the anxiety of society as a whole with the pandemic, so people turn to what they think are anxiety relieving products. However, the anxiety-relieving effects of alcohol diminish over time and actually promote anxiety. Someone may say, “Well, my wine is the only thing that helps,” and it becomes the thing that hurts the most with their anxiety in the long run. But on top of that, women tend to be responsible for the family, have the increased stress of children at home, and are managing an entirely new routine.

Plus, our social norms are that you really couldn’t drink on the job for the most part. But if you’re suddenly working at home, how would the boss know if you grab that glass of wine at 3 pm versus 6 pm? Nobody has any idea what you’re doing. And the normalization of drinking at home has been promoted with the advent of Zoom happy hours and social media memes.

Why is it important to discuss the health effects of alcohol?

It’s hard to find an organ system that’s not affected by alcohol. Classic examples that we talk about start off with the liver and liver damage. Types of liver damage can vary from what is called a fatty liver and advance to alcoholic hepatitis or alcoholic fibrosis. It can progress all the way to cirrhosis and liver failure, when the person will need a transplant.

Cardiovascular issues are pervasive among people who are heavy drinkers. Not only does it promote hypertension and high blood pressure, but heavy drinking also weakens the heart muscle and promotes arrhythmia, or irregular heartbeat, and stroke.

The gastrointestinal system or GI system can be irritated and develop ulcers or GI bleeds. The pancreas can frequently be acutely inflamed with alcohol and oftentimes people can develop pancreatitis. Alcohol is not safe for our brain, and long-term alcohol use can lead to cognitive impairment. It affects our psychiatric health and emotional health in many ways. Heavy alcohol use can interrupt our ability to metabolize certain vitamins and minerals such that people can develop chronic dementia. And alcohol can promote a variety of cancers. The way alcohol affects our body is very profound.

What is the difference between a heavy drinker and an alcoholic?

When we talk about alcoholism, the clinical term we use is alcohol use disorder. That’s a disease that’s been codified in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, or DSM-5. Alcohol use disorder is diagnosed by 11 different criteria. It’s not something you can diagnose with a blood test. If you’ve got two to three criteria, it’s mild. If you’ve got four to five, it’s moderate. If you’ve got more than five, that’s considered a severe alcohol use disorder. Heavy drinking is not defined in the DSM-5. But the guidelines from the National Institute on Alcohol Abuse and Alcoholism we discussed earlier define low risk drinking to high-risk drinking based on the number of drinks consumed in a week. Let’s say for example, a biological female has more than seven drinks per week. But a clinician goes through that DSM-5 criteria with them, and they have none of criteria. You can’t diagnose them with an alcohol use disorder. You wouldn’t call them an alcoholic, but technically, they’re a high-risk drinker. And I think it’s reasonable to classify high risk and heavy drinkers in the same way.

Now that the pandemic is over, would you expect less drinking-related health concerns?

It’s well established in our field that once a substance use disorder takes hold, it does not go away by simply changing one factor in our environment. Alcohol hijacks the reward pathway in our central nervous system. It’s very hard to break that cycle, without any treatment and without any actual abstinence.

What should people do if they think they have a problem with alcohol?

First, there are some patient-facing websites that allow a person to quantify their alcohol use and explore it. The National Institute of Alcohol Abuse and Alcoholism has a lot of great information and interactive tools. I also encourage people to talk to their doctor. Often, people don’t realize the damage alcohol is doing to their body. And they may be self-medicating because of some other issue, like struggling with sleep or anxiety. And revealing that to their doctor can address the primary issue.

If you think you have an alcohol use disorder, I encourage people to check out a meeting of Alcoholics Anonymous. You don’t need to be an alcoholic to go to an AA meeting—there are Open Meetings where anyone can attend. And if you determine that you do have an alcohol use disorder, I always recommend that people get formal addiction treatment. And by that, I mean finding someone who is board-certified in addiction medicine. I trained in pediatrics, and then followed that with an addiction medicine fellowship. Unlike addiction psychiatry, addiction medicine is a multi-specialty subspecialty so there are a lot of different paths into it. Mine was pediatrics, but others might be internal medicine or family medicine. The good news is, there is a lot of help and resources for people seeking help.

Learn more about the Addiction Institute of Mount Sinai

Fertility Options for Patients Facing Cancer and Hereditary Cancer Risk

Updated on Sep 7, 2024 | Your Health

A diagnosis of cancer, or knowing you have genes that mean you have an elevated risk for cancer, can complicate family planning decisions. Cancer treatments can affect your fertility, while a diagnosis of “hereditary cancers,” notably breast or ovarian cancer, will likely affect plans for conception.

