A large presence of local, state and federal authorities have responded to the area of Quincy Avenue and Libby Street, on the Brockton Hospital campus.

Brockton and Massachusetts State Police received a call around noon of a man “trapped by a Bobcat skid steer loader,” Plymouth County District Attorney Tim Cruz told reporters at about 3:45 p.m.

Authorities said the man, identified as Roger Porter of East Sandwich, was pronounced dead on scene.

Cruz made clear Porter was not driving the construction vehicle when the accident took place, but rather, the 63-year-old was “leveling out gravel as it was being put into a pit.”

WCVB reported earlier Tuesday afternoon its news helicopter had flown over Brockton Hospital, finding a Bobcat construction vehicle had fallen over into a hole next to the facility’s foundation.

Massachusetts State Police confirmed a piece of construction equipment had struck the victim, resulting in his death.

The state Office of the Chief Medical Examiner arrived at the hospital around 3:15 p.m. Authorities have alerted the victim’s family, according to a statement from Signature Healthcare, which runs Brockton Hospital.

“It is with most profound sadness that we are reporting a fatal injury that occurred on the campus of Signature Healthcare Brockton Hospital today around noon,” Signature’s statement reads. “A construction contractor was working onsite at Brockton Hospital when an accident occurred, killing the worker.”

LMA Services Company, LLC is receiving an inspection from the federal Occupational Safety and Health Administration following the accident.

Brockton Hospital has been closed since early February following a 10-alarm transformer fire which drew the largest emergency response in city history. That incident displaced 176 patients, with 138 being taken for treatment at nearby health facilities.

Officials had hoped the hospital would reopen by mid May, a best case scenario. However, the main facility remains shuttered, while Signature Healthcare’s outlying centers are open for care.

Tuesday’s accident comes days after a construction worker was seriously injured at Norwood Hospital, which is being rebuilt in the wake of a flash flood that permanently shut down the 215-bed facility in June 2020.

The worker in that incident reportedly fell from the top of the second floor, according to Norwood Fire Department.

Supporters of the new study commissioned by the Blue Cross Blue Shield of Massachusetts Foundation say it helps reveal the broader consequences of health inequities and provides motivation for public and private sector leaders to help rectify the disparities. The research also looks to the future of the state’s population, where communities of color are driving growth but are also the ones who are the most heavily impacted by health inequities.

As the next generation rises, the report said, these groups will represent nearly half of the state’s population compared to the less than one-third share they represent today.

“Massachusetts faces a choice to ‘pay now or pay greater later,’ as demonstrated by this report, which highlights the unacceptable cost being paid by communities of color and ultimately borne by businesses and the commonwealth,” the advocacy organization Health Equity Compact said in a statement included with the report.

The authors of the report said it is a “first of its kind” to quantify in economic terms the cost of health inequities for individuals and families, health care providers, employers, public and private sector payers, and the overall Massachusetts economy.

The economic burden associated with health inequities experienced by communities of color in Massachusetts totals nearly $6 billion but could grow to $11.2 billion by 2050 if no action is taken, the report said.

The time to shift from “awareness of the problem to action on solutions” is now after analysis made clear the “staggering economic toll” of health disparities, said Audrey Shelto, president and CEO of the Blue Cross Blue Shield of Massachusetts Foundation.

“Our commonwealth led the way in expanding health insurance coverage and improving access, and we have a shared responsibility to act similarly to achieve health equity and eliminate health disparities,” Shelto said in a statement.

Populations of color in the state are disproportionately affected by housing instability, food insecurity, environmental toxins and stressors, and higher rates of poverty as a result of longstanding systemic racism in social and economic structures, policies, and practices, the report said.

That has led to less access to health coverage and care and differences in the quality of care received, researchers wrote in the study.

Differences in delivery of care also stem back to “mistrust in the health care system due to historical and systemic racism and experiences of continued lack of respect and breaches of trust reported by many,” the report said.

Researchers found Black and Hispanic/Latino residents report poorer health and mental health statuses than White residents; pregnancy-associated mortality and severe maternal morbidity are higher for Black residents; and higher rates of diabetes and asthma are reported among Black and Hispanic/Latino residents.

Higher rates of disease and disability in a population require more healthcare services to treat those conditions, which means higher healthcare spending, researchers said.

“By computing the gap between health care spending under the current health status for Massachusetts adults and health care spending if populations of color achieved the health equity target health status, we estimated that avoidable health care spending due to health inequities is $1.5 billion each year, or about 2 percent of total Massachusetts annual health spending,” the report said.

Working-age adults who are less healthy tend to work fewer hours, take more sick days, and be less productive on the job, the report said. The analysis compared the productivity of working-age populations of color with their current health status to the same group if they were fully healthy.

“We estimated that health inequities experienced by populations of color today cost Massachusetts $1.4 billion each year in lost labor productivity across industries,” the report said.

The analysis also compared the current mortality rates by race and ethnicity at each with the “health equity targets” for mortality at each age.

“We found that health inequities are estimated to lead to premature death for Massachusetts residents of all ages,” the report said.

Researchers at Mass Eye and Ear looked at the loss of olfactory and gustatory senses and estimated that about 25% of Americans who had COVID-19 reported only partial or no recovery of taste or smell.

“We wanted to quantify the national impact of smell disorders resulting from COVID,” said Neil Bhattacharyya, professor of Otolaryngology at Mass Eye and Ear.

“With this data we can understand, in big numbers, how many people lost their sense of smell or taste due to COVID infection and how many people never fully recovered those senses,” Bhattacharyya added.

The researchers examined data from the 2021 National Health Interview Survey (NHIS), a CDC branch, which includes survey data from 29,696 adults.

In the NHIS data, COVID patients were asked about the severity of their symptoms, any loss of taste or smell, and their recovery of those senses.

The research team reported that about 60% of surveyed participants infected with COVID experienced loss of smell and about 58% experienced loss of taste.

The study found that around 72% of patients fully recovered their sense of smell, but 24% only had a partial recovery, and more than 3% had no recovery.

Similarly, of those who experienced a loss of taste due to COVID, about 76% fully recovered the sense, while 20% only partially recovered, and more than 2% did not recover at all.

The researchers estimated that almost 28 million Americans had been potentially left with a decreased sense of smell after a COVID infection.

Bhattacharyya said one of the motivations for the study was his patient who lost 50 pounds due to COVID-related smell loss.

“The patient wasn’t eating and became very sick and very depressed because of the loss of smell,” Bhattacharyya said. “When you hear about COVID-related smell loss, you think most people get it back and are fine. But there is a substantial number of people who don’t recover it.”

“The value of this study is that we are highlighting a group of people who have been a bit neglected,” Bhattacharyya added. “Losing your sense of smell or taste isn’t as benign as you may think. It can lead to decreased eating for pleasure and, in more extreme cases, it can lead to depression and weight loss.”

The study also found that there’s a correlation between COVID symptom severity and loss of smell or taste. As symptom severity increased, the percentage of patients with smell or taste loss also went up.

Moreover, the likelihood of smell and taste sensory recovery dropped with more severe COVID symptoms.

The field of personalized nutrition, sometimes referred to as precision nutrition, is making important advancements thanks to artificial intelligence (AI) and research funded by the National Institutes of Health (NIH).

AI uses computers to perform human-like decision-making and problem-solving. The NIH Nutrition for Precision Health (NPH) study will use AI to create and validate algorithms to predict individual responses to foods and eating patterns. This study is part of a larger All of Us research initiative to better understand how individual human biology influences the effects of diet and environmental, behavioral and social factors on health using data from one million study participants from across the United States.

Precision nutrition is the evaluation of factors like genetics, health data, the microbiome and metabolic responses to food and eating patterns to help choose foods and diets to prevent or treat illness within individuals. For example, previous studies have shown that people consuming identical diets will have different responses in blood glucose, insulin and triglycerides. The findings from the NPH study will have the potential to enrich the field of nutrition, providing data to better individualize nutrition recommendations.

Well-designed studies that look at the role of nutrition in health are important because common causes of death among Americans including cardiovascular disease, diabetes and cancer are nutrition-related. While precision nutrition using artificial intelligence is cutting-edge now, NIH believes that it will become a part of mainstream medical care by 2030. General tips like “drink eight cups of water per day for hydration” and “cut back on sugar for diabetes” could be obsolete due to access to precision nutrition.

Findings from the NPH study will likely help healthcare providers and nutrition experts provide more individualized, evidenced-based nutrition and food recommendations than ever before. While only time will tell how AI will impact daily life, it is already aiming to improve the nutrition and health of humans.

In the meantime, here are some important strategies to create an individualized nutrition and wellness routine:

1. Meet with a registered dietitian to create an individualized nutrition plan that takes into account your family and individual medical history, lab results, lifestyle, fitness and health goals and other factors.
2. Create an eating schedule that works for your lifestyle and nutrition needs.
3. Focus on good sleep hygiene for adequate, high-quality sleep which supports healthy hormones and a sharp mind.
4. Eat a wide variety of nutrient-dense foods.
5. Keep a food journal to increase awareness about your eating habits and to find areas for improvement.
6. Set realistic health goals that are both specific and can be measured by time such as “to walk 30 minutes on weekdays” or “to lower my cholesterol level by 10 percent in six months”.
7. Avoid the hype of trendy foods and diets that are not backed by science.

LeeAnn Weintraub, MPH, RD is a registered dietitian, providing nutrition counseling and consulting to individuals, families and organizations. She can be reached by email at RD@halfacup.com.

During its regular meeting last week, Commissioners learned that, though the state is home to hundreds of thousands of veterans, many of whom would qualify for medical marijuana as a result of service connected disabilities, veterans are not entering the medical marijuana program at nearly the same rates as other adults.

Part of the problem is the law.

“Access to medical marijuana in the regulated industry for veterans in Massachusetts continue to face significant barriers primarily due to the existing federal illegality of cannabis,” commissioners were shown during a presentation by Commissioner Bruce Stebbins.

For the 71,000 Massachusetts veterans using a Veterans Administration facility for healthcare or the 11,000 who are 100% disabled as a result of their service, marijuana remains illegal at the federal level, making it inaccessible through the VA. That means veterans cannot get a recommendation from their doctors to get a medical marijuana card or even ask their doctors for advice about use of marijuana.

“I believe that federal prohibition of cannabis has had a chilling effect on our veterans ability to seek treatment here in Massachusetts and perhaps even to pursue employment in the cannabis industry,” Stebbins said. “This is really a question of access and equity for our veterans.”

Another part of the problem is the cost of certification. Medical marijuana cards are issued on a yearly basis with an annual cost for both licensing and processing. That additional expense, on top of the cost of the cannabis itself, can be too much for a veteran on a fixed disability income to add to their already steep health costs.

Commissioners indicated, as a possible statement of policy, that they will support expanding the definition of “qualifying patient” to include veterans using the VA for healthcare who can furnish documentation demonstrating the federal department has diagnosed the veteran with a condition which would normally qualify them for the program.

The commission could also support changing their list of qualifying “debilitating conditions” to include PTSD, or Post-Traumatic Stress Disorder, and opioid addiction. Too many veterans, commissioners learned, are turning to more dangerous or addictive drugs because they simply have no alternative.

“Veterans are more susceptible to opioid addiction as they are more likely to suffer from chronic pain. In addition, many veterans suffer from mental health problems like Post-Traumatic Stress Disorder, making them more likely to abuse drugs and alcohol in an attempt to self medicate,” Commissioner Kimberly Roy said.

Mortality rates from drug overdoses among the veteran population have increased by more than 50% in the last decade, Roy told her colleagues, but it’s a problem that the commission is in a unique position to help solve, she said.

“Addressing drug overdose in the veteran population requires accessible and non-judgmental, low threshold, wraparound, and holistic solutions that recognize the complex etiology of overdose risk for veterans,” she said.

While marijuana is legal for adult use in Massachusetts — with or without a medical recommendation — it remains a Schedule 1 Controlled Substance under federal law alongside drugs like heroin or LSD. According to the Drug Enforcement Agency, Schedule 1 drugs “are defined as drugs with no currently accepted medical use and a high potential for abuse.”

My Golden Retriever is about to turn 14. As you might expect, she has several typical maladies associated with old dog age, including arthritis and weakness in getting up and down, cloudy eyes and reduced vision, poor hearing, and less energy. She is on several medications such as Amlodipine, Trazodone, Meloxicam, and Tresaderm. We used to live in California where she was started on all of these medications. We have been East for over six months, and she is doing OK. She has had chronic ear infections for years and, as a result, developed stenotic ear canals and calcification. My husband was just offered a position back West. Our previous vet told us that flying with the ear calcification could be damaging to her and we want to avoid that. Since she has been on this coast, her ear issues have completely resolved. Do you think we could fly her across the country when we move again?  B.McD.

Dear B. McD.,

As I review the various medications that you dog is taking, I suspect that one is for blood pressure, one for anxiety, one for pain and inflammation management, and one for ear infections, that being the Tresaderm. Chronic ear infections can be extremely painful to dogs and can lead to narrowed ear canals and calcification known as otosclerosis.

The fact that your dog’s ears have completely cleared up on this side of the country mean that you either treated them long enough to finally clear up the infections or that she possibly had atopic allergies before that are gone since she either outgrew them or is exposed to a different environment now. I would have a good otoscopic examination done to visualize the eardrums (tympanum) to be sure they are clear, glistening, and not ruptured. If the ears look normal at this time, I suspect that she should be able to travel by air without any problems. Realize that when you return out West that the allergic ear problems, if that is what they were, might well return.

