Jane Weese | JASE Medical

Medical supply shortage is in crisis

Reports through the nation’s hospitals are sharing stories of severe shortages of medicines, IV solutions, durable medical equipment and contrast dyes used in diagnostic procedures. The situation is dire and isn’t getting any better soon.

Supply shortages include

  • Dialysis supplies
  • Laboratory testing reagents and testing supplies
  • Vinyl examination gloves and surgical gowns
  • Ventilator related products
  • Contrast dyes for CT and MRI procedures

How are supply shortages determined?

The CARES act of 2020

According to the FDA:

The Coronavirus Aid Relief and Economic Security Act(CARES Act) was signed into law on March 27.2020 to aid response efforts and ease the economic impact of COVID-19. In addition, the CARES act authorized the FDAs ability to identify, prevent and mitigate possible shortages of drugs and medical product supply chains. Drug shortages can occur for various reasons, including manufacturing and quality problems, delays, and discontinuations. Drug manufacturers provide FDA with most of the drug shortage information the agency receives, and the agency works closely with manufacturers to prevent or reduce the impact of shortages. This has proven to be a tremendous help in identifying potential drug and medical supply shortages and possible future shortages. Even with this act in place we are experiencing historic shortages that the cause of is out of our control.

Logistics, Lockdowns and Backlogged

The ongoing health crisis has prevented the manufacture and flow of medical supplies worldwide. Backlogged ports, lockdowns in China, ingredients to manufacture drugs and supplies are all impacted. Hospitals and medical facilities around the United States have been dealing with disruptions and in some cases out of stock medications and supplies. Many hospitals are reporting they have had to ration procedures and supplies to extreme, lifesaving emergencies. Raw materials for many drugs that are sourced from India and shipped to China to manufacture the medications are unable to ship their material to China due to the ongoing lockdowns and port closures in China.

This situation could turn very dire this summer if restrictions and lockdowns continue. Shutdowns have yet to fully work their way through the supply chain, meaning that constrained supplies could get worse this summer, especially if the lockdowns drag on.

Supply logistics are another problem. Once the supplies and drugs arrive at the US ports they still must be shipped across the country to hospitals, clinics, and other healthcare facilities. The diesel shortage and skyrocketing cost of diesel are playing a huge part in this lag time.

These shortages are expected to impact our healthcare facilities, and ultimately us, the patients well into 2023.

A look at critical supply shortages

Over the next weeks we will be exploring the different medical supply shortages affecting healthcare facilities in the United States, beginning with contrast media.

Contrast media for CT studies and imaging.

Iohexol- trade name Omnipaque

This is an iodine-based contrast dye widely used in CT scans and x rays, such as kidney, heart, urinary tract, GI tract and spine. It belongs to a class of drugs known as contrast media or dyes. It works by adding contrast to body parts and fluids in imaging tests, allowing the doctor to see abnormalities or changes in a patient’s condition. About 40% of all CT scans use contrast media.

Contrast media has been rationed and hospitals and healthcare facilities have been asked to only use in the most emergent cases. This has led to cancellation of exploratory and routine CT and Xray procedures.

According to a statement from the AHA website:

Nancy Foster, AHA’s vice president for quality and patient safety policy, said, “We are aware of this global shortage of IV contrast fluid due to production shutdowns in China and have raised this issue with the Administration. While we have been told to expect normal production to resume late next month, hospitals are exploring various conservation strategies including the use of other imaging technologies, using other contrast agents, rationing contrast, and ensuring every available drop of contrast dye is used efficiently, and postponing some scans that can be postponed, to give a few examples, to continue to provide needed care. The AHA will continue to monitor this situation and provide updates to the hospital and health system field.”

GE Healthcare reports on restarting production of Omnipaque:

“The impacted facility (in Shanghai) had increased production output from 0% of capacity when the plant was closed to 60% by May 21, 2022. GE Healthcare expects the plant to be producing at 75% in the next two weeks.” In addition, they are expanding production in their Cork, Ireland facility. They are projecting more contrast dye will be available by June 30tj.