While making decisions about whether to preserve your fertility isn’t simple, knowing your options can empower you to take proactive steps that will match your family-building goals.

In this Q&A, Matthew Lederman, MD, and Jovana Lekovich, MD, Assistant Clinical Professors in the Raquel and Jaime Gilinski Department of Obstetrics, Gynecology and Reproductive Science at the Icahn School of Medicine at Mount Sinai and Reproductive Endocrinologists at RMA of New York, explain fertility preservation options for patients with cancer or who have a risk of hereditary cancer. Dr. Lekovich is also Director of the Oncofertility Program at the Blavatnik Family Chelsea Medical Center at Mount Sinai.

What is a hereditary cancer?

The most common hereditary cancer syndromes are the result of mutations of the BRCA1 and BRCA2 genes. These genes typically produce tumor suppressor proteins that help repair damaged DNA. However, when either of these genes is mutated or does not function properly, DNA damage is not repaired properly, and cells are more likely to develop genetic alterations that can lead to cancer.

What types of cancers are commonly seen as a result of these mutations?

Women with a BRCA mutation have an estimated 50-85 percent lifetime risk of developing breast cancer, an estimated 16-60 percent lifetime risk of developing ovarian cancer, and are at a higher risk of developing either of these cancers at much younger ages.

How can a hereditary cancer or a cancer diagnosis affect my fertility?

Individuals diagnosed with cancer or who face a risk of hereditary cancer may face issues regarding their desire to conceive, including:

If and when to undergo risk-reducing surgery, particularly the removal of fallopian tubes and ovaries
Potential risk of a diminished ovarian reserve, which can result in lower egg quality and quantity
Age, which plays a role in all women’s fertility
Desired family size
Possibility of passing on the BRCA mutation since there is a 50 percent chance an offspring will be a carrier

What fertility options are available for cancer patients?

Patients who want to preserve their fertility may elect to freeze their eggs, a process called oncofertility, or may decide to undergo a less invasive option such as hormone monitoring.

What is oncofertility?

Cancer treatments such as chemotherapy or radiation are considered gonadotoxic treatments, which means treatments that could potentially harm your reproductive system and fertility. Oncofertility is the process of preserving fertility prior to undergoing those treatments. Eggs are frozen using a process called vitrification, which preserves them at their current age. In the future, they can be thawed, fertilized, and implanted to achieve a successful pregnancy, even if your fallopian tubes and ovaries have been removed. Embryos can also be frozen.

What is hormone monitoring?

If you are not ready to consider egg or embryo freezing but still want to be proactive, a less invasive option is hormone monitoring. Annual monitoring of your ovarian reserve includes a blood test to evaluate AMH (Anti-Mullerian hormone) and a transvaginal ultrasound of the ovaries to assess follicle count. A reproductive endocrinologist and fertility specialist can help you evaluate your fertility and decide the right time to freeze eggs and/or embryos.

How does RMA of New York work with the Blavatnik Family Chelsea Medical Center at Mount Sinai to provide fertility preservation treatments for individuals diagnosed with cancer?

Through an expedited referral process, RMA of New York works with a patient’s oncology team to schedule an appointment with a reproductive endocrinologist within 48 hours of initial contact and prior to any gonadotoxic treatments. In most cases, fertility preservation procedures can be completed within weeks of that initial appointment and scheduled around cancer diagnostic procedures and treatments. In this way, patients are able to preserve their fertility, and safely store their specimens until they are ready to focus on building a family.

To learn more about your carrier status or to assess your fertility, make an appointment with a reproductive specialist at RMA of New York.

New Clinical Trial Offers Hope for Pediatric Patients With Alopecia Areata

Sep 5, 2024 | Your Health

Emma Guttman, MD, PhD, with a young patient before and after treatment. To see if your child qualifies for the new clinical trial, email our Clinical Research Program Director, Giselle Singer at giselle.singer@mssm.edu .

Pediatric alopecia areata, an autoimmune skin disease that causes hair loss, affects about 1 in 1,000 children and teens. Alopecia areata often first appears in childhood, with 40 percent of people with alopecia developing symptoms before the age of 40.

While alopecia areata is not a life-threatening condition, it can be devastating to live with this disease, according to Emma Guttman, MD, PhD, the Waldman Professor and System Chair of Dermatology and Immunology at the Icahn School of Medicine at Mount Sinai.

“This condition has a tremendous negative psychological impact on many people who suffer from it, and those difficulties can be unique in the pediatric population compared with adults,” says Dr. Guttman. For example, about half of teens report that they’re embarrassed by their hair loss and 40 percent say that they’ve been bullied, according to the National Alopecia Areata Foundation.

