Shortage of contrast media puts lives at risk

Q: As a cardiologist, I am outraged that there is a critical shortage of contrast media for heart CT scans. We use this during coronary angiograms to visualize arteries and see where there may be blockages. It tells whether a patient needs surgery or stents and

also helps us see if there are blood clots in the lungs. All of these require urgent treatment, so not having contrast puts lives at risk. A country that can’t manage access to such essential medications is sick!

A: The United States is highly dependent on foreign suppliers for indispensable medical supplies, including the iodine solution that provides contrast on CT scans. In the most recent shortage, a factory in Shanghai, China, shut down to slow the spread of COVID19. As a result, hospitals in the U.S. are running out. Unfortunately, drug shortages are not rare events. Even before the pandemic, many health care systems reported difficulties accessing critical medications. Without significant changes in the way we manage our supply chains, shortages are likely to continue.

Q: I’ve been dealing with what I thought were fungal infections on three toes for about four years now. No matter what topical antifungal treatment I used, over the counter or prescription, the nails did not improve.

I saw an article in your newsletter about bacterial nail infections. That made sense to me, since it explains why antifungals may fail. I began using Neosporin on all three toenails. Their appearance has improved greatly. I’m seeing clear pink under the nails where there used to be cloudy white patches. For me, this is a real game changer!

A: We were surprised to read that some nail infections are caused by bacteria as well as fungi ( Journal of the American Podiatric Medical Association, March 1, 2021). That could help explain why nail infections may persist despite treatment with antifungal medications. Other readers have also reported success with the antibiotic cream Neosporin.