Recycling unused contrast media program

In the meantime, however, there remains a severe shortage of Omnipaque. GE healthcare has been recycling iodine-based contrast media left over from procedures since 2006 in 11 European countries and since spring of 2021 has expanded its service to the United States and Canada. Canada currently has 15 collection sites, and as of this writing, the United States is in the exploratory phase to implement this program

Taking personal responsibility for your health

As we continue to experience supply chain shortages in the most critical sector of our lives, mainly the healthcare industry, it would be a good time to assess you and your loved one’s medical readiness at home, and to take preventative steps towards health, such as nutrition, stress reduction, exercise and nurturing close relationships.

In addition, it would be a good time to go through your medicine chest and discard out of date medications, stock up on first aid supplies that you may be running low on, and to renew your prescription medications.


Monkeypox – Should we be concerned?

Reports of Monkey Pox are in the headlines now, from case fatality rates as high as 10 percent to the virus being part of a planned bioterror attack.

A few recent headlines:

British officials confirm 19 more monkeypox cases

Monkeypox spread “concerning” say President Biden

Third possible case of monkeypox found in US

WHO asks for ‘strengthened coordination’ as monkeypox outbreak reaches the US

To sort out fact from sensational headlines below are some statistics and facts taken from the World Health Organization and CDC:

About Monkeypox:

Monkeypox is a rare disease that is in the same genus as smallpox and cowpox. Monkeypox was first discovered in 1958 when two outbreaks of a pox-like disease occurred in colonies of monkeys kept for research, hence the name ‘monkeypox.’ The first human case of monkeypox was recorded in 1970 in the Democratic Republic of the Congo (DRC) during a period of intensified effort to eliminate smallpox. Since then, there have been small outbreaks throughout the world, The first outbreak in the US was in 2003 when 71 individuals were infected following sale of prairie dogs infected with Gambian giant rats that had been imported from Ghana. They had been housed in the same facility for an extended time and became infected. Since then, there has been isolated outbreaks in the United States.

About the monkeypox virus

There are two clades of monkeypox virus: the West African clade and Congo Basin (Central African) clade. Although the West African clade of monkeypox virus infection sometimes leads to severe illness in some individuals, disease is usually self-limiting. The case fatality ratio for the West African clade has been documented to be around 1%, whereas for the Congo Basin clade, it may be as high as 10%. Children are also at higher risk, and monkeypox during pregnancy may lead to complications, congenital monkeypox or stillbirth.

On May 6th, 2022, the first laboratory confirmed case of West African monkeypox in a UK resident returning from a visit to Delta and Lagos in Nigeria. Since then, there have been reports of the virus in Europe (e.g., England, Portugal, Spain, Sweden, Italy, Belgium, France), North America (e.g., United States, Canada) and Australia. Some cases were reported among men who have sex with men. Some cases were also reported in people who live in the same household as an infected person.

None of these people reported having recently been in central or west African countries where monkeypox usually occurs, including the Democratic Republic of the Congo and Nigeria,

The current outbreak appears to be the less severe form of monkeypox- the West African monkeypox virus.

Facts taken from the CDC website on monkeypox:

  • Monkeypox is less contagious than smallpox and causes less severe illness.
  • Transmission is from one person to another by close contact with lesions, body fluids, respiratory droplets and contaminated materials such as bedding or clothing.

  Incubation period

Infection with monkeypox virus begins with an incubation period. A person is not contagious during this period.

  • Incubation period averages 7−14 days but can range from 5−21 days.
  • A person does not have symptoms and may feel fine.

Monkeypox symptoms usually happen in two stages.

  • The first stage includes
  • fever, headache
  • , muscle aches
  • , swollen lymph nodes,
  • and exhaustion.
  • One to three days after the fever starts, a rash appears.

The second stage begins with the rash that starts on the face before spreading to other parts of the body.

  • The first lesions to develop are on the tongue and in the mouth.
  • Within 1-2 days a macular rash appears on the skin, starting on the face and spreading to the arms and legs and then to the hands and feet, including the palms and soles.
  • The rash typically spreads to all parts of the body within 24 hours becoming most concentrated on the face, arms, and legs (centrifugal distribution).
  • By the third day of rash, lesions have progressed from macular (flat) to papular (raised).
  • By the fourth to fifth day, lesions have become vesicular (raised and filled with clear fluid).
  • By the sixth to seventh day, lesions have become pustular (filled with opaque fluid) – sharply raised, usually round, and firm to the touch (deep seated).
  • Lesions will develop a depression in the center (umbilication).
  • The pustules will remain for approximately 5 to 7 days before beginning to crust.
  • By the end of the second week, pustules have crusted and scabbed over.
  • Scabs will remain for about a week before beginning to fall off.
  • Pitted scars and/or areas of lighter or darker skin may remain after scabs have fallen off. Once all scabs have fallen off a person is no longer contagious.


