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I keep hearing about New World Screwworm in the news. Can you tell me more about it?

A parasitic fly called the New World Screwworm has recently been found in US animals for the first time in decades. Although the current risk to people in the US is very low, it’s worth knowing the signs, especially if you have pets and live in an affected area.

What is New World Screwworm (NWS)?

New World Screwworm (Cochliomyia hominivorax) is a parasitic fly whose larvae (maggots) burrow into, AKA infest, and feed on the living tissue of animals with warm blood, including livestock, pets, and people. This is unlike most other types of fly larvae that feed on dead tissue. It can cause severe wounds and, if it’s not treated, can cause death.

(Source: CDC)

Although people can be affected too, this is very rare. Human cases typically involve larvae burrowing down into an existing wound. The main concern right now is livestock. If New World Screwworm gains a foothold in the US, it could cause shortages of animal products like meat, milk, and other products that use animal components. And this could result in economic damage to rural areas.

How did we get here?

The US eliminated New World Screwworm in the 1960s using a technique called the Sterile Insect Technique (SIT), which involves releasing huge numbers of lab-sterilized male flies to interrupt reproduction. This technique was used all the way south to Panama and a biological barrier created using these sterile insects in Panama kept the flies in check for decades. But unfortunately in 2023, Panama and Costa Rica identified a new outbreak. Since then, every country in Central America and Mexico where screwworm had previously been controlled has reported cases and there have been more than 185,000 animal cases and over 2,200 human cases reported in the region [archived link].

🤓Nerd alert: Although many sources speak of the eradication of New World Screwworm, in the traditional epi-sense this isn’t strictly true. Let’s break it down:

Eradication means a disease has been wiped out globally, so not just in one part of the world or one country. There are only two diseases that have truly been eradicated: smallpox (in humans) and rinderpest (in animals).

Elimination means that a disease has been wiped out in a specific geographical region, like the US.

So in the case of New World Screwworm, it was eliminated from the US through Central America as far as Panama, but it remains endemic (meaning it circulates at a steady, ongoing level) across much of South America and parts of the Caribbean..

What’s happening in the US right now?

On June 3, 2026, the U.S. Department of Agriculture (USDA) confirmed the first animal case in the United States since a small outbreak in deer in Florida in 2016. Additional cases in Texas and New Mexico have since been confirmed in a dog, some sheep and goats [archived link]. The USDA has a dashboard tracking cases, which you can access here and our friends at GenomicEpi.com have also created a great tool to keep track.

So far there have been no reports of human cases from this outbreak. The risk to people remains low and is concentrated in areas where screwworm flies are actively circulating. However, some humans are more at risk than others [archived link]. Unhoused people with limited access to healthcare are especially vulnerable, as well as agricultural workers and people with open wounds, for example due to diabetes or other skin conditions. If you travel to Central America or Mexico, you should make sure any wounds on your body are covered and watch for signs of an infestation. If you live in the Southwest and have pets that go outside, you should regularly check them for wounds and keep them indoors if they are injured.

⚖️ Health Equity Alert

Farm workers, a workforce that is majority immigrant in many US regions, can be at higher risk for several reasons: Close contact with livestock raises their risk of exposure to screwworm flies. Once affected, additional barriers can delay or prevent people from seeking treatment. These can include the fear of immigration consequences or job loss if seeking health care. Limited access to healthcare can also be due to language barriers, long working hours beyond clinic opening times and living in rural locations with long distances to healthcare facilities. Unhoused people who sleep outdoors are also at higher risk for many health problems, including New World Screwworm and complications arising from infections.

So, should I be worried and is there anything I can do?

🔶 If you live in the US, but DON’T have livestock or pets, and you live in an area that is NOT currently affected, the risk of getting an infestation for you or your animals right now is very low. The bigger concern in the near term is about animal health and the impact on farming.

🔶 If you DO live in an area where NWS has been reported, and in particular if you have contact with or own cattle or pets, keep an eye out for any suspicious-looking maggot-infested wounds in your animals or in yourself.

This includes unusual wound activity, like swelling, an unpleasant smell or discharge from wounds in animals or in yourself. Wounds may also look different because they contain maggots or eggs, and you may see little openings where parts of the maggots poke out.

(Source: USDA National Agricultural Library)

Those wounds can smell really bad, and an affected animal may not want to eat, may be distressed, or isolating itself from others. So, if you are in doubt, get them checked out.

😅There is one bit of good news though: The FDA recently gave emergency use authorizations for drugs that can treat dogs and cats infested with New World Screwworm [archived link].

🔶 If you’re traveling to Mexico,Central America or South America, it’s worth knowing the signs of an infestation that we mention above, and if you have existing wounds, keep them clean and covered, especially if you have contact with livestock and pets. It is also recommended to wear long-sleeved tops and pants and to use an EPA-approved insect repellent.

Bottom line: New World Screwworm is worth taking seriously. This is not because most of us face a personal health risk, but because it’s a developing situation and the stakes for animals, agricultural communities, and vulnerable people in affected areas are real. If you have livestock or pets in affected areas, stay alert. For everyone else, stay curious. We’ll keep watching this one and update you as things develop.

Stay well, stay curious.

Love,

Those Nerdy Girls

Useful links:

Centers for Disease Control and Prevention (CDC): NWS - Clinical Overview [archived link]

NWS - Outbreak Summary [archived link]

Animal and Plant Health Inspection Service (APHIS): Confirmed detection of NWS

Report suspected cases of NWS [archived link]

NWS story map [archived link]

Genomic Epi - NWS tracker

The Guardian - Farm workers at high risk amid US NSW outbreak

CIDRAP - How to prevent NWS infestations in cats and dogs

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What’s going on with this outbreak of diarrhea in the US?

There is an outbreak of cyclosporiasis happening. It’s a parasite that causes horrible diarrhea. Although we don’t know yet what the source is, there are ways to reduce your risk of getting infected.

Although most cases have been reported in Michigan, more than 30 states are affected, so it’s worth knowing the symptoms and how you can reduce your risk of getting it.

So what is this cyclo-thing?

Cyclosporiasis (yes, it’s a mouthful!) is a parasite that causes an infection in your gut. It spreads through food or water that is contaminated with human faeces (AKA poop). The good news is that this does not directly spread from person to person. You can’t get this if you are around someone who is infected, as the parasite needs to “sporulate”, which means the parasite needs time - days to weeks - in the environment to develop into a form that can infect people.

What are the main symptoms?

💩💥 The main symptom is watery and sometimes explosive diarrhea. When we talk about “explosive”, this means sudden onset, uncontrolled, and very watery.

🤢 Other symptoms include nausea, vomiting, stomach cramps and fatigue. Some folks also get a fever - these are all classic gastrointestinal symptoms (meaning they affect the stomach and gut).

🗓️ Symptoms usually show up within a week or so of exposure, but in some cases, it may be days, and in others weeks. And some folks never show any symptoms. Because of this delay in symptom onset, epidemiologists are having a hard time tracking down exactly what is causing this outbreak.

What do I do if I get it?

Although this is very unpleasant and can be severe in cases, the biggest risk is dehydration (loss of fluid) from the diarrhoea, so keeping your fluids up is really important. This is especially important for older folks, pregnant people, those who are immunocompromised, and kids, so make sure you contact a trusted clinician if you are worried.

If you have been diagnosed with cyclosporiasis (normally through a stool sample), your clinician might prescribe a course of antibiotics that kills the parasite.

💡If you’re getting tested, make sure to mention cyclosporiasis to your clinician specifically, as it’s not always included in standard stool testing.

Symptoms usually go away on their own after a few days, but it’s possible to experience diarrhoea on and off for a few weeks after. And especially if it’s been untreated, some people can experience relapses, meaning symptoms can come back, even months later.

It’s still not clear yet what the source of this outbreak is, but here are some general tips if you want to reduce the risk of getting an infection:

🥗In the past, the main culprits have been fresh foods like bagged lettuce, leafy greens, fresh herbs like cilantro (also called coriander in some parts of the world) and berries, so one option is to avoid these types of products until we know more.

🔶Cooking vegetables is the safest option as it kills the parasite. It needs to be 158F (or 70C), though. And if you use a microwave, temperatures need to be even higher.

Lettuce might be a bit meh if cooked, so if you want to eat lettuce, buy a head, peel off and throw away the outer layers, then wash each remaining leaf thoroughly. It won’t kill or remove all of the parasites if they’re present, but it’s a better option than bagged salad.

🔶 If you choose to eat raw fresh fruit or vegetables, make sure you wash them thoroughly (this might not get rid of all the parasites, but it can lower the count). And avoiding veggies and fruit with lots of wrinkles is also a good idea (the parasite loves to hide in nooks and crannies!)

🔶 Buy fresh fruit and vegetables you can peel - think cucumber, melon, bananas and the like. Make sure you still wash them, though.

🔶 If you can, buying local produce from a farmers’ market is also less risky, and even better if you grow your own.

🔶 Consider avoiding raw food when eating out, as you won’t necessarily know where the produce is from.

🫧Thorough general hygiene routines around food preparation are always a good idea too. This includes washing your hands with soap and water before and after preparing raw veggies and fruit, and also cleaning work surfaces.

Something to be aware of:

The internet is rife with claims about “parasite cleansing” - an unproven “treatment” that usually consists of a combination of laxatives and herbal supplements. There is no evidence that they work, and in fact, they might make matters worse, especially if you are already dehydrated.

As always, we’ll keep watching this one for you.

Stay safe. Stay well.

Love,

Those Nerdy Girls

Useful resources:

Michigan Department of Health and Human Services (MDHHS) - Recommendations on preventing food-borne illness

Centers for Disease Control and Prevention(CDC) - Cyclosporiasis [archived link]

CDC - Surveillance of Cyclosporiasis [archived link]

CDC - Clinical Care of Cyclosporiasis [archived link]

NPR - What to know about the cyclosporiasis outbreak hitting more than half of U.S. states

Cleveland Clinic - No, you don’t need a “parasite cleanse”

And if you want to nerd out and dive a little deeper, check out this brief by The Evidence Collective with tons of information

(information correct as of 7/12/26)

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What is an asthma action plan?

An asthma action plan is a form that you fill out with a clinician that details asthma medications, triggers, symptoms, and plans for asthma flares.

An asthma action plan is a clinician-approved guide that covers medications, triggers, symptoms, and ER guidelines for people with asthma. You fill out the form with your clinician and it’s an important way to learn about and manage asthma. Asthma education generally helps reduce hospitalization and emergency department visits. An Asthma action plan can help people manage asthma and decrease missed time from work and school. Parents of children with asthma should share the plan with a kiddo’s school and anyone else who might look after their child.

Ultimately, the goal of an asthma action plan is to help control asthma and prevent flare-ups so that asthma doesn’t interfere with sleep or daily activities.

What is asthma?

First, we’ll start with lung anatomy. Imagine the lungs as upside down trees. The trunk of the tree is the trachea, aka the windpipe, which is the tube that helps guide the air you breathe in. The air goes from your nose into your pharynx then into your larynx then the trachea into the bronchi. The bronchi are the larger branches that go off the tree trunk. Those separate into smaller branches called bronchioles. Eventually, those branches end in little sacs, which you can think of as leaves on this upside down tree, called alveoli that fill up with air and then help the oxygen get to your blood. Lungs also produce mucus to help trap any dust or dirt that you breathe in. Ultimately, you cough up or swallow mucus to get rid of the trapped mucus.

Allergic asthma is the most common type of asthma, that includes inflammation in the airways. The inflammation is caused by immune cells, which are also involved in allergies and hives (which is why clinicians might talk about the triad of asthma, eczema, and allergies, which often occur together). These cells release molecules when someone encounters a specific trigger, such as dust or pollen. These molecules cause the bronchioles (the small branches of the tree) to tighten too much, which can make someone with asthma feel short of breath, experience chest tightness and wheezing. People with asthma also produce increased amounts of mucus in the lungs, which can also make it hard to breathe. All these symptoms can be distressing and interfere with work, school, and sleep. That’s why early diagnosis and an asthma action plan is so important for people living with asthma.

What are asthma triggers?

Knowing your asthma triggers can also help reduce asthma exacerbations. Common triggers include dust mites, cockroaches and rodents, animal fur, mold, pollen, tobacco smoke, cold air, and certain medications, but you should work with your clinician to try to identify what your triggers are.

How is asthma managed?