Using the Trazadone and meloxicam should help ease any discomfort she might feel on the plane or on any given day. Good luck with the move and keeping her comfortable.

Dr. John de Jong owns and operates the Boston Mobile Veterinary Clinic.He can be reached at 781-899-9994.

Opioids have long been used medically to treat pain. But highly potent opioids like fentanyl, which is rampant throughout the illicit drug market, are now the leading cause of overdose deaths across all ages, including children and adolescents.

If someone in your home takes opioids for any reason, you should carry naloxone and keep it in your home in case of emergencies (just like a fire extinguisher). Naloxone is a lifesaving medication that can reverse an opioid overdose in minutes.

It’s available as a nasal spray that is easy to administer.

Naloxone is recommended for anyone who:

Uses opioids, including illicit opioids such as heroin or fentanyl, or prescribed opioid medications in a way their doctor did not intend

Has a substance use disorder (“addiction”)

Lives with someone who uses opioids in a nonmedical way or who has a substance use disorder

Has opioids in the home (from a prescription, for example) — particularly if small children are in the home who might unintentionally ingest them

Opioids are the most common cause of poisoning deaths in children. Fentanyl is one of the most potent opioids. It can quickly cause an overdose, especially in children and adolescents. Fentanyl is at least 50 times more potent than heroin. A dose of fentanyl that fits on the tip of a pencil can be deadly.

Fentanyl is sometimes used medically to treat pain or for anesthesia. However, the fentanyl that is widely available in the illicit drug market and in counterfeit pills is illegally manufactured and highly dangerous. Public health experts blame illicit fentanyl for the sharp increase in overdoses.

Among adolescents aged 10-19 years, fake (counterfeit) pills are to blame for at least a quarter of poisoning and overdose deaths. Fake pills are widely available for purchase in the illicit drug market and through social media platforms that teens commonly use, such as TikTok and Snapchat. The pills are made to look like real prescription pills like oxycodone or Xanax.

However, they instead commonly include a deadly amount of illicit fentanyl.

Fentanyl has also been found in lethal quantities in other drugs like cocaine. Signs of opioid overdose may include unconsciousness or unresponsiveness; shallow, slow or no breathing; limpness; pale skin, with blue lips or fingertips; slow or irregular heartbeat or pulse; vomiting or gurgling noises; slurred speech; or the center part of the eye is very small (called “pinpoint pupils”).

Naloxone should be administered at the first sign of overdose symptoms. This is especially important for toddlers and small children, who may inadvertently take medication or encounter a counterfeit pill. Follow the instructions on the package of naloxone; there are also many online videos of how to administer naloxone nasal spray.

After giving someone naloxone, call 911 right away. Naloxone is a temporary treatment, and its effects do not last long. A person who has overdosed and who receives naloxone will usually wake up within one to three minutes. Stay with the person, even if they are conscious, until emergency medical help arrives.

The person could lapse back into unconsciousness and might need another dose of naloxone. This is because the overdose can worsen and last for up to several hours, whereas naloxone can wear off after 30 to 90 minutes. Keep trying to wake the person up and keep them breathing. Also, lay them on their side to prevent them from choking if they are unconscious.

Naloxone can be purchased without a prescription at retail pharmacies in all 50 states, Washington, D.C., and Puerto Rico. All you need to do is contact your local pharmacy and state that you would like to receive naloxone through your state’s “standing order.” You will need to provide your name and date of birth, and your insurance will be charged. Often, the copay is $0. You can also find free naloxone in your community. It is often given out by local organizations.

Naloxone can be used for a suspected overdose in infants, children, teens, adults and the elderly. There is virtually no downside to giving naloxone to a child or teen, even if you are not sure if they overdosed on opioids. (Babies treated for neonatal opioid withdrawal syndrome may require an alternate product recommended by their pediatrician instead of naloxone.)

There are two forms of naloxone: a nasal spray and a shot that is injected. The U.S. Food and Drug Administration has approved the first over-the-counter naloxone nasal spray (also known as Narcan). It will be available in late summer 2023. Anyone will be able to buy the nasal spray at drug stores, grocery stores, convenience stores, gas stations and online, but it is likely to cost more than if you receive it through your state’s “standing order” and have it billed to your insurance.

The FDA recently approved a prescription nasal spray called nalmefene (also known as Opvee). Nalmefene nasal spray is for emergency treatment of opioid overdose in people age 12 years and older.

Remember to always store medications in a locked medicine cabinet or box that is out of reach. Dispose of unused prescription medications and keep illicit drugs out of your home.

For more information, go to the AAP website for parents, HealthyChildren.org.

Scott Hadland, MD, MPH, MS, FAAP, is the Chief of Adolescent and Young Adult Medicine at Massachusetts General Hospital and an Associate Professor of Pediatrics at Harvard Medical School. He holds triple board certification in General Pediatrics, Adolescent Medicine, and Addiction Medicine, and his work focuses on adolescent and young adult substance use disorder prevention and treatment.

Tribune News Service

Kamaia, a 14-year-old lion that zoo officials say is “severely anemic,” received blood from his brother, Dinari, during a transfusion done Friday to help determine the cause of his ongoing health issues.

Part of the 3-hour procedure included doctors removing Kamaia’s spleen, which zoo officials determined to be “massively enlarged — at least twice the size it should be.”

“We are hopeful that he will be feeling better very soon. This was a major surgery, and we will continue to monitor him closely to ensure that he is comfortable and recovering well,” said Dr. Chris Bonar, Zoo New England’s director of animal health.

Dinari, also 14, on Thursday underwent a procedure to help his sick brother. The zoo’s veterinary team drew blood from Dinari to see if it was a match with Kamaia.

“Blood transfusions are not often performed in zoological settings because it can difficult to find a suitable donor,” Bonar said. “Because Kamaia and his brother were littermates, Dinari was the perfect donor for this much-needed transfusion.”

Doctors found nothing “abnormal” during the surgery beyond Kamaia’s enlarged spleen, and officials expect to receive results in a week from the samples of his spleen.

Kamaia, who has lived at Franklin Park with his brother since 2015, fought through pneumonia earlier this spring, and comprehensive diagnostic tests came up inconclusive of any underlying health issues, according to officials.

Kamaia’s care team will continue closely monitoring him for the next few weeks as he’s expected to remain in his off-exhibit space while he recovers.

“We have been so touched by the tremendous outpouring of support for the lion brothers and our incredible team who works so hard to care for them,” said John Linehan, president and CEO of Zoo New England.

Six communities in Massachusetts have already directed their police departments to not make arrests for possession of psilocybin, a move that effectively decriminalizes the use of the drug. Advocates now argue the lawmakers should pass bills from a pair of Democrats that decriminalize so-called magic mushrooms on a statewide level.

“It’s ridiculous that a plant medicine we’ve been using for tens of thousands of years that grows straight from the ground that … has the lowest harms of any controlled substance, far less than alcohol and cigarettes that we buy at corner stores, is not available to people who could really benefit,” said James Davis, a former Beacon Hill staffer who now runs Bay Staters for Natural Medicine.

Rep. Lindsay Sabadossa and Sen. Pat Jehlen filed bills that decriminalize possession, ingestion, obtaining, growing, giving away “without financial gain” to people 18 years and older, and transportation of up to two grams of psilocybin, psilocyn, dimethyltryptamine, ibogaine, and mescaline.

The proposals are scheduled for a Tuesday hearing in front of the Judiciary Committee, which is chaired by two Democrats, Sen. Jamie Eldridge and Rep. Michael Day.

Psilocybin is the chemical commonly found in magic mushrooms. The U.S. Food and Drug Administration granted “breakthrough” status to psilocybin in 2017, and has since approved applications for companies to investigate its use in treating various disorders.

Somerville, Cambridge, Northampton, Easthampton, Amherst, and Salem are the communities in Massachusetts that have directed their police to not make arrests related to psilocybin.

Former City Councilor William Dwight and Councilor Rachel Maiore proposed the resolution in Northampton on psilocybin mushrooms, arguing the use of the substance helps people with post-traumatic stress disorder, chronic depression, cluster headaches, and substance abuse.

“The COVID-19 pandemic has led to a resurgence of heroin and opioid overdose deaths and severe depression in Massachusetts communities, two ailments that entheogenic plants have been shown to have particularly strong utility in treating according to published, peer-reviewed medical research,” the two city lawmakers wrote in their successful resolution.

Sabadosa, a Democrat from Northampton, said being able to turn back to the local debate “really does help” when putting together legislation at the State House. And the idea for the bill, she said, came from constituents, who pitched her on the proposal during a meeting at a coffee shop.

“Their stories resonated with me because what they were telling me was that they were looking for what is effectively a harm reduction bill … It’ll decriminalize, it doesn’t legalize,’ she told the Herald. “… I believe very strongly in this idea of decriminalizing and making things safer for people.”

Colorado voted to legalize psilocybin in 2022 and Oregon was the first state to allow adults to use the drug after a successful ballot measure passed in 2020. Davis said legalization in Massachusetts would reduce the stigma that surrounds research scholars from studying the effects of the drug.

Adults found growing magic mushrooms could face up to 10 years in prison, according to the Bay State for Natural Medicine.

“The state law is really necessary to back up that community power. And a lot of police already privately don’t enforce laws against psilocybin mushrooms, it does happen,” Davis said. “And some people have had their lives destroyed by those arrests.”

They may come in handy this summer, as seen in cities along the East Coast this week with people again putting on masks to deal with the hazardous smoke from the raging Canadian wildfires.

The smoke and haze conditions have drastically improved in Massachusetts since Tuesday, but meteorologists warn that the wildfire smoke could return in waves over the next several weeks.

When those high concentrations of smoke come back, masks will help reduce peoples’ exposure to the PM2.5 air pollution from wildfires, according to John Rogan, professor of geography at Clark University in Worcester.

“If people are outside, wearing masks during those hazardous air quality days will be important,” Rogan, whose recent research projects have involved mapping wildfire burn severity in southern California and southeastern Arizona, told the Herald on Thursday.

He noted that N95 respirator masks offer far greater protection than cloth masks.

Nova Scotia and Quebec have already seen record fires this season, leading to the massive plumes of smoke from up north impacting the U.S. East Coast.

This wildfire anomaly was sparked by a prolonged drought and lightning strikes from storms. More wildfire burning is expected this summer.

“It’s unprecedented what’s going on in Quebec,” Rogan said. “And cities are getting pummeled by these large smoke plumes that are dense on the ground.”

He noted that tall buildings in cities are acting as canyons for that smoke.

“It’s a very serious threat,” he added, emphasizing the impact on those with respiratory conditions.

Many have wondered about the smoke’s impact on dogs and cats. When the poor air quality returns, owners should limit how much time their pets spend outside, said Meg Whelan, chief medical officer of Angell Animal Medical Center.

Owners could also wipe down their pet with a warm washcloth, she added.

Some cats have asthma, and these conditions can be “a trigger for pets that are sensitive,” Whelan said.

As far as the near-term weather forecast, wildfire smoke from Canada will continue to influence fine particle levels in parts of Massachusetts on Friday.

“Fine particle levels will likely average in the Moderate range over much of the State with Unhealthy for Sensitive Groups levels likely in southeast areas of the State,” the Massachusetts Department of Environmental Protection wrote in an air quality alert.

President Biden spoke with Prime Minister Justin Trudeau to “offer additional help putting out these fires, particularly those in Quebec that have severe impacts on American communities,” the president tweeted.

Biden also tweeted, “Folks, head to AirNow.gov to stay up-to-date with the air quality in your area and take the right precautions to help keep you and your family safe.”

A panic attack is an episode of intense fear with an abrupt onset, lasting from several minutes to up to an hour. It has many mental and physical symptoms such as chest pain, shortness of breath, nausea, dizziness, chest pain and a sense of pending doom. These symptoms may cause significant worry in people as they may mimic signs of medical problems such as heart issues. However, panic attacks can occur when there isn’t a real danger or apparent cause.

Panic attacks aren’t life-threatening, but they can be frightening for the person experiencing the attack and their loved ones. These attacks can affect your quality of life, especially if you have multiple or unexpected panic attacks.

What are the signs of a panic attack?

A panic attack usually begins suddenly and without warning. Typically, symptoms peak in minutes, and you may feel tired and worn out after it subsides. Panic attacks can cause chest pain and breathing problems that lead some people to seek medical care.

To be diagnosed as a panic attack, the episode must have at least four of these symptoms simultaneously:

— Chest pain or discomfort

— Chills or heat sensations

— Derealization (feelings of unreality) or depersonalization (being detached from oneself)

— Fast beating, fluttering or pounding heart

— Fear of dying

— Fear of losing control or “going crazy”

— Feeling dizzy, unsteady, light-headed or faint

— Feelings of choking

— Nausea or abdominal distress

— Numbness or tingling sensations

— Sensations of shortness of breath or smothering

— Sweating

— Trembling or shaking

Panic attack symptoms may also resemble other psychiatric conditions, such as:

— Agoraphobia — marked fear or avoidance of two or more places or situations

— Caffeine or nicotine dependence — high doses of either substance may result in increased anxiety

— Obsessive-compulsive disorder — obsessions often leading to ruminations or brooding

— Phobias — fear of specific objects or situations

— Post-traumatic stress disorder — involves emotions from previous events affecting a current situation

— Separation anxiety disorder — fear of separation from attachment figures

— Social anxiety disorder — fear of social situations

Do I need to go to the emergency room if I have a panic attack?