Since monkeypox and smallpox are very similar the smallpox vaccine is considered effective to prevent monkeypox.

ACAM200 and JYNNEOSTM (also known as Imvamune or Imvanex) are the two currently licensed vaccines in the United States to prevent smallpox. JYNNEOS is also licensed specifically to prevent monkeypox. You are not considered fully vaccinated until you receive 2 doses of the vaccine.

Vaccination after exposure

CDC recommends that the vaccine be given within 4 days from the date of exposure in order to prevent onset of the disease. If given between 4–14 days after the date of exposure, vaccination may reduce the symptoms of disease, but may not prevent the disease. Persons exposed to monkeypox virus and who have not received the smallpox vaccine within the last 3 years, should consider getting vaccinated.

The sooner the person receives the vaccine, the more effective it will be in protecting against monkeypox virus.

In conclusion

At his point there seems to be no real threat to contracting monkeypox unless you have been directly exposed to someone who has a confirmed case, or you have traveled to an at-risk nation/region. There are vaccinations with an 85% success rate available, and the US has enough supply of vaccines for now. Always consult your primary health practitioner for guidance.



Baby Formula Shortage and Available Resources

As parents desperately search from store to store, city to city and even reports of state to state for baby formula we are left with some questions:

When and where did the formula shortage start?

Back in February,  Abbott Laboratories initiated a recall of powdered infant formula produced at its Sturgis, Michigan, facility, after receiving reports of bacterial infection in several babies. Similac 60/40 PM was the first formula to be recalled after two infants died after ingesting the formula that carried the bacteria Cronobacter sakazakii.  The Similac PM 60/40 recall is in addition to other lots of Similac, Alimentum, and EleCare powdered formula that were recalled on February 17, 2022, for possible Cronobacter contamination.

By May 8th there was a 43% shortage of formula across the U.S.

There are only 4 companies that produce formula in the States. The reason being is there are extensive regulations and inspections surrounding the production of baby formula. According to data compiled by Allied Market Research, four companies control about 90% of the U.S. infant formula industry:

  • Abbott Nutrition
  • Mead Johnson Nutrition
  • Nestle USA
  • Perrio Company

What is the pathogen that has contaminated the formula and how does it infect?

Cronobacter sakazakii is a bacterium that causes a rare but often fatal infection of the bloodstream and central nervous system. Infants with weakened immune systems, particularly premature infants, are most likely to contract an Cronobacter infection, although the bacteria have caused illnesses in all age groups. What makes this bacteria so dangerous is that it can live in dry conditions for over 2 years. This bacteria caused a recall of tampons in 2011.

When will the supply be replenished and up and running?

The FDA has reached an agreement with Abbot to reopen their formula making facility. They will require a third-party expert at the facility to assure the formula is made safely. A spokesman for the facility has stated it will take between 6 and 8 weeks before formula will be available on grocery shelves.

In the meantime, the White House reports that it has launched Operation Fly Formula. The Department of Defense will use its contracts with commercial cargo airlines to transport products from manufacturing facilities abroad that have met Food and Drug Administration safety standards.

Also, Nestle is flying formula in from Netherlands and Switzerland to combat the formula shortage.

Why not just make your own formula?

Infant formula shortage has led to some parents attempting some desperate measures. One ER physician recounts parents feeding their infants diluted formula, leading to sodium deficiencies. This has led to some babies having a depleted fluid volume, resulting in a dangerously low blood pressure and low circulating oxygen volume.  Electrolyte balances in infants is very dangerous. Their bodies, being small and still developing cannot cope with electrolyte depletion as compared to older children and adults. In extreme cases these imbalances can lead to seizures.

Some online advice advocates feeding cow’s milk to infants who are under 12 months of age. According to the American Association of Pediatrics for babies older than 6 months, cow’s milk is an option “for a brief period of time” but the AAP cautions it “should not become routine” due to concerns infants won’t get enough iron.