Since asthma treatment plans often involve multiple medications that are each used differently and may change over time, it can feel pretty complicated to keep straight. This is why asthma action plans can be so helpful. These plans can look a bit different depending on your age, but they usually include a fast-acting inhaler for quick symptom relief and a maintenance (or “controller”) one for prevention — sometimes the same inhaler can be used for both. Some plans may also include allergy medications to prevent asthma triggers.

For many years, a short-acting beta-2 agonist, or SABA, has been used alone as a “rescue” inhaler when asthma symptoms flare. This type of medication is a bronchodilator, which means it helps open up the airways. Today, it’s more common for clinicians to recommend a combination inhaler. These may contain a bronchodilator such as a SABA or a long-acting beta-2 agonist (LABA), along with an inhaled corticosteroid (ICS), which lowers inflammation in the lungs. Only some types can be used for quick relief while others are only used as maintenance treatments. Your asthma plan explains exactly which inhaler is for daily use and which is for quick relief.

There are also newer therapies that may be added if maintenance inhalers alone aren’t enough to control symptoms. These are called biologics and are usually given as shots.

Overall, when determining what medicine to use, clinicians use a step-wise approach to adjust your medicines to your changing symptoms and severity to show it can go up or down. But there is no one plan for everyone and it’s common for plans to change over time.

It’s also essential that you or your child know how to use your inhaler properly. Not all inhalers have the same instructions, so make sure to ask your clinician or pharmacist for guidance on how to use your specific type.

What does an asthma action plan include?

Most asthma action plans are color coded. Here are some examples:

(Source:Allergy and Asthma Network)

(Source: American Lung Association)

(Source:American Academy of Pediatrics)

🟩 The green section discusses how to manage asthma when the person with asthma is doing well.

🟨 The yellow section walks through signs of worsening asthma and how to treat it.

🟥 The red section helps folks make plans for a severe asthma flare up.

Each section will list which medications to take, how much, and how often they should be taken.

What do green/yellow/red symptoms look like?

🟩 The green zone:

The person isn’t coughing or wheezing, they can do all their normal activities, and they aren’t waking up coughing or feeling short of breath.

🟨 The yellow zone:

They can feel short of breath, cough or wheeze more frequently, have trouble doing their normal activities and they might wake up at night coughing or wheezing.

🟥 The red zone includes:

Severe breathing problems, difficulty with activities like walking and talking, and their regular medications aren’t helping.

If someone is in the red, this is serious and a medical emergency, and they should be taken to the hospital.

Some asthma action plans also include a section for your primary care clinician’s contact information in case of emergencies.

⚖️ Health Equity Alert

Children who live in cities have increased rates of asthma symptoms and hospitalizations. Studies have shown that increased pollution also worsens asthma. There are also racial disparities in asthma hospitalizations and visits to the emergency room in Medicaid-enrolled children with asthma. Though asthma action plans are an important start, addressing racial health disparities and pollution will go a long way to keeping kids with asthma healthy.

Everyone with asthma should see their clinician regularly to update their plan. Knowing your asthma triggers and how to handle each zone can help improve asthma control and reduce asthma attacks.

Resources and useful information:

Medscape - Asthma

Global Initiative for Asthma (GINA) - Global Strategy for Asthma Management and Prevention (2025)

Yale Medicine - Still Using the Same Rescue Inhaler for Asthma? You Might Have Better Options

Action Plans:

Allergy and Asthma Network - Asthma Action Plan

American Academy of Pediatrics - Asthma Action Plan

American Lung Association - Create an Asthma Action Plan

ICYMI - Digest of Recent Posts:

Data Literacy: What are heuristics, and why does this matter?

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What do I need to know about daraxonrasib, the new treatment for pancreatic cancer?

A new drug called daraxonrasib nearly doubled survival time for patients enrolled in a phase-3 clinical trial. That’s a big deal, because treatment options for pancreatic cancer are limited and survival rates at 5 years are very low.

In 2002, my grandmother was diagnosed with pancreatic cancer. Six months later she was admitted to hospice, and less than a year after her diagnosis, she passed away. I can still remember how alarmingly fast the disease took her. It felt like one day she was her usual energetic self, and the next she was fading away before our eyes.

More than 20 years later, treatment options that slow progression and extend life remain far too limited for many people diagnosed with pancreatic cancer. Regardless of stage, only 13% of people diagnosed with pancreatic cancer are still alive after 5 years [archived link]. Despite the fact that pancreatic cancer only accounts for about 3% of all annual cancer diagnoses, it is the third leading cause of cancer deaths in the U.S., after lung and colorectal cancers [archived link].

What is pancreatic cancer?

There are two main types of pancreatic cancer: exocrine and endocrine. Pancreatic exocrine cancer arises from cells that produce digestive juices and includes the most common type of pancreatic cancer (pancreatic ductal adenocarcinoma, or PDAC). Pancreatic endocrine cancer occurs when tumors form in pancreatic cells that produce hormones. It is much rarer than PDAC and makes up less than 5% of all diagnoses. Unfortunately, the PDAC is also one of the most aggressive types of cancer that has ever been discovered. Pancreatic cancer cells are nested within tough scar tissue, and the genetic changes, or mutations, that cause the cancer also result in changes to the pancreas that further support its survival and growth. Compared with other gastrointestinal cancers, pancreatic cancer is often harder to treat with traditional chemotherapy because of these unique features.

Why is pancreatic cancer so difficult to diagnose and treat?

Source: PDQ Cancer Information Summaries

Part of the difficulty of diagnosing and treating pancreatic cancer is simply the location of the pancreas. It is a small organ that sits deep in the abdomen just below the liver and behind the stomach. Because of this, it is not possible for a clinician to examine from the outside of the body.

Even more problematic is the fact that early symptoms of pancreatic cancer are either mild and non-specific (meaning that they can be caused by a wide range of other health problems), or absent altogether. There are also no reliable routine early screening tools available. Pancreatic cancer survival rates are much better when a diagnosis is made early when surgery is still possible (discussed below), but because it is so difficult to detect, it is usually caught later when treatments are no longer as effective.

What are the risk factors for pancreatic cancer?

Pancreatic cancer has many of the same risk factors as other more common cancers. It is usually diagnosed in older patients, with average age at diagnosis around 70 years old. Other common risk factors include tobacco use, having excess body weight, type 2 diabetes, chronic pancreatitis, and heavy exposure to chemicals used in dry cleaning and metal-working. There are also some genetic risk factors for pancreatic cancer. For example, genes that cause hereditary breast cancer (BRCA1/BRCA2/PALB2) also raise the risk for pancreatic cancer. However, only 1 in 10 people with pancreatic cancer have an identifiable inherited risk factor. It is also worth noting that cancer, including pancreatic cancer, disproportionately affects some groups more than others due to health disparities.

What treatments are available?

The usual cancer treatments, such as surgery, chemotherapy, and radiation, are currently used to treat pancreatic cancer. People treated with surgery tend to have the best chance of survival because surgery is only possible if the cancer is caught early, before it has spread. Surgery is also the only treatment that can cure pancreatic cancer. There are few second-line options to treat pancreatic cancer besides additional chemotherapy. There are some immunotherapy options and newer targeted therapies, but only a small percentage of patients qualify for them. There are ongoing clinical trials to develop more immunotherapies.

What is daraxonrasib and what makes it different?

Daraxonrasib is a type of drug known as a targeted RAS inhibitor [archived link]. Some cancers make a broken version of a protein called RAS. In healthy cells, RAS acts like a light switch. It briefly turns on a “grow and divide” signal, then turns it off. In cancer cells, RAS can get stuck in the “on” position, causing uncontrolled growth. Daraxonrasib interferes with that stuck switch, preventing the cancer cells from getting the signal to keep growing.

Daraxonrasib is still undergoing clinical trials, but early results have been promising [archived link] and it is expected to become the new second-line standard of care [archived link]. Importantly, daraxonrasib can be effective for treating PDAC, the most common type of pancreatic cancer. More than 90% of metastatic PDACs are caused by a mutation in the KRAS gene, called a RAS G12 variant, that results in an overactive KRAS protein. Previously available RAS inhibitors are specific to one of the altered versions of the protein, but daraxonrasib is a new kind of RAS inhibitor called a RAS(ON) multi-selective inhibitor. It can turn off the KRAS protein to stop cancer growth whether there is a KRAS variant or not, and regardless of which variant it is. Daraxonrasib is taken as a daily pill and usually has fewer side effects compared to traditional chemotherapy and radiation.

All patients who received daraxonrasib in the phase-3 clinical trial had already received chemotherapy. Participants were randomized to receive either daraxonrasib or additional chemotherapy. The average survival time was doubled in the daraxonrasib group, from 6.7 months to 13.2 months [archived link]. That may not seem like a lot, but the patients in this trial had advanced cancer that had failed to respond to other treatments. This is a very promising treatment direction and may lead to further discoveries that will lead to better outcomes for people diagnosed with pancreatic cancer. More studies to determine if daraxonrasib can be used as a first-line treatment are currently underway.

Bottom Line

Pancreatic cancer is one of the most serious cancer diagnoses a person can receive because it is usually caught late and is difficult to treat. While the outlook has remained stubbornly poor, new advances in immunotherapy (including personalized mRNA vaccines), and RAS inhibitors may finally give people and families affected by pancreatic cancer powerful tools that will extend and improve their lifespans.

Stay well, stay safe.

Love,

Those Nerdy Girls

Resources and further reading:

Memorial Sloan Kettering Cancer Center - What to Know about Pancreatic Cancer

UC Health Today - A new pancreatic cancer drug is changing survival rates for one of the deadliest cancers [archived link]

Hirshberg Foundation - FDA Expands Access to Daraxonrasib: What Patients Need to Know [archived link]

NEJM - Daraxonrasib in Previously Treated Advanced RAS-Mutated Pancreatic Cancer

Cancer Causes & Control - Trends in pancreatic cancer mortality in the United States 1999–2020: a CDC database population-based study

PanCan - Resources for Caregivers

National Comprehensive Cancer Network - Pancreatic Cancer Guidelines for Patients

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Welcome to the June edition of the Those Nerdy Girls’ Monthly Roundup—our quick, curated collection of the evidence-based posts that sparked the most conversation this past month. Each roundup is designed to help you stay informed on trending health topics and easily share trusted information with colleagues, friends, and your network.

👀 See something useful? Save it, share it, and help good health information reach more people.

🔶 There’s a new sunscreen on the block: Here’s what to know.

While that’s exciting (especially for sunscreen nerds), it doesn’t change what we already know: sun safety habits over time matter more than having one more product on a shelf.

🔶 What is One Health, and why is it important?

One Health is a framework for understanding how and why our impact on the planet can put human and animal health at risk. Incidents like the hantavirus cruise ship and Ebola outbreaks remind us that the environment can affect our health in unexpected ways.

🔶 What are cold sores, and what causes them?

Cold sores are caused by a virus called herpes simplex type 1, one of the most common recurring viral infections in the world. Let’s clear up some of the stigma and confusion that still exists.

🔶 Nerdy Note: From early lab research to clinical treatments - science takes time.

Studies in mice can be helpful and important. They can point scientists toward new ideas. But they do not guarantee that the same thing will work in humans. That’s why scientists are careful about big health claims based only on Petri dish or mouse data.

🔶 What is a differential diagnosis?

Differential diagnosis helps clinicians figure out what questions to ask, makes sure they rule out “can’t miss” diagnoses, and helps them determine what testing and follow-up a patient needs.

Stay well. Stay curious.

Love,

Those Nerdy Girls

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Nerdy Note: Antidepressants are an important tool.

You may have heard recent buzz about antidepressants being “overprescribed” or difficult to stop. Antidepressants are not habit-forming, but like other medications, decisions about stopping them are best made in partnership with a clinician who can help guide what’s right for you. Many people benefit from these medications, including some of the Nerds who share their experiences in this post.

Updated [7/1/26]: A reader pointed out that our original phrasing around interacting medications could be misleading. We’ve amended this to avoid confusion. If you have any questions always check with your clinician. Thank you!

Science and safety

SSRIs and SNRIs, selective serotonin reuptake inhibitors and serotonin and norepinephrine reuptake inhibitors, the two most common types of antidepressants used to treat both depression and anxiety sometimes get bad publicity. Whenever people harp on the side effects of medications, I’m reminded of something I was once told by a physician I admire, “there is no free lunch in pharmacology.” That means that any medication can have side effects. There is no perfect pill or supplement that does only what you want with zero risk of unwanted effects. With that in mind, let’s talk about some of the critiques of these medications and why the critiques might be overblown.

