In October, 1995 the author (NR) was completing a clinical rotation with a physician in a rural comunity as part of his Physician Assistant Training. His responsibilities included covering the Emergency Room in the hospital and helping the town physician at his three clinics. Emergency Room call was shared with a medical student and the hospital and clinic rotation was for five weeks. A week into the training, a home health care agency nurse visited the clinic and asked if the medical student or the author knew of a treatment that could help a "terminal" breast cancer patient with pain control. She said the patient had cancer for several years and the latest bone scan showed that the cancer had metastasized to "nearly every bone in her skeleton." She was particularly worried about pain from ametastatic lesion in the the patient's left upper arm. The patient was taking I.V. morphine for pain and needed sublingual morphine to cope with pain associated with getting up and going to the bathroom.
The medical student (who planned on a career in pain management and anesthesia), enthusiastically described a nerve block procedure that would relieve the pain but, "unfortunately," loss of function of the arm, as well. Information about the experiences at The Center with the control of metastatic bone pain using high doses of intravenous vitamin C was given to the nurse. She was also furnished with references describing the usefulness of Vitamin C in helping cancer patients. One article, from the present authors, (NR, JAJ, HDR)
described the preferential toxicity of
vitamin C toward tumor cells, and presented evidence listing the plasma concentrations of vitamin C that would be beneficial as a preferential cytotoxic agent in humans.
The nurse's reaction was less than enthusiastic. She said she would ask the patient if she was interested and would also ask the physician if he would be willing to try something like vitamin C. Since the doses suggested in the article were in excess of 100 grams intravenous per day, and the RDA for vitamin C is 60 mg per day, a positive reply was not expected. Some physicians and health care workers believe (wrongly) that any dose over two grams intravenously will either kill you or make you very ill by inducing an acidotic state. As fate would have it, this patient visited the clinic the next day complaining of a painful, swollen, left arm. A Doppler venogram revealed both subclavian veins to be blocked by blood clots. She was admitted to the hospital and started on anticoagulant therapy. Many staff did not think she would leave the hospital alive.
During clinical rounds, the patient said that she had read the paper on vitamin C and was anxious to try the I.V. C therapy because it offered her some hope. Also, the Home Health nurse said that she and the physician had read the article and were were willing to try the I.V. vitamin C treatments. The physician later said he was enthusiastic to try something that could actually have a positive effect on the pain and disease processes. He also said that he wanted to clear the blood clots before starting the vitamin C treatment. He was concerned that if an embolism occurred and the patient died, it would be blamed on the I.V. vitamin C treatment (obviously an enlightened physician). He did start the patient on oral vitamin C, 250 mg per day, to prevent scurvy, a common occurrence in disseminated metastatic disease. The patient was treated one time with Activase R to clear the clots. An arterial blood sample was drawn from the patient's wrist shortly after the anticoagulant therapy. This resulted in extensive subcutaneous bleeding with bruising of the entire arm, and the site subsequently became infected, swollen, and hot to the touch. She continued to receive small doses of I.V. and oral anticoagulant therapy, antibiotic therapy and oral vitamin C. The infection had not cleared within a week, probably due to poor circulation in the arm and depressed immune system of the patient. The next week, the patient's physician visited Wichita and spoke to H Riordan at The Center. Riordan furnished him with vitamin C to use in the I.V. treatment.