You should not make your own formula using a recipe found online or elsewhere, according to the FDA and the AAP. Homemade formulas can be dangerous, leading to contamination and low calcium, the FDA says. Reports of infant deaths using homemade formulas have been reported.

Available Resources

  • Check with your baby’s pediatrician for any available sources of formula and if it is ok to switch formulas if necessary. Your babys doctor know what is best for your baby.
  • In addition, ask your pediatrician if there are any goats milk formulas that would work
  • Check online sources, such as larger online stores that may have formula available. Only purchase from well recognized distributors
  • Check social media groups, local WIC offices, parents groups for any available formula.
  • Contact the Human Milk Bank of America for guidance
  • Locate your local Community Action Association for assistance
  • In some instances, if breastfeeding had been discontinued, the La Leche league states that it may be possible to restart breastfeeding, also known as relactation. This would require time, patience, determination, and a cooperative baby, according to their website

Manufacturer Hotlines

  • Gerber’s MyGerber Baby Expert : reach a certified nutrition or lactation consultant by phone, text, Facebook Messenger, web chat, or video call, who can help you identify a similar formula that may be more readily available
  • Abbott’s Consumer Hotline: call 1-800-986-8540
  • Abbott’s urgent product request line : ask your OBGYN or your infant’s pediatrician to submit an urgent product request by downloading and completing the form – PDF
  • Reckitt’s Customer Service line: call 1-800 BABY-123 (222-9123)

Hopefully the formula shortage will be short lived. In the meantime, utilize the above resources to help you find the formula your infant needs. For future reference, once formula is available it is NOT hoarding to buy extra formula and put it away. Just like stocking extra food for the upcoming food shortage our government is telling us about, your infants food supply is a priority.




Mental illness or a reaction to what’s going on- or both?

This morning I looked outside my large living room window and was greeted by snow. It had started snowing early morning, and the weather had decided it was a good idea to continue throughout the morning. Granted it wasn’t much snow, but it was enough to squelch my plans for getting my planter boxes up and ready for summer. I wanted to cry. Or at the very least feel sorry for myself and frustrated with the prospect of having to find indoor projects when my heart yearned to be outdoors, planting and working in the yard.

Resigning myself to the fact I would be working indoors most of the day (I had plenty of chores waiting for me indoors) I brewed some extra strong coffee and settled on the couch. The view out the window really was beautiful and tranquil. My thoughts turned to all the change and turmoil going on in the world, our country, town, families and even myself.

We are hearing of impending food shortages, escalating tensions in the world leading to possible war, fuel prices skyrocketing, avian influenza, unusual weather patterns (I am personally experiencing) leading to crop failures, supply disruptions in all sectors of industry and on and on.

And the pandemic is still ongoing….

We are being challenged to manage our stress and way of life as it changes before our very eyes. I could provide statistics from NAMI (National Alliance for Mentally Ill) the CDC, WHO etc. about how, over the past 2 plus years anxiety, depression, substance abuse, domestic abuse and even suicide has skyrocketed; however, I am pretty sure we are all aware of the stress and strain we have all been through, so I won’t be going down that path. We will explore our reactions and hopefully provide some suggestions and solutions to manage these stressors.

To begin with, there are many causes for mental illness/mental distress. Some forms are genetic and some are environmental. Either way adding stress onto an already full plate of emotions can easily overwhelm even the most mentally robust person.

In the case of the population with serious mental illness such as bipolar or other challenges this can be excruciatingly difficult.

What is our goal?

Our nervous systems are designed to activate chemicals such as adrenaline when faced with danger or perceived danger.

This is the fight or flight mechanism kicking in that much of our industrialized society lives in daily. News reports, traffic, the escalating cost of basic necessities can be perceived as danger/stress in our lives. The reaction is to either try to leave the situation or face it head on with aggression. If leaving the situation isn’t an option (which in many cases it may not be) We may turn to self-destructive (aggressive towards self) behaviors such as alcohol abuse, overeating, self-harm, or domestic abuse.

We may feel helpless in our situation without the tools to navigate these uncharted waters. Our goal is to calm the nervous system down so that we feel safe and secure and able to deal with whatever challenges that may come our way.