Psychiatric conditions, including depression, anxiety, bipolar disorder, and schizophrenia are very complex. You might have heard about depression and anxiety being linked to brain chemicals and that SSRIs and SNRIs work by shifting brain chemistry to improve mood. SSRIs and SNRIs work in similar ways. Your brain communicates with chemical signals. The neurons (or specialized cells in your brain) are basically lined up in long rows with a gap, called a synapse, between them. The first neuron will release their chemical signals, and those signals will land on the second neuron. The second neuron reads the signals with a receptor, which is a bit like an antenna for specific chemical signals. Eventually, the first neuron picks up all the chemicals in the synapse and the signal goes away. Two of those chemicals are called serotonin and norepinephrine. It’s long been thought that serotonin and norepinephrine play a role in depression and anxiety. SSRIs and SNRIs are “reuptake inhibitors.” They stop the first neuron from picking up the serotonin and norepinephrine in the synapse, which keeps the signal going for longer, helping with the symptoms of depression and anxiety. There are other medications with different mechanisms of action used to treat depression and anxiety, like MAOIs (monoamine oxidase inhibitors, which stop the protein that breaks down serotonin and norepinephrine), but they’re not prescribed as commonly.

(Image credit: E. Wish)

Interestingly, it turns out that our concept of the chemical aspect of depression and anxiety might not be the whole story. Research suggests they might work to treat mood-related conditions in more ways than simply “balancing” brain chemicals. And we now know that mental health conditions are caused by many factors, including genetics and many other things happening in your body and life. For example, researchers are also looking at inflammation and how the gut microbiome might impact depression as well. All of that is to say that these are complex conditions that we still don’t fully understand and there is no one-size-fits-all approach to treatment. And while we may not fully understand all of the causes of disorders like depression and anxiety, medications like SSRIs and SNRIs are very safe and can be very helpful to people when appropriately prescribed and taken.

What about the side effects? Remember, there’s no free lunch in pharmacology, so all medications have some side effects. The most common side effects of SSRIs and SNRIs are nausea, decreased sexual drive (libido), dry mouth, headaches, increased tiredness or insomnia, and decreased or increased blood pressure. Each medication has different side effects and some are more common with some medications than others. That’s why psychiatric clinicians emphasize discussing side effects and working together to figure out what medication works best for each person. More serious side effects are possible if you take antidepressants with an interacting medication. That’s why it’s always important to make sure your pharmacy and your healthcare team know what medications you take and to check with them before taking anything new, including supplements or medications sold over the counter.

What about withdrawal symptoms if you decide to stop your medication? Antidepressants are not habit-forming but they can still cause bothersome side effects if stopped abruptly. So it’s best to get guidance from your prescriber. They can guide you on how to slowly decrease the dose to avoid side effects. Psychiatric and other clinicians will generally monitor you very carefully during this time period to ensure you are tolerating the decreases well. It’s possible for your moods to worsen during or after stopping an antidepressant so it’s good to check in with your clinician and to have a backup plan or support in place in case this happens. You can talk to your psychiatric clinician about how easy or hard it is to taper off medication.

Health Equity Alert:

Antidepressants are only one part of mental health care. But therapy and other support from mental health clinicians are often hard to access. The types of services available may also vary depending on where you live. A 2017 study showed that outpatient mental health offices tended to be in higher income areas whereas inpatient mental health services tended to be located in lower income areas. This suggests that those in lower income neighborhoods have less access to generalized or preventive mental health care like therapy. Another study looking at therapy use between 2018 and 2021 showed that people who were college educated and had higher income were more likely to work with psychotherapists than people with less economic privilege. The study also found that men were less likely to use therapy services than women, which is an important finding as men are more likely to die by suicide than women, though women are more likely to attempt suicide. These studies also show that folks in rural areas and kids also have a harder time accessing mental health care.

Our stories

Kenzie:

Unfortunately, the narrative that psychiatric clinicians and other prescribers are “pill pushers” who value profits over healing is still alive and well. It’s difficult to escape the feeling of stigma when this same narrative is echoed in church, school, and even youth mentorship settings, even when (as in my privileged case) you grow up in a household that is highly supportive of seeking professional help for mental health concerns.

Over the past decade, feelings of self-doubt would occasionally surface as I moved from one SSRI regimen to another in an attempt to find one that works for me. Was I being played by big pharma? Do I need to offboard meds entirely and simply try being stronger and more resilient? Then, as I progressed in my public health education: There really is historical evidence that Black women have been unjustly experimented on in the past; are my doctors experimenting on me right now? These questions stemmed from feelings of mistrust (and, to an extent, distrust) of both the healthcare system and myself. As a young adult, my priority became listening to my body more, trusting that I had expertise in my own needs, and being a firm self-advocate in voicing these needs. Taking a couple of minutes to do some pre-appointment planning took away so much of the “stage fright” I usually felt when outlining my mental health concerns to clinicians. Soon enough, I was prescribed a medication that has been working for me better than ever. I can say with complete confidence that I am better off for having gone through the trial-and-error of identifying the best medication for me rather than trying to “tough it out” without professional support or relying solely on my own research.

But let’s talk health equity for a second. The stance of current Health and Human Services (HHS) leadership is that “Psychiatric medications have a role in care, but we will no longer treat them as the default.” Evidence shows that SSRIs can be highly effective first-line treatments for mental health (especially in severe cases). At the same time, it’s valid to desire a world where primary prevention – the type that sustainably enhances our sense of well-being in our homes, neighborhoods, workplaces, and government – is prioritized over medications. Know how we can create a world like this? By funding social welfare programs and supporting social policies that can remove all the economic and discrimination-related life stressors that induce (or worsen existing) mental illness. If the current administration genuinely wants to tackle America’s mental health crisis, they’d be wise to start with acknowledging root causes (one of their favorite phrases) and reforming unjust systems, not taking away the effective treatment options that are working for them.

Rebecca:

I was always an “anxious kid” but in college, the anxiety tipped over to OCD. The fear of infection took hours from my day and my therapist recommended I see a psychiatric clinician to start medications. I resisted starting medication for a long time because I felt like I should be able to control my thoughts, or fix myself, but going on medication allowed me to stabilize. Over the years, I’ve been on and off different medications. I’ve tried lifestyle interventions alone, including therapy, healthy eating, meditation and exercise. And, thanks to my OCD, I actually have years of data on myself that shows me when I feel the best. If I am consistent with exercise and healthy eating and taking my medication, I feel much better than any intervention alone. Everyone is different, but seeing that helped me realize that it was okay to take medications. I still get anxious but with tools I’ve learned in therapy and help from the medication, I am able to get through it.

Liz:

When I was newly postpartum with my second child, my days and nights were filled with what-ifs. I couldn’t sleep without worrying about what would happen if she stopped breathing and I wasn’t around to notice. I couldn’t walk by the stairs without envisioning myself accidentally falling down while holding her. Then, when she was six weeks old, she developed a fever and had to be admitted to the hospital for three days. When we got home my anxiety was so bad I was barely able to function. Finally, a dear friend reminded me that I didn’t have to try to power through alone. That I deserved help, and to actually enjoy these moments (though yes, of course, they’re also hard). She helped inspire me to connect back to a therapist, prioritize moving my body (which is key for my mental health) and I went on an SSRI. Eventually I started to actually enjoy having two kids, and the constant drumming of what-ifs, and anxiety, died down. I am so grateful that these tools existed, and that I was connected to them at a time I really needed them.

MK:

My first time being prescribed medication was when I was 18 after a sexual assault. I was left feeling broken physically and emotionally. While my body healed, medication helped stabilize me mentally so that I could do the significant healing work involved in trauma recovery with an amazing therapist.

Throughout the next 33 years, I have had periods of needing medication and therapy to restabilize. Pregnant with my second child and worried about bringing another child into the world who might have chronic illness, working on the frontline during the pandemic, losing my mom unexpectedly, worsening symptoms after my first COVID infection, the rollercoaster of perimenopause and the ongoing work of healing from trauma. Through the many transitions and challenges of living life fully as a caregiver and clinician, I have needed medication as part of my comprehensive approach to staying healthy.

I am lucky I have had access to a high quality mental health care team, which includes a psychiatric nurse practitioner who works diligently with me to make sure I am on effective medications, at the correct doses for my particular brain chemistry, for the right amount of time. I also have access to a quality inpatient psychiatric hospital when I have needed it, and a truly gifted LCSW-C (licensed clinical social worker) therapist. Together, these have been life saving. And I mean that quite literally.

As Kenzie noted in the Health Equity Alert, not everyone has the access I have had. And because of lack of access, people suffer. People die.

Right now, we need to do everything we can to advocate for expanding access, not shrinking it.

As an FNP, I bring my lived experience into the patient visit. I have patients who express concerns about taking medication to help regulate or support the neurotransmitters and hormones in their brain. Sometimes the questions are about side effects or how the medication works and those are more straightforward to answer. But sometimes it’s clear they are viewing their mental health through a stigmatizing lens. They express feeling shame or weakness. When this happens, I ask them to reframe their thinking this way: “Your brain is an organ, right? Just like your pancreas. If your friend’s pancreas didn’t make insulin anymore, would you be embarrassed for them if they needed insulin?” The answer is “Of course not!” And then I see an “a-ha” moment wash over them along with a wave of relief.

On days when I am feeling shame for how my brain works, I remind myself of the same analogy and it helps me face and dismantle the internalized stigma that we were all conditioned to believe, that having mental illness makes us bad or less than.

Medication is only one tool. But it is a critical one.

In my particular toolbox, I have 5 daily tools, plus weekly therapy. I call them the 5 Ms–medication, meditation, movement, merriment and music. (There used to be only 4, but then our incomparable content manager, Sandy, shared with me a Those Nerdy Girls Work ‘N’ Chill playlist on Apple Music one day when my other 4 Ms weren’t cutting it. I found that music, in fact, is a game changer for me.)

With this post, we are sharing our stories to highlight the importance of mental health care, to destigmatize mental illness, and to advocate for everyone having equal access to evidence-based care.

Share your stories and tools in the comments .

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Can some medications make me more heat sensitive?

Yes, certain medications can make you more likely to experience heat-related illness. While we can’t control the weather, we can prepare and help more people stay safe.

To understand how medications can affect our bodies when outside temperatures rise, let’s look at the body’s normal cooling process.

Our warm-blooded bodies are designed to maintain a fairly constant internal temperature. When the temperature in our environment rises, our bodies have a number of cooling mechanisms to prevent overheating, including:

✅Stimulation of sweat glands

✅Increased blood flow to the skin (vasodilation)

✅Changes in hormones to lower metabolism

✅Behavior changes to help cool ourselves

But like all bodily systems, the body’s cooling mechanisms don’t always work perfectly. Likewise, they’re prone to disruptions, including from medications. Read on to learn what medications to watch out for.

➡️Antidepressants

Antidepressants work by changing levels of neurotransmitters (brain chemicals). Some of these changes can also change how your body responds to heat.

Serotonin is a brain chemical that affects mood. It can also raise your body temperature and cause sweating. Many antidepressants affect serotonin, including SSRIs (selective serotonin reuptake inhibitors) and SNRIs (selective norepinephrine reuptake inhibitors).

Popular examples of each include:

✅SSRIs: fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft)

✅SNRIs: duloxetine (Cymbalta), venlafaxine (Effexor XR)

Since serotonin can raise your body temperature, taking antidepressants that raise serotonin levels may make you more vulnerable to heat exhaustion. Certain antidepressants can also make you less heat-tolerant by blocking a chemical in the body called acetylcholine. This action decreases your body’s ability to cool itself. Many medications can cause “anticholinergic” effects, which we discuss further below.

➡️Blood pressure medications

People with heart-related conditions are more prone to heat exhaustion. Taking blood pressure medications may also make you more susceptible.

Common types and examples include:

✅ACE inhibitors: lisinopril (Prinivil, Zestril), enalapril (Vasotec)

✅ARBs: losartan (Cozaar), olmesartan (Benicar), valsartan (Diovan)

✅Calcium channel blockers: diltiazem (Cardizem, Tiazac, Cartia XT), verapamil (Veralan)

✅Diuretics: hydrochlorothiazide (Microzide), chlorthalidone (Thalitone)

If you take one or more of these types of meds, you may be more likely to get dehydrated on hot days. In addition to causing fluid loss, they can lower your thirst sensation, so you might become dehydrated without even noticing. What’s more, dehydration can worsen some blood pressure medication side effects such as electrolyte imbalances and dizziness.

