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Polio & Post-Polio Syndrome

Polio is a virus that can attack the nerves and cause paralysis. Vaccination prevents it, and it is now very rare in the United States. Many people who had polio as children develop new weakness and fatigue decades later, called post-polio syndrome, which is managed with pacing, therapy and equipment. New trouble breathing or swallowing, or sudden weakness, needs prompt medical care.

Seek medical care right away for sudden weakness or paralysis, especially with fever, headache, vomiting or a stiff neck, or for any trouble breathing. CDC says anyone who suspects polio should contact a health care provider right away or go to an emergency room (CDC). The NHS in the UK tells people to call for an ambulance if they or their child cannot move part or all of the body, or have difficulty breathing, and to say if they have recently traveled to an area where polio is a risk or been in close contact with someone who has (NHS). MBHA suggests treating severe breathlessness or choking as an emergency too.

  • Tell the doctor about travel and vaccination. CDC advises clinicians to consider polio in people with polio-like symptoms, especially if they are unvaccinated or incompletely vaccinated, have recently traveled to an area where polio occurs, or were exposed to someone who did. Polio is a reportable condition, and a clinician who suspects it works with the state and local health department on testing (CDC).
  • If you had polio years ago and notice new trouble breathing or swallowing, do not wait for a routine visit. Post-Polio Health International advises an immediate respiratory evaluation for a combination of signs such as morning headaches, daytime sleepiness, a weak cough, or shortness of breath on exertion (Post-Polio Health International), and a swallowing study for any suspected swallowing problem (Post-Polio Health International).
  • People with new symptoms years after polio have not been re-infected and are not contagious (Post-Polio Health International, NINDS).

What is polio?

Polio, or poliomyelitis, is caused by the poliovirus. The virus attacks the nervous system, and in serious cases it can cause paralysis that may be lifelong and sometimes life-threatening (MedlinePlus). WHO describes it as a highly infectious disease that can cause total paralysis in a matter of hours (WHO). There is no cure for polio. It can only be prevented, and the vaccine does that very well (WHO).

Polio mainly affects children under 5, but anyone of any age who is unvaccinated can get it (WHO). It spreads mainly through contact with the stool of an infected person and, less often, through droplets from a cough or sneeze (CDC). People can spread it from just before symptoms start until up to 2 weeks afterward, and people with no symptoms can spread it too. Alcohol-based hand sanitizer does not kill poliovirus, so CDC advises washing hands with soap and water (CDC).

A short history

In the great 1916 New York epidemic, about 27,000 people were disabled and 6,000 died. Jonas Salk’s inactivated vaccine was declared safe, potent and effective in April 1955, and Albert Sabin’s oral vaccine became the vaccine of choice in the United States in the early 1960s. Between them, the two vaccines brought about a dramatic decline in polio (Post-Polio Health International). Today CDC says wild poliovirus has been eliminated in the United States (CDC), and WHO certified the Americas polio-free in 1994 (WHO).

How rare is polio now?

Since 1988, cases of wild poliovirus have fallen by more than 99% worldwide, but WHO reports that transmission continues in areas of Afghanistan and Pakistan, and that children everywhere stay at risk as long as a single child is infected (WHO). CDC points out that it only takes one person with polio traveling from another country to bring the virus into the United States, and that anyone not up to date on polio vaccines is at risk (CDC).

That is not just theory. In 2022 a person who had not been vaccinated developed paralytic polio in New York State from a vaccine-derived type 2 poliovirus, and the virus was later found in wastewater. The suspected case was reported through national surveillance for acute flaccid myelitis to the state health department and then to CDC (CDC MMWR, 2022). Even so, polio in the United States is extraordinarily rare, and vaccination is the reason.

Symptoms and paralytic polio

Most people infected with poliovirus have no visible symptoms. About 1 in 4 get flu-like symptoms such as sore throat, fever, tiredness, nausea, headache or stomach pain, usually lasting 2 to 5 days. Meningitis (infection of the covering of the brain and spinal cord) affects about 1 to 5 in 100 infected people, and paralysis or limb weakness about 1 in 200 to 1 in 2,000, depending on the virus type (CDC).