The action rest and digest state is where our bodies heal, our immune system is able to function at its best, blood pressure lowers, digestion is triggered and our decision making, and focus is appropriate.

4 steps to go from Reaction (fight or flight) to Action (Rest and digest)

  1. Have a positive mindset

A positive mindset is essentially exercise for the mind. It gets stronger and easier the more you do it. Start to focus on what you can do about a situation and not about what you can’t do. For instance, given the skyrocketing food prices there is much chatter on the internet about starting a garden, something not possible in an apartment setting. What could you do instead? Look for solutions. Tower gardens, and even starting sprouts for your salads are easy and inexpensive ways to start to take control of your food supply.

Essentially, instead of turning to destructive behaviors, start to focus on how to turn lemons into lemonade.

  1. Don’t get stuck with self-limiting beliefs

Self-limiting beliefs, such as not being good at crafts, exercise, gardening, school and coursework, etc. may not be true at all. We may have picked up on these beliefs as we grew up, or decided it was easier to believe we couldn’t do something rather than trying and finding out we can do it, given the proper training and tools. Even if you aren’t successful, the only failure isn’t trying something you really wanted to try.

  1. Take control of your life

This goes along with # 1 and 2. Along with a positive mindset and trying out things you really wanted to do that you thought you couldn’t do is taking control of your life. What we put in our minds and bodies has profound effects on our wellbeing.  Be aware of how much time you spend watching and listening to the news. Check in with your feelings. Take note- are you feeling empowered and able to tackle the challenges or does the news leave you feeling helpless and unable to cope? Food plays an important part of this equation. Along with adequate hydration (being slightly dehydrated can lead to feelings of depression) how you eat (not rushed, enjoyable atmosphere) and what you eat can have profound effects on your well-being. Be sure to eat adequate fruits and vegetables. Plan your meals ahead and if able, try to have foods and meals prepared ahead of time. This eliminates stress eating and the accompanying poor food choices.

Physical exercise plays an integral part of any self-care routine. A 15 minute walk every day has been proven to beat anxiety and depression in mildly depressed populations. While walking, focus on your surroundings. Take deep breaths and let go of negative thoughts.

Practice an attitude of gratitude. Write down 5 things you are grateful for every day, no matter how small. Do this for 30 days. It really is life changing!
Get good quality sleep, go to bed at a regular time (if possible) Have an evening routine. This signals your body it is time for bed and it will be easier to fall asleep. If you are having difficulty sleeping or falling asleep try turning off the wifi in your home and set your phone to airplane mode. Cellular signals and wifi can disrupt our sleep patterns. In addition, studies have found that blue light emitted from our computers and cellphones has negative effects on sleep and overall health

If you are on medication for any mental health condition, be sure to keep your appointments and have adequate supply of medicines on hand. This is one of the most important steps you can take in taking charge of your life.

  1. Reach out to community and loved ones for support

You are not alone in your feelings. Sometimes just talking out your concerns can turn a corner and bring solutions. One of the unintended consequences of the pandemic was social isolation. We are social beings with a need to connect with each other.

If unable to find positive, supportive community or loved ones you feel comfortable talking to seek online mental health counselling.

The following are a few websites and phone numbers that can help you navigate this terrain.

National Alliance for Mental Illness (NAMI)

Suicide Prevention Hotline    800-273-8255

National Domestic Violence Hotline




After Antibiotics, Restoring Gut Health

After antibiotics, Restoring Gut Health

Antibiotics are literally lifesaving. In the most dire of circumstances they can bring someone back from the brink of death. They are powerful medicines. Our lives have greatly benefitted from the use of antibiotics, whether we have used them or not. They have saved millions of lives and the lives of our animals. At Jase medical we take antibiotic stewardship very seriously and advise only using them under the supervision of your healthcare provider. There is much concern over the use of antibiotics and its ability to wipe out the delicate flora of our gastrointestinal system. This concern is founded.

Antibiotics anti- against, biotic- life- against life.

