When Canada first passed its assisted dying legislation, also known as the Bill C-14 in 2016, it soon became a landmark in healthcare and personal autonomy. It is officially known as Medical Assistance in Dying (MAID) and was initially available only to those adults who were terminally ill. The eligibility criteria had strict parameters: the person had to be suffering from a "serious and incurable illness", be in an "advanced sate of irreversible decline", experience "intolerable suffering", and crucially their natural death had to be "reasonable foreseeable".

This legal threshold was also known as Track 1. This was modeled on end-of-life care and largely served people with terminal cancer or other severe illness who wanted control over their dying process. Track 1 is a relatively swift procedure, with some patients receiving MAID within a day of applying.

However, many Canadians live with severe, non-terminal conditions and they felt left out. These were people with degenerative diseases, chronic pain, or spinal injuries. They had and continued to suffer deeply, but were not imminently dying. They also began to request for MAID, however, were routinely denied.

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This led to a legal challenge by Jean Truchon, reports The New York Times. He is a man with spastic cerebral palsy whose suffering wasn’t deemed terminal. In 2019, a Quebec court ruled that the “reasonably foreseeable death” clause was unconstitutional. This case prompted the introduction of Bill C-7 in 2021, which created Track 2 — extending MAID eligibility to people with serious, incurable conditions causing enduring suffering, even if their deaths weren’t foreseeable.

Track 2 includes additional safeguards: a 90-day assessment period, evaluation by two independent clinicians, and consultation with specialists if necessary. Applicants must also be informed of other ways to alleviate their suffering and show they’ve seriously considered those options. While mental illness alone was technically included under Track 2, implementation has been delayed until 2027 due to concerns about inadequate mental health infrastructure.

Despite its tighter process and ethical complexities, Track 2 MAID has steadily gained use. In 2023, there were 622 deaths under Track 2 compared to 14,721 under Track 1. Still, Track 2 has ignited national debate, with critics claiming it opens the door to premature death among vulnerable populations — and supporters defending it as a compassionate choice for those trapped in non-terminal agony.

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Paula Ritchie And The Doctor Who Stepped Forward To Assess Track 2 Patients

A 52-year-old woman from Smith Falls, Ontario had a far from simple case, assessed by Dr Matt Wonnacott, who agreed to assess Track 2 patients. He believed that these patients too had the right to autonomy and must be able to guide care decision, including the right to choose death when suffering becomes unbearable, reports The New York Times.

Paula had a long history of chronic pain and mental health challenges: fibromyalgia, chronic fatigue syndrome, migraines, depression, PTSD, borderline personality disorder, and more. But things got worse in early 2023 after a head injury. She began experiencing vertigo, migraines, uncontrollable muscle movements, and an overwhelming dizziness that made even basic tasks impossible.

Doctors failed to find a physical cause. Some attributed her symptoms to psychological distress, while others diagnosed post-concussion syndrome. Treatments ranged from Percocet and Ativan to acupuncture and reiki, but nothing worked. Paula’s life shrank to a single room, her body wracked with pain, her mind spinning. She tried to end her life — and failed.

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Frustrated by her inability to access help or relief, Paula began pursuing MAID. Her first request was denied. But she persisted, calling the regional MAID coordination center daily until she was finally reassessed by Wonnacott and a psychiatrist, Dr. Elspeth MacEwan.

During the assessment, Wonnacott asked if she would wait five years for a hypothetical cure. Paula said no — she could barely get through a day. She felt tortured. A veterinarian, she told a friend, would euthanize a dog in better shape.

Importantly, Wonnacott found her reasoning sound. She was not acting out of untreated mental illness or impulsivity. She had sought treatment. She had given it time. And she had thought carefully about her request. MacEwan agreed. Paula met the criteria under Track 2.

Rebecca Pinto, physiotherapist and nutritionist shared a video on her Instagram account where she cites a case of a man who used hair loss treatment and was admitted to hospital on complain of chest pain. She points out that not everything that is available over the counter is safe to use. She says the key ingredients in many easily available hair loss treatment is minoxidil, which could trigger chest pain or angina as it can lower blood pressure.

Health and Me spoke to Dr Sanjay Bhat, Sr Consultant, Interventional Cardiology at Aster CMI Hospital, Bengaluru to fact check this claim and here is what we found out.

Fact Check: Can Minoxidil Cause Severe Chest Pain?

Health and Me asked Dr Bhat if this easily available ingredient could actually cause someone’s life. To this, Dr Bhat explained that it is a commonly used medicine for treating hair loss and is easily available in many pharmacies as a topical solution or form. He said it works by improving blood flow to the hair follicles and helping hair grow. “When used on the scalp as recommended, it is generally safe for most people. However, long-term or excessive use may sometimes cause side effects. Some people may absorb a small amount of the medicine into the bloodstream, which can affect the heart and blood vessels,” he explains.