✅Beta blockers

Beta blockers are another class of blood pressure medication that are also used for heart conditions. They work by slowing your heart rate. This may decrease your ability to stay cool by allowing less blood flow to your skin’s surface. As a result, more heat stays trapped inside your body since less is brought to your body’s surface where it can escape into the air.

➡️Substances that cause fluid loss

Dehydration is one of the main ways heat exhaustion leads to symptoms like dizziness, fatigue, and nausea.

Some substances that cause fluid loss include:

✅Diuretics (water pills) like hydrochlorothiazide (Microzide) or furosemide (Lasix)

✅Some diabetes medications: SGLT2 inhibitors like empagliflozin (Jardiance) and canagliflozin (Invokana)

✅Laxatives like bisacodyl (Dulcolax) or senna (Senokot)

✅Antibiotics (when they cause diarrhea)

✅Alcohol

Diuretics cause your kidneys to remove more water and salt. SGLT2 inhibitors treat diabetes by helping more sugar leave your body as urine, but this process also makes you lose water. Any medication that causes you to have diarrhea or loose stools leads to fluid loss. Consuming drinks with alcohol also has a dehydrating effect.

➡️Anticholinergic medications

Blocking acetylcholine can affect your body’s response to heat. Many medications block acetylcholine.

Some examples of types of medications with notable anticholinergic effects include:

✅Antipsychotics like risperidone (Risperdal) and quetiapine (Seroquel)

✅Parkinson’s disease medications like benztropine

✅Bladder control medications: oxybutynin and solifenacin

✅Antihistamines (sedating types): diphenhydramine (Benadryl) and doxylamine (Unisom)

✅Antidepressants: especially tricyclic antidepressants like amitriptyline and nortriptyline

Medications with anticholinergic properties can decrease your body’s ability to adapt to the heat in two ways:

• Decreased sweating

• Decreased blood flow to the skin

Both effects make it harder for heat to escape from your body. If heat becomes trapped, your body may overheat. Older adults are particularly sensitive to this effect.

➡️Stimulants

Stimulants rev up your metabolism, causing your internal temp to increase.

Common stimulants include:

✅Medications for ADHD (attention deficit hyperactivity disorder), including:

• Methylphenidate (Concerta, Ritalin)

• Amphetamine mixed salts (Adderall)

• Lisdexamfetamine (Vyvanse)

✅Cold and allergy medications containing pseudoephedrine (a decongestant)

✅Weight-loss medications containing phentermine

Stimulants can also make it harder for your body to cool down when your body gets too hot. A common stimulant side effect is vasoconstriction (narrowing of blood vessels), which is the opposite of your body’s vasodilation cooling response that increases blood flow to the skin.

➡️Sedatives

While sedatives might not directly interrupt your body’s cooling system, they may make you less likely to take actions that keep you safe in the heat.

Common sedatives include:

✅Benzodiazepines such as alprazolam (Xanax) and clonazepam (Klonopin)

✅Opioid medications such as oxycodone and hydrocodone / acetaminophen

✅Sleep aids (any over-the-counter or prescription medications that help you feel sleepy)

✅Alcohol

If you get overheated after taking a sedative, you might be less likely to get water to drink, turn a fan on, or change into something cooler. You might also oversleep, not noticing how hot your surroundings are, while your body temperature climbs higher.

➡️Thyroid replacement medications

Medications like levothyroxine (Synthroid) for low thyroid (hypothyroidism) can affect your body’s internal thermostat. Just like the thyroid hormone in your body, levothyroxine increases your body’s core temperature. And because levothyroxine may also increase sweating or cause diarrhea, dehydration when spending time in the heat is another concern.

➡️How to stay safe in the heat

Heat exhaustion can happen to anyone. Early signs include dizziness, irritability, and weakness. Some people also experience fast heartbeat, nausea, or vomiting. Consider these signs to take action to do whatever you can to get cooler quickly. Getting help is essential if your symptoms are severe. If you don’t have access to cold water or a place to cool down, get help right away even if your symptoms feel mild.

⚖️Health Equity Alert: One study in Connecticut found that communities of color are facing increasing exposure to urban heat while having fewer ways to stay cool. People who live in areas with more pollution and fewer cooling resources from shade tree cover and air conditioning are also more likely to experience negative outcomes from extreme heat. Heat exposure is the largest cause of weather-related deaths in the U.S. Improving access to cooling resources and shade cover is vital to ensuring all communities can stay cool and safe.

It’s a good idea to know if you or a loved one may be more heat sensitive so you can prepare and have backup plans when temperatures rise.

Your clinician or pharmacist can tell you if a new or current medication might affect your body’s natural cool-down system. However, medications are just one factor that may increase your risk of heat exhaustion. Taking extra precautions in the heat is also important if you:

✅Are a child, older adult, or pregnant person

✅Have a disability

✅Have a heart or lung condition

✅Have diabetes

✅Have lower kidney function

✅Work or play sports outside

✅Live without air conditioning

Heat-related illnesses are preventable with planning. Staying informed will help. In the U.S., Heat.gov has tips for staying safe during a heat wave and includes weather maps with forecasts to help you plan. If heat exhaustion progresses, it can lead to heat stroke. Though not technically a stroke (like a brain attack), a heat stroke is also a life-threatening emergency that requires immediate medical care.

➡️Remember other sun and heat considerations

Take extra care to protect your medications from exposure to heat and sunlight and avoid storing them in the car. Use an insulated bag (without an ice pack) when needed to keep on-the-go critical medications like insulin or epinephrine within their manufacturer’s recommended temperature range. Not sure what that range is or how to store it? Ask your pharmacist for help.

Also, take extra care to protect your skin from sunlight if you take a medication that increases sun sensitivity. Your prescription bottle or package may have a warning sticker on it if it’s one of them. You can also ask your pharmacist or check this FDA resource: The Sun and Your Medicine.

Stay informed. Stay ready. And stay safe while taking your medications

Further reading:

Preventing Heat-Related Illness

Who Is Most At Risk To Extreme Heat?

Heat-Related Illnesses and First Aid

5 Steps to Prepare for Hot Days For People with Heart Disease

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What are cold sores, and what causes them?

Cold sores are caused by a virus called herpes simplex type 1, one of the most common recurring viral infections in the world. Let’s clear up some of the stigma and confusion that still exists.

❓What are cold sores?

Cold sores (also called fever blisters) are small, fluid-filled blisters that usually appear on or around the lips. They usually break open, crust over, and heal within days to a couple of weeks.

Cold sores are most often caused by herpes simplex virus type 1 (HSV-1), a very common virus. (Occasionally, a different type of herpes causes cold sores, which we’ll cover below.) According to the World Health Organization (WHO), about 64% of people under age 50 worldwide carry HSV-1. Many people are exposed during childhood through common day-to-day contact, including exposure to saliva through things like goodbye kisses from relatives or shared cups or utensils.

After infection, the virus stays in nearby nerve cells near the base of the skull for life and can become active again later, causing recurring cold sores. Common triggers include illness, stress, fatigue, hormonal changes, and sun exposure. Many people notice tingling, burning, or itching before a sore appears.

Many people with HSV-1 never develop noticeable cold sores at all.

🔎Cold Sores vs. Canker Sores

These are often confused, but they are different conditions.

Cold sores:

• Are caused by a virus

• Usually appear on the lips or skin around the mouth

• Often begin as clusters of small blisters

• Are contagious

Canker sores:

• Are not caused by herpes viruses

• Occur inside the mouth (such as inside the cheeks, on the gums, or under the tongue)

• Usually appear as round white or yellow sores

• Are not contagious

If you are not sure which you have, the location is often the biggest clue. One confusing detail: when someone is first infected with HSV-1, they can sometimes develop sores inside the mouth during that initial infection.

🔎Oral Herpes vs. Genital Herpes

HSV-1 most often causes oral herpes (cold sores), while HSV-2 more commonly causes genital herpes, but the distinction is not perfect. Either virus can infect either location [archived link].

For example, an increasing number of genital herpes infections are caused by HSV-1, especially in younger adults. This type of infection occurs through oral-genital contact.

Even in the same person, HSV-1 can spread to other parts of the body like eyes, fingers, or even the brain. Fortunately, this is rare, but when it happens in the eyes or brain it can cause serious infections called herpetic keratitis and herpes simplex virus encephalitis.

🛡️Preventing Spread

Cold sores are most contagious when a sore is forming or present, especially when blisters are open or oozing. However, HSV-1 can sometimes spread even when no sore is visible. This is called asymptomatic shedding.

If you have an active cold sore, the following are recommended:

• Avoid kissing and oral-genital contact.

• Avoid sharing lip balm, utensils, cups, towels, or razors.

• Wash your hands after touching your face.

• Avoid touching your eyes or touching active cold sores.

• Be especially cautious around newborns (see below), people with weakened immune systems, and people with eczema (a common skin condition that causes dry, itchy skin), because HSV infections can sometimes become serious in these groups.

There are more recommendations about self-care on the American Academy of Dermatology Association’s page on cold sore treatment.

General precautions, whether or not you have an active cold sore:

• Be aware that transmission can happen without visible symptoms.

• Avoid sharing drinks or utensils with others, especially children (who may not have been exposed) or anyone concerned about being exposed to HSV1.

• Consider barrier methods like condoms and dental dams, which can reduce (but not fully get rid of) the risk of spreading HSV-1 or -2 during oral sex. Talking openly with partners about cold sores or herpes history can also help people make informed decisions together.

🔎Neonatal Herpes

Neonatal herpes (HSV infection in newborns) is a rare but serious condition. Babies are most commonly exposed to the virus during vaginal childbirth from a birthing parent with genital herpes. Either HSV-1 or HSV-2 can be transmitted to a baby this way. Newborns can also be exposed to HSV-1 after birth through contact with relatives or healthcare workers who have cold sores or are unknowingly shedding the virus.

The good news is that neonatal herpes is often preventable. It’s important for pregnant people to discuss their herpes history with their prenatal clinician and mention any oral or genital sores that develop during pregnancy. After birth, everyone can protect newborns by using good hand hygiene and being careful to avoid spread from anyone who has an active cold sore.

❓Why do some people get recurrent cold sores while others don’t?

This is one of the most interesting parts of HSV research.

Most people with HSV-1 don’t even know they have it. They don’t get cold sores, or don’t notice them. Other people get cold sores frequently. While we still don’t know all the answers, researchers think both genetics and environmental factors play a role in whether and how often the virus reemerges.

A 2014 study that is still widely cited today identified a specific difference (called a gene variant), which influences how often and how severely people with HSV-1 experience cold sore outbreaks, helping explain why some people get them often while others rarely do. Research since then has continued to uncover other genetic factors at play, and scientists are still actively working to understand the full picture.

Once someone already gets cold sores, things that can trigger another one include stress, illness, sun exposure, and changes in the immune system.

💊 Self-Care and Treatment

Can Medications Help? Yes, even though they do not get rid of the virus from the body.

If cold sores are frequent, severe, affecting your eyes, or affecting your quality of life, it is a good idea to talk with a clinician.

Antiviral medications such as acyclovir, valacyclovir, and famciclovir can shorten the length of time a cold sore is active and reduce symptom severity, especially when started very early, ideally at the first tingling or burning sensation.

Over-the-counter creams containing docosanol can help cold sores heal a little faster if used early and frequently, though prescription oral antiviral medications are more effective for many people.

There are also numbing agents or patches that might help you be more comfortable as your cold sore heals. You can ask your pharmacist for help if you’re unsure.

For some people, using sunscreen or SPF lip balm may help prevent cold sores triggered by sun exposure.

🧬Is there a cure or vaccine?

Not yet, but research is ongoing. This type of virus is tricky to treat because once someone is infected, the virus stays in the body for life.

Scientists are studying several approaches, including vaccines and gene-editing technologies aimed at targeting the virus while it is hiding out in nerve cells. As of now, there is no approved vaccine or cure for HSV-1.

🔬What about testing?

Routine testing is generally not recommended for HSV-1.

If you have mouth or skin sores that look like herpes, the fluid can be swabbed and tested to confirm if herpes is the cause and to know which type. This method usually uses a polymerase chain reaction (PCR) test. “PCR” may sound familiar from testing during the first couple of years of Covid - it’s the same type of test, but for HSV1 (or 2). For a common cold sore, though, your clinician probably won’t recommend PCR testing.

Blood antibody tests can be done even when no sore is present and look for signs that the immune system has responded to the virus. However, they are not always accurate and can sometimes miss an HSV infection or come back positive when someone does not actually have HSV. They also cannot reliably tell you when you were infected - a positive result may reflect an infection acquired years ago. Some tests also can’t distinguish between HSV-1 and HSV-2.