In most cases, a single panic attack episode does not require emergency medical care. However, it’s important to discuss your symptoms with your health care team. They will evaluate you for medical disorders that may contribute to your symptoms, such as cardiac arrhythmia, respiratory diseases, pulmonary emboli, thyroid disorders, adrenal tumors or medication side effects.

What’s the difference between a panic attack and panic disorder?

A person with ongoing, unexpected panic attacks who spends time worrying about another panic attack may have a panic disorder. People with panic disorders may be afraid of experiencing more panic attacks and live in a constant state of fear that affects the quality of their lives. Often, they change their behaviors and habits so much that it interferes with daily activities. This could result in the person missing social events, school or work.

People with panic disorder have panic attacks with mental and physical symptoms. The attacks happen without warning and can last several minutes to an hour.

Such people also may:

— Worry about having panic attacks in the future.

— Avoid situations that might cause them to have a panic attack.

— Seek medical care at a clinic or Emergency Department when experiencing a panic attack.

Is there a test for panic disorder?

No. There is no test, but your health care team can determine if you have panic disorder or another condition based on your symptoms. You may have a complete physical exam, blood test or psychological evaluation to discuss your symptoms, fears, stress and family history.

Can panic attacks be treated?

Yes, treatment can reduce the intensity and frequency of panic attacks and panic disorder.

Treatment may include:

— Cognitive behavioral therapy: Usually, this is the first treatment offered for panic attacks and panic disorder. During cognitive behavioral therapy, you talk with a psychologist or counselor about your experiences and learn how to react to situations differently. This teaches you how to cope better with your feelings and overcome fears of situations you may have avoided because of panic attacks. In some cases, it is possible to participate in cognitive behavioral therapy virtually, such as meeting with a therapist online or through a video call, rather than in person.

— Medications: Medications can help reduce symptoms associated with panic attacks and depression. There are many options, and if one medication doesn’t work for you, your health care team may switch you to a different medication. All medications have a risk of side effects, so talk with your health care team about the best choice for your situation.

You don’t need to suffer alone or avoid aspects of life because of panic attacks. Talk with your health care team about your symptoms and about treatment options that can make a difference.

____

(Brian Hesler, M.D. , is a psychiatrist in Psychiatry & Psychology in Albert Lea, Minnesota)

©2023 Mayo Clinic News Network. Visit newsnetwork.mayoclinic.org. Distributed by Tribune Content Agency, LLC.

After smoke from the Canadian wildfires caused the air quality to plummet across Massachusetts in recent days and some people put back on their N95 masks, meteorologists are warning that smoke from up north could impact the region at times over the next several weeks.

“We might be experiencing this off and on throughout the summer, depending on how the weather pattern shapes up,” AccuWeather senior meteorologist John Gresiak told the Herald on Wednesday — which was a better day for air quality in the Bay State, while New York City and other spots on the East Coast dealt with hazardous conditions.

The haze and smoke could continue to affect the region because the Canadian wildfires are out of control, and it doesn’t appear they’ll be put out soon.

The wildfires are in remote areas of northern Quebec where very few people live, Gresiak said.

“It may be awhile before the fires get extinguished,” he added.

When the air quality drastically plummets, AccuWeather estimates that breathing the polluted air for several hours can be compared to smoking five to 10 cigarettes.

“There are a lot of particulates in this wildfire smoke, and that stuff can cause all kinds of problems when it gets into your lungs, especially if you have asthma or other conditions,” Gresiak said. “Even healthy people don’t want to inhale too much of this.”

Secondhand smoke is a respiratory irritant, and this is a respiratory irritant “in much the same way,” according to Scott Goldberg, director of emergency medical services for Mass General Brigham.

The particulate matter can cause shortness of breath, especially for those in sensitive groups, which includes children, senior citizens, those with pre-existing respiratory and cardiac conditions, and pregnant people.

“If you’re feeling any respiratory symptoms, go inside to a cool place and rest,” said Goldberg, who’s also an emergency medicine physician at Brigham and Women’s Hospital.

People especially in sensitive groups should try to limit their time outdoors until the levels of particulate matter decrease, he said, adding that they should have their rescue medications on hand.

While much of the focus has been on outside pollution, the tiny particles from the wildfire smoke can get into homes and cause health risks, said Shichao Liu, a Worcester Polytechnic Institute assistant professor of architectural engineering and fire protection engineering.

“Even though people are staying in buildings, they’re not 100% prevented from the exposure of the outdoor smoke conditions,” he said.

Liu said people can attach an air filter to the back of a box fan to help clean out their home’s inside air. He also advised people to make sure their vehicle’s A/C is on recirculation mode to avoid bringing the outside air inside the vehicle.

As far as the near future forecast in Massachusetts, Thursday’s smoke will be mainly situated south of the Mass Pike corridor, according to the National Weather Service’s Boston office.

The Massachusetts Department of Environmental Protection has again issued an air quality advisory for Thursday.

“AIR QUALITY: Wildfire smoke from Canada will continue to influence fine particle levels in parts of our region on Thursday,” the advisory reads. “Fine particle levels will likely average in the Good range in northeast sections of the State and Moderate range in the remainder of eastern and central parts of the State. Unhealthy for Sensitive Groups levels are once again likely in western sections of the State and an Air Quality Alert remains posted for particle pollution in western sections.”

Just like with the coronavirus, the stronger the mask, the better, although any face covering is better than none, said Ramón Tallaj, a doctor who leads SOMOS Community Care, a nonprofit health network based in New York.

Dr. Jennifer Logan, a pediatric pulmonologist with Lehigh Valley Health Network in Pennsylvania, told The Morning Call that wearing most masks will not help protect against smoke inhalation and the small particulates in the smoke can even collect in the masks, meaning that wearing a cloth, surgical or low-quality filtration mask may actually be counterproductive.

However, Chrysan Cronin, director of public health at Muhlenberg College in Allentown, Pennsylvania, said for people who have to spend extended amounts of time outdoors for work or some other reason, a N95 mask can be effective, as it can filter out extremely small particles.

Meteorologist John Homenuk also said N95 masks are “going to filter out these particles most effectively.”

“If you still have an N95 mask or you want to go grab one, it’s recommended to wear them because they do filter the harmful particles out, at least to some degree,” Homenuk told the New York Daily News.

Tallaj did have a tip for those who may only have surgical masks on hand: Flip the mask so that the smoother, blue side is on the inside, near your mouth.

“Surgeons use it with the blue part outside, because they don’t want their mouth and their breathing to go inside the patients during surgery,” Tallaj said. “In this case, it’s the other way around. You don’t want the [particles] to come to you.”

Is this smoke just uncomfortable or dangerous?

Both.

Logan told The Morning Call that for children, the elderly and those with respiratory conditions like asthma, chronic obstructive pulmonary disease and cystic fibrosis, the small particulates in the smoke can be particularly harmful. But she added everyone should try to minimize their exposure to the smoke.

She said the particulate matter in the smoke is very small and can easily work its way into the smallest airways of the lungs, which can cause coughing and wheezing, particularly in people with chronic respiratory conditions.

However, even for healthy people, prolonged exposure can cause short-term problems like eye irritation, pulmonary inflammation and issues with lung function, according to the U.S. Environmental Protection Agency.

Dr. Douglas Corwin, a critical care physician specializing in pulmonary disease with St. Luke’s University Health Network based in Pennsylvania, said for most people, short-term exposure should cause nothing more than temporary annoyance or mild discomfort.

“The smell can be irritating, annoying or it can be a little frankly nauseating, but in terms of long-term health repercussions this short burst shouldn’t cause any permanent damage,” Corwin said.

Should I even go outside?

Young people, older adults and people with underlying health issues should stay indoors and keep their windows shut. All others should also limit their exposure to the outdoors and take precautions.

“The main thing is to limit outdoor exposure and obviously any strenuous activity. You don’t want to be gasping for air and breathing this stuff in all day, if you can avoid it,” Homenuk told the Daily News.

Parents should limit outdoor play for their children, Logan said. “Children breathe faster and when you’re exercising you breathe in much deeper and faster so you will inhale more particulate matter if you are exercising outside,” Logan said.

Corwin said that those with respiratory issues or parents of children with respiratory issues should follow existing action plans set out by their physicians or should contact their doctors if they need extra guidance. Logan said everyone should stay inside when possible, keep windows closed and make sure their air filters are clean.

“If you can smell the smoke, you’re probably breathing in the particulate matter,” Logan said. “If you’re not smelling it, you’re probably in the clear.”

Are there effects of repeated smoke inhalation?

Research into the effects of repeated short-term exposure to wildfire smoke is limited. Studies have shown reduced and worsening lung function in firefighters exposed to heavy smoke while fighting wildfires, according to the EPA. Some studies have shown also correlations with wildfire smoke exposure and increases in general mortality, respiratory illness and cancer.

However, wildfires and wildfire smoke exposure has been shown to cause respiratory issues leading to increased emergency room visits and hospital admissions for respiratory illness in affected areas. Corwin said this is why both people with chronic respiratory illness and healthy people should be careful.

“Be smart about it. If you don’t need to be outside training for a marathon, for the next couple of days maybe this is the time to be inside in the gym, where there’s kind of purified or filtered air via air conditioning,” Corwin said. “Hopefully this is a relatively transient event. It should be hopefully clearing out the next 24 to 48 hours — if activities can be delayed, they should.”

Contributing: Leif Greiss, The Morning Call; Josephine Stratman and Chris Sommerfeldt, New York Daily News

In New York City, a cough-inducing, yellow-orange haze has created hazardous air-quality conditions caused by smoke that’s been blown southward from the hundreds of wildfires. Outdoor activities at public schools, along with planned concerts, sporting events and other happenings across the city were canceled Wednesday.

Here are some of the scenes across the eastern U.S:

Contributing: Getty, The Morning Call, New York Daily News, Baltimore Sun

The court document does not list the amounts owed to each creditor but a separate filing from earlier this week says Compass Medical has between 100 to 199 creditors, assets of between $10 million and $50 million, and liabilities of between $1 million and $10 million.

Other entities the Quincy-based health organization listed as creditors include the Braintree Electric Light Department, Comcast, state Department of Revenue, Eversource Massachusetts, Fedex, Whitman’s Flowers Forever, Pfizer, the Plymouth County Sheriff’s Civil Process Division, and the Taunton Municipal Light Plant, among others

Compass Medical also owes money to a handful of cities and towns in Massachusetts as well, including Quincy, Taunton, East Bridgewater, Easton, and Middleborough.

The Herald reached out late Wednesday to several of the listed creditors. Attorney General Andrea Campbell’s office declined to comment.

The healthcare group announced earlier this month its immediate intention to close all of its facilities in Massachusetts, a move that came as a shock to patients and has prompted at least one lawsuit that accuses the company of “patient abandonment.”

Compass Medical Board President Dr. Bruce Weinstein has said the need to close the company became clear at the end of May “when our plan to continue operations collapsed.”

“Since that time, Compass has mobilized its limited remaining resources to stand up a website to assist patients locate their providers, to preserve the medical records and access to them after our closure, and to provide a plan to assure continuity of care for our 70,000 patients including the provision of on-call coverage during this transition,” he said in a statement last week.

State officials have said they are looking into the closure of the roughly 450-employee business.

Compass Medical filed for bankruptcy on Monday, listing attorneys from Murphy & King as their lawyers.

Compass Medical was convicted on 10 counts of fraud in October 2022 after a 15-day trial in Boston and was ordered to pay Steward Medical Group, a Dallas-based healthcare company, $16.4 million.

Compass had originally sued Steward in 2017 over failure to pay bonuses to doctors and make rental payments, but a jury instead sided with Steward.

The list of Compass Medical creditors names Steward Medical Group, but it is unclear if that is related to the 2022 ruling.

Compass Medical has proposed an “unwind plan” that includes recommendations on how to maintain former patients’ medical records, Weintein said in a Wednesday statement to the Herald.

“It will be the trustee’s decision as to whether or not to accept entirely, modify or replace this plan and the trustee’s responsibility to assure preservation of and access to medical records in accordance with state and federal regulations,” Weinstein said.

State regulations require healthcare providers licensed by the Department of Public Health to maintain medical records in a manner “which permits the former patient or a successor physician reasonable access.”

A spokesperson for the Department of Public Health said Compass Medical is not licensed by the state because it is a private physician group practice. Individual physicians are licensed by the state’s Board of Registry in Medicine.

The Compass Medical website appeared to be down as of Wednesday afternoon, with a message telling visitors “error establishing database connection.”

Weinstein had said last week that Compass Medical would update their website “regularly with information” on how to contact their physician in their new practice and how to obtain medical records.”

The team out of the Jacobs School of Engineering outlined their invention and findings in a paper that was published in the peer-reviewed journal, Scientific Reports, last week.

Researchers note that hypertension, or high blood pressure, is a leading cause of preventable premature death and disability worldwide. Monitoring blood pressure is also crucial for pregnant mothers who could be at risk of life-threatening conditions like preeclampsia.

Edward Wang, a professor of electrical and computer engineering at UC San Diego and one of the authors of the study, highlighted the low cost to produce the BPClip as a key for making this tool more accessible.

It costs less than $1 to make a BPClip, while traditional at-home blood pressure monitors with a cuff can cost between $30 to $75.