In this Q&A, Benjamin Ungar, MD, Director of the Alopecia Center of Excellence, explains how pediatric patients and their families can find some relief and discussed the latest clinical trial at the Center.

“We have motivated patients who come to Mount Sinai seeking help, as well as a fantastic team of researchers working together to identify new treatment targets and design clinical trials to establish new treatments,” he says.

Out of all the clinical trials your department is doing, is there one you are most passionate about and why?

We’re excited about many trials, but one that comes to mind is the clinical trial with dupilumab in children in partnership with the National Institutes of Health (NIH). This is a population with a serious unmet need for safe and effective treatments.

What do you hope to accomplish with this clinical trial?

The NIH grant for the clinical trial for dupilumab in children is so exciting because it offers promise and hope for a population in need. We aim to evaluate dupilumab, which has been shown to be extremely safe in atopic dermatitis and other conditions, as an effective treatment for children with alopecia areata. Additionally, this trial will serve to provide insights into what causes the disease that will help progress future research.

Does alopecia areata differ at all in its presentation, severity, or prognosis in children than in adults?

Overall, alopecia areata in childhood generally presents similarly in children and adults, although an earlier onset in life can be associated with a worse prognosis in terms of severity and response to treatment. It’s also important to note that this condition has a tremendous negative psychological impact on many people who live with it, and those difficulties can be unique in the pediatric population compared with adults.

Why is it so important to develop treatments for children with moderate to severe alopecia?

We understand that it’s important to treat this disease within a few years of its onset, as the longer it goes untreated, the less likely an excellent response to treatment will occur.

To see if your child qualifies for the new clinical trial, email our Clinical Research Program Director, Giselle Singer at giselle.singer@mssm.edu .

Learn more about the Alopecia Center of Excellence:

Learn more about the new NIH clinical trial

The Facts About Food Poisoning: Most Cases Happen at Home

Sep 4, 2024 | Your Health

Food poisoning is more common than you think. According to the U.S. Centers for Disease Control and Prevention (CDC), about one in six people in the United States get food poisoning each year. That’s about 48 million people. We usually only hear about food poisoning when there’s a food recall or when a restaurant is linked to an outbreak. In cases like this it may become big news, as it did recently after the CDC posted an alert about recalls of some deli meats due to contamination with listeria.

Most cases of food poisoning come from improperly prepared meals at home or at outdoor gatherings where food like deviled eggs, tuna salad, or other dishes sit out in the sun for too long. In this Q&A, Bernard Camins, MD, Professor of Medicine (Infectious Diseases) at the Icahn School of Medicine at Mount Sinai and the Medical Director for Infection Prevention for the Mount Sinai Health System, discusses food poisoning and when you may need to go seek medical care.

What are the symptoms of food poisoning?

Symptoms of food poisoning can include nausea, vomiting, diarrhea, and sometimes fever. You may not have these symptoms right away. Depending on the type of food poisoning you have, it can take 24 to 48 hours, or even a little longer, until you develop symptoms.

When should I go to the doctor?

Most people recover from food poisoning on their own. Once your body has eliminated the toxin or the offending agent, you may recover on your own. If you experience symptoms for more than three days, if you become dehydrated and cannot keep liquids down, or if you have a fever for more than 24 hours, it’s time to see a physician.

How do I prevent food poisoning?

The majority of food poisoning happens at home. There are a few basic rules to prevent it:

Washing is very important. Wash your hands with soap and warm water for at least 20 seconds before, during, and after preparing food, and before eating. Always wash your hands after handling eggs, flour, or uncooked meat. Don’t forget to rinse your fruits and vegetables under running water. Also, wash your knives and other utensils, cutting boards, and countertops with hot soapy water after preparing each type of food, especially raw meat or unwashed vegetables.
Keep uncooked meat, poultry, fish, and eggs separate from everything else. They harbor bacteria that can cause infections. That means keeping them separate all the way from the supermarket to your refrigerator at home. Meat, poultry, and fish, especially might leak liquids that could spread germs. If possible, use two cutting boards—one for raw meat, seafood, and poultry and another one for produce, bread, and other foods you serve raw.
Cook meat, poultry, and fish to the recommended temperature. You can use a meat thermometer to check. If you use the microwave, follow the directions carefully; for instance, letting food sit after you’ve microwaved it can help it cook more thoroughly.
Refrigerate your food carefully. Don’t let perishables sit out on the table or counter for more than two hours—or, if it’s over 90 degrees Fahrenheit, not more than one hour. Thaw food in the refrigerator, in cold water, or in the microwave, not on the counter. Thawing on the counter can allow bacteria to grow more quickly.
Keep on top of food recalls. You can check the website from the CDC to see what foods are being recalled due to contamination. If it turns out you have a food that has been recalled, throw that food out right away. Then clean the refrigerator shelves and drawers thoroughly, because germs in the recalled food could easily spread throughout your fridge.