How polio is diagnosed

A provider takes a history, including vaccination and travel, does a physical exam, and collects samples such as stool, saliva, blood, urine and spinal fluid. The virus is most likely to be found in stool, and an MRI may be used to look at the spinal cord (MedlinePlus). A negative spinal fluid test cannot rule polio out (CDC).

Post-polio syndrome (PPS)

Post-polio syndrome affects some polio survivors many years after they recovered, usually 15 to 40 years later, and it is not contagious (MedlinePlus). NINDS says it is believed to result from the gradual deterioration of motor neurons over many years, that not everyone who had polio develops it, and that only someone who has had polio can (NINDS). CDC says studies estimate that 25 to 40 in 100 polio survivors have it (CDC).

How PPS is diagnosed

There is no single test. Post-Polio Health International lists criteria based on NINDS: earlier paralytic polio with evidence of motor neuron loss; partial or complete recovery followed by a stable period, usually 15 years or more; gradual new weakness or abnormal muscle tiring; symptoms lasting at least a year; and exclusion of other neuromuscular, medical and orthopedic causes (Post-Polio Health International). Because PPS is a diagnosis of exclusion, it is important to rule out or treat other conditions with similar symptoms, and the group advises not trying to diagnose yourself. A physiatrist (rehabilitation specialist) or a neurologist usually does the neuromuscular examination (Post-Polio Health International). A hurried conclusion that old polio explains everything can deprive survivors of treatable problems (Post-Polio Health International).

Fatigue in PPS is probably multifactorial (weight gain, breathing problems, poor sleep and multiple medicines can all contribute), and no validated diagnostic test exists (Li Hi Shing et al., 2019). For other causes of tiredness, see our Chronic Fatigue guide, and for other causes of sudden weakness, our Guillain-Barré guide and Stroke guide.

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Acute polio: hospital care, pain relief, fluids and help with breathing when needed, plus therapy. Post-polio syndrome: a specialist evaluation, then an individual plan of pacing, gentle exercise, braces and mobility aids, breathing support and swallowing care. No medicine has been shown to stop PPS. Medicare Part B pays for medically necessary outpatient physical and occupational therapy (you pay 20% of the Medicare-approved amount after the Part B deductible, with no yearly limit). Medically necessary equipment such as walkers, wheelchairs and respiratory assist devices is also covered with the same 20%. Other costs: being researched. Research on PPS treatments is limited. Pacing, fitting braces and treating breathing and sleep problems are the mainstays; the best-studied medicines have not helped.
Chiropractic No role in preventing or treating polio. Some polio survivors use it for back and neck pain; the only item we found is a single case report. About $55 to $100 per follow-up visit paying cash, per The Pricer. Medicare covers only spinal adjustments for a subluxation. Never a substitute for emergency care or a specialist evaluation. Weak muscles, uneven leg length and spinal curves can make joints less stable, so tell the chiropractor about your polio and ask for gentle techniques.
Acupuncture Sometimes tried for pain and fatigue in polio survivors. About $90 to $185 per follow-up visit paying cash, per The Pricer. Medicare covers acupuncture only for chronic low back pain. We found little research, and the reports we found are decades old. Reported benefits are unproven. Choose a licensed practitioner who uses sterile needles.
Herbal medicine No herb or supplement has been shown to treat post-polio syndrome or restore strength. Cost estimate being researched. Two supplements tested against placebo in post-polio syndrome did not help. Tell your doctor and pharmacist about every product, especially before surgery.
Massage therapy Gentle bodywork for muscle tension and comfort alongside pacing and therapy. One national chain: about $70 to $90 a month on a 12-month membership, per The Pricer. We found little research. Relief reported by polio survivors is unproven. Keep pressure light and the session short enough that you are not left exhausted.
MBHA Wellness Coach Everyday habits that support a post-polio plan: pacing, energy conservation, steady gentle activity, sleep, food and weight, and emotional support. Cost estimate being researched. Supports — never replaces — medical evaluation, therapy and equipment. The aim is to avoid overuse and exhaustion, not to push harder.

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Conventional medicine (AMA)

Treatment depends on whether the question is acute polio or the late effects.