Once someone starts a course of antibiotics the entire course must be completed to kill the invading organism. This comes at a cost to our bodies, however.  While the antibiotic kills off the harmful organism it also kills off beneficial bacteria. A study titled “ Short-Term Effect of Antibiotics on Human Gut Microbiota” revealed that after taking certain antibiotics there was up to a tenfold decrease in gut microbiota.  Some studies show gut bacteria can return to normal within 6 months. Other studies conclude it can take years. There is much debate over this topic. The type of antibiotic, age, sex, and overall health contribute to gut health and bacterial diversity returning to normal.

This can result in an opportunistic bacteria or yeast to overtake and invade the body.  Some people are prone to yeast infections during the course of therapy. Sometimes prescription antifungals are used, in other instances a diet rich in probiotic rich yogurt, over the counter creams and mouthwashes can help.

Our gut houses our immune system

Our immune system is housed in our intestines in tissue known as GALT- gut associated lymphatic tissue. Over 70 percent of our immune system is housed in this tissue, and when taking oral antibiotics, it puts a strain on this part of our immune system. Some of the cells the GALT produces prevent pathogens from adhering and taking up residence in our intestines. The GALT also includes Peyers patches. These patches, which are very similar to spleen cells, line the intestine and house white blood cells. They monitor and kill pathogenic bacteria and viruses when healthy and functioning. They also play an important role in in anti-inflammatory responses. Use of antibiotics puts a strain on this important and not too often talked about system.

In order to restore health to our entire gastrointestinal system functional medicine has come up with the acronym known as the 4 Rs to gut health- remove the offending substance, replace with beneficial foods and bacteria, reinoculate and repair the damage. There is no real definite way to repair the damage, however a diverse gut microbiome helps fight off a variety of pathogenic bacteria.

These steps should be taken during antibiotic therapy and should be a part of a health promoting lifestyle if not already in place.

Remove offending substance

This step can include removing foods that can cause opportunistic bacteria to grow, such as sugar and processed foods, sodas, and high sugar juices. In addition, avoid alcohol, cigarettes, and stress. These suppress the immune system and can make healing the gut very difficult.

Replace with probiotic and prebiotic rich foods and probiotics

Probiotic rich foods

Probiotic rich foods help inoculate the gut with beneficial bacteria and promote include yogurt with active cultures, kefir, fermented foods such as sauerkraut, kimchi, tempeh, other fermented vegetables and kombucha. You don’t need a lot of these foods to benefit. A tablespoon of sauerkraut provides a group of bacteria called lactic acid bacteria which evidence shows helps fight cancer, contributes to cardiovascular health and even metabolism. Kefir is known for its powerful anti-inflammatory effects and fights viral infections. As a side note, kefir has been speculated to reduce or prevent cytokine storm associated with Covid 19.

Prebiotic rich foods

A substance called butyrate is a short-chain fatty acid produced by your gut microbes when they break down dietary fiber. Butyrate has numerous health benefits. butyrate is produced when your gut microbes transform the dietary fiber you eat into these beneficial compounds. These compounds help feed the beneficial bacteria in your gut lining; without butyrate your beneficial bacteria wouldn’t survive. Butyrate is made from prebiotic rich foods that your intestine ferments and digests food. Foods high in fiber promote butyrate production such as whole grains, legumes, berries, fresh fruits, and vegetables. Inulin, a prebiotic fiber  found in Jerusalem artichokes, chicory root, unripe(green) bananas, and asparagus has been found to positively modulate bacterial diversity during antibiotic therapy

A probiotic called Saccharomyces Boulardii (Trade name Florastor) has been shown to help prevent antibiotic related diarrhea and fight candida infections while on antibiotic therapy. It is a beneficial yeast and not a bacteria, so it isn’t affected by antibiotics.  Saccharomyces Boulardii should be taken during antibiotic therapy and for a month after or as your healthcare provider recommends.


Along with the above recommendations a good probiotic supplement may be necessary to restore gut health. Due to supply chain issues the probiotic I would recommend is no longer available, however here is a link-perhaps you may be able to source a similar product- check with your healthcare provider which probiotic they recommend.


To repair damage caused by illness and antibiotic therapy Supplementation with L-glutamine, vitamin C and zinc may be necessary. A good quality, balanced multivitamin is also a good idea.

Continue with above recommendations and make this change a permanent lifestyle.

In conclusion

As we enter this time of supply chain disruption and uncertainty the one asset, we and our loved ones have is our health. Without that nothing else matters.