Ultimately, he said the goal is not to replace the traditional blood pressure monitors being used, but rather create an option that could easily be used in telemedicine settings or be provided to people in disadvantaged and rural areas at no cost.

He explained that having a low-cost device like this could help change the dynamic of how people can assess their risk and measure blood pressure.

After about three years of development, the UCSD researchers created a 3D-printed clip and a finger plate with a spring that attaches to the front-facing camera of an Android phone. While using the device, the phone screen displays prompts for the test and data for measuring blood pressure.

“What’s nice I think about the system is that it just needs the camera and a flash or some light source. And so every phone has that and there’s nothing that’s super special about the requirements of the phone,” Wang said.

The key to measuring blood pressure with the BPClip is the brightness of the camera light as the user applies different levels of pressure to their finger. As the user presses on the BPClip, the camera light shines through a pinhole on the finger plate.

That brightness of the light fluctuates with the amount of blood flowing in and out of the finger because the blood will absorb some amount of light, Wang said.

The phone camera captures the change in pressure applied visually based on the changing size of the circle created by the pinhole. For instance, when maximum pressure is applied, the circle will be the largest and the bright light will not fluctuate because the flow of blood has stopped.

The real goal, Wang explained, is to measure when the cutoff of blood flow happens. The scientific method used by the BPClip to measure blood pressure is similar to traditional cuff monitors in the sense that it looks at how much blood is flowing at varying levels of pressure applied to the artery.

The BPClip application collects 20 data points of the user pressing on the device, then uses 18 of those data points to establish an estimate of blood pressure measurements.

The study was based on the results of 24 participants with systolic blood pressure ranging from 80 to 156 mmHg and diastolic blood pressure ranging from 57 to 97 mmHg.

Another key feature of the BPClip is that it doesn’t require calibration, Wang said. He explained that other cuff-less blood pressure monitors on the market, such as watches, require users to first figure out their baseline measurements using a traditional cuff monitor.

At the moment, the BPClip is good enough to do screenings — and for instance, catch a spike in blood pressure — but there’s still more refining to be done to try and cut the margin of error down by half, Wang said.

Now, the team is focused on fine-tuning the mechanics of the device so it is user-friendly and improves the accuracy of data collection. Wang said they recently submitted an application for a federal grant to help make these improvements.

Wang works with researchers in The Design Lab to develop tools and devices that are powered by everyday smartphones. Another idea to come out of this lab is using a smartphone camera to measure blood oxygen levels.

But taking those concepts from a research setting to a commercial product isn’t easy, so Wang partnered with Colin Barry and Chelsea Maples to launch a standalone business called Billion Labs.

Wang said the goal of this small company is to serve as a vehicle for commercializing UCSD-licensed technology, like the BPClip, that was developed in a lab and get it to work on any kind of smartphone.

The study outlining how the BPClip works was published by Yinan Xuan, Colin Barry, Jessica De Souza, Jessica H. Wen, Nick Antipa, Alison A. Moore and Edward J. Wang.

©2023 The San Diego Union-Tribune. Visit sandiegouniontribune.com. Distributed by Tribune Content Agency, LLC.

More than 600,000 Americans have lost Medicaid coverage since pandemic protections ended on April 1. And a KFF Health News analysis of state data shows the vast majority were removed from state rolls for not completing paperwork.

Under normal circumstances, states review their Medicaid enrollment lists regularly to ensure every recipient qualifies for coverage. But because of a nationwide pause in those reviews during the pandemic, the health insurance program for low-income and disabled Americans kept people covered even if they no longer qualified.

Now, in what’s known as the Medicaid unwinding, states are combing through rolls and deciding who stays and who goes. People who are no longer eligible or don’t complete paperwork in time will be dropped.

The overwhelming majority of people who have lost coverage in most states were dropped because of technicalities, not because state officials determined they no longer meet Medicaid income limits. Four out of every five people dropped so far either never returned the paperwork or omitted required documents, according to a KFF Health News analysis of data from 11 states that provided details on recent cancellations. Now, lawmakers and advocates are expressing alarm over the volume of people losing coverage and, in some states, calling to pause the process.

KFF Health News sought data from the 19 states that started cancellations by May 1. Based on records from 14 states that provided detailed numbers, either in response to a public records request or by posting online, 36% of people whose eligibility was reviewed have been disenrolled.

In Indiana, 53,000 residents lost coverage in the first month of the unwinding, 89% for procedural reasons like not returning renewal forms. State Rep. Ed Clere, a Republican, expressed dismay at those “staggering numbers” in a May 24 Medicaid advisory group meeting, repeatedly questioning state officials about forms mailed to out-of-date addresses and urging them to give people more than two weeks’ notice before canceling their coverage.

Clere warned that the cancellations set in motion an avoidable revolving door. Some people dropped from Medicaid will have to forgo filling prescriptions and cancel doctor visits because they can’t afford care. Months down the line, after untreated chronic illnesses spiral out of control, they’ll end up in the emergency room where social workers will need to again help them join the program, he said.

Before the unwinding, more than 1 in 4 Americans — 93 million — were covered by Medicaid or CHIP, the Children’s Health Insurance Program, according to KFF Health News’ analysis of the latest enrollment data . Half of all kids are covered by the programs.

About 15 million people will be dropped over the next year as states review participants’ eligibility in monthly tranches.

Most people will find health coverage through new jobs or qualify for subsidized plans through the Affordable Care Act. But millions of others, including many children, will become uninsured and unable to afford basic prescriptions or preventive care. The uninsured rate among those under 65 is projected to rise from a historical low of 8.3% today to 9.3% next year, according to the Congressional Budget Office.

Because each state is handling the unwinding differently, the share of enrollees dropped in the first weeks varies widely.

Several states are first reviewing people officials believe are no longer eligible or who haven’t recently used their insurance. High cancellation rates in those states should level out as the agencies move on to people who likely still qualify.

In Utah, nearly 56% of people included in early reviews were dropped. In New Hampshire, 44% received cancellation letters within the first two months — almost all for procedural reasons, like not returning paperwork.

But New Hampshire officials found that thousands of people who didn’t fill out the forms indeed earn too much to qualify, according to Henry Lipman, the state’s Medicaid director. They would have been denied anyway. Even so, more people than he expected are not returning renewal forms. “That tells us that we need to change up our strategy,” said Lipman.

In other states, like Virginia and Nebraska, which aren’t prioritizing renewals by likely eligibility, about 90% have been renewed.

Because of the three-year pause in renewals, many people on Medicaid have never been through the process or aren’t aware they may need to fill out long verification forms, as a recent KFF poll found. Some people moved and didn’t update their contact information.

And while agencies are required to assist enrollees who don’t speak English well, many are sending the forms in only a few common languages.

Tens of thousands of children are losing coverage, as researchers have warned, even though some may still qualify for Medicaid or CHIP. In its first month of reviews, South Dakota ended coverage for 10% of all Medicaid and CHIP enrollees in the state. More than half of them were children. In Arkansas, about 40% were kids.

Many parents don’t know that limits on household income are significantly higher for children than adults. Parents should fill out renewal forms even if they don’t qualify themselves, said Joan Alker, executive director of the Georgetown University Center for Children and Families.

New Hampshire has moved most families with children to the end of the review process. Lipman, the state’s Medicaid director, said his biggest worry is that a child will end up uninsured. Florida also planned to push kids with serious health conditions and other vulnerable groups to the end of the review line.

But according to Miriam Harmatz, advocacy director and founder of the Florida Health Justice Project, state officials sent cancellation letters to several clients with disabled children who probably still qualify. She’s helping those families appeal.

Nearly 250,000 Floridians reviewed in the first month of the unwinding lost coverage, 82% of them for reasons like incomplete paperwork, the state reported to federal authorities. House Democrats from the state petitioned Republican Gov. Ron DeSantis to pause the unwinding.

Advocacy coalitions in both Florida and Arkansas also have called for investigations into the review process and a pause on cancellations.

The state is contacting enrollees by phone, email, and text, and continues to process late applications, said Tori Cuddy, a spokesperson for the Florida Department of Children and Families. Cuddy did not respond to questions about issues raised in the petitions.

Federal officials are investigating those complaints and any other problems that emerge, said Dan Tsai, director of the Center for Medicaid & CHIP Services. “If we find that the rules are not being followed, we will take action.”

His agency has directed states to automatically reenroll residents using data from other government programs like unemployment and food assistance when possible. Anyone who can’t be approved through that process must act quickly.

“For the past three years, people have been told to ignore the mail around this, that the renewal was not going to lead to a termination.” Suddenly that mail matters, he said.

Federal law requires states to tell people why they’re losing Medicaid coverage and how to appeal the decision.

Harmatz said some cancellation notices in Florida are vague and could violate due process rules. Letters that she’s seen say “your Medicaid for this period is ending” rather than providing a specific reason for disenrollment, like having too high an income or incomplete paperwork.

If a person requests a hearing before their cancellation takes effect, they can stay covered during the appeals process. Even after being disenrolled, many still have a 90-day window to restore coverage.

In New Hampshire, 13% of people deemed ineligible in the first month have asked for extra time to provide the necessary records. “If you’re eligible for Medicaid, we don’t want you to lose it,” said Lipman.

Clere, the Indiana state representative, pushed his state’s Medicaid officials during the May meeting to immediately make changes to avoid people unnecessarily becoming uninsured. One official responded that they’ll learn and improve over time.

“I’m just concerned that we’re going to be ‘learning’ as a result of people losing coverage,” Clere replied. “So I don’t want to learn at their expense.”

©2023 KFF Health News. Distributed by Tribune Content Agency, LLC.

The air may have the smell of smoke at times on Tuesday, as Massachusetts environmental officials have issued an “Air Quality Alert” until midnight on Tuesday.

“AIR QUALITY: Smoke from Canadian wildfires over our region will likely elevate fine particle levels into the Unhealthy for Sensitive Groups range over much of the State,” the Massachusetts Department of Environmental Protection’s forecast reads.

“An Air Quality Alert will be posted for these elevated PM2.5 levels for the midnight to midnight period Tuesday,” MassDEP added.

The significant smoke from the Canadian wildfires might lead to a hazy sun during the day.

Other states have also issued alerts due to the smoke from the Canadian wildfires, including the New Hampshire Department of Environmental Services.

“Sensitive individuals include children and older adults; anyone with lung disease such as asthma, emphysema, and bronchitis; and people who are active outdoors,” the Granite State alert reads. “Even healthy individuals may experience mild health effects and should consider limiting strenuous or prolonged outdoor activities.”

The other weather development on Tuesday will be scattered showers and thunderstorms in the afternoon.

Small hail and gusty winds will be possible with the strongest storms.

The storms are expected to be hit or miss, according to the National Weather Service.

“Greatest risk for this activity seems to be southeast of an Orange…to Fitchburg…to Boston line,” the National Weather Service’s forecast discussion reads. “Again though this activity will be hit or miss…so not everyone will get wet and the vast majority of the day will be rain free in a given location.”

A wildfire that forced thousands of residents from their homes in Nova Scotia is now contained, while a second wildfire remains out of control.

Nova Scotia’s natural resources department said the Tantallon fire northwest of Halifax is now under control, meaning it is not expected to grow but is not yet out.

The blaze broke out a week ago, forcing 16,000 people from their suburban homes and destroying some 200 structures, including 151 homes.

But in Shelburne County in southwest Nova Scotia, the wildfire continues to burn out of control. The blaze covered 97 square miles as of Sunday morning and has destroyed at least 50 homes and cottages.

Canadian soldiers and firefighters from abroad are now on the ground helping the effort to extinguish the blazes that have been burning in several parts of Nova Scotia for the past week.

Herald wire services were used in this report.

CHICAGO — Jaylin Green was still adjusting to a new school in a new neighborhood when his barely rooted new life was uprooted in March of his freshman year. Something called COVID-19 was abruptly shutting down schools and hurtling students into one of many unknowns: remote learning.

The shift was jarring enough, even with Green thinking at first that “we’re going to go and have normal class in a week or so.”

When that week turned into the rest of the school year, the sense of isolation set in.

“It was really challenging. … I was just in my room, just looking at a computer screen, and I know there’s a lot of people there, but I was still by myself,” said Green, now part of the class of 2023 of Chicago’s Mather High School, whose seniors graduated Wednesday evening.

Green and his peers have been dubbed by some the “class of COVID” — freshmen when the pandemic hit and, as it happened, seniors on the verge of earning their diplomas when the public health emergency formally ended in May. The coronavirus brought unprecedented academic, social and psychological upheaval even to those who didn’t get sick or lose a loved one; for many graduating seniors, it dominated and defined their high school experience.

Green was already dealing with a lot of change before the arrival of COVID-19, even though he got good grades his first semester as a freshman. He’d recently moved from the Southwest Side to the North Side, a transfer to Mather and without his old social crutches. And in Chicago Public Schools, the school year had already been disrupted by a two-week teachers strike that fall.

Then when COVID-19 hit, Green was having to juggle full-time remote learning with helping care for his toddler-aged nieces and nephews while other family members worked. Sometimes the stress got to him.

“It kicked into depression, and I struggled to be positive and felt like ‘woah, what’s happening?’ It was just a lot of confusion.”

Part of what helped Green stay the course was the one-on-one support from Stephanie Estrada, a student support manager at Mather.

“I’d talk to her and feel somewhat safe, not have to deal with other people, not my family or friends.”