Acute polio

The NHS says there is no treatment for polio, but care can lower the risk of long-term problems: hospital care, painkillers, fluids, help with breathing, and regular stretches and exercises to prevent muscle and joint problems (NHS). MedlinePlus adds that physical or occupational therapy helps with arm or leg weakness and that the earlier it starts, the better, and that a ventilator may be needed if the breathing muscles are weak or paralyzed (MedlinePlus). CDC says clinicians may consult neurology and infectious disease experts (CDC).

Post-polio syndrome: the care plan

There is no cure for PPS, but treatments can help manage symptoms (MedlinePlus). Post-Polio Health International recommends a management plan designed for the individual. It may include (Post-Polio Health International):

  • bracing to support weak muscles and overworked joints;
  • canes and crutches to take weight off weak limbs and prevent falls, and customized shoes for unequal leg lengths, which can cause back pain and cost extra energy to walk;
  • a wheelchair or motorized scooter for long distances;
  • weight loss when appropriate;
  • specific, selected exercises that avoid both disuse weakness and overuse weakness;
  • a breathing machine at night to treat underventilation.

Braces. Many survivors who set their braces aside years ago need support again. Bracing can reduce pain, prevent tripping and falls, may prevent a joint deformity from worsening, and may make walking more efficient. A physician’s prescription is generally needed for insurance to pay, and an orthotist (brace specialist) builds the device (Post-Polio Health International).

Exercise. MedlinePlus says non-fatiguing exercise — exercise that does not cause pain or fatigue lasting more than 10 minutes — may improve muscle strength and reduce tiredness (MedlinePlus). See “What the research says” below and the Wellness Coach tab for pacing.

What the research says

  • Cochrane review of treatments. This review included 13 trials with 675 people. None was completely free of risk of bias. Intravenous immunoglobulin (IVIg) had no beneficial effect on activity limitations, and several medicines (modafinil, pyridostigmine, amantadine, prednisone) and rehabilitation in a warm or cold climate were not beneficial. Lamotrigine, muscle strengthening of thumb muscles and static magnetic fields might help but need further study. The authors concluded that they could not draw definite conclusions about what works (Koopman et al., 2015). A separate review reached a similar view on IVIg, which it said is unlikely to improve pain, fatigue or strength (Huang et al., 2015).
  • Exercise. A 2021 review of 21 studies found that muscle-strengthening and fitness programs favored improvement in function, and called for individualized exercise research (Ramachandran et al., 2021). In a small trial of 32 people, both hospital-based and home-based aerobic programs improved fatigue and quality of life, with more gains in the hospital group (Oncu et al., 2009). Yet in a trial of 68 severely fatigued people, neither exercise therapy nor cognitive behavioral therapy beat usual care for fatigue (Koopman et al., 2016).
  • Programs. In a retrospective study of 214 people who completed a residential self-management program in the UK, fatigue, pain and walking speed improved at 6 months, though quality of life did not; there was no comparison group (Curtis et al., 2020).
  • In summary, no medicine has been found that stops or slows the weakening of muscles, and care centers on symptom relief and individualized rehabilitation such as energy conservation (Li Hi Shing et al., 2019).

We don’t list doses.

What it costs

Medicare Part B covers medically necessary outpatient physical therapy, including therapy to improve or maintain function or slow decline; after the Part B deductible you pay 20% of the Medicare-approved amount, with no yearly limit (Medicare.gov). Occupational therapy is covered the same way (Medicare.gov). Part B also covers medically necessary durable equipment ordered for use at home, including walkers, wheelchairs and scooters, and respiratory assist devices, with 20% after the deductible (Medicare.gov). Other costs: being researched.

Find a medical doctor in our directory

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Chiropractic

Chiropractic care has no role in preventing or treating polio, and it cannot replace a specialist evaluation for new weakness, breathing or swallowing problems. Post-Polio Health International lists chiropractic among the “bodywork” therapies polio survivors try, and says improvements in range of motion, pain and fatigue are “often reported” — reports, not controlled evidence (Post-Polio Health International).

What we found

The only item we found is a 2023 case report of one man with post-polio syndrome and neck and low-back pain. His chiropractors used neck and lumbar manipulation, spinal traction, deep muscle massage and core-muscle training for 40 months, and he reported full resolution of his complaints (Chu and Zoubi, 2023). One person’s course of care cannot show that any part of it worked.