💚Final Thoughts

Cold sores are incredibly common. Getting them does not say anything about a person’s cleanliness or character. Most people are exposed to HSV-1 long before adulthood, and many never even know they carry it.

Good information and less stigma can make cold sores much easier to talk about and manage.

Love,

Those Nerdy Girls+&

ℹ️ Resources:

WHO - Herpes Simplex Virus

American Academy of Dermatology Association (AAD) - Cold sores: overview

AAD - Cold sores: signs and symptoms

AAD - Cold sore remedies dermatologists recommend

CDC - About Genital Herpes [archived link]

American Sexual Health Association (ASHA) - Five things you should know about Herpes

NHS - cold sores

Healthychildren.org - Cold sores in children

ICYMI - Digest of Recent Posts:

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What is a differential diagnosis?

Tl;dr: Differential diagnosis helps clinicians figure out what questions to ask, makes sure they rule out “can’t miss” diagnoses, and helps them determine what testing and follow-up a patient needs.

If you’ve ever read the note your doctor, PA, or NP wrote about you on your patient portal for an emergency room visit, hospital stay, or even a sick visit, you might notice something a little strange. They rarely say that they are 100% certain that you have one particular illness unless there’s a specific test that says exactly what’s going on (for example, a positive swab for flu or an x-ray showing a broken arm). Even then, you might notice language like “Arm pain most likely due to fracture demonstrated on X-ray.” And you read that and might say, “Well duh, of course someone’s arm hurts because it’s broken.” So why do clinicians have this weird way of describing what could be going on with you? The answer is two words: differential diagnosis.

What is a differential diagnosis?

A differential diagnosis is a list of conditions that could be related to a particular symptom.

Here’s a common example: “A patient presents with a headache.” Before a clinician even sees you, they look at the main complaint (also called a chief complaint) and come up with a list of all the possible things that could cause that headache. For example, the headache could be from something as simple as not drinking enough water, or due to a migraine, or a cluster headache, or a tension headache. Then the clinician has to ensure they think about the more serious conditions, so they’ll add tumors, infections, and brain bleeds to the list.

Before a clinician even sees a patient, they have a list of several things that could be going on. That’s important for a few reasons.

1. Guiding questions: A broad differential list helps guide the sorts of questions a clinician asks. For the patient with a headache, the clinician is going to want to know the intensity of the headache, if there are triggers, what part of the head hurts, if there have been recent life stressors, just to name a few immediate questions. These questions help the clinician eliminate some diagnoses and push others to the top of the list.

2. Reducing “anchoring”: Anchoring is when a patient says something and the clinician focuses on that at the expense of other information that could suggest something else. Let’s stay with our headache example. Say our patient has a history of migraines. The clinician might think that it’s a slam dunk, just more migraines. So they prescribe some migraine medication and move on with their day. But if they had asked the patient about other symptoms, they’d have learned that the patient has headaches that are waking them from sleep, and they then immediately vomit. Those symptoms are “red flag” signs for a brain tumor. It’s an extreme example, but it’s important to avoid anchoring because clinicians can miss the actual diagnosis. In medical school, for example, my peers and I are taught to always have a list of “can’t miss” diagnoses for a wide variety of chief complaints.

3. Broadens or narrows testing: Having a broad differential also helps the clinician figure out what tests to order. We’re going to stick with the headache example from above. If the patient is describing a headache that radiates from the shoulders up to the back of the head, and they’ve had a huge work project this month and have spent hours hunched over a computer, that sounds like a tension headache. A clinician wouldn’t order imaging for that. But for the patient with the horrible headaches that wake them up from sleep, the clinician would order a brain MRI to rule out a potential tumor. With the right questions, clinicians can figure out what tests to order to confirm what’s going on.

What can you do to help your clinician get to the right diagnosis?

• Keep an accurate log of your symptoms, including when the symptoms started and anything else you’ve been experiencing (such as fevers, vomiting etc.).

• Be descriptive in how you talk about your symptoms (for example, if you’re having pain, is it dull and achy or sharp and stabbing. Does the pain radiate anywhere?).

• Know your medical history (any conditions you might have, such as diabetes or hypertension) and any medications you take.

• Be honest about any recent changes in your health history because sometimes the small things are the most important (for example, any recent new supplements, any drug use, any recent travel, any changes in eating habits)

Further Reading:

How can I prepare to get the most out of my next medical appointment?

How do I best navigate a health appointment?

ICYMI - Digest of Recent Posts:

Mental Health: What is self-care, and why is it important?

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Every year on June 19th, we take time to recognize Juneteenth and to reflect on how the ongoing legacy of American slavery shapes our understanding of health equity and the work still ahead. Here is our post from yesterday in case you missed it:
Liberation and health equity go hand-in-hand.

The Association of Schools & Programs of Public Health also has a short post about Honoring Juneteenth for 2026, reminding us that understanding history and working towards health equity are important aspects of preparing and supporting new leaders in Public Health.

We would love to hear from readers about how you honor Juneteenth in your community, school, family, or workplace.

Stay curious,

Those Nerdy Girls &+

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There’s a new sunscreen on the block: Here’s what to know.

While that’s exciting (especially for sunscreen nerds), it doesn’t change what we already know: sun safety habits over time matter more than having one more product on a shelf.

When I joined Those Nerdy Girls two years ago, sun safety was a topic I was excited to cover. A few years earlier, I’d had skin cancer and was eager to share more about sun safety. In this post, I’m excited to share some exciting news!

📣 Bemotrizinol (BEMT) is Coming to U.S. Shelves 📣

The Food and Drug Administration (FDA) just approved the first new sunscreen active ingredient for use in over‑the‑counter products since 1999.

Bemotrizinol (BEMT) is a new-generation sunscreen widely used in other countries that provides good protection from both UVA and UVB. Both of these types of ultraviolet (UV) radiation contribute to skin cancer, eye damage, and photoaging. A broad‑spectrum sunscreen like BEMT is a welcome addition to the many safe sunscreen options we already have.

BEMT will be sold under the brand name PARSOL® Shield and found as an active ingredient at concentrations up to 6% in sunscreens for adults and children as young as six months old.

Manufacturers are expected to start making new BEMT-containing sunscreen products later this summer. It will likely appear as an active ingredient in many familiar sunscreen product types, and may be combined with other chemical or mineral sunscreens already in use.

😎Sun protection is important for everyone. But sunscreen is only one part of staying safe in the sun. Learn about everyday UV protection in this post on sun safety habits.

What type of sunscreen is bemotrizinol (BEMT)?

BEMT is a chemical (organic) UV filter. Based on BEMT’s low systemic absorption and safety profile, the FDA has classified BEMT as GRASE — which stands for “generally recognized as safe and effective”.

Some key BEMT features include:

➡️ Lightweight and easy to apply: BEMT is oil soluble, so it can mix well into lotions, creams, and other formulations, making them smoother and easier to spread, without the visible white cast that mineral sunscreens often leave.

➡️ Highly photostable: This means it doesn’t break down as quickly in sunlight as some other chemical sunscreens do, so it should keep working well while you’re outside (though, you’ll still need to follow the product’s directions on how often to reapply).

➡️ Strong UVA protection: In addition to good UVB protection, it has better UVA protection compared with many other sunscreens. Both types of UV radiation are harmful to the skin and eyes, so broad-spectrum protection is important in a sunscreen.

Having a new sunscreen option that’s easy to apply, wears well without a white cast, is classified as GRASE, and has broad UV-protection is great news.

The biggest downside to BEMT-containing sunscreens is likely to be cost. There’s a good chance these sunscreens will carry a premium price tag for at least the first 18 months.

With the cost of everyday essentials rising, sunscreen is an extra expense many families can’t afford, especially a pricey one.

🧡 If you have the means, consider bringing extra sunscreen to share and donating sunscreen to your local pantry, school, or camp to help keep their supplies stocked.

Are other sunscreens safe to use?

Yes. Dermatologists say that the best sunscreen is the one you have available and will use. Even a single sunburn can increase future skin cancer risk. For young children, during pregnancy, or if you have sensitive skin, your clinician might recommend a specific product type, such as a mineral sunscreen, for regular use. You can also ask your pharmacist for a recommendation if you’re unsure which product to buy.

Are all sunscreens sold in the U.S. classified as GRASE?

No. The FDA classifies mineral (physical) sunscreens as GRASE since they aren’t readily absorbed into the body. These inorganic UV filters include zinc oxide and titanium dioxide. BEMT is currently the only chemical-type sunscreen classified as GRASE. Older organic UV filters like avobenzone, homosalate, and octisalate provide critical UV protection, but they were approved before the FDA updated their GRASE requirements. Since some studies have found they might get absorbed into the body through the skin, the FDA is still reviewing them for GRASE status. However, the FDA recommends that people continue using them.

The bottom line

A new sunscreen ingredient is exciting (especially for sunscreen nerds like me), but it doesn’t change what we already know: sun safety awareness and habits matter more than having one more product on a shelf. And the best sunscreen will still be the one you’ll actually use.

🌞Be sun-safe. Get outdoors. And have fun! 🌞

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What are the 3 most important sun-safe habits your skin will thank you for?

Sun safety requires a combination of everyday protective measures. These include covering up, using sunscreen, and being sensible about sun exposure.

🌞 🌞 Be sure to look out for our post coming tomorrow: "There’s a new sunscreen on the block: Here’s what to know.”

(Note: This post was updated by Those Nerdy Girls from the original published on May 17, 2024.)

Summer is brimming with blooms, celebrations, and plans. As you gear up to spend more time outdoors, it’s also a good time to check in on your sun-safety routine.

The 3 most important sun-safe habits are:

➡️Covering up

➡️Using sunscreen

➡️Being sensible about sun exposure

But it’s not just what you do; it’s how you do it that matters. To effectively protect your skin, sun protection needs to be done correctly and consistently.

😎 Remember, sun protection is for everyone. 😎

While it is true that people with lighter skin are more vulnerable to ultraviolet (UV) radiation, all skin types are susceptible to UV damage, and anyone can get skin cancer.

Below are key points to help you get the most benefit from each type of sun protection.

✅ Cover up

This is often the most effective place to start. Covering up is a quick and easy way to provide broad coverage and protect delicate areas.

A wide-brimmed hat

• Choose a hat made with densely woven fabric that protects your face, ears, and back of your neck.

• A chin strap is a good option to keep your hat in place on breezy days.

• Your hat should feel comfortable to wear for long stretches of time.

UV protective sunglasses

• Wear sunglasses with 100% UV protection (or UV absorption up to 400nm).

• Choose sunglasses with full, wraparound coverage.

• Pricy polarized pairs don’t provide any extra UV protection.

Sun-protective clothing and swimwear

Look for options made from lightweight, comfortable fabrics with ultraviolet protection factor (UPF).

✅ Use sunscreen

The FDA regulates sunscreens as over-the-counter drugs. They’re considered safe and effective for adults and children over the age of 6 months, but they need to be used as directed for them to work.

😎Dermatologists recommend regular sunscreen use for everyone, including people with darker skin tones. 😎

The American Academy of Dermatology Association (AAD) doesn’t recommend a specific type of sunscreen, but they do recommend using a sunscreen labeled with all of the following:

• Sunburn protection factor (SPF) of 30 or higher

• Broad Spectrum (blocks UVA and UVB rays)

• “Water resistant” (lasts 40 minutes) or “very water resistant” (lasts 80 minutes)

The best sunscreen is one you’ll use and can afford. Read and follow your product’s instructions and make sure it’s not expired.

Sunscreens with an SPF 30 block 97% of UVB rays (the kind that cause sunburn). A higher SPF provides a bit more protection, but doesn’t last any longer.

🤓What’s the difference between UVA and UVB? These are the two main types of ultraviolet (UV) radiation that travel from the sun to the earth. They have different wavelengths that affect our skin in slightly different ways. Sunburns are mainly caused by UVB rays, while UVA rays penetrate skin more deeply and can even pass through most window glass. Both types cause eye and skin damage and can contribute to skin cancer, so it’s important for a sunscreen to have broad-spectrum protection from both. It’s also why tanning beds, which mostly emit UVA rays, are not safe even if they’re less likely to cause sunburns than sunlight.

Mineral-based sunscreens containing zinc oxide or titanium dioxide are generally recognized as safe and aren’t readily absorbed through the skin. You may see these products labeled as “baby” or “sensitive” since clinicians often recommend them for young children (6 months and older) and during pregnancy.