What are the most common causes of food poisoning?

The most common causes of food poisoning are:

Norovirus: This highly contagious virus causes vomiting and diarrhea. This has caused numerous outbreaks on cruise ships.
Salmonella (non–typhoid): Salmonella is actually the name of the bacteria that causes infection from contaminated food. The salmonella infection leads to diarrhea, fever, and stomach cramps.
Clostridium perfringens: Caused by meat, poultry, and gravy kept at an unsafe temperature, clostridium perfringens results in diarrhea and stomach cramps.
Campylobacter: Usually stemming from eating raw or uncooked poultry or drinking untreated water, campylobacter gives you diarrhea.
Staphylococcus aureus: This bacterium primarily causes skin and soft tissue infection. Some people can carry it on their hands. When they prepare or serve food without washing hands, this bacteria can produce a toxin that causes nausea, vomiting, stomach cramps, and diarrhea.

It is worth noting that listeriosis, or listeria infection, is rare compared with these other illnesses. Listeriosis can become serious and can be fatal for people at higher risk for severe disease, such as the elderly, pregnant persons, and people with weakened immune systems. The CDC says that the good news is that the listeria bacteria are easily killed by heating food to a high enough temperatures, and following the other basic food-safety steps.

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Are Artificial Sweeteners Good for Me?

Updated on Aug 29, 2024 | Endocrinology, Your Health

Whether you prefer sugar substitutes in your coffee or enjoy artificially sweetened foods, you may wonder how these products affect your body, and if there are potential health risks.

David Lam, MD

In this Q&A, David Lam, MD, Medical Director of the Clinical Diabetes Institute at the Icahn School of Medicine at Mount Sinai, explains what the research says and how to use artificial sweeteners for weight loss.

What are the health benefits of using artificial sweeteners?

The only demonstrated health benefit of artificial sweeteners is they reduce your chances for developing cavities. These sweeteners have zero or very few calories, compared with sugar. However, for those who are looking to reduce their weight or control diabetes, the research is conflicting. There is some evidence that in the short term, there are some improvements in weight loss and glucose control, but the research is not definitive on whether artificial sweeteners help with weight loss in the long term.

What are the potential risks?

There are concerns about whether sugar substitutes increase your risk for cardiovascular complications and diabetes. However, for each study that shows an increased risk, another shows it’s not so defined. While the research so far is inconclusive, patients should be aware these questions exist.

One thing you do need to be wary of—the blanket terms “artificial sweeteners” and “sugar substitutes” are broad.

What are the different types of artificial sweeteners?

Sugar substitutes generally fall into three categories:

Synthetic sugars are made in laboratories and factories. Examples include Sweet’N Low^® and Splenda^®.
Sugar alcohols are often found in processed foods labeled as diet products. Despite the name, these products don’t contain actual alcohol. Unlike synthetic sugar, sugar alcohols can affect your blood sugar, so the marketing labels on these products (e.g., “sugar free”) may be misleading. Additionally, people who have underlying digestive problems may have a negative reaction to sugar alcohols, such as stomach upset and bowel movement changes.
Natural sugar substitutes, such as Stevia, are extracted from plants. These sugar substitutes are processed in laboratories and factories, but are essentially natural products, such as agave or honey.

How can I know if a food product contains sugar alcohol?

Sugar alcohols are usually found in diet products labeled “sugar free.” If you look at the food label and see ingredients ending in “ol” as in alcohol—such as sorbitol, xylitol, maltitol—it contains sugar alcohols.

Is there a way I can use artificial sweeteners for weight loss?

Artificial sweeteners are useful for weening yourself off added sugar and gradually adapting a wholefood diet. We know they are not effective long term. A doctor or dietician can guide you on how to create a long-term weight loss plan that works for you. For example, a nutritionist can help you understand how to integrate whole fruits into your diet. While fruits contain sugar, they also contain fiber and other nutrients that are part of a wholesome diet, and can be a healthy substitute for processed snacks. Ultimately, there is no one perfect solution for weight loss. You need to weigh the pros and cons of artificial sweeteners on an individual level, and a health care professional can help you do that.

Concerned about your blood sugar and weight? Schedule an appointment with a primary care physician

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