Safety

NCCIH says serious side effects from spinal manipulation are very rare, but that the likelihood may be greater in people with underlying health problems that raise their risk of injury (NCCIH). Survivors of paralytic polio may develop leg weakness, leg length differences and pelvic tilt (Chu and Zoubi, 2023), and scoliosis (MedlinePlus), and Post-Polio Health International notes that tight muscles and ligaments sometimes provide support for joints that would otherwise be unstable (Post-Polio Health International). MBHA suggests telling any chiropractor you had polio, asking your doctor whether thrust techniques or aggressive stretching are safe for you, and asking for gentle methods. For back or neck pain, see our back pain guide.

What it costs

The Pricer lists about $55 to $100 for a self-pay follow-up visit and $90 to $200 for a first appointment (The Pricer). Medicare covers only spinal adjustments by a chiropractor to correct a subluxation (Medicare.gov).

Find a chiropractor in our directory

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Acupuncture

Post-Polio Health International lists acupuncture and acupressure among the “energy work” therapies, which it says typically promote a sense of well-being and relaxation, with improvements in pain and fatigue “frequently reported” (Post-Polio Health International). Again, that describes reports, not trials.

What we found

We found little research. A PubMed search for acupuncture in polio or post-polio syndrome returned mostly reports from the 1990s and earlier, many from China. One, published in 1987, has the title “A clinical study of series electro-acupuncture of 1000 cases of poliomyelitis sequelae,” but PubMed shows no abstract, so we cannot say what it found (Gu et al., 1987). The Cochrane review of treatments for post-polio syndrome included drug trials, muscle strengthening, rehabilitation in different climates and static magnetic fields, and no acupuncture trials (Koopman et al., 2015). So there is no good evidence either way.

Safety

NCCIH says relatively few complications have been reported, mostly from nonsterile needles and improper treatment, and that when not delivered properly acupuncture can cause serious adverse effects, including infections, punctured organs and injury to the central nervous system (NCCIH). MBHA suggests choosing a licensed practitioner, telling them about your polio and any breathing equipment, and treating acupuncture as a possible comfort measure alongside, not instead of, your medical plan.

What it costs

The Pricer lists about $90 to $185 per follow-up visit and up to about $230 for a first private appointment, with community acupuncture around $50 to $90 (The Pricer). Medicare covers acupuncture only for chronic low back pain (Medicare.gov).

Find an acupuncturist in our directory

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Herbal medicine

No herb or supplement has been shown to treat post-polio syndrome, restore lost strength or replace a rehabilitation plan.

Supplements that were tested

  • Coenzyme Q10. In a placebo-controlled trial of 103 polio survivors with moderate to high fatigue, taking it for 60 days did not reduce fatigue more than placebo; it was safe and well tolerated (Peel et al., 2015).
  • L-citrulline. In a 24-week trial of 29 people with post-polio syndrome, the supplement group did not show a beneficial effect on timed muscle function compared with placebo; it was safe and well tolerated (Putananickal et al., 2021).

Trials of medicines for PPS have likewise mostly not found benefit (Koopman et al., 2015).

Safety

Natural does not always mean safe. Supplements can interact with medicines, and before surgery some can raise bleeding risk or affect your response to anesthesia, so NCCIH advises telling all providers about every supplement you take (NCCIH). NCCIH notes that the rules for making and selling dietary supplements are less strict than those for prescription or over-the-counter drugs (NCCIH), and Post-Polio Health International advises checking herbs for possible interactions with medications (Post-Polio Health International). Chinese herbal products have been studied for many conditions, but because many studies were of poor quality NCCIH says no firm conclusions can be made about their effectiveness (NCCIH). Show every product to your doctor and pharmacist; we don’t list doses. See our medication safety guide.

What it costs

Cost estimate being researched.

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Massage therapy

Massage will not treat polio or restore strength, but gentle bodywork may help with comfort and muscle tension. Post-Polio Health International lists massage, myofascial release and similar bodywork among the therapies polio survivors try and says improvements in range of motion, pain and fatigue are often reported (Post-Polio Health International).

What we found

We found little research on massage in polio survivors. The one published case we found used deep muscle massage as one part of a multi-part program, so its effect cannot be separated out (Chu and Zoubi, 2023).