Your clinician or pharmacist can help you pick a sunscreen if you’re unsure which to use. They can also help you know how careful you need to be in the sun based on your skin type and risk factors for skin cancer and other sun-related conditions.

All sunscreens need to be reapplied at least every 2 hours and after swimming. And don’t forget to use a lip balm with sun protection too.

A word on sunscreen sprays: They’re handy to use but they may not be your best option. It can be harder to tell if you’re using enough and there’s a risk of inhalation. Spraying in your hand and then applying is a good idea if someone else is nearby.

✅ Consider UV exposure

Outdoor sunlight carries the risk of cancer, photoaging, and eye disease. To lower these risks—but still enjoy the benefits of being outdoors—consider the following:

• Use sun protection every day no matter the season—cloudy and cold days count too.

• Be extra careful between 10 am and 4 pm daylight saving time (or 9 am and 3 pm standard time) when the sun’s rays are strongest.

• Seek shade, or bring your own.

• Sand, water, and snow reflect sunlight and increase your UV exposure so be extra mindful in these environments.

• Don’t discount short everyday sun exposures. Sun damage can happen on days you weren’t planning on being in the sun. A quick “Hi” to a neighbor outside turns into a long conversation. The cafe only has outdoor seating. That’s why regular sunscreen use and bringing protection with you is a good idea.

Soaking up some sun feels good—and it’s good for you.

Spending time outdoors around green spaces has been linked to lower blood pressure, better sleep, and less chronic disease. Time spent in nature can also lift moods and bring a sense of calm.

Making sun safety an everyday habit helps you enjoy some sun without harming your skin.

Check for sunscreen recalls here: Drug Recalls

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Is leucovorin an effective treatment for autism?

While probably not harmful, there is not enough evidence that leucovorin is an effective treatment for autism. Demand for the drug among parents of children with autism recently skyrocketed after a press conference last fall in which federal health officials claimed, with little evidence, that the drug is a promising treatment for autism.

You may have heard of folic acid and folate. Both are forms of vitamin B9. Leucovorin, also called folinic acid, is a reduced form of folate. Folic acid and folate are found in foods and supplements and are essential for many functions in the body. The leucovorin being discussed for autism is a prescription medication that is mainly used in certain cancer treatment regimens and to treat rare deficiencies and toxicities. The current administration correctly stated that the drug could be used to treat cerebral folate deficiency (CFD), a rare brain disorder. CFD is marked by low folate levels in cerebrospinal fluid and usually appears in infancy, causing a variety of neurological symptoms, such as seizures and cognitive impairment. It may be present in a subset of autistic people, but the condition is so rare (only 50 cases ever documented in the medical literature) that it is very challenging to say what, if any, connection there is between CFD and autism.

So far, there’s no strong evidence that leucovorin is beneficial for children with autism who do not have CFD. Currently, there are only a few double-blinded, placebo-controlled trials (the gold standard for new treatments) that have tested the drug’s effectiveness in children with autism. The largest of them was retracted in early 2026 due to problems with the data and statistical analyses. Experts say there’s not enough research to know whether leucovorin can benefit kids with autism or how to safely prescribe it and monitor kids who are taking it.

This limited research is why the American Academy of Pediatrics, the Child Neurology Society, and the Society for Developmental and Behavioral Pediatrics are recommending against the routine use of leucovorin for autism.

Unfortunately, the current administration’s claim that leucovorin could help “tens of thousands” of children with autism has led to a lot of false hope. The increasing demand for the drug has created rifts between patients and doctors, many of whom are reluctant to prescribe it due to limited evidence. As pediatric neurologist Audrey C. Brumback wrote in an op‑ed for MedPage Today, “[Patients] deserve the best that science and medicine have to offer. That doesn’t include prescribing drugs without scientific evidence, which are unlikely to help and could even cause harm.”

Autism is a complex neurological condition and each child is unique. At present, parents often have more questions than experts have answers to. That’s especially frustrating when getting an appointment or even having time to ask questions can be difficult. Still, your child’s clinician is one of your best sources of information, and they can help you sort through options based on your child’s specific situation.

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Nerdy Note: From early lab research to clinical treatments - science takes time.

Studies in mice can be helpful and important. They can point scientists toward new ideas. But they do not guarantee that the same thing will work in humans. That’s why scientists are careful about big health claims based only on Petri dish or mouse data. And it’s why I want to share a story from my PhD research.

[NOTE: This is another in our series Nerdy Notes: Science in Story & Verse. In these posts, our Nerdy Girl scientists and clinicians share personal stories, insights, poetry, and more. While these posts may be lighter in terms of numbers and figures, they are still rooted in our tradition and commitment to providing accessible and trustworthy information.]

When I started my PhD in Molecular and Cellular Oncology at George Washington University, I inherited a research question that had already been studied in mouse models. The question was: how do cancer cells, living in an area of the tumor with less oxygen, become less sensitive to chemotherapy? We know that cells in solid cancers do not get the same amount of food and oxygen because blood supply is uneven. So certain chemical pathways take over in these low oxygen regions that can make chemotherapy less effective. The plan was to understand this process in human cells and to eventually make chemotherapy work better. I found these questions exciting and jumped in with a lot of confidence and passion.

On paper, it sounded pretty simple. In real life, it was anything but.

I started working with human breast cancer cells (and later other types of cancer cells). I expected the move from mouse cells (where this process had previously been studied in our lab) to human cells to be hard but still doable. What I didn’t realize was just how different those cells could be, even in a tightly controlled lab. I just couldn’t figure out the right conditions to get the human cells to do what had been seen in the mouse model. It took me about a year and a half just to figure out the basics: the right drug doses, timing, and conditions that would give meaningful results and point to a specific mechanism for making chemotherapy less effective in human cells. And those conditions were very different from what worked in mouse models. That year and a half included failed experiments, constant troubleshooting, repeating the same work, frustration…and yes, a lot of crying. And this wasn’t even in humans. This was work in a Petri dish, in very controlled conditions, without many of the complicated factors you find in a real human body.

I remember going into my proposal defense (half way through my research project) with very few positive results to show, meaning we mostly saw no effect. I couldn’t get the human cells to show they had become less sensitive to chemotherapy (under the same conditions we had used in the mouse model) and I couldn’t figure out the pathway that was involved so I could begin to reverse it to make the chemotherapy work. In other words, I was stuck! It felt like the finish line for my PhD was getting further away. (And yes, negative results still matter. Learning that something doesn’t work is important science. But that’s a topic for another day.)

Even though it was really hard at the time, that experience taught me something very important.. It’s one reason I wanted to share this. When scientists share what research actually looks like, it can help all of us think more clearly about the science we hear about. Moving from cell or animal research to human research is not easy. And if it’s this hard just to go from mouse cells to human cells in a Petri dish, imagine how much harder it is to turn that into a safe and effective treatment in people. That’s why scientists are cautious about bold claims based only on (sometimes even weak) mouse data. And it’s why we want to talk about these experiences.

We are constantly seeing claims online about nutrition, supplements, cancer treatments, and “easy fixes.” There is so much information that it can feel overwhelming, and we sometimes stop asking questions.

Basic lab research is where many discoveries begin. It helps scientists understand how things work, test ideas, and build new questions. It is the foundation of medical progress, but it is only one step of many. To turn a lab finding into a real treatment, much more work is needed. Studies have to be repeated. Conditions have to be refined. Human trials must be done. And there is a lot of uncertainty along the way.

I love basic research and the questions it raises. That’s why it’s upsetting to see funding for it being cut. This work is slow and detailed. It can look invisible from the outside, but it is essential. Just as important, the public deserves a clear understanding of what early research can and cannot tell us. A mouse study is not meaningless, but it is also not proof for humans.

So, the next time you see a big claim on social media about a supplement or treatment based only on limited animal studies, take a moment. Ask questions. Be curious. And remember how much work it takes to turn early research into something that can truly help people.

ICYMI - Digest of Recent Posts:

Families/Kids & Staying Safe: How can I keep kids safe around water?

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Monthly Roundup: May 2026

Welcome to the May edition of the Those Nerdy Girls’ Monthly Roundup—our quick, curated collection of the evidence-based posts that sparked the most conversation this past month. Each roundup is designed to help you stay informed on trending health topics and easily share trusted information with colleagues, friends, and your network.

👀 See something useful? Save it, share it, and help good health information reach more people.

1. The Cancer Vaccine We Already Have

TL;DR:

• The HPV vaccine prevents multiple types of cancer in both men and women.

• Rates of cervical cancer have dropped dramatically for younger women since the vaccine’s introduction.

• The HPV vaccine has a very strong safety record over 20 years and hundreds of millions of doses.

• HPV vaccine coverage in the US (and worldwide) is still lagging where it could be.

This post is a collaboration with Jennifer Dowd‘s Data for Health, Those Nerdy Girls, and the Dartmouth International Vaccine Initiative.

2. It’s been over six months since I’ve had my last COVID vaccine. Is it still a good idea to get vaccinated this spring?

There’s no universally recommended “spring booster” campaign in the U.S. right now, but if you haven’t had a shot since last fall, and you are eligible, this spring is a good time to get one.

3. Abortions are not just surgical procedures.

As a matter of fact, most abortion care in the U.S. is safely provided with the help of two medications (also called “abortion pills”): mifepristone and misoprostol.

4. Can you tell me more about hantavirus? It’s been in the news, and I’m worried.

Hantavirus sounds scary in the headlines, but understanding how it actually spreads can help you see why most people have little to worry about, and there are some steps you can take to protect yourself if you happen to be in a high-risk exposure group.

5. Can a tick bite really make you allergic to meat? Yes, and here’s what to know.

A tick bite really can trigger a new allergy to meat, thanks to a condition called alpha‑gal syndrome (AGS). But this tick‑borne food allergy isn’t only about meat. AGS can also cause delayed allergic reactions after eating dairy and other products from mammals, including some that are hidden as ingredients.

6. Do I need to be worried about Ebola?

Ebola is a serious disease, but the most important thing to know right up front is this: your risk in the United States is currently extremely low. Understanding what Ebola is, how it spreads, and how outbreaks are controlled can help put this situation into perspective.

In health,

Those Nerdy Girls

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What is One Health, and why is it important?

One Health is a framework for understanding how and why our impact on the planet can put human and animal health at risk. Incidents like the hantavirus cruise ship and Ebola outbreaks remind us that the environment can affect our health in unexpected ways.

You may have followed headlines recently about a rare infectious disease called hantavirus after passengers on a cruise ship contracted a rare form of the virus (Andes strain) that can spread from person to person. This was followed by a WHO declaration of a public health emergency of international concern due to an Ebola outbreak in the Democratic Republic of Congo and Uganda [archived link]. While the risk to the general public outside of the affected regions remains low, spillover events (when diseases that normally infect animals infect human hosts) are occurring more often than in the past, and we can expect them to become more common [archived link]. That’s because climate change, the destruction of forests, and the growth of cities are increasing the number of wild animals that come into contact with humans.

What is One Health?

Source: US Geological Survey [USGS]

One Health is the concept that human health, animal health, and planetary health are all interconnected. The “one” in One Health implies that when one part is affected, the others will be as well [archived link]. Looking at human health in this context helps us to see the bigger picture and anticipate potential problems before they occur. For example, One Health principles helped us to understand the origins of the COVID-19 pandemic. Although we may never know the exact sequence of events that led to its emergence, we do know that horseshoe bats are a reservoir for SARS-related coronaviruses [archived link]. You can think of a reservoir species as a home base or natural habitat for a given germ that can cause disease. This usually isn’t a problem as long as bats and people stay away from each other, but when factors like deforestation, the illegal wildlife trade, and urbanization bring wild animals and humans together, sometimes the results are catastrophic.

Why is One Health important?

One Health teaches us that keeping people healthy requires us to look beyond the human world [archived link]. Ignoring One Health can lead to poor outcomes like spillover events, unsafe food and water, food shortages, and antibiotic resistance. One Health is also important because it encourages doctors, vets, scientists, and public health experts to work together, which can prevent outbreaks and lead to better, more lasting solutions.

Another reason One Health is important is that due to global travel and shipping, humans are more mobile than ever before. That means that if an outbreak starts on one continent, it has the potential to spread around the world. Worldwide shipping can also accidentally transport animals and plants to new places where they don’t naturally belong. This can threaten local wildlife or damage crops and other important food sources. The more often these events occur, the more risk there is for everyone.

How does One Health affect me?