Estrada works at Mather in partnership with Communities In Schools of Chicago, one of the city’s largest education nonprofits, to provide counseling to a caseload of 50 students. She had already been working with Green and other students pre-pandemic; that work, too, had to move online.

“The conversations that were hardest to have were the ones where students were experiencing grief, because a lot of what happened during COVID was the loss of family members, the loss of friends,” Estrada said. “And to have those conversations not in person was very difficult.”

Estrada recalls one day asking Green how his classes were going and Green responded that he hadn’t even logged on yet. It was noon.

“He had lost motivation and it was a recurring thing,” Estrada said. “Looking back, that’s memorable to me because I now see him and he’s on time for school, he’s involved, he stays after school — so I see a big difference in him.”

For all the focus on test scores and learning loss, Estrada said there needs to be a greater emphasis on the impact of the pandemic on students’ mental health.

“I firmly believe that students are not able to perform academically if they don’t have the social-emotional supports that they need,” she said. “They are going to have a tough time focusing on school work if they’re experiencing depression or anxiety, if they’ve got social issues happening.”

Ismael Flores is another member of the class of 2023 who never thought at first a two-week school shutdown would turn into a yearslong disruption.

He still recalls March 13, 2020, when all the students and staff of Marist High School gathered in the gym as officials announced spring break would be two weeks instead of one. That was the day Illinois Gov. J.B. Pritzker ordered all schools to shut down.

“To be quite frank, after COVID, I don’t think everything ever was the same,” Flores said moments before receiving his diploma last month from Marist, a Catholic school on Chicago’s Southwest Side.

One way the pandemic affected Flores, a resident of Palos Heights, was that he wasn’t able to get the full experience of being a student ambassador. If not for COVID-19, he’d have spent time giving tours at the school’s open house, visiting elementary schools and assisting with special events.

“Freshman year I had so much fun, I enjoyed every day. After COVID, it really impacted me, just kind of reminding myself every day, when am I going to be finishing? It made my school days at Marist feel longer,” Flores said.

During the graduation ceremony that sent off 387 seniors, Marist Principal Meg Dunneback noted that their high school experience began typically enough, from the anxieties of learning their class schedules to attending homecoming.

By sophomore year, the school had reopened — sooner than local public schools — on a “blended” schedule, meaning two groups of students alternated between online and in-person classes for a few hours a day.

That year, “you were never together as a full class,” Dunneback said. “Classes were so different, but hey, at least you were here and you were learning.”

When junior year rolled in, students attended school in person wearing masks, and lunch breaks were split, with some students in the gym and others in the cafeteria.

Senior year was the students’ “most back-to-normal year since early on that freshman year,” Dunneback said. “So we’ve come full circle. You did it all and you did it during a pandemic. You demonstrated perseverance.”

Fellow Marist graduating senior Demarco Hunter, 18, of Lansing, said it was strange having to stare at a screen all day for school work.

“I went from being active, working out anywhere between four to six times a week, to pretty much doing nothing and just sitting down (with) my iPad the whole day,” Hunter said. “It was a lot of adjustment to get used to that.”

As a football player, Hunter struggled with split schedules his sophomore year. He often had to go to practice on days he had online learning. The usual season was upended, with training in the fall and only a six-game season in the spring.

“I wish that time wasn’t taken from us,” he said. “There’s no telling what we would’ve been able to do in that time.”

For all the disruption, fear and challenges the pandemic brought, some seniors said they gained something useful from the experience.

Melina Fonseca, a graduating senior at Chicago’s John Hancock College Preparatory High School, said she’d just signed up to run track when the school had to close.

Though her first extracurricular experience “went down the drain immediately,” Fonseca said being at home allowed her to focus more on academics without the usual social distractions. But when she returned to school a year and a half later, in a brand-new building, she said felt a “culture shock.”

“It was like I was doing my freshman year all over again, I had to get used to this brand-new space, and I had to continue to make friends all over again,” Fonseca said. “I had to try to get involved, and so I was trying out different things. I was trying to find what made sense to me. … It was just like before, but entirely different with the restrictions put in place.”

With just over 200 students in her grade, Fonseca said the students created a tightknit community since returning to school.

Principal Vanessa Puentes saw students in the class of 2023 return to school ready to find their voices and advocate for what they need to feel safe and successful. She said she hopes the students can hold onto these skills to better themselves, their families and their communities.

“It’s really incredible what my students have done since then,” Puentes said. “I have kids that are going to amazing colleges that have bounced back from the pandemic, who are pushing me to really think about what school means for young people.”

Deja Miles is a member of the Englewood STEM High School class of 2023 — the school’s first.

For Miles, the most challenging part of the pandemic was transitioning back to in-person learning.

“We were so used to being at home doing work, being in our own comfort zone, and not being in a context socially with our friends or other students,” she said. “So coming back in contact with them, seeing new students that we didn’t see before, it was a social change.”

Her classmateIja Lanford said she preferred learning remotely because the instruction felt more personal, and Kamarah McNulty shared that the class of 2023 had to “start over” socially after spending time apart.

Joserik Figueroa-Duran, a senior at Chicago’s Whitney Young Magnet High School, said the early pandemic days felt like “a break from real life” for her. During that time, she said, she spent almost all her time in her room, and her great-grandfather, with whom she was close, died.

“My mental health became so much worse because I felt like I lost such a big part of my life,” Figueroa-Duran said. “And I was just so unmotivated at school.”

After traveling to Mexico to attend the funeral, many family members caught COVID-19, which only added to the stress. Figueroa-Duran said her school counselors were able to help through offering group therapy sessions and by checking in with her over email, and teachers made accommodations to help her finish her classwork during that time.

The pandemic also made it difficult for Figueroa-Duran to plan for a life after high school.

“Throughout the pandemic, I did not know what I wanted to do with my life,” she said. “I really was just thinking, I’m going to graduate school and not do anything afterwards.”

Since childhood, she’d been participating in Young Eagles, a program through which local pilots introduce students to aviation and take them on flights. Those had to stop at the beginning of the pandemic, but when the restrictions were lifted, she once again realized how much she loved airplanes.

“After that, everything in my world just became about airplanes,” she said.

She began taking dual enrollment classes in aviation maintenance through Olive-Harvey College during the second semester of her junior year, once she felt mentally prepared to get started. Figueroa-Duran will graduate this month with 15 college credits, having taken classes after school twice a week and every day over the summer. Figueroa-Duran said she’s learned the importance of doing something every day to prepare for her future.

During the pandemic, she said, many of her peers struggled emotionally to the extent that they stopped talking to their friends. While she and her friends made up later, Figueroa-Duran said they were so estranged during the height of COVID-19 that they had no idea the challenges one another experienced.

“I don’t know if they lost a parent or a sibling and it’s just so hard because there’s nobody really wants to talk about that either,” she said.

Figueroa-Duran’s mother, Erika Duran, said she found it difficult to encourage her daughter when she was at home and it felt like the world was ending.

Duran, who works at Whitney Young as a school associate, still sees the effects of COVID-19 and the loss of social, emotional and academic connections the students endured. She also sees the impact of grief on many students who lost loved ones.

“I always tell kids, ‘You’re not alone. You always have someone to talk to here,’” Duran said. “’Think about how many people went through what you went through.’”

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Once a month, Rios, 47, logs online from Orlando to video chat with a group of people with the same genetic mutation that gave him dominantly inherited Alzheimer’s disease, a very rare form of early-onset dementia. There are fewer than 10 people in his group and only one is over 50.

“Sometimes it’s sad, sometimes it’s funny. Sometimes it’s well, you know, heartbreaking, but it’s what life is, right? You’re not always going to be sad. You’re not always going to be happy. It’s just a roller coaster,” Rios said. “And it’s a blessing that I’ve met good people in my support group.”

He’s supported as well by his wife, Zahydie Burgos, a 38-year-old clinical psychologist. To help her husband with his currently mild symptoms, she’s taken over managing the household finances and started working from home. She shuttles him to doctors’ appointments and travels with him to and from Missouri and Puerto Rico for an ongoing clinical trial. She’s started social media accounts to raise awareness about his disease, particularly among other Hispanics, who suffer from it at disproportionate rates. Her Tiktok is @unforgettablemind, and her Instagram is @inolvidable.mente.

Burgos’ stance on their situation is clear: though this is tragic, it is not a tragedy. It’s a love story.

“We know what true love is. And I know that not a lot of people get that in their lifetime, but we did. And I’m so happy; I’m so lucky to have that,” she said. “Whatever caregiving I’m doing is only carried because of the love, is only carried because of the respect that we have for each other. … I make sure that I am keeping his integrity, his dignity, who he is, and not forgetting about that.”

Burgos’ commitment to her partner of 20 years is shared by hundreds of thousands of other people in the state.

Behind the estimated 580,000 Alzheimer’s patients living in Florida stand 827,000 loved ones providing unpaid care, often on top of full-time jobs, according to estimates from the Alzheimer’s Association.

Caregivers vary in age, race, economic status and background. Lucky ones, like Burgos, are young, healthy and engage in tools to manage their mental health.

But even with all the right resources, it can be difficult. The majority of caregivers for people with Alzheimer’s have at least one chronic health condition themselves, can’t afford help, and nearly one in three are depressed, according to a 2023 Alzheimer’s Association report.

Rios said he saw firsthand how difficult his mother had it when his father deteriorated from the disease, and doesn’t want his wife to go through something similar. At the same time, the Orlando couple is determined to make meaning out of the diagnosis. They have become advocates, spreading awareness of early onset Alzheimer’s and sharing the importance of prioritizing mental health for patients and their caregivers.

Burgos, a clinical psychologist, is part of multiple support groups, arranges therapy for both herself and her husband and leans on loved ones, who stay with him while she goes to work or attends yoga. She knows the importance of mental health and encourages open discussion about it.

“A lot of people do not have the family, the friends that will step up to the plate and give you a hand. So to me, that is the foundation for everything else,” Burgos said.

Rios agreed.

“I am so thankful to have [my wife] on my side through this process. I am one of the lucky ones that has so much support from my family,” he said.

Lyndsey Taylor, program manager of the Central and North Florida chapter of the Alzheimer’s Association, says support exists even for caregivers without a strong network of friends and family. The Alzheimer’s Association offers some, and the state offers training and care navigators who can connect families to local resources, available at its 24/7 helpline: 800-272-3900.

“We have a ton of free resources, but we kind of see that they’re underutilized or that the awareness of these resources just isn’t there,” Taylor said. “We’re really doing a push to try to talk to caregivers and say, ‘You need to focus on your own self-care. Asking for help through support groups, or respite care, isn’t weak; it’s a necessity.’”

Black and Hispanic people may be even more reluctant to access respite care because of cultural values, said the Alzheimer’s Association’s Director of Diversity, Equity and Inclusion Keith Gibson. People of these ethnicities disproportionately take on the role of caregiver for their relatives with Alzheimer’s.

“In both the Black and Hispanic cultures, it’s all about taking care of your own. And, you know, it’s also commonplace in the Black and Hispanic communities, as part of their cultural values, that they don’t want anybody to know about their business,” Gibson said. “That kind of leads to a shielding or isolation … which contributes to the higher rate of Black and Hispanic caregivers.”

At the same time, not every caregiver who seeks help will get it in Florida.

Even though the state leads the nation in Alzheimer’s funding, only a small fraction goes toward supporting unpaid caregivers. Many cannot afford to pay for others to care for their loved ones, and long waitlists for state support services keep them from getting assistance.

One of Burgos’ main concerns is whether they will be able to continue to afford her husband’s care as he needs higher and higher levels. He may eventually need to enter an inpatient memory care unit, which averages nearly $7,000 a month in the U.S., according to the American Association of Retired People.

“When you think about the amount of money, it’s a lot and it’s scary, and it’s just, it’s very intimidating,” Burgos said.

In Florida, free and discounted respite care for caregivers is available through the Alzheimer’s Disease Initiative, which offers services such as adult daycares or home aids. The initiative served over 15,700 last year and is set this year to receive a record $60 million from the state, pending the governor’s approval. This program can be accessed through local area agencies on aging.

The waitlist for respite care, however, is over 16,000 statewide as of April and 1,251 in Central Florida as of June, according to the region’s area agency on aging, the Senior Resource Alliance. Only a small portion of this year’s funds — $3.6 million — were allocated toward getting people off the waitlist.

Burgos said she will continue to care for her husband until she no longer can.

“I will always do whatever is in his best interest,” she said. “If at any point, I feel that his needs are greater than what I can help or provide, then he needs to trust that I will always do what is best for him.”

I had two 17-year-old sister cats until one died two months ago. The remaining sister has been losing weight for a few months. I finally had my vet look at her. They took bloodwork, and the diagnosis came back as her being hyperthyroid. I was told that it was consistent with her weight loss. I was given a few options on how to treat her and I opted for using a transdermal paste because one option was too expensive and the other meant giving her pills or oral liquids and she is difficult to handle or medicate. Should this option work and what is your experience in using such a form of treatment?  B.L.

Dear B.L.,

I am sorry for your loss of one of the cats but luckily you have a diagnosis on your remaining cat that will allow you to have her for a few years to come. Cats with hyperthyroidism typically present with weight loss with a simultaneous ravenous appetite and are often found to have rapid heart rates. The excess thyroid hormone production puts their metabolism in high gear.