This could lead to symptoms such as chest pain, rapid heartbeat, dizziness, swelling of the hands or feet, or low blood pressure. “In rare cases, people may go to the emergency room if they feel severe chest discomfort or palpitations. Long-term use without medical advice may also cause scalp irritation or unwanted hair growth on other parts of the body. Therefore, it is important to use minoxidil only as directed and consult a doctor if unusual symptoms appear,” he said.

What To Do If You Feel Chest Pain While Using Minoxidil?

Doctor explains, “If a person develops chest pain after using Minoxidil, the first step is to stop using the medicine and seek medical attention immediately. Doctors will first evaluate the patient to make sure the chest pain is not due to a serious heart problem. This usually includes checking blood pressure, heart rate, oxygen levels, and performing tests such as an electrocardiogram (ECG) and blood tests.”

If minoxidil is suspected to be the cause, treatment mainly focuses on managing the symptoms. Doctors could also give medicines to control heart rate, reduce palpitations, or stabilize blood pressure. Depending on the reports, if the patient has fluid retention or swelling, diuretics may be prescribed to remove excess fluid from the body. Patients may also be monitored in the hospital for a short time if symptoms are severe. Once the symptoms settle, doctors usually advise avoiding minoxidil and may suggest safer alternative treatments for hair loss.

Are There Any Alternative Hair Loss Treatment Without Minoxidil?

The answer is yes. Dr Bhat points out Finasteride, an oral medicine to be one of the common alternatives to minoxidil for hair loss treatments. This medicine works by reducing the hormone DHT, which is linked to male pattern baldness. This also helps in slowing down the hair loss and promoting regrowth.

Platelet Rich Plasma Therapy: This is another alternative available points out Dr Bhat. This is when blood is processed and injected into the scalp to stimulate hair follicles and improve hair thickness.

He also pointed out that doctors often recommend Low Level Laser Therapy, which is a painless treatment using red light lasers to improve blood flow to hair follicles and encourage hair growth.

Lastly, Hair Transplant Surgery is another option for people facing significant hair loss, where follicles from one part of the scalp are moved to bald areas.

“In addition, treatments such as microneedling, nutritional supplements, and treatment of underlying medical conditions may also help improve hair growth,” points out Dr Bhat.

Leucovorin, a high-dose vitamin - folinic acid, were mostly used for treating toxic side effects of chemotherapy, until last year when the White House touted it as a potential treatment for some children with autism. New prescriptions for leucovorin double within weeks of announcement and parents have been trying hard to get it prescribed. This is also because many doctors have been hesitant to prescribe a chemotherapy medicine for childhood autism. They have also stated that not enough evidence is available to prescribe this drug officially.

CNN reported that in Austin, Texas, Meagan Johnson spent four days calling pharmacies across the region searching for leucovorin for her three-year-old son Jack, who has autism. She contacted nearly 40 pharmacies around her home in Pflugerville, hoping to locate the medication.

The effort came after a neurologist agreed to prescribe leucovorin on a trial basis. Johnson’s hope was simple: even a small improvement in her son’s communication would mean a lot. At age three, most children can say hundreds of words, but Jack speaks only about 20, many of which only his mother understands.

However, getting the prescription turned out to be far harder than obtaining it.

Across the United States, pharmacies have been reporting growing difficulty keeping leucovorin tablets in stock. Online support groups for parents of autistic children are now filled with posts from families searching for the medication or asking where it might still be available.

Although leucovorin is not approved specifically for autism, some small studies have suggested that it may help certain children who have unusually low levels of folate in the brain. Families who have tried it report possible improvements in language and social interaction.

A study published in The Lancet found that prescriptions for leucovorin doubled within weeks of the public remarks and remained elevated through early December. Researchers analysed electronic medical records covering nearly 300 million patients to identify the trend.

Experts say such spikes can quickly strain the supply of inexpensive generic drugs.

A Classic Demand-Driven Shortage

Pharmacy supply specialists describe the leucovorin situation as a demand-side shortage. Unlike manufacturing disruptions, these shortages happen when demand rises faster than manufacturers can increase production.

Generic drug manufacturers typically plan production schedules a year or more in advance. Because leucovorin had historically been a niche medication, companies were not prepared for a sudden surge in prescriptions.

As demand increased, pharmacies began running out of tablets. Many manufacturers have placed the drug on allocation or backorder, meaning pharmacies can only order limited quantities.

To ease the pressure, the US Food and Drug Administration allowed temporary imports of leucovorin tablets from Canada and Spain. However, the drug has not yet been officially listed on the FDA’s national drug shortage database, a designation that could trigger additional measures to boost supply.