One Health isn’t just about identifying potential threats, it’s also about finding workable solutions. For example, the American South once suffered from high rates of hookworm infection. Between 1865 and 1910, approximately 40% of people living in the southern U.S. are believed to have been infected with this parasite [archived link]. Hookworm infections can cause symptoms such as diarrhea, fatigue, iron deficiency, and impaired cognitive development in children [archived link]. Hookworm infections are now rare as a result of the first major public health initiative carried out in the U.S. The solution involved a combination of deworming and educating the population about proper sanitation. This campaign proved that large-scale public health interventions could be successful and eventually led to the founding of a national public health service.

The campaign to reduce the burden of hookworm infections is an example of a successful One Health intervention because it combined treatment with education, sanitation, infrastructure improvement, and collaboration between health authorities and local communities. While hookworm has never been fully eradicated, thanks to One Health measures it is no longer a major threat to human health in the U.S [archived link].

What can I do to protect my community and my environment?

There are some simple strategies to protect yourself and your community from zoonotic diseases (diseases that spread from animals to people) [archived link]. Most of these are common sense, and you’re probably doing a lot of them already!

✅Vaccinate pets and supervise them when outdoors [archived link] ; pets can harm local wildlife [archived link] and come into contact with infectious diseases [archived link], which may spread to humans. While keeping pets indoors is not always practical, unsupervised outdoor time should be limited when possible.

✅Take appropriate precautions when spending time outdoors, such as using insect repellent and avoiding tall grass and heavily forested areas.

❌ Never approach or handle a wild animal, especially if it appears hurt or sick; instead, call your local state wildlife management organization or a licensed wildlife rehabilitator to report sick or dead animals.

✅Teach children to respect wildlife and inform them of the dangers they may pose to human health and safety.

✅Use PPE (such as gloves and masks) when cleaning areas where animal waste or remains may be present, and wash hands thoroughly after.

✅Wash and cook food thoroughly to avoid contaminants.

✅When traveling overseas, check to see if additional vaccinations or prophylactic medications are recommended for the local region.

✅Join a local environmental advocacy group to learn about threats to your community and get involved in the solutions.

Bottom Line: Becoming familiar with One Health can help you appreciate the many links between the environment and human health. Knowing about the risks of spillover events, taking precautions when you spend time outdoors, and learning about threats to your local environment are great ways to become responsible stewards of global health.

Stay well, stay safe.

Love,

Those Nerdy Girls

Resources and further reading:

AVMA - One Health

CDC - One Health Publications

CDC - National Center for Emerging and Zoonotic Infectious Diseases

EPA - One Health

FDA - One Health: It’s for All of US

Indian Journal of Community Medicine - One Health: A Holistic Approach to Tackling Global Health Issues

Johns Hopkins Center for Health Security - One Health

One Health Commission - One Health Library

Pathogens - The Importance of the One Health Concept in Combating Zoonoses

Tropical Medicine and Infectious Diseases - The One Health Approach: Why Is It So Important?

WHO - One Health Initiative

WOAH - One Health

ICYMI - Digest of Recent Posts:

General Health: What is psyllium, and is it good for you?

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Almost seven years ago, I lay in bed with my snoozy newborn on my chest, and googled “why does it look like a little ball is coming out of my vagina?”. In the weeks prior, I’d been reassured by my midwife that the pelvic pressure I was experiencing was “quite normal” following a vaginal delivery. I was reminded of what a big deal it is for a baby to make its way out of a body, even in a “textbook labor” like mine. I was told that the area still had a lot of swelling, and that I simply needed to be patient as my body healed.

Spoiler: The problem wasn’t my patience but a society that’s historically de-prioritized and dismissed women’s health and maternal wellbeing.

I hadn’t minded being the last one of my newly postpartum friends to break the protective bubble of my quiet home. I’d actually loved the idea of a slow postpartum transition, inspired by cultures with traditional practices for nourishing and supporting the new mother and baby through the fourth trimester.

But at almost four weeks postpartum, the ache hadn’t subsided and I felt an entirely foreign vaginal bulging sensation any time I was on my feet. I finally began to question the reassurance I’d been given.

As a 2^nd year doctoral student in clinical health psychology, I knew the risk of consulting doctor google. But what’s a newly postpartum mother supposed to do when her provider tells her, “Everything is fine!” and she knows it is not? (To be fair, I also searched google scholar ;)).

Over the weeks and months that followed, I learned that in the process of bringing our tiny perfect human into this world, I sustained a pelvic floor muscle injury (levator ani avulsion) and had developed pelvic organ prolapse. I’ve since learned that I am not alone, and there is so much I know now that I wish I knew then.

What is pelvic organ prolapse?

Pelvic organ prolapse is a condition in which one of the pelvic organs (bladder, rectum, or uterus) drops down from their “normal” position due to injured or weakened pelvic floor musculature and connective tissues. This can create a bulge near the vaginal opening. Many describe the sensation as like “a tampon falling out.” Other symptoms can also be things like pelvic pressure/heaviness worse with prolonged standing, urinary or fecal incontinence, splinting for bowel movements, aching low back pain. Despite rarely being discussed, postpartum prolapse is present in approximately 30% of postpartum people.

I was given the advice to permanently limit heavy lifting, “learn to love gentle walking”, and “come back for surgery when you’re done having babies”. As a former high-level athlete these words were devastating to me. I had imagined long hikes with my baby in a carrier and family bike-packing trips.

What I should have been told is that pelvic floor symptoms are multi-factorial and benefit from a whole-person approach (i.e., not just kegels or immediate referral for surgery). For some, this could look like addressing tension, practicing diaphragmatic breathing, and un-learning societally-conditioned patterns of holding in one’s belly. For others, symptoms will benefit from dietary changes such as increased fiber and water intake to reduce constipation. This complexity can feel overwhelming at times but it also means we have so many potential tools to use. If one approach doesn’t work well, we still have so many options.

Instead, my prolapse diagnosis and the way it was framed (by both social media and the majority of the providers I saw) completely destabilized my sense of self and my vision for my future.

I had felt well-prepared for sleep deprivation, adjusted rhythms, and loss of freedom over my schedule. I was not prepared for a muscle torn from bone or a bladder trying to escape.

I remember sitting on the floor late one night as my daughter slept in her bassinet beside me, poring through the multitude of pregnancy and childbirth books I’d collected, with tears streaming down my face. “Did I just miss this?” I wondered, “How did I miss this? My whole life is changed by something I didn’t even realize was possible.” In fact, I did not miss it. In fact, it was not included in any of my pregnancy books or childbirth class or even the pelvic floor prep workshop I’d attended.

I felt blindsided, broken, and betrayed.

I allowed those feelings to fuel action, and I began to push back against the societal stigma surrounding birth-related pelvic floor injuries and conditions. I decided not to keep it a secret, just like I hadn’t ever felt the need to keep my bike racing injuries a secret. I refused to inadvertently perpetuate – through my own shame-induced silence – the idea that our job as women and mothers is to quietly accept the impact of under-addressed and underfunded health issues.

The discussions that followed, with both providers and postpartum people, confirmed that the physical, mental, and social aspects of birth-related pelvic floor injuries are a significant unmet need.

I am not grateful for my birth injury, but I am grateful for the fact that I was well-positioned as a clinical psychology doctoral student to be a part of the solution. Now, seven years later, I’m a licensed clinical psychologist and postdoctoral research fellow. I’m currently leading a 6-session education and coping skills group for individuals with postpartum pelvic floor concerns, and hope to make this resource more widely available in the future.

I wish I could go back in time and deliver the information I have now to that devastated version of myself… that new mother fumbling through the tender transition of matrescence (the transition to motherhood) with the added weight of pelvic floor symptoms, diagnostic uncertainty, physical activity restrictions (largely non-evidence-based), and medical gaslighting.

But in lieu of a time machine, helping others feel less alone and broken than I did will have to do. Here are a few things I wish I had known when I was there myself.

The narratives surrounding prolapse can often fall into unhelpful extremes. You might hear either “this is normal, keep living your life!” or “don’t ever run or lift heavy or you’ll make things worse!” These mixed messages may bring a sense of confusion and fear, and can make it difficult to navigate what you can and cannot do. One of the most helpful things I learned was that the off-limits physical activity list is shorter than we may have been led to believe. It’s not so much what but how. This helped me combat fear of movement, embrace a “lets try” mentality, and ultimately rebuild strength, athleticism, and trust in my body.

Our symptoms are real, but our brains matter too. We can learn strategies to help our brains work for us. These tools can include mindfulness-based practices to begin to re-orient our relationship with physical symptoms, relaxation skills to reduce tension and help our systems feel safe and supported, cognitive behavioral techniques to recognize and challenge unhelpful thought traps, and behavioral strategies to flexibly increase engagement in valued activities even with symptoms in the background. Over time, even frustratingly persistent symptoms can start to be experienced as sensory signals in the background versus an urgent message of danger or imminent worsening.

Pessaries can improve quality of life. A pessary is an internal silicone prosthetic device inserted vaginally to provide additional pelvic support. There are also pessary options specifically designed to help with stress urinary incontinence (urine leakage due to running, sneezing, etc.) They can be a tool that gives a lot of freedom. It doesn’t need to be seen as a source of embarrassment or shame. Think of it like eye glasses or supportive knee braces. A pessary can help people live more fully with less discomfort.

Unfortunately, many people struggle longer than necessary because of misconceptions and stigma around pessaries. I’ve encountered a lot of myths, so here are some important reminders:

• Pessaries can be helpful for all stages of prolapse, not just severe prolapse.

• Pessaries are for people of all ages.

• Pessary insertion and removal typically gets easier with practice and can be self-managed at home.

• Pessaries do not automatically compromise one’s ability to be intimate and can actually enhance it. I don’t know about you all, but I have a much stronger desire to be intimate with my partner when I’m able to engage in mood-boosting, value-aligned activities with fewer prolapse symptoms in the background.

Many need to try several different shapes and sizes to find the optimal fit, so please don’t give up after the first try if you haven’t found an option that provides comfortable support. There are also a number of external support garments that many find to be useful.

You are not alone and resources exist!

1. Pelvic floor physical therapy is a great place to start, but provider shortages and long waitlists and lack of insurance coverage are real barriers so there are also other options.

2. Bimonthly community group through my Substack for people managing postpartum pelvic floor injuries and conditions, including prolapse.

3. Online prolapse course by Margo Kwiatkowsky, a physical therapist and mother of two who experienced prolapse herself. It covers education and rehab/activity progression guidance.

4. Follow trustworthy voices in this space such as Julie Wiebe, Carrie Pagliano, and Rebecca Maidansky.

5. Before you return to activity post-partum, check out these resources.

I hope some of this was helpful, and please feel free to reach out if you’d like to connect! In addition to my Substack, you can find me on Instagram at @wildmatrescence or email me at drkimberleyjohnson@gmail.com

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We Missed Some Important Things. You Told Us. We Listened. 🧡

A conversation with Priscilla Corson, AuDHDer and therapist

Hosted by MK Haber, Executive Director, Those Nerdy Girls &+

Recorded April 17, 2026

A note before we begin:

In February, Those Nerdy Girls published a post on therapies for autism spectrum disorder. Our goal was definitely in line with what we do here: debunk genuinely dangerous or ineffective “treatments” like bleach and chelation. But we missed something important. We listed Applied Behavior Analysis (ABA) as safe and effective, and you, our readers let us know, clearly and firmly, that we hadn’t captured the full story.

You were right.

Your incoming comments showed us our community doing exactly what we have tried to cultivate: a safe space for us all learning and growing together, holding each other accountable with evidence, lived experience, and care. Autistic adults. Clinicians. Researchers. Parents. Friends.

I was relaying this to a friend and fellow clinician and they said, “I have got to connect you with Priscilla Corson!” Priscilla is an autistic ADHDer, Latinx therapist, and neurodiversity nerd whose special interest is exactly this terrain. I want you to hear directly from her. This conversation is our answer to your questions and concerns. From all of us at Those Nerdy Girls, thank you for being in this with us.🙏

— MK

MK: Priscilla, before we get into ABA (Applied Behavior Analysis) specifically, can you help us understand where it came from? Because I think most people encounter it without any historical context at all.

Priscilla: Understanding and language around Autism in general has evolved so much. And to understand ABA, you have to understand what was happening before it existed.

There was a period of time when autism was being essentially discovered, or more accurately, a label was being defined. Clinicians were trying to identify a set of symptoms that would eventually become what informed the DSM (Diagnostic and Statistical Manual of Mental Disorders) criteria. And at the time, they didn’t know what might be leading to autism, or why certain individuals presented as autistic. This is an oversimplification but you essentially had an entire camp that blamed parents. “Non-nurturing” mothers were called “refrigerator moms.” Children were removed from their homes. They essentially became science experiments.