In the past, surgical removal of the thyroid gland was done but for the most part that is no longer done. Another option was a radioactive iodine treatment of I-131 that typically costs over $1,500. There is a dietary means of treatment with a prescription diet called Hill’s y/d and some have had success using that. Going forward, you should avoid feeding her fish foods and canned foods are better for her in providing more moisture to replace fluids lost with increased urine production as well as providing the high protein and high calorie levels that she needs. The drug of choice to treat hyperthyroidism is methimazole, either given in pill form, compounded into tuna or chicken flavored liquid form, or transdermal pastes which can be rubbed on the inside of the ears. Since you just started treatment, a follow up blood test should be done in 1-2 months to make sure that she is being dosed appropriately. After that and depending on how she is doing, checkups with bloods should be done every 6 or 12 months.

Dr. John de Jong owns and operates the Boston Mobile Veterinary Clinic. He can be reached at 781-899-9994.

Board President Dr. Bruce Weinstein did not offer any more details about what brought the Quincy-based company to its breaking point, which was suddenly made public earlier this week. In a brief response to Herald follow-up questions, Weinstein said specific details about what pushed Compass Medical over the edge were protected by “various” non-disclosure agreements.

“Compass Medical’s closure became a necessity on Friday, (May 26) when our plan to continue operations collapsed,” Weinstein said. “Since that time, Compass has mobilized its limited remaining resources to stand up a website to assist patients locate their providers, to preserve the medical records and access to them after our closure, and to provide a plan to assure continuity of care for our 70,000 patients including the provision of on-call coverage during this transition.”

State officials, including Gov. Maura Healey and Attorney General Andrea Campbell, have said they are looking into the abrupt closure of the 450-employee company. Compass Medical announced in a statement on its website Wednesday that it would shut down, a move that left many patients scratching their heads and scrambling to secure primary care.

The closure has prompted at least one lawsuit from a former patient, Abington’s John Callanan, who accused Compass Medical of “patient abandonment” and shutting down “without any prior notice” to patients.

But in the Saturday afternoon statement, Weinstein said the company has worked to find landing spots for all their primary care providers and specialists. And they have “worked, to the best of our ability,” to provide resources to assist employees in finding new jobs.

“We have been in regular contact with the appropriate state agencies to review and refine our plan, made modification to this plan per their recommendations, and have worked to secure funding to support the transition plan following our closure,” Weinstein said in the email.

Speaking to reporters at the State House on Thursday, Healey called Compass Medical’s decision to close its doors “concerning and distressing.”

“I think I appreciate the real distress that causes for patients out there affected by this,” Healey said. “We are working closely with our secretary of Health and Human Services, who has already reached out to learn more information about what is going on, and what can be done to ensure that patients continue with care. That continuum of care is so, so important.”

Weinstein said once it became clear “closure was unavoidable” at Compass, officials there started to focus on making sure that patients could transition to new practices, “knowing that disruption was inevitable but committing all our resources to help mitigate where we could.”

“Throughout this effort, our management and our extended teams have acted diligently and responsibly in extremely difficult and sad circumstances and, at all times, focused on the needs of our patients,” he said.

Others view the timeline of events in a different light.

Attorney Jonathan Sweet, who is representing Callanan in the lawsuit against Compass Medical, said Weinstein did not address the process for notifying patients of the company’s decision to close.

“I find it implausible that on (May 26), they all of a sudden said, ‘Oh, my God, we need to close tomorrow.’ This is a huge operation,” Sweet told the Herald on Saturday. “And these kinds of discussions would have to be taking place well in advance for this to happen.”

Compass Medical was convicted on 10 counts of fraud in October 2022 and ordered to pay a Dallas-based medical group $16.4 million. Compass had originally sued Steward in 2017 over failure to pay bonuses to doctors and make rental payments, but jurors sided with Steward, instead finding Compass liable for fraud.

Sweet points to that settlement — which could reach even higher as court proceedings play out — and the associated financial pressures as one reason the business decided to close.

Weinstein declined to comment on the lawsuit with Dallas’s Steward Medical Group.

“The court has yet to issue a final judgment regarding the verdict and damages have not yet been confirmed. Compass still has a substantial claim against Steward which the court has yet to hear,” he said in a follow-up email to the Herald. “These details are publicly available.”

Attorney Howard Cooper, a partner at Todd & Weld who represented Steward during a 15-day trial in Boston, told the Herald earlier this week that it is unclear who will pay the $16.4 million settlement owed to Steward Medical Group.”

But as far as Compass Medical’s legacy is concerned, Weinstein said he is “immensely proud” of former employees and “profoundly grateful” for their work.

“While our company is closing, our providers will continue caring for patients at various practices throughout our region,” he said. “Through these providers and their new practices, and ultimately the teams that will continue to support them, I am confident that Compass’s legacy of high-quality patient care will continue throughout Southeastern Massachusetts.”

Compass Medical announced its decision to shut down in a statement posted to its website on Wednesday, leaving many patients scratching their heads as to the sudden loss of primary care options.

The move came after Compass Medical was convicted on 10 counts of fraud in October 2022 and ordered to pay a Dallas-based medical group $16.4 million. An attorney for the Dallas group was surprised to hear of the closure and left wondering how the settlement would be paid.

And now, John Callanan of Abington, a former patient of Compass Medical, said the Quincy medical group abruptly closed all of its patient care facilities in Massachusetts “without any prior notice” to Callanan or others involved in his class action lawsuit. Callanan’s lawyers said the closure amounted to “patient abandonment.”

“What we’re hoping to accomplish is to shine a light on this unconscionable business practice and to hopefully get every one of these patients who’s been affected by some kind of financial relief,” said Attorney Jonathan Sweet of the personal injury firm Keches Law Group.

Patients were left in a “chaotic, stressful, disruptive, and unsafe position” as they rushed to find new medical providers, deal with prescriptions, and schedule or reschedule important medical tests and appointments, the lawsuit said.

“Compass violated generally accepted industry standards and guidelines for the orderly winding down and closing of a medical practice,” the lawsuit said. “Compass opted for a sudden unannounced closure so it would not lose revenue while it remained in operation.”

The lawsuit said Compass Medical’s decision to shut down was based on financial pressures from the $16.4 million ruling in 2022. And the law firm said there were likely more than 70,000 Compass Medical patients across its multiple medical facilities.

In a statement issued Thursday, Compass Board President Dr. Bruce Weinstein said “most” physicians at the 450-employee company would continue to provide care in their local communities as part of other practices.

Weinstein said medical records would be preserved and available pursuant to federal and state regulations.

“Compass will be updating the website regularly with information on how patients can contact their physician in their new practice setting and how they can obtain access to their medical records,” Weinstein said in a statement.

State officials have said they are looking into Compass Medical’s closure.

A Boston jury ordered Compass Medical to pay millions to Steward Medical Group following a 15-day trial inside Suffolk County Superior Court. Compass had originally sued Steward in 2017 over failure to pay bonuses to doctors and make rental payments, but jurors sided with Steward, instead finding Compass liable for fraud.

Attorney Howard Cooper, a partner at Todd & Weld who was the lead lawyer for Steward during the fall 2022 trial, said attorneys on both sides were in the process of having settlement discussions to avoid a Compass Medical bankruptcy.

“What had been happening over the last few months since the jury came back is the parties, I should say at least Steward, was attempting to engage in settlement discussion,” Cooper told the Herald. “And we were as surprised as everybody else [on Wednesday] to hear that Compass was shutting its doors.”

Cooper said it is unclear who will pay the $16.4 million owed to Steward Medical Group, though there will be future arguments about who is responsible.

If Compass files for bankruptcy, payment obligations will have to play out in bankruptcy court. If they do not file for bankruptcy, those questions could be answered in post-trial hearings for the Suffolk County Superior Court lawsuit.

A spokesperson for Compass Medical declined to comment on the lawsuit and settlement.

Compass Medical announced its “imminent plan” to close all of its facilities Wednesday, a decision that has prompted top state leaders to express concern and a willingness to look into the situation.

In a statement Thursday, Compass Board President Bruce Weinstein said officials “deeply regret the impact that Compass Medical P.C.’s closure will have on our patients and would like them to know that we are implementing a plan to ensure the continuity of their care.”

“Most Compass physicians will continue to provide medical care in their local communities as part of other practices,” the statement said. “Compass will be updating the website regularly with information on how patients can contact their physician in their new practice setting and how they can obtain access to their medical records.

The Massachusetts Health and Hospital Association said Compass Medical’s closure is of “significant concern” to its members, especially as hospitals continue to experience capacity constraints and as facilities in the southeast support additional patients during the Brockton Hospital recovery.

“In these early stages, we hope that Compass staff can be quickly re-deployed to other local facilities and that health plans will consider easing burdensome authorization requirements for patients in need of timely care,” said Patricia Noga, vice president of clinical affairs for the association.

Katie Murphy, president of the Massachusetts Nurses Association, said she is concerned about patients now “scrambling” for a primary care provider.

“I feel a lot of concern about this, we really do,” Murphy said.

“We were inspired by the natural system and wanted to mimic it,” said Weichen Wang, whose team published its success in the journal Science. “Maybe we can someday help patients to not only restore motor function, but also restore their sensations.”

Much faster, larger and more sophisticated circuitry is needed before so-called “e-skin” holds promise for people.

But, in a milestone, the device showed remarkable success in a lab rat. When researchers pressed the rat’s e-skin and sent electronic pulses to its brain, the animal responded by twitching its leg.

Scientists have long dreamed of building prosthetic limbs that not only restore movement but also provide perception – sensing pressure, temperature and vibration, for instance — to help restore a more normal quality of life. Skin damage and amputation cause a massive disruption in the loop of perception and movement, so even simple tasks like feeling or grasping an object are challenging.

“If you pick up a glass of beer and you can’t sense that it’s not cold, then you won’t get the right taste,” said Ravinder Dahiya, professor of electrical and computer engineering at Northeastern University in Boston, who is also studying the use of flexible electronics to develop artificial skin.

Electronic skin also could be used to clad robots so they feel sensations in the same way that humans do. This is critical to the safety of industries where robots and humans have physical interactions, such as passing tools on a manufacturing floor.

But the sensation of touch is complicated. Human skin has millions of receptors that sense when they are poked or pressed, squeezed or scalded. They react by sending electrical pulses to the brain, through nerves. The brain responds by sending information back, telling muscles to move.

And biological skin is soft and can stretch, repeatedly, for many decades.

The Stanford team, led by chemical engineering professor Zhenan Bao, has been working on e-skin designs for several years. But an earlier effort used rigid electronics and 30 volts of power, which requires 10 batteries and isn’t safe. And it wasn’t able to endure continuous stretching without losing its electrical properties.

“The hurdle was not so much finding mechanisms to mimic the remarkable sensory abilities of human touch, but bringing them together using only skin-like materials,” said Bao, in a statement.

The new e-skin is innovative because it uses networked layers of stretchable organic transistors that perceive and transmit electrical signals. When sandwiched, the layers are only about 25 to 50 microns thick – as thin as a sheet of paper, similar to skin.

And the e-skin runs on only 5 volts of electricity.

To test the system, the Stanford team implanted it into a live rat. When the rat’s e-skin was touched, a pulse was transmitted by a wire to the rat’s brain – specifically, an area called the somatosensory cortex, which is responsible for processing physical sensations.

The rat’s brain responded by sending an electrical signal down to its leg. This was done using a device that amplifies and transmits signals from the brain to muscles, mimicking connections in the nervous system called synapses.

The rat’s leg twitched. Significantly, its movement corresponded to varying levels of pressure, said Wang, an engineering PhD and first author on the new paper. For example, the team could increase the leg’s movement by pushing the e-skin harder, which boosted the signal’s frequency and the transistor’s output.

If tested in humans, the device would not require implantation of a wire to send sensory information to the brain. Rather, the team envisions using wireless communication between e-skin and an electrical stimulator located next to a nerve.

Joe McTernan of the American Orthotic and Prosthetic Association said such research encourages technological advancements that could someday provide real-time biofeedback for people who have lost limbs.

“Although this skin technology is fairly new, there has been significant research and development in recent years that have focused on creating a positive tactile experience for the patient,” he said.

The Stanford team’s closed-loop system — from sensation to muscle movement — is “very exciting…very much a proof of concept,” bioelectronics expert Alejandro Carnicer-Lombarte of University of Cambridge told the journal Nature.

In the field of artificial prosthetics, most researchers tend to work on individual components, he said. “Combining those things, in sequence, is not trivial.”

Dahiya applauded the team’s success in building flexible electronics and then making them work. “That’s where they’ve done a nice job,” he said.

But he said there’s still a missing piece of the puzzle: creating memory. Unlike Stanford’s e-skin, human skin learns how an object feels, then can anticipate it.

There’s another challenge: The transmission of signals is currently too slow to be useful. The flow of information through the team’s flexible carbon-based transistors is sluggish compared to more traditional silicon-based transistors, he said.

Such a delay “will not allow us to get a real feeling,” Dahiya said. “And without real feeling, then you have a practical bottleneck.”

At Stanford, the next step is to pack more and different sensors into the e-skin, to more closely replicate the many sensations felt by the human hand, said Wang.

“We’re scaling up,” he said. “It will be more advanced.

“The whole field is under development,” he said. “It will take many more generations of developments to realize our target.”

Compass Medical, which has 450 employees in the state, announced an “imminent plan” to close all of its facilities in a statement posted to its website Wednesday that left many scratching their heads. It comes after the company lost a lawsuit to a Dallas-based physicians group, costing them millions.