Safety

  • NCCIH says the risk of harm from massage appears low, though rare serious problems — a blood clot, nerve injury or bone fracture — have been reported, some after vigorous deep-tissue work or in people at higher risk of injury such as older adults (NCCIH).
  • MBHA suggests asking for light to moderate pressure, avoiding forceful deep-tissue work, and telling the therapist which muscles are weak and which joints are unstable.
  • Fatigue is a real limit. Post-Polio Health International advises avoiding activity that brings on pain or fatigue lasting more than ten minutes (Post-Polio Health International), so MBHA suggests short sessions and planned rest afterward.

What it costs

One national chain’s membership runs about $70 to $90 a month on a 12-month term (The Pricer).

Find a massage therapist in our directory

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MBHA Wellness Coach

An MBHA Wellness Coach can help you carry out the daily habits that Post-Polio Health International and rehabilitation teams emphasize — alongside, never instead of, a medical evaluation, therapy and equipment. The goal is to protect your energy, not to push through.

Pace yourself

Pacing means interspersing activity with rest to avoid excessive fatigue. Post-Polio Health International says it can reduce muscle fatigue and improve recovery of strength, and calls rest and pacing the most effective approaches to fatigue to date; it may take two or more days to recover from an exhausting activity (Post-Polio Health International). Its guidance includes stopping before pain rises more than one point on a ten-point scale over your baseline, plus these energy-saving ideas (Post-Polio Health International):

  • Learn your limits and rest before you are exhausted. Signs a task is too much include twitching, weakness or fatigue in muscles, shortness of breath, or a sense of more than mild to moderate effort.
  • Spread activities across the week, and use the “15-minute rule”: rotate among about four different activities, with a rest each hour or half hour.
  • Use the large muscles of the shoulders, thighs and trunk rather than small muscles of the hands and back, avoid carrying heavy loads, and use carts.

The same group advises resting 15 to 30 minutes several times a day (Post-Polio Health International). MBHA suggests working these out with a therapist and adjusting as you learn what works for you.

Move gently

The group says an exercise program should focus on endurance rather than strength, that exercise causing pain or excessive fatigue should be limited or stopped, and that weakened muscles respond poorly to vigorous strengthening; very gradual strengthening, guided by fatigue and pain, can bring modest improvements. It names swimming as the best endurance exercise because it is easy on tendons and joints, and says weight-bearing exercise may help slow osteoporosis and balance exercises can reduce falls (Post-Polio Health International). A coach can help you keep to the plan your therapists design. See our balance guide and osteoporosis guide.

Gentle practices such as yoga, tai chi and qigong are often recommended for polio survivors, with experienced practitioners who have adaptive training (Post-Polio Health International). NCCIH says tai chi and qigong appear to be safe (NCCIH). In one small pilot of 10 people with post-polio syndrome and cold intolerance, three months of qigong was followed by less cold intolerance, in a before-and-after design without a comparison group (Ramos et al., 2012).

Food, weight and sleep

MedlinePlus lists a healthy diet, enough sleep and not smoking among lifestyle changes for PPS (MedlinePlus). Weight gain can add to fatigue (Li Hi Shing et al., 2019), and weight loss is one of the usual recommendations (Post-Polio Health International). Sleep apnea, low breathing during sleep and restless legs seem to be more common in polio survivors, and a review suggests screening for sleep disorders in follow-up (Léotard et al., 2020). If you wake unrefreshed or with headaches, raise it with your doctor. See our sleep apnea guide and weight control guide.

Mood and support

Living with new limits can be hard. Post-Polio Health International suggests support groups or individual or family counseling to help make lifestyle changes (Post-Polio Health International). See our depression and anxiety guides. A coach can help you set realistic goals and keep up routines.

What it costs

Cost estimate being researched.

Another approach

Polio vaccination

Vaccination is the way to prevent polio. WHO says the vaccine, given several times, can protect a child for life (WHO), and CDC calls it safe and effective (CDC).