Families Searching For A Treatment

For parents like Johnson, the debate over research evidence matters less than the possibility of progress.

After days of phone calls, a CVS pharmacist finally located a supply at another branch nearly an hour away. Johnson drove the distance to pick up the medication and gave Jack his first dose that same evening.

The moment brought relief, but also frustration.

Drug shortage advocates say the situation was predictable. Because leucovorin is inexpensive and historically prone to shortages, any sudden increase in demand could easily disrupt supply.

Still, families continue to search for it.

Turns out, kidney disease is not just a ‘kidney’ problem anymore, it can, in fact, affect other organs, and could even be linked to other chronic conditions, revealed a recent study.

In the US, more than 1 in 7 adults are affected by chronic kidney disease or (CKD). This means that 35.5 million Americans are affected by it, and what makes it worse is that 9 out of 10 people do not even know they have CKD, says the Centers for Disease Control and Prevention (CDC). Amid all these numbers thrown on to, something more concerning lies. A recent Lancet study shows a link between the rise in CKD and other chronic diseases. We are talking about chronic conditions like diabetes, high blood pressure, and obesity.

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So, What Does The Study Say?

The researcher saw that 14 percent of adults who are over the age 20 or older, which makes 788 million Americans who had CKD in 2022. The biggest problem is not the disease itself, but the unawareness. Doctors, experts, and researchers from time and again have pointed out how kidney disease is often asymptomatic, this is why it is ignored until it becomes advanced. However, at that point the patients could already need dialysis or even an organ transplant. This gap in early diagnosis and treatment is what has made CKD the ninth leading reason of death, worldwide.

When you kidney functions naturally, it works as the powerhouse of filtration. A pair of healthy kidneys are able to filter and process more than 150 liters of fluid from the blood. These organs are also responsible for filtering out the waste and toxins through your urine. Not just that, but your kidneys also help in red blood cells production that keeps you healthy. When all of that does not happen, it can eventually impact every other organ in your body.

Like they say, everything is connected, and it surely is. For instance, somewhere around 20% of the blood that your heart pumps goes to your kidneys. If someone has diabetes and high blood pressure, it could damage the blood vessels and lead to protein in the urine and a slower filtration rate. It can then lead to other chronic infections, autoimmune disorders, and even genetic variants.

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Kidney-Body Relation

If you leave your kidney disease untreated, it could lead to kidney failure. This is when you would be more in need of dialysis or a transplant. Doctors have pointed out that most people do not die of chronic kidney disease, rather it impacts their quality of life, worsening their cardiovascular conditions. It can lead to complications like a heart attack, a stroke, or a heart failure.

How Does This Happen?

People who have kidney diseases are at an increased risk for high blood pressure. Due to hurdles in the process of filtration, plaque build ups and hardens the arteries. This in return increases stress on the heart. In fact, the American Heart Association also defined the link between kidney and heart as 'cardiovascular-kidney metabolic syndrome'. This defines a health disorder that is a condition of the overlap of obesity, chronic kidney disease and cardiovascular diseases.

The bleed out of CKD is not just limited to your heart. The National Institute of Health, US points out that along with heart complications and high blood pressure, CKD could also lead to anemia, mineral and bone disorder, metabolic acidosis, malnutrition, and electrolyte imbalances in the blood.

So, What Is The Best Way To Keep Yourself Safe?

The first way is to note any symptoms and get yourself diagnosed. Look for signs like loss of appetite, unexplained nausea or vomiting. Do you feel tired often? Are you having trouble concentrating? Is there any change in how often you go pee?

Other symptoms like a change in your urine color or texture, or feeling itchy or dry, muscle cramps, unexplained weight loss or skin conditions could also signal towards kidney diseases.

However, not always does CKD show symptoms, experts suggest that to be one step ahead, it is important to undergo regular health checkups, including blood culture. General guidelines usually point towards getting a blood test done every 3 to 6 months. For someone with high blood pressure, diabetes or any other disease, the current guidelines say that those people should get regular blood and urine tests to screen for kidney disease. But what really happens is that though these tests exist, they are still used far too little. Doctors point out that many patients skip them because collecting a urine sample feels inconvenient, and overall awareness about kidney disease remains low. As a result, research shows that only about 35 percent of people with diabetes, and just 4 percent of those with high blood pressure, actually end up getting the recommended urine screening.

A ray of hope is that there are now several effective tools to slow the progression of kidney disease. Along with traditional options like ACE inhibitors, newer classes of medications including certain heart failure drugs and GLP-1 drugs. These medicines have shown to help protect kidney function. Although these newer treatments are not widely used yet, their adoption is steadily increasing.

What is important to remember is to also always consult your GP to ensure all preventative measures are followed carefully.