At an unrelated press conference inside the State House Thursday, Gov. Maura Healey said anytime someone’s access to health care is interfered with, “that’s troubling.”

“It’s very concerning and distressing, and I think I appreciate the real distress that causes for patients out there affected by this,” Healey told reporters. “We are working closely with our secretary of Health and Human Services, who has already reached out to learn more information about what is going on, and what can be done to ensure that patients continue with care. That continuum of care is so, so important.”

Healey said her office has been in touch with the Attorney General’s Office, adding that Compass Medical is a physician’s group, which means it is not licensed by the state. A spokesperson for the Executive Office of Health and Human Services said the administration is “concerned” by reports of the closure.

A spokesperson for Attorney General Andrea Campbell said the office is gathering information on the closure and is in “close communication” with the Healey administration.

“Affected consumers and patients are encouraged to contact the AG’s office to share their concerns,” the spokesperson said.

Compass Medical has facilities in Brockton, South Weymouth, Attleboro, Dorchester, Milton, Taunton, North Easton, Bridgewater, and Stoughton, among other places.

“After a steady stream of challenges, we were ultimately forced to make the devastating decision to close all offices of Compass Medical PC. effective immediately,” the statement said. “There is no good way to share this news. We are heartbroken and truly sorry as we know the unprecedented impact on our valued patients.”

In a Thursday statement, Compass Medical Board President Dr. Bruce Weinstein said “most” physicians at the company will continue to provide medical care in their local communities as part of other practices. Medical records will be preserved and available pursuant to federal and state regulations, the statement said.

“Compass will be updating the website regularly with information on how patients can contact their physician in their new practice setting and how they can obtain access to their medical records,” Weinstein said.

It was not immediately clear how many physicians worked at Compass Medical, and a spokesperson for the state Board of Registry in Medicine, which licenses physicians in Massachusetts, did not immediately return a request for comment.

House Speaker Ronald Mariano, a Quincy Democrat, said the Compass closure is “further evidence” the state’s healthcare system has yet to recover from the financial pressures brought on by the pandemic.

“It’s critical that patients impacted by these closures are able to transition their care to alternative providers in a manner that does not further threaten the stability of the region’s health care resources,” Mariano said in statement.

The closure comes after a jury ordered Compass Medical to pay $16.4 million to Dallas-based Steward Medical Group following a Fall 2022 multi-day trial in Suffolk County Superior Court, according to court records. Steward Medical Group owned Quincy Medical Center, which closed in 2020.

Compass Medical originally sued Steward Medical Group in 2017, accusing the Dallas company of failing to give incentive payments to Compass doctors and failing to “make rental payments for office space and for medical equipment leased by compass on SMG’s behalf,” the lawsuit said.

But the jury instead sided with Steward Medical Group, finding that Compass Medical engaged in a breach of contract, intentional misrepresentation, negligent misrepresentation, and unjust enrichment, according to a jury verdict form dated October 2022.

The case status is listed as open as of Thursday and a court hearing was last held on April 27, according to court records.

A spokesperson for Steward Health Care — the parent company of Steward Medical Group — said Compass Medical lost a $16.4 million verdict, was found guilty, and convicted on 10 counts of fraud.

“Compass has not paid Steward any part of that claim and has nothing to do with them going bankrupt,” the spokesperson said. “… We understand how difficult this is for the community, in the wake of the fire at Signature Healthcare Brockton Hospital, the expected closure of Compass Medical will create even more restrictions on access to care for patients.

The Steward Health Care spokesperson said the company is planning a series of job fairs over the next week to help Compass Medical clinicians and employees find jobs “that allow them to continue to serve their patients in the local community.”

1798: Robert Willan, the father of modern dermatology, describes a skin condition called eczema solare, or skin sensitivity to light.

1820: English physician Sir Everard Home first proposes that skin pigmentation has protective effects against the sun and that a component of sunlight other than heat affects the skin.

1878: Otto Veiel of Austria describes tannins as a form of sun protection. However, the darkening effect of tannins on the skin prevents them from being commercialized as a sunscreen.

1889: Erik Johan Widmark of Stockholm publishes a landmark study that experimentally proves UV radiation can cause skin erythema and burns.

1891: Dr. Hammer of Stuttgart, Germany, is the first to specifically recommend the use of chemical sunscreens to prevent UV radiation from causing erythema solare of the skin; he uses quinine prepared in an ointment as the first human sunscreen.

1896: Dr. Paul Unna, a German physician, first describes an association between sun exposure and skin cancer: he explains precursor skin cancer changes, such as hyperkeratosis, on sun-exposed skin.

1910: Dr. Unna develops a sunscreen from chestnut extract, sold under the names “Zeozon” and “Ultrazeozon.”

1920s: Coco Chanel popularizes the idea of tanning after photographs of her are taken following a Mediterranean cruise. Her friend, Prince Jean-Louis de Faucigny-Lucigne, says: “I think she may have invented sunbathing.” Tanned skin becomes a sign of a healthy, leisurely, and privileged way of life in Western culture.

1928: Dr. G. M. Findlay publishes a paper with the first experimental proof of the association between UV radiation and skin cancer in an animal study (mice).

1935: Eugene Schueler, founder of today’s L’Oréal, develops the first tanning oil with UV radiation-filtering properties; the active ingredient is benzyl salicylate.

1938: Swiss chemist Franz Greiter gets sunburned while climbing Mt. Piz Buin — an event that will inspire him to create the first modern sunscreen a decade later.

1942: Stephen Rothman and Jack Rubin first describe para-aminobenzoic acid, active ingredients that will become the most popular in sunscreens in the U.S. for many years.

1942: The Army Air Force approaches the American Medical Association Council of Pharmacy and Chemistry for a “top secret experiment” to study the most effective protective substances to prevent sunburn of men stranded in the desert or on life rafts. They find that dark red veterinary petroleum is waterproof, inexpensive and free of toxicity.

1944: Pharmacist Benjamin Green, who served as an airman during World War II and used red veterinary petroleum, develops a more pleasing, consumer-friendly version of the product by adding cocoa butter and coconut oil, a combination that eventually becomes the Coppertone suntan lotion.

1946: Swiss chemist Franz Greiter develops and commercializes the first modern sunscreen, known as “Gletscher Crème,” or Glacier Cream. He names his brand Piz Buin in honor of the mountain he climbed.

1962: Greiter is credited with inventing the sun protection factor (SPF) rating; the original Gletscher Crème has an SPF rating of 2.

1967: Water-resistant sunscreens are developed.

1978: The U.S. Food and Drug Administration begins to regulate the booming sunscreen market. UV tanning beds also start to appear in the U.S.

1980s: Australia, followed by other countries, accepts the definition of SPF as “the ratio of UV energy needed to produce a minimal erythemal dose on protected to unprotected skin.” SPF becomes the standard in testing sunscreen formulations.

1990s: Most sunscreen products in the market have SPFs ranging from 15 to 30; avobenzone (with octyl triazone added to increase photostability) is the most common ingredient for UVA protection, whereas octyl methoxycinnamate is the most common ingredient for UVB protection.

2007: The International Agency for Research on Cancer publishes a landmark study confirming the association between tanning beds and melanoma.

2008: Marine scientist Roberto Danovaro and colleagues publish the first study describing the potential role of sunscreen ingredients causing coral bleaching in areas with high levels of human recreational use.

2018: Following ecotoxicologist Craig Downs and colleagues’ paper raising concern for potential harm of two sunscreen ingredients — oxybenzone and octinoxate — on coral bleaching and underwater ecosystems, Hawaii becomes the first state to pass a bill banning the sale of sunscreens containing oxybenzone and octinoxate, active ingredients found in most major sunscreen brands.

2019: The FDA‘s Muraili Matta and colleagues’ study in the Journal of the American Medical Association details the application of four commonly available sunscreens on healthy volunteers that resulted in plasma concentrations above the exceeded level established by the FDA for waiving nonclinical toxicology studies for sunscreen. The active ingredients included in the study are avobenzone, oxybenzone, octocrylene, and ecamsule. This study has served as a catapult for the need for further studies to determine the significance of these findings as the chemicals were being absorbed by the body.

Sources: National Library of Medicine, American Academy of Dermatology, American Cancer Society, Cancernet.org, Melanoma Research Foundation

The annual study, released Tuesday, surveyed 3,000 adults in the Bay State between November 2022 and this January, finding one in three reported they continue to struggle securing healthy food on a consistent basis.

Though the rate is the same as in 2021, food agency leaders say they are concerned about what numbers may look like in the months ahead as low-income residents will soon lose  state-funded supplements for food assistance.

Friday’s scheduled allotment of the state-funded emergency assistance will be the third and final under Gov. Maura Healey’s $388.7 million supplemental budget. The payments provided roughly $60 per month, since April, to the average household participating in the federal Supplemental Nutrition Assistance Program.

“Even with the offramp of supplemental benefits that the state funded, we have already been seeing a lot of need at food pantries There’s this other looming threat of additional benefit cuts through the negotiations of the current debt ceiling,” GBFB’s vice president of communications and public affairs Catherine Lynn told the Herald.

Congress late last year disconnected the SNAP program from other pandemic relief plans, and February was the last month families received the extra federal money. The COVID-era subsidies resulted in an average bump of $151 to a participating household’s normal monthly benefit of $335, according to the state Department of Transitional Assistance.

Now, Congress is deciding on a bill that would suspend the nation’s debt limit through 2025 to avoid a federal default while limiting government spending. Part of the agreement looks to expand work requirements for SNAP users, bringing the maximum age limit to 54, from 49, by 2025.

Vicky Negus, of the Massachusetts Law Reform Institute, said she is working closely with the state’s congressional delegation on how to ensure the SNAP program can be most beneficial for participants.

“Our federal government has under invested in what families and communities need in order to meaningfully put food on the table on a consistent basis,” Negus told the Herald.

In the GBFB study, 87% of respondents said they’re worried about being able to afford enough food if the SNAP increase ended. With the extra benefits, 65% of respondents said they were able to pay for more of their bills. About 58% reported they were going to food pantries less frequently.

“We asked how much more money families would need to support their household’s food needs, and over half of the SNAP users reported they’d need $100 or more per week,” said lead researcher Dr. Lauren Fiechtner, director of nutrition at Mass General for Children. “We’ve all seen how expensive groceries are, so there’s more of a need than ever.”

The Associated Press contributed to this report.

While cancer drugs have been most publicized recently, experts in pharmacy say they often find themselves scrambling to find common generic medications such as antibiotics and fear having to resort to rationing.

They say only a national effort to bring generic drug manufacturing back from overseas, among other steps, will help relieve the problem, which mostly affects injectable drugs, including chemotherapy and cardiac medications.

“It is not just cancer, said Dr. Peter Yu, physician-in-chief of the Hartford HealthCare Cancer Institute in Hartford, Connecticut. “It’s pediatrics, it’s infectious diseases, it’s rheumatology.”

Yu said the American Society of Clinical Oncology looked into the problem when he was president in 2014-15. “In part what we learned is it wasn’t just oncology; it really is a health economics issue about how drugs are paid for and manufactured and distributed in the United States and the world,” he said.

“We are experiencing it ourselves across Hartford HealthCare,” Yu said. “We treat hundreds of patients a day with chemotherapy. We tried to keep a several weeks’ supply of our chemotherapy drugs on hand and we’ve been down to as low as a two-day supply, which makes us extremely nervous.”

Yu said health care systems rely on a few large distributors, “big names like Cardinal Health, American BioSource and McKesson, and they’re unable to tell us when they can deliver supplies. We call every day and they say, we’re not sure we can distribute your order.”

He said Hartford HealthCare has been able to shift supplies among its seven hospitals to avoid a total shortage, but “there’s very little margin for error here, or very limited.”

‘A spike in shortages’

“What we’re seeing now is a spike in shortages,” said Eric Arlia, vice president for pharmacy services at Hartford HealthCare.” We’ve gone through these waves on and off over the last five years. We seem to be going through another period where there’s going to be more than the typical number of drug shortages that we’re dealing with.”

Arlia said the business office and pharmacy buyers for the health care system are holding weekly meetings because of the seriousness of the issue.

“The team is tracking 46 drugs in short supply as of this week,” Arlia said last week. “Not all at the same level of criticality, but 46 of them that they’re talking about and talking about mitigation strategies, whether that be trying to buy it from a different company or looking at different dosage forms.”

Other options are looking at therapeutically equivalent medications and switching patients to another drug if necessary. But that isn’t always the best treatment, especially if a patient has been on one medication for a while.

The two main cancer chemotherapy drugs, cisplatin and carboplatin, have been among those in short supply, but Arlia said methylprednisolone, used to treat asthma, arthritis and allergies, is “our No. 1 shortage product at the moment.”

“It’s an anti-inflammatory — probably one of the biggest issues is people with breathing issues to help them breathe better, but it has other uses too,” Arlia said.

However, “the good news with that one is sometimes people can take oral if they’re able to and then there’s a couple other drugs … in the same therapeutic class with similar effects,” he said.

Manufacturing in China and India

According to a U.S. Department of Homeland Security report, drug shortages increased 30% between 2021 and 2022. There was a five-year high of 295 drug shortages at the end of 2022, according to the report.

A major concern is that 90% to 95% of the chemicals that make up acute-care injectable drugs, known as the active pharmaceutical ingredient, are manufactured in India and China, according to the report. The Food and Drug Administration does not have the same level of oversight of those countries, and officials worry about geopolitical threats disrupting supply.