  • Which vaccine. Since 2000 the only polio vaccine used in the United States is the inactivated polio vaccine (IPV), given as a shot. The oral vaccine (drops) is still used in much of the world (MedlinePlus).
  • Children. Four doses of IPV, at 2 months, 4 months, 6 to 18 months, and 4 to 6 years (CDC). Over 99% of children who receive all recommended doses are protected (CDC).
  • Adults. CDC says most adults were likely vaccinated in childhood. Adults who were never vaccinated should get three doses of IPV, and those who had one or two doses before should get the remaining doses. Fully vaccinated adults at increased risk of exposure, such as travelers to places where polio is more of a risk, may receive one lifetime booster (CDC). Laboratory and health care workers who handle samples that might contain the virus can be at higher risk (MedlinePlus).
  • How well it works. Two doses give at least 90% protection and three doses at least 99% (CDC).
  • Side effects and who should wait. CDC says IPV has not been known to cause serious problems and most people have none; a sore spot where the shot was given is common. People who had a severe, life-threatening allergic reaction to a dose or to a component should not get it, and people who are moderately or severely ill should wait until they recover (CDC).
  • If you already had polio. The NHS says you should still be vaccinated, because polio vaccines protect against the different types of polio (NHS).

If you are unsure of your or your child’s records, MBHA suggests asking your health care provider. Good handwashing with soap and water also helps (CDC).

What it costs

Cost estimate being researched.

Another approach

Breathing, swallowing and sleep

These are the late effects of polio that are most important to catch early.

Breathing (underventilation)

Post-Polio Health International says new breathing problems can progress slowly and go unnoticed by both survivors and clinicians. Underventilation is most common during sleep, and risk factors include chest wall deformities such as scoliosis, weak breathing muscles, sleep apnea, smoking and obesity. Signs include daytime sleepiness, morning headaches, not feeling rested, needing to sleep sitting up, shortness of breath on exertion, and a weak cough with more chest infections. Anyone with a combination should seek a respiratory evaluation, ideally by a pulmonologist experienced in neuromuscular disease, preferably with an in-lab sleep study. The usual treatment is noninvasive ventilation (often just at night), and oxygen alone can make underventilation worse (Post-Polio Health International). NINDS lists shortness of breath when lying down, recurrent chest infections and morning headaches as features of weak breathing muscles in motor neuron diseases, a group that includes PPS (NINDS). Medicare Part B covers respiratory assist devices when medically necessary (Medicare.gov). See our guide to pacemakers, pumps and ventilators.

Swallowing

Swallowing trouble is not a primary symptom, but many cases are reported; about 18% of polio survivors are estimated to have it, most often those who had bulbar polio. Food can be left behind in the throat and risk going into the airway, and a weak cough raises the risk of breathing trouble. Anyone suspected of having a swallowing problem should be referred for a swallowing study (modified barium swallow or endoscopic evaluation). Changing head position, such as turning the head or tucking the chin, adjusting food types and alternating liquids and solids can help, avoid eating when extremely tired, and aggressive exercise of the swallowing muscles tends to fatigue them more than strengthen them (Post-Polio Health International). Medicare Part B covers medically necessary outpatient speech-language pathology, which includes swallowing skills, with the same 20% after the deductible (Medicare.gov).

Sleep

A review of 41 studies found that sleep apnea, low overnight breathing and restless legs syndrome seemed more common in polio survivors than in the general population and that screening should be part of follow-up (Léotard et al., 2020).

Another approach

Surgery, anesthesia and hospital stays

Modern anesthesia is extremely safe, but polio survivors have special considerations. Post-Polio Health International advises every survivor, especially anyone with past breathing involvement, to tell the surgeon and anesthesiologist about having had polio. Potential issues include greater sensitivity to muscle-relaxing drugs, a possible need for a breathing machine after surgery, and extra pain after surgery. No published study documents anesthesia problems in polio survivors, but some survivors felt their symptoms worsened after regional anesthesia (Post-Polio Health International). NCCIH also advises telling providers about supplements well before an operation (NCCIH). MBHA suggests asking whether the hospital has an intensive care unit available and a team familiar with neuromuscular conditions, and bringing a written summary of your history and equipment.

Another approach

For family and caregivers

People with new symptoms years after polio are not contagious and have not been re-infected, and they need understanding and support (Post-Polio Health International). Post-Polio Health International suggests that family members encourage an evaluation, help carry out the treatment plan, and work as a team with the health professionals. A support group or family counseling can help (Post-Polio Health International). Some survivors avoid doctors because of early memories of polio or a past visit that did not help (Post-Polio Health International), so a gentle offer to go along can matter.

What it costs

Cost estimate being researched.

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This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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