And when you really think about that terminology, refrigerator mom, you’re probably talking about another autistic human who didn’t have a diagnosis. Who didn’t have the right supports for themselves, and therefore didn’t have the right supports for their children.

Eventually, parents got fed up. They pushed back. ABA, a form of behaviorism, became popular to address the horrors of autistic kids being institutionalized. It was kind of the next generation that would define the autistic parental movement. A way of keeping their children in the home, and refusing to frame them as broken.

MK: So ABA started as an act of protection.

Priscilla: In a lot of ways for parents, yes. And that matters for how we hold this history. Those parents were responding to something genuinely harmful. The problem is that the model they and the clinicians of the time adopted still had behavioral adaptation at its core: teaching children to survive in a neurotypical society, rather than asking whether that society needed to change.

And then something shifted. Those children grew up. In the mid 90s you had this wonderful, beautiful movement emerge, the Neurodiversity Movement, driven by autistic adults who had been through ABA themselves. They pushed toward things that were more neuroaffirming. They pushed against being forced to mask, to perform neurotypically. They wanted to be able to freely express themselves. And in that, we learned a lot. The DSM criteria actually changed.

MK: Let’s talk about masking, because I think it’s central to understanding the critique of ABA. What is it, and why does it matter?

Priscilla: Masking is when autistic people suppress or hide their autistic traits, things like stimming, differences in eye contact, communication style, in order to blend in and appear neurotypical. And we are growing in our understanding that chronic masking causes real harm. Chronic fatigue. Gut issues. Depression, anxiety. Significant health consequences, because that stress is going somewhere else in the body.

ABA, at its core, teaches masking. It’s focused on observable, external behavior, and it measures success by how much less autistic a child appears. It doesn’t ask about the internal experience of that child.

MK: And yet you’ve said that masking can’t be fully eliminated. That’s where the nuance really lives.

Priscilla: Right. And this is where I have to bring in my own perspective as a Latinx clinician, because this is not a one-size-fits-all conversation.

Society hasn’t evolved enough to fully hold space for neurodivergent people yet. And we know that the mass elimination of masking as a concept would be disproportionately harmful to minority communities.

Brown and Black autistic communities are already saying: we appreciate the visibility this movement has brought, but this conversation has swung to the opposite extreme. It’s not capturing the full scope of the spectrum, and it’s not capturing what might only be accessible to us.

So there’s a difference between masking as identity erasure, which is harmful, and having the capacity to modulate your presentation in specific, high-stakes contexts. For a lot of autistic people of color, that capacity is not about fitting in socially. It can be about survival. Navigating encounters with law enforcement, for example. Moving through systems that were never designed with them in mind.

MK: Ok, the goal is to give people the tools, so that if they’re in a situation where their safety is at stake, they have a choice.

Priscilla: Exactly. I always tell my late diagnosed adult clients: you now have three choices. You can mask. You can unmask. Or you can accommodate yourself. Before this choice may not have been happening consciously. And the goal is to teach not masking itself, but what masking feels like in your body, so that you know when you’re doing it, and you’re doing it by choice, not because someone trained it into you.

Because a lot of people don’t even know when they’re masking. They’ve been doing it so long it feels like just existing but not understanding why they feel chronically exhausted and burned out. And we don’t want that. We want people to have genuine choice.

MK: Where does that leave ABA? You mentioned there are clinicians trying to do it in a more neuroaffirming way.

Priscilla: There are good clinicians out there who are ABA clinicians and are genuinely attempting to be more neuroaffirming. But here’s the thing: if you remove the human element from the equation, if you just look at what ABA is at its basis, the core of it is still problematic. It’s teaching behavioral adaptation for survival in a neurotypical society. Which is really not what we’re looking for.

What we’re looking for is full acceptance and inclusion for people to exist within their primary neurotype. As they are.

It’s the same arc we’ve seen in the LGBTQ+ movement. We’ve had enough conversation to establish that people can be who they are, love who they love, but we haven’t gotten to the next question, which is: why is this still a conversation? Why are we still accommodating the discomfort of the majority rather than asking the majority to expand?

The autistic community is in similar places. We have some supports. We need more supports in many neurotypical contexts. Would we need all the same supports if people were actually allowed to exist in their primary neurotype? Can differences be allowed? Would this reduce the number of supports we need?

MK: That parallel is so clarifying. It reframes the whole question.

Priscilla: And I think you’re starting to see a newer movement emerging, beyond the original neurodivergent focused movement, that’s exploring neurodiversity as a whole. This concept that everyone can exist, that there are predominant neurotypes, and that difference isn’t deficit. It’s very new. But the direction is clear: things need to keep evolving. We need to keep having change.

MK: What do you want families, especially families who have already used ABA or are being told it’s the only evidence-based option, to hear from this conversation?

Priscilla: I think I want them to hear that this isn’t about blame. The parents who turn to ABA are doing the best they can with what’s available. Just like the parents who fought against the “refrigerator mom” era were doing the best they could.

What we know now is that we can do this work in a much more neuroaffirming way. Ways that support the individual and their autism without ever forcing them to mask, and instead give them choice. Speech therapy, OT, neuroaffirming approaches, when done well and with the right lens, can be genuinely supportive because they work with the person. They build on strengths and address real barriers that the person themselves wants support with.

That’s a different thing entirely from training a child to perform neurotypically for the comfort of the adults around them.

And the conversation isn’t over. It keeps evolving. Which means we have to keep evolving with it.

Those Nerdy Girls thank Priscilla Corson for her time, her expertise, and her generosity in helping us deepen our understanding of this topic.

With appreciation,

Those Nerdy Girls &+🧡🤓

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Do I need to be worried about Ebola?

Ebola is a serious disease, but the most important thing to know right up front is this: your risk in the United States is currently extremely low. Understanding what Ebola is, how it spreads, and how outbreaks are controlled can help put this situation into perspective.

Buckle up Nerds, there is a lot of important information you should know about the ongoing outbreak of Ebola. Ebola is a serious disease, but the most important thing to know right up front is this: your risk in the United States, or more generally in the global North, is currently extremely low. Understanding what Ebola is, how it spreads, and how outbreaks are controlled can help put this situation into perspective.

As with the spread of many viral diseases, this situation is rapidly changing. We want to keep you informed, so consider this information current as of the morning of Saturday, May 23, 2026.

Here‘s what we know so far about the current outbreak

The current outbreak of Ebola disease likely began in March in the Democratic Republic of Congo (DRC) in an area close to the border with Uganda and South Sudan. Most of the over 700 suspected or confirmed cases so far have been in the DRC, and five have been confirmed in neighboring Uganda.

Ebola disease is caused by the Ebola virus. Ebola virus is actually a family of viruses, like brothers and sisters, or cousins. One member of this family, Zaire ebolavirus (EBOV), has caused several significant outbreaks in Africa, and the more recent outbreak of which was controlled with the help of a large-scale vaccination program. Unfortunately, there is no specific vaccine for the version involved in the current outbreak. It is a different member of the family, called Bundibugyo virus (BDBV).

Image from CDC website. [archived link]

How does Ebola spread?

One piece of good news is that Ebola does not spread easily. Ebola spreads through direct contact with bodily fluids. These are things like blood, urine, feces, saliva, or vomit. And, they are spread by someone who is currently sick with symptoms, from someone who died of the disease, or from touching things contaminated with body fluids such as needles or soiled bedsheets from someone with, or who died from, the disease.

This means outbreaks tend to spread in healthcare settings or among close caregivers.

So what happens after someone is exposed?

Symptoms typically appear between 2 and 21 days. That can be a long time, and coupled with the fact that early symptoms can look like common viral infections, it makes identifying cases tricky. The early symptoms include fever, fatigue, muscle aches, headache, and sore throat. However, patients rapidly get very sick and have vomiting, diarrhea, and sometimes experience internal and external bleeding. Ebola disease belongs to a group of illnesses called viral hemorrhagic fevers because of the bleeding.

🤓🚨 Nerd alert: Hemorrhage is heavy or uncontrolled bleeding that happens when blood escapes damaged blood vessels. Although Ebola disease is sometimes called hemorrhagic disease, severe bleeding is not as common as the other symptoms.

Controlling an Ebola outbreak depends on early testing and isolating infected people. Infections are confirmed by blood tests for the virus’s genetic material, or blueprints, but results can take several days or more depending on how close a diagnostic lab is to where the samples are collected. Because those early symptoms are non-specific, testing and tracing exposed contacts are important to stop outbreaks.

Unfortunately, there is no specific prevention, treatment, or cure for this virus infection. Promising research studies have shown some protection against Bundibugyo virus (BDBV) using experimental vaccines or the available Ebola Zaire (EBOV) vaccine, but it is unclear if they will be used in this outbreak. This means patients must be isolated as quickly as possible to stop the spread and then treated with supportive care: things like fluids, electrolytes, and treatment for complications. Patients who are able to go to high quality health facilities fare much better than patients in rural hospitals with low resources like those at the epicenter of this outbreak. Even so, in previous outbreaks, of the people who got sick with Bundibugyo virus 25-50% of them died. To put that into perspective, that is up to 50 out of 100 people compared to 1-2 out of 100 that would die from flu or COVID.

That is very scary, but it is important to stress that the risk to the general public in most places remains very low. As of today, no one has tested positive for Bundibugyo in the US. Ebola outbreaks are typically contained close to their place of origin through rapid isolation, contact tracing, and international monitoring.

What is happening internationally to help manage this outbreak?

The World Health Organization, or the WHO, is assisting with isolating ill people, tracing people they had contact with, and deploying international monitoring. On May 17, the WHO declared this outbreak a public health emergency of international concern (called a PHEIC, which is pronounced “fake”, yes really!) because there is confirmed international spread to neighboring countries in Africa, there is a high risk for broader spread due to international travel, and there is likely an underestimation of the number of people with and dying from the disease. In addition to the 82 laboratory-confirmed and over 750 suspected cases in the DRC, there have now been five total cases confirmed in Uganda including at least one in Kampala, the capital of Uganda, which has a population of 4.3 million people. We are likely to see many more cases, and deaths, before this outbreak is under control. The designation by the WHO allows it to ramp up international coordination and cooperation necessary for information sharing, surveillance, and control. Unfortunately, the dismantling of the US Office of Pandemic Preparedness and Response Policy (OPPR) and the departure of the US from the WHO puts it on the outside looking in and not a central player in obtaining information. And it limits its trained public health officials from helping in the response to the outbreak.

What is the US doing about this outbreak?

On May 18, the US Centers for Disease Control and Prevention (CDC) announced new travel restrictions for visitors from the African countries at the center of this outbreak. For the next 30 days, anyone who has traveled through that area in the prior 21 days will not be allowed into the US. The restriction does not apply to US citizens, but on Friday the government added green card holders to the restricted list. This policy has already led to the diversion of a Denver bound flight from Paris because a passenger was from one of the counties covered by this new restriction. Those not covered by the restrictions and who are allowed to come to the US must now land in Dulles International Airport in Virginia for health screening before being allowed entry. While travel bans may sound like a reasonable way to stop spread, unfortunately, studies show that they have only minor effects on limiting the spread of Ebola. Moreover, travel bans can limit movement of supplies, equipment and humanitarian aid. While the US has mobilized 23 million USD in bilateral foreign assistance, it is unclear how much of that will be used in the US for screening and potential isolation of sick people entering the US versus external aid. The US government has announced that it is providing resources to establish up to 50 Ebola response clinics in the DRC and Uganda.

What can you do to keep your risk low?

ℹ️ Keep up on the outbreak, but don’t panic!

🙅 Distance yourself from anyone who has recently traveled to areas near where this outbreak is happening.

🚫 Don’t travel to where this outbreak is happening.

🤲🏾 Frequently and thoroughly wash your hands.

🥤 Don’t share things like cups where you could get exposed to someone else’s bodily fluids.

The bottom line is that Ebola is a serious disease, so it is worth keeping an eye on how it develops, but your risk in the US right now is extremely low.

Resources/ further reading:

WHO - WHO declares PHEIC

CDC - Ebola Disease: current situation [archived link]

CDC - Travel restrictions declaration

WHO - Disease Outbreak News: Ebola disease caused by Bundibugyo virus, Democratic Republic of the Congo & Uganda

Médecins Sans Frontières (Doctors Without Borders) - Information on Bundibugyo

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