“The drugs are being manufactured overseas and not just the drugs but also the active ingredients” and the inactive ingredients, said C. Michael White, chairman of the Department of Pharmacy Practice at the University of Connecticut School of Pharmacy.

“India makes most of the finished pharmaceutical products,” he said. “So that’s the actual tablet or the capsule. China makes a lot of the active ingredients.” And that won’t change anytime soon.

“One of the things that’s actually scary from a national security standpoint is that the United States doesn’t have any capacity to be able to have the fermenting plants that they would need to have to make penicillin and cephalosporin antibiotics,” White said. “They’ve all shut down and they’ve all moved overseas, and most of them are now in China.”

That could cause a major problem if China were to attack Taiwan, for example, he said. 

“You can’t just build a manufacturing plant for pharmaceuticals,” White said. “It takes years in order to be able to construct it. And that’s one of the things I think we found with COVID, is that we’re always behind the eight ball because we didn’t have the capacity to be able to manufacture it here, so we were beholden to the normal supply chains, which were all being interrupted.” 

A contamination scandal

A major shortage occurred when Ranbaxy USA, based in India, was found to have contaminated drugs and was shut down.

“The FDA did not have any funding in order to be able to go overseas and do any of the inspections of those foreign manufacturing plants,” White said. The companies were put on the honor system, “where you would send them reports of the stuff that you were doing, but they would never visit you.”

After a whistleblower notified the FDA that Ranbaxy was falsifying reports, the FDA began scheduling inspections, but the foreign companies knew when inspectors were coming so that would take plants offline to bring them up to standards. That in itself causes shortages, White said.

Another issue is the age of equipment. “They were beating us on price because they were dealing with equipment that was much much older and then prone to breakdowns and whatnot, but because it was less expensive to be able to use that equipment they ended up dominating the market, putting other people out of business,” White said. “But then when the equipment breaks, then you have a drug shortage.”

However, the quality of foreign-made drugs is higher now than it had been, he said.

“The FDA is behind on inspecting them, and sometimes when they get to them, if they have violations, they can shut them down and then it just has a trickle effect,” Arlia said.

“Obviously, if companies either in the U.S. or in another part of the world can’t get the raw materials needed to make a medication, there’s going to be a shortage.”

Looming threat of rationing

Dr. Daniel Petrylak, an oncologist and professor of urology at the Yale Cancer Center in New Haven, Connecticut, said a notice went out two months ago about a shortage of cisplatin, also known as cisplatinum.

“Unfortunately, for tumors such as testes cancer, there are no alternatives,” Petrylak said. “Cisplatinum is the backbone of treatment for these patients. Same thing with bladder cancer for those patients that can receive cisplatinum.”

He said there was a clinical trial comparing cisplatin and carboplatin in testes cancer patients “because the concept was that (carboplatin) was a less toxic drug, but unfortunately it was found that there was a higher relapse rate in those patients who received carboplatinum versus those patients who received cisplatinum.”

If there is a shortage, decisions about who will get the drug are difficult to make, Petrylak said.

“I’m not trying to say that it’s any less important to treat somebody who is older but most of the testes patients are in their 20s and 30s, and they have long lives ahead of them,” he said. “And this is a pretty much curable disease in most patients. In fact, in a good-risk patient, 90% of those patients are cured.”

Older men have a higher relapse rate, which requires more treatment and could lead to side effects. “So there’s not only a quantity-of-life issue but a quality-of-life issue,” Petrylak said. “Those are important factors, but I view this as a national health emergency. No question.”

Lisa Holle, clinical professor of pharmacy practice at the UConn School of Pharmacy and an oncology pharmacist, also sees rationing as a possibility. 

A consideration is, “What is the reason they’re getting the chemotherapy?” she said. “Is it because we know we could cure this patient of their cancer and they can be free from their disease? … But in some instances, we can’t cure the cancer because it’s such an advanced stage of cancer and we’re giving the chemotherapy to try to keep the cancer at bay for as long as we can.”

In that ethical situation, “we might think about the patients who are curable versus those who are not,” Holle said. “And of course we do not ever want to be in that situation because we think it’s really important to also keep some of these cancers at bay, but those are sort of ethical dilemmas I think that one gets faced with when there’s a limited supply of a life-saving drug.”

Another alternative is for the FDA to allow importing of unapproved foreign drugs on an emergency basis, Holle said.

“Back in 2012, 2013, there was a drug that was in short supply, and the FDA allowed an emergency use of an internationally manufactured version of the drugs,” she said. “It required the FDA to be able to approve this drug temporarily so that we could import it into the United States and use it for patients because there was no alternative to that drug for that type of cancer.”

‘Inconsistent availability’

Dr. Pragna Kapadia, assistant professor in hematology and medical oncology at UConn Health, said the health care system has avoided shortages of cisplatin, docetaxel and carboplatin, three common chemotherapy drugs, so far.

“Fortunately, we have not had any issues that have directly impacted a patient, meaning we haven’t had to change a treatment course or substituted therapeutic drugs because of a shortage,” she said. 

“We previously had tried to keep a one-month supply of most of our medications on hand,” Kapadia said. “There are certain chemotherapy drugs as of late it’s just not available. So we have more of maybe a two- to three-week supply on hand and it’s just inconsistent availability.”

This causes pharmacists to have to be creative, she said. 

“So there may be certain vial sizes that are available and certain concentrations that are available, but then it’s up to us, our pharmacists, to compound the medication to make it what we need it to be, because it’s not available in the form that we need it to be,” she said.

She said UConn Health has not had to resort to rationing of drugs.

“I will say, I’ve been at UConn for five years, and there was a point where … they said, we have X number of doses of this drug and so be mindful of that as you talk to patients about starting them on a treatment regimen that includes that drug,” Kapadia said.

Doctors don’t want to alter a treatment plan because “that is only going to potentially be harmful to the patient, she said. 

UConn Health uses a group purchasing organization, Vizient, which helps mitigate shortages. Kapadia said that is more available to large health care systems, whereas smaller hospitals may not have access.

“You never want to be that patient who has to hear, I can’t treat you with what is felt to be our best standard of care because the drug isn’t available,” Kapadia said “You never want to have to have that conversation with a patient.”

She said she hasn’t had to do that recently, “but it’s something that we worry about, and I do think that smaller institutions who don’t have these large purchasing groups, or they don’t have a large volume that they’re purchasing, I think they are at a higher risk of not having enough drugs.”

Cardiovascular drug issues

In cardiovascular medicine, the biggest shortages are in lidocaine, adenosine and dofetilide, White said.

Lidocaine is an anesthetic that also treats arrhythmias. A shortage can lead to delayed procedures, White said.

A lack of adenosine, used for people in arrhythmia, “acutely causes a break so people will go back into a regular heart rhythm.” A lack of it can put patients at risk because the substitute, calcium channel blockers, stay in the system for several hours.

“The adenosine gives you the advantage that you can come in and you could break the person out of that arrhythmia, put them back into a regular heart rhythm,” White said. “And then you only have to do that intensive monitoring for a few minutes.”

If channel blockers must be used, “you may have more low blood pressure and you’ve got to monitor the patient and be concerned for a longer period of time,” he said. Adenosine is also used in stress tests.

Dofetilide is used daily to prevent atrial fibrillation. The problem with the substitute, sotalol, is that dofetilide must be out of the system before the new drug is used, putting the patient at risk for several days, White said. Both drugs require a three-day hospital stay when they are introduced.

“You can’t just on the same day take somebody off dofetilide and put them on sotalol,” White said. “You have to wait until all of the dofetilide is out of the body. And then you have to bring them into the hospital for another three days to put them on sotalol.”

When dofetilide is available again, doctors are faced with a conundrum. “Do you keep them on the sotalol, or do you take them off, give them several days without any antiarrhythmic therapy, and then have to put them back on the dofetilide?” White said.

No one keeps reserves

To Arlia, “the other big issue is that nobody keeps any reserve supplies in the supply chain anymore.”

Companies used to keep inventory reserves, but economics has eliminated that, he said.

“What happens now is, if there’s even a relatively minor disruption, it just hits everybody very fast, because there’s just very little reserves in the system.” He said there are programs where “if you’ll commit to buying a certain product, they’ll guarantee that they’ll hold 90 or 120 days’ supply in a warehouse for you. And we did that with a few drugs.”

Arlia said he would “happily commit to buying one brand of a generic, commit to it for a year or a couple of years at a certain price if I know they’re going to hold stock for me. … Because ultimately, I think you end up spending more money when you have a shortage and you’re changing things around. And of course, it’s bad for patient care.”

For Arlia, the lack of reserves is a critical issue. “I think there just needs to be more of a national focused effort on this,” he said.

“As a country, to me it’s a vulnerability that we don’t have reserve supply of critical pharmaceuticals. And nobody’s going to do it out of the goodness of their heart. Somebody needs to be incentivized, really, to hold more supply than they need to for their general business.”

“You may have everything that you need, but then you don’t have the vial or you don’t have the ampule, or you don’t have one of the really important ingredients but you have all the others,” disrupting the manufacturing process, White said.

Kapadia sees another cause. “If you look across the board at the different medications that have been affected, I think some of it is still a ripple effect from COVID, workforce issues and supply chain issues,” she said. “Even though we feel that the pandemic is behind us, those things I think are still playing a role.”

The problem with generics

The low prices of generics have their own issues, according to Yu. As long as a manufacturer has a patent, the price may be high.

“When that patent drops, you get the entry of generic manufacturers that can now produce that drug … but the price begins to drop, and it drops pretty quickly,” Yu said. “So within a year’s time, the price may fall by 97% or more. So it fairly rapidly reaches a level where that generic manufacturer is no longer so interested in making that drug. … Manufacturers may shift to another generic drug where they have a higher margin.” 

White said manufacturers’ move to overseas added to the problem.

Generic drug manufacturing “shifted overseas with the understanding that prices would continue to go down, which they have for generic drugs,” he said. “And that created a lot of pressure on the system so that only the ones that have the cheapest price were the ones that we’re going to be getting a majority of the sale.”

Insurance companies reimburse based on the lowest-priced drug, so there is little incentive to spend money to increase automation or maintain equipment, White said. And companies have consolidated so there may be just two making one drug.

White said of the shortages that “at most points, it’s a severe inconvenience. … Periodically it becomes dangerous when some of the drugs that are in shortage are more vital-type drugs, like the cancer drugs.

“But we have this extreme vulnerability and the extreme vulnerability could really be devastating to the United States if all of the manufacturing was taken away,” he said.

UConn working on problem

White said one faculty member is working on “a new manufacturing-type process that is much, much more efficient and doesn’t use a lot of worker time in order to be able to set up and be able to create.”

“The U.S. had allocated money. I think there’s like a billion dollars or whatever into research specifically on bringing manufacturing back to the United States. … And UConn is is part of a consortium of major universities in the country, called NIfTI (Neuroimaging Informatics Technology Initiative) that have been working on ways to be able to support bringing manufacturing back to the United States and be able to do it in an efficient manner.” 

Yu said Congress passed a law requiring manufacturers to notify the FDA if they anticipate a drug shortage within six months.

“Often they don’t know six months in advance if there’s going to be a problem,” Yu said. “And just notifying people that there’s a problem doesn’t solve the problem. It’s not a very satisfying answer.

“I think we need Congress to put sharper focus on this,” Yu said. “I think we need to think about this as a consumer protection issue as well as a public health issue.”

Yu called the health care system “very fragmented and nonsensical in many ways. We have some parts of the health system that are highly regulated, and then some parts like drug manufacturing and production that have a lot less regulation behind pricing and distribution.”

Ed Stannard can be reached at estannard@courant.com.

Our German Shepherd is 13 years old and was diagnosed last year as being anemic, found to have a mass on her spleen, had it removed, and luckily it was benign. Arthritis has set in, and our vet gave us Rimadyl which seems to work well but it is costly! I understand there is a generic version which costs less but is it equally effective? She has had intermittent diarrhea and an upset stomach with some regularity. Tests have shown no parasites. She does have a propensity to get into various things that she ingests outdoors such as feces from wildlife and even garbage. Can I give her Tums to settle her stomach? Most of the time, the diarrhea resolves. Sometimes there is also some vomiting. What do you suggest? I am almost too embarrassed to contact my vet about the same issue again and again. W.M.

Dear W.M.,

Let me start by saying that I am happy for you that the splenic mass proved to be benign since so many are malignant hemangiosarcomas that often lead to a very shortened life. The NSAID drug, Rimadyl, is my favorite drug of choice when such a medication is called for. As with most drugs, generic options are available, and you can surely ask your veterinarian to order or prescribe it for your dog. It’s worth a try to see if the efficacy is the same. If not, you can always go back to what you are using now.

As for the gastrointestinal issues, the first thing is that you need to be vigilant in watching what she ingests. I suspect that, given the history, a lot of what you see is due to her eating things that she shouldn’t. Tums is not something you should give your dog! It has an ingredient known as xylitol which is highly toxic to dogs. If your dog has an upset stomach, giving Pepcid or Prilosec could be used safely but do not do so without consulting with your veterinarian first. It is not uncommon that pet owners reach for over-the-counter human medications for common ailments but, while some may be safe to give, dosing can be much different or inappropriate all together. The good news is that it seems your old dog’s GI issues often resolve spontaneously. Never hesitate to contact your veterinarian.

Dr. John de Jong owns and operates the Boston Mobile Veterinary Clinic.He can be reached at 